Founders Keepers

There is a term in population genetics called the founder’s effect and I have caught myself thinking about it a lot lately.

Basically, in a founder’s effect a small subset of a population is isolated from the larger population. For instance, maybe seven people went on a three hour boat tour but instead ended up stranded on a deserted island. The Professor and Mary Ann mate and reproduce, as people are wont to do, and several generations later the resulting population on that island looks very different from the larger population that it originated from. There is a loss of genetic variation and certain traits get reproduced at a greater rate than you would find elsewhere. Sometimes this is benign, like with a greater proportion of blue eyes or brown hair. Sometimes it is bad, like when you have a higher predisposition to develop colon cancer or maybe a higher rate of growing an extra leg out of your backside…

EPIC is one of the largest electronic health record in the US. It is highly customizable. Therein lies its power AND its weakness.

Keep in mind that I have only a small part of the picture and I am making certain assumptions, but here is what I have gathered:

When a healthcare system decides to go with EPIC there is a build out, or personalization, that occurs. The EHR that I see is very different from the one used by a physician in another healthcare system across town or in one across the country even though they are all called EPIC. 

From that initial build out, there are changes made as the product is tweaked. For instance, when we went live, we had to enter our password to log in but then had to enter it again with each and every note we signed, every single order we placed. Hundreds of times a day I was typing in my password. Now? I only type it in to log on. Good thing, too, as I was at risk of destroying expensive equipment.

I have staff in my clinic who have worked for three other major hospital systems in the area who also use EPIC. What they describe is much, much easier to use than what we have currently. In fact, they regularly threaten to leave and go back to those other organizations so they can feel at peace again.

How does that happen? 

How do they have such different products? 

Because they are all starting with a basic product. It is thrown out onto a deserted island with a few people making decisions and then everyone waits to see what you get down the road. 

The founder’s effect.

No one from the other hospital systems is sharing what works for them from what I can tell. There is no collaboration. So each one has parts that work well and other areas not so much. Why can’t we help each other?

THEN you have smaller islands. We are a small clinic in a huge system. We did not get support staff who came out to help us after going live until the following week and then only for two days. The bigger clinics? They had trainers there on day one. Some clinics never got anyone. Training classes done before had very little to do with the reality of the EPIC we were presented with on day one. So we have muddled through figuring out our own work arounds. Some good. Some bad. We need an infusion of fresh genetic material to correct our problems. 

That only works well when you have someone visiting your island to add to your gene pool and that only works if that person is genetically diverse themselves. Getting people to leave their islands is difficult. Distance to travel, time constraints, don’t know how to swim, etc… 

So we get this perpetuation of problems and errors… fractured systems. It has been really interesting to watch from my vantage point at the bottom, looking up. I wonder what this will look like in six months.

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90 thoughts on “Founders Keepers

  1. And, so much for the security of patient records. All those little islands cannot be equally secure given the differences in the way the product is operated. Probably not too much of a stretch to postulate that none of them is really secure (despite appearances).

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  2. Unfortunately, the very consultants you might bring into help improve things may be part of another isolated gene pool. If they have only built “bad” versions you’ll simply get another “bad” one. It’s important to cross-pollinate and bring in new blood. (I’m flailing in my medical analogies here!)

    “Collaboration” is the latest buzzword that addresses what we called “knowledge management” back in the 1990s. We all should learn from the successes – and failures – of the people around us. The people who “regularly threaten to leave and go back to those other organizations so they can feel at peace again” should be given feedback priority so that *your* EPIC can truly be epic.

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  3. “I wonder what this will look like in six months.”

    Well,I’m just hoping it doesn’t involve bad guys hacking into our DNA and then cloning us in a lab somewhere so they can sell our organs as spare parts. Or perhaps turn us all into Soylent Green.

    Liked by 1 person

    • Agreed. I can think of a million things they could do to make it more user friendly. Given how many bright minds use a version of this program every day I cannot believe I am the only one who has thought of these things which means someone somewhere is ignoring a helluva lot of complaints.

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  4. What is the system for. Is it big brother wanting to keep records, is it the money people wanting to follow every penny or is it the medical people wanting to provide good and efficient care?

