Sunday, November 22, 2015

Clinical Informatics 101 for Cerner EHR System

So you decided to make the leap from general duty nursing to clinical informatics? Good choice. My ride so far in the world of clinical informatics has been the most rewarding, albeit tear jerking experience of my life. I started out as a bright eyed bushy tailed bunny looking to experience a new side of healthcare.

The journey that ensued has been one of the most personal growth I've ever experienced in my entire life. I went from the structured and disciplined role of nursing, every med when due, every patient turn when indicated, to this haphazard role or EHR trainer/System Analyst/System Optimization Expert/Technical Adviser/Committee Representative. I can't put it into words. I made this transition from run-of-the-mill RN to a personal whose role wasn't fully understood.....yet was overloaded.

I chuckle at the early days in my role. Clinical Informatics. What is a Clinical Informaticist? I still can't fully answer that question. To this day I struggle trying to explain my role in healthcare to friends, sometimes even colleagues.

I started out in a very small Clinical Informatics department at my regional hospital before the title, the role, or even the scope of Clinical Informatics was fully understood. We started as a small group of four serving a 220 bed hospital with roughly 1500 employees in total. We were the nerds down in the basement formulating theories and crafting up "off the beaten path" optimizations. It was a strange time for the field of Clinical Informatics. The role, in my opinion, only came into existence because of Electronic Health Records systems. In our case that EHR (EMR/EHR.....etc) was Cerner.

It's strange to look back at those days. I remember the days before we had settled into our own where no one knew our roles. I'd get calls in the middle of the night asking about how to chart or order the most mundane of things/tasks. During the early time we acted as EHR trainers, but whenever free time came, and it was limited, we were always trying to improve the system as a whole. I remember creating ticket after ticket for optimizations, some as simple as help desk tickets to our IT teams, others as complex as having to graph out flow diagrams for enterprise wide changes to workflow. I look back and laugh, it was the roughest part of my career to date but that sense of accomplishment in the face of true adversity is something I will take to my grave. This might sound reminiscent of some old war vet talking about Vietnam, and in a way it was, people all around me on the verge of retirement were throwing their hands up at the idea of having to learn this new system and bowing out. I couldn't see the daylight yet.

Then one random night ~18 months after we had initially adopted our new EHR, it happened. I get the call at 10:30pm, "Cerner is down we don't know what to do". Now a call like that might make some cringe, but that night.....that call was what I had been waiting for, we couldn't live without it. The call had come down from the nursing supervisor. We had finally gotten fully behind this system, and what's more is that when presented with the only option of falling back to paper charting people relished the idea, instead of happily transitioning. We had a downtime and people were upset about it, I had waited so long for that validation....it was working....it was going to work out. 

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