Tell us about yourself (including your love of sloths – See the @gvmhe Twitter account avatar) and your organization.
I’m a Nebraska native that trained in rural Family Medicine. However, I’ve also been a Navy Nuclear operator and Chem/RadCon on submarines and studied Chemical Engineer (BS and MS) and later got a Masters of Medical Informatics from Northwestern University. In my current role at GVMH, I’m a Senior leader over the Information Technology and Pharmacy Departments. I’m also an advocate for patient safety, care quality, and consumerism. I love empowering people and leveraging technology in healthcare.
Golden Valley Memorial Healthcare is a 55 bed hospital in Clinton, Missouri (1 hour southeast of Kansas City) with 4 multi-specialty clinics. I feel lucky to work with great people, caring for our friends, families and neighbors.
As for the sloths, sloths are a curiosity. The slowness is unsettling. They just do their thing irrespective of their surroundings. Completely unshakable and Cute.
Word on the street is that you’ve built a mouse click logger. How does it work? Why did you build it?
The logger resides in the background as a service. It watches system calls for either left or right mouse clicks and counts them. Every 10 seconds it looks at the totals… if they are nonzero it sends an insert query to a MySQL server with username, IP, MAC, left count, right count and that is time stamped.
This gives me the ability to pull clicks per day, per user, per workstation, per week, per patient, per day of the week etc.
I built it in Python. To be fair, I build a lot of things in Python and do quite a bit with MySQL so I have a lot of programming infrastructure I have built up over the last 5 years. It is like a 20 liner with thousands of lines of underlying code.
I looked for a COTS solution for a few weeks and couldn’t find one at any price so I built it. In hindsight I wish I had just built it from the beginning. I spent way more time looking than writing it.
We took a methodical approach to deployment (IT Sysadmin and I) because I didn’t want to “break anything.” Put it on one system… then 4 systems… then all of our exam room systems. The deployment took longer than I wanted but we had to be safe. We did that the month prior to go-live so there were many other things on our plates. It went live a week before we did so we could get some baseline data. I would have loved to have more but it didn’t work out.
I plan to use it to monitor use and optimization. I will pull the numbers and see how usability tweaks affect clicks. Clicks are a proxy for work in the EMR. They aren’t necessarily a bad thing but I would like to reduce them. I am a known hater of pop-ups and other distractions that merely add to work.
What have been some of the findings from your logger?
It is too early to tell. The trend the week of go-live is about 20% less clicks and those have trended down daily. To be fair, we aren’t full speed and people don’t have a complete grasp of what the system can do. The scope on training was very tight so people aren’t overwhelmed. MEDITECH Expanse can do way more than we have shown.
What have you done with those results?
I plant to incorporate them into my presentation at the MUSE Executive Institute in Newport, CA in January. Will use to guide decision making to some extent when we have more data. Perhaps roll out to all 800 workstations if we have no glitches. It is very low bandwidth.
You just did an EHR Go-Live. How were you able to do this project and an EHR go-live?
Great question. If you are standing still you are missing something. Keep your head on a swivel and keep moving.
Any big lessons you can share from the recent EHR Go-Live?
Yes, and no. None of it is earth shattering for us informatics guys/gals.
First and foremost it is an organizational transformation project enabled by IT. It is NOT an IT project.
Every area must take part for success. Change and transitions are not sudden things. They are the integral (AUC) of a bunch of small skirmishes, grieving, hatred, arguments, turf-defending, loss of autonomy of issues big and small. It can be death by 1,000 cuts during the build. This can be uncomfortable… but it spreads the discomfort over the year prior. The arguments are over and eyes are open going into go-live. This approach allowed us to concentrate on the business at hand for go-live. Nothing at go-live is supposed to be different from expectations. You have already healed your cuts.
Testing testing testing. We delayed two months so we could do more testing. We could have delayed more and taken more time but you will never find some things until you are live.
Mandatory training… more than anybody wants.
Customization at the user level.
Lots of superusers
Good partners. A great project manager is crucial and very capable specialists are a must.
Listen more than you talk. This applies to everyone.
Nothing is ever as bad as it seems.
Excellent governance and structure even when it hurts and it will.
Administrative team and CEO that trust the process and structure and let your people solve the problems during the build and make the decisions that THEY have to live with. I don’t register patients. I know nothing about that. We have experts in that… let them do their thing.
Where are you planning to take the mouse click logging next?
As above. Any way I can use it to assist in patient care for our organization I will.
If anyone is interested I can probably help get this going for them too.
What can the healthcare IT community do for you?
The HIT community can be more open sharing their projects and ideas. So we can see what people are working on.
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