    Liked by 1 person

    • It could really help patient care if done right but it needs so much work to get there it isn’t even funny. The money people like it because it captures more charges. I used to could sneak a few things under the table when a patient needed it. I cannot do that anymore. A lot of it is the government dictating how to use our EHR, making stupid requirements that hinder care rather than help it. It is our own damn fault. We let it happen. I am not sure we can fix it.

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  5. My oldest daughter, the nurse, has been using EPIC for some time now in a prompt care clinic setting. Their EHR is the ONE thing I have never heard her complain about so it is either working well for them (and they are connected organizationally to a very large healthcare system) or the rest is so disheartening that she just hasn’t gotten around to being that frustrated by EPIC.

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  6. YAY! Professor and Mary Ann finally found each other. I’ve been secretly wishing for this since forEVER!

    Seriously: I find it curious that there isn’t collaboration and sharing of answers/solutions – a Facebook Group? Nothing? Does this fit with what you’d expect?

    Liked by 2 people

    • It is not at all what I expected. A few minor tweaks and personalizations I could understand but an almost entirely different system? How much input does EPIC give about what works or does not work during the build stage and how much of it was listened to by our people? These are burning questions that I have…

      Liked by 1 person

  7. Same with the International Bank I worked for. A new ‘base’ system was introduced with the idea that anyone could sign in in any country on any machine and work. Great theory. Except different countries handled different aspects of banking for their clients, thus what was relevant for one was unnecessary for another and so the system had to be tweaked and modifed accordingly. It didn’t always work, and so some clever people were redesigning the software to suit their clients needs which was totally incompatible to everyone else. Ho hum. Progress I think they call it. πŸ™‚

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  8. Oh, my. I can hear the stress in this post. As the spouse of a person who has participated now in three EPIC go-lives in three different systems, I can tell you the stress level does seem to go down after a few months. I’m sorry you are going through the pain right now. Hopefully your clinic will come out the other end better and more efficient for the experience.

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    • I hear that EPIC has moods mapped out on a graph, or so the suits say. We were never privy to any of that. I think on some level people get beaten down and just stop caring that what they have sucks….
      πŸ™‚

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  9. I’m surprised that a large national platform like this doesn’t have a User Group. For mature software platforms, these forums are sometimes sponsored by the developer and quite formal, so various users can share their experiences and tricks. It might be worthwhile to have that discussion with EPIC … or a contact in the hospital system.

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  10. The woman who was typing my info into the computer at the doctor’s last fall noted that when they passed the legislation instituting electronic records they should have made it the SAME electronic records for everyone, so it would be easy to communicate. If only someone somewhere had some common sense…(sigh) (K)

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  11. Sounds like the hospital dispensing system . In retail the software program cannot be touched. It’s generic thus as a pharmacist if you’ve used it in one shop you can locum as many shops as you liked and can easily dispense .
    The hospital systems are another kettle of fish. It’s a basic system and then customised according to the needs of a particular hospital . So you think you know the software you go to work at another hospital and found your short cut to that certain field you want to get in is nulled. You can’t use it as it’s a different short cut…instead of [inq] now it’s [inv] I locum once and was pulling my hair out . Couldn’t go into the fields I wanted just frustrating .

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  12. I retired just as the electronic charting, health care data base was being set up….I was in on the gathering of info and inputting, but the doctors and nurses had not started their part yet…..I am still a fan of paper and pen….paper charts and medical record shelves that go on forever….LOL however I am happy that all I have to do is type in a note to my MD and we can chit chat away…LOL hope it gets better for you…at least you only have to log on once, all the doctors we went to see used there badge to open the computer program and shut it off…looked like they were all still getting used to that practice…..xxkat

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  13. Oh Doc, what do you want??? You know this is keeping someone working. Some Ahole who speaks only geek speak needed a job and so they let him bastardize the system so he would be able to keep his job.We are not up on Epic, but can access it to read charts for people we admit. We still use McKesson and have made such a mess of it that we had to have the company come out and walk us through our system to get it to work….and guess what, it still doesn’t. I could go on for hours about our ridiculous documentation…but well, you know all about it. And the government is about to make it worse. New CoP’s active July, 2017.

