How do you begin to manage an EMR system as complex as Cerner Millennium®— with a back end containing more than 35 million lines of code from Cerner along with Linux, AIX, HP-UX, VMS, Oracle, WebSphere MQ, Sonic ESB, MySQL, Java, storage area networks (SANs), networks, clustering software, network connections between Oracle instances, Citrix, Windows servers and desktops; with a front end that has more than 4 GB of space in its code warehouse; and with countless application builds?
I recommend you start your work by stepping away from your computer screens and talking to the people who are using the system to care for patients. Are they frustrated with response times? System availability? The number of clicks to admit or discharge a patient? Don’t dismiss their complaints with the assumption that “clinicians just don’t understand computers.” They are highly skilled people who understand the most complex system on the planet: human life. You might be surprised what you can learn when you take the time to really listen. Or shadow them during their rounds.
When I worked at Cerner, I brought my stopwatch with me to one hospital to join the CMIO and director of nursing informatics on the floor. It took more than 15 seconds to place one order in PowerChart®. That’s an eternity when you’re with a patient and still have the rest of your rounds to complete. When I took the data back to the engineering lead responsible for the code, she emphatically told me, “Fifteen seconds is fast enough. They (the clinicians) just do not understand computers.” No wonder the clinical staff was frustrated. The system was hampering their ability to provide patient care, but their concerns weren’t given any consideration by the people capable of addressing the problems.
So I encourage you to gather the staff’s list of concerns, criticisms and objections. If they feel they’re not normally heard, no matter how bad their experiences, don’t be surprised if they’re distrustful at first and reluctant to talk. Keep at it. Move through the obligatory moans and groans to get to their true desires.
Now that the easy work is done, begin to rebuild their faith in the system by evaluating each complaint against each need and determine how to address them. You can use Millennium’s greatest asset, its flexibility, to configure it for very specific purposes. If the issues outweigh your staff’s ability to correct them — we’re back to that complexity I mentioned earlier — don’t be too proud to seek outside help. (If you’ll be at the Cerner Health Conference next month in Kansas City, I’d be happy to listen to your system concerns and talk through some options.) Then you can begin the journey of reconfiguring this multifaceted solution set into the system your clinicians actually enjoy using rather than avoid using or simply tolerate.