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  14. When I first read about the arrival of your EHR, I wondered if it was EPIC. I have been working with it for a few years now and I found much of what you say to be true. Some things are good others are bad, and we had to fly by the seat if our pants to learn it. It won’t get better but I think you’ll adjust. I can’t offer much more than that.

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  15. Ahahahahahagood luck with that? … Nope. Um. Remember that nanosecond I worked for the big place I called Behemoth? In 2015 they went live with EPIC, to the tune of over $80 million. They are still having problems with it. Our little place is now associated with Behemoth (boooo!) and there is grudging talk about going to EPIC, but no one is in any big hurry due to the ongoing problems Behemoth has with it. I recall it being glitchy, and that it didn’t really talk to the other big programs Behemoth had, which made it really unwieldy to use. But I don’t recall specifics because that seems like lifetimes ago. At $80 million they qualified to have a tad of tech support and trainings and discussions and… yeah.

    To be fair, I haven’t heard of a system yet that doesn’t have issues. Is there any software program for anything that is perfect?

    The systems we are using at Lil Place seem to be one step above abacus. There’s not a day goes by that I don’t look at it and tilt my head and wonder wtf? There are times I long for my technology-adverse old boss’s paper files and 3×5 cards.

    Sincerely, I hope your system evolves for you, and that you can find a rhythm with it.

    Liked by 1 person

  16. That IS an interesting comparison. I remember studying about a small island off the coast of Virginia. They speak with a lot of Elizabethan English words there, because of the isolation. Haven’t heard about Founder’s Effect since.
    I use software that I have never been trained to use. I am smart enough to do well enough, but then someone else from my office comes over and clicks “Calculate” which has been there, out on the right, since I started in July — not that I’d ever noticed its little blue box, and then all the expenses are added and I’m like, “Wow. I was totally using a calculator for all that.” Then there’s an awkward silence followed by commentary on how I need more training, but it never comes. The work keeps coming while I wonder what else the software could be doing for me. Honestly, how many people can afford a training day?
    Best of luck πŸ™‚

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  17. I work with a manager who prefers to whisper and avoids giving proper briefings and detailed explanations. She is great at her job but she whispers too much.

    What happens? One person does the work in method A, the other in method B and she has to fix the situation again. I stopped giving a fuck. I am not the manager and even if I could solve the problem my manager keeps whispering. I drink my coffee, do my job and leave when I am done…

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    • I envy people who can do that, not give a fuck. I had a patient today…she’s 89… tell me how she does not give anything second thought if she cannot control it. I asked her how she got to that point. Her response was that she was always that way. And THAT is why she is going to live to be 100. You cannot learn that kind of stuff.

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      • Well I refuse to get stressed out. I mind the details because my perfectionism is unavoidable but since I started meditating I have been able to let go a bit.

        If people want me to solve all their problems I demand they make a list, define each problem in minute detail and specify the reward for solving each problem. Not going to happen so I focus on the things I find interesting and enjoyable.

        I do my thing and what is necessary. After that people can talk about me all they want. I do my job and they keep talking. I finish work, leave and live my life again. Life is too short…

        Liked by 1 person

  18. I have found this effect in numerous systems in my professional area. Customization, if done listening the users, may feel great initially, but the users pay for it later. Much greater pain and effort is required to upgrade and add useful stuff – simply because it doesn’t ‘fit’ the customized platform.

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  19. I have so much more sympathy for my doctor.Respect too, now that I know a little about management obstacles. How he is sble to be so peaceful and attentive is amazing. But maybe letting off steam in a forum like this helps. I’m including all front-line medical persons in my prayers from now on. We should honor them, and trachers, as much as we do returning soldiers.

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  20. An interesting perspective, Victoire. My diagnostic: you need help. Outside help. Before you destroy the machine or “kill” someone. (Figuratively speaking, of course). You evidently have wasted so much of your time fighting with this version… Goes on any longer, you will go bezerk. Maybe you can hire an outside consultant for a moderate fee, to help you guys adjust (the) (and to) the system. I figure a week would be enough. Spread it in time. 2 hours a day for 10 days? You need to do something about it. Please?

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