August 6, 2024 • 37 mins
Are there monster truck rallies in Madison, Wisconsin? Maybe. But there's definitely Epic - and now Barbara's medical center has Epic too! Does that make us Epic?
In this episode, Barbara and Teja talk about the two-year transformation of her medical center from the Southwest Airlines of medical technology into a jet fighter.
Integration of all those systems feels good, but how should we prepare our clicker fingers for all the extra activity? How do patients benefit from it all? And why don't any of these systems talk to each other? What about AI.
Be Epic with us today on Living Forward!
Follow us on Instagram @wearelivingforward
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:03):
Live from Massachusetts.
It's Barbara and Taya withLiving Forward.
Forward, forward, forwardforward, forward, forward
forward, and Monster TrucksTrucks trucks, trucks, trucks,
trucks, trucks.
Speaker 2 (00:16):
Actually, I would love to go just to see Monster
Trucks, at least once.
Speaker 1 (00:22):
Really yeah, yeah.
You know I want to get'm goingto eat a hot dog, have some
cheap beer.
Speaker 2 (00:28):
Watch a monster rally truck thing a monster truck
rally thing.
I see I want to see one ofthose things overturn bounce
around yeah.
And then drag race or whatever,and then I'll be done, oh okay,
yeah, cool, all right.
And then I'll be done.
Speaker 1 (00:43):
Oh okay, yeah Cool, all right, because they used to
have them at the Centrum.
Speaker 2 (00:46):
Centrum.
Did they really?
They used to.
Oh, wait a minute, they did,right, what?
Speaker 1 (00:50):
happened?
I don't know.
I haven't seen an ad for one ofthose in a long time.
Speaker 2 (00:58):
I don't know what happened.
Speaker 1 (00:59):
You should bring that back.
Speaker 2 (01:00):
Yeah, I don find one, I'm sure there there is one
somewhere, maybe even in madison, wisconsin, let's do it because
you know what's in madison,wisconsin, don't you?
Uh, no, what's in madisonwisconsin.
Why do I want to know?
Speaker 1 (01:17):
oh no, you look on your face, you know what's in
madison, wisconsin al franken Iuh, I don't, I wouldn't know sir
, I couldn't possibly say sirMadison Wisconsin.
Speaker 2 (01:33):
I don't know.
Speaker 1 (01:34):
Epic.
Speaker 2 (01:36):
Oh, is that where they're from?
Yes, Epic the company is inMadison, Wisconsin.
Speaker 1 (01:43):
Yes, epic, the medical record company.
Why did I always think theywere?
Speaker 2 (01:45):
silicon valley types?
No, I guess not.
Speaker 1 (01:48):
Huh no wow fascinating madison wisconsin
lower taxes I don't know, Idon't know, I don't know,
actually, when the companystarted so most of you probably
have some idea, peripherally,subconsciously.
Maybe you don't, but you dohave a connection to a company
(02:10):
called epic yeah, whether youknow it or not, chances are your
data is in epic somewhere theyknow everything about you your
girth, your birth oh, wow I wasgonna come up with a third one.
I couldn't, you couldn't oh okay, yes, epic is a medical record
(02:34):
system.
Oh, everybody has a smurf.
I remember this.
Speaker 2 (02:40):
I loved the smurf there's a little Grossman's in
you.
Speaker 1 (02:49):
They have an ICD-10 code for that.
Icd-10 code A39.AZX is Grossmanin, you Get it out.
It burns.
Yeah, so we went live with anew electronic medical record
(03:11):
system called epic, uh on june.
First I see epic epic becauseit is epic and it is an epic.
Um yeah, no potential yeah, uh,it's.
It's hard to change systems in ahospital.
Let's just put it.
Let's just put that right outthere to start out with it.
(03:32):
It is just hard, honestly, nomatter what you're going from or
to.
And on top of that, not onlydid our hospital system go live,
but another hospital system inthe Boston area also went live
on Epic on the same day.
Speaker 2 (03:54):
What is the primary reason for it being so difficult
to change systems systems?
Speaker 1 (04:00):
oh well, okay.
So imagine all of the functionsof a hospital every department,
every.
You've got inpatients, you'vegot outpatients, you've got
every type of staff member youcould imagine.
You've got people who handlethe billing and the registration
(04:24):
.
You've got um, everything hasgot to happen and it has to
happen securely.
It has to happen securely andideally in a single system.
You see, that that's the thing.
Okay, our last system, when itwas developed, was like amazing,
(04:45):
but it was developed like 30years ago.
Speaker 2 (04:50):
Was it amazing 30 years ago?
And it was no longer amazing.
It was no longer amazing.
Speaker 1 (04:55):
And then the tech stack that they had to grow
around that to support it.
I think honestly they hadpeople sometimes working on that
system who otherwise would havewanted to retire, but they
asked them, or probably cajoledthem, to stay on because nobody
studies that programminglanguage anymore, kind of thing.
Speaker 2 (05:18):
Yeah, that's how old it was what would be a good
analogy for?
Could it be something like?
Speaker 1 (05:25):
A 36-year-old cat.
Speaker 2 (05:29):
If you can't herd cats and if all the cats are 36
years old.
Speaker 1 (05:36):
Yeah, see, there are no 36-year-old cats.
Speaker 2 (05:38):
Okay so.
Speaker 1 (05:40):
Yeah, that's what I'm trying to.
That's not a very nice analogy.
Speaker 2 (05:44):
But so, for example, what about like an air traffic
controller or a unit of airtraffic controllers?
Speaker 1 (05:52):
Well, actually, let's think about it.
Speaker 2 (05:54):
And if all the planes change, if all the airports
change, their direction and thelanguage they use changes and
their computer systems change?
Is that what we're talkingabout?
Speaker 1 (06:07):
Kind of.
But also, if you don't change,then you get into, to continue
the airplane scenario.
You get into the Southwestsystem, right?
Remember when Southwest justcompletely fell?
Apart because some part oftheir elderly communication,
their elderly computer system,broke down and next thing you
(06:27):
know there's thousands ofcanceled flights.
Speaker 2 (06:29):
Right.
Speaker 1 (06:30):
So canceling a flight is not quite as life altering,
shall we say, as the entirehospital system going down while
you're admitted.
See, that would be terrible.
Speaker 2 (06:42):
And especially, that would be what would be called a
disaster.
Speaker 1 (06:51):
If what if it was during covid?
Well see, I think we would havegone live sooner if it weren't
for covid, because they wereplanning it.
And then they're like okay,we've got to wait for covid to
go, yeah, yeah, no, that thatwould, that would have if we.
You just made me think of a wayin which it could have been
worse.
Speaker 2 (07:07):
You know, I'm always here for you to imagine the
worst possible case scenarios.
Speaker 1 (07:13):
Yeah, actually, honestly, I think COVID helped.
You know why?
Guess why?
Speaker 2 (07:22):
Okay, let me see COVID helped because people were
, more people were working.
Why?
Okay, let me see COVID helpedbecause more people were working
remote Okay.
So there was a need forpatients, doctors, care
providers to be able tocommunicate, log on and get
people's data very quickly.
Speaker 1 (07:42):
No.
Speaker 2 (07:43):
Okay.
Speaker 1 (07:45):
Because of the meetings.
Speaker 2 (07:48):
The meetings.
Yes, who likes meetings?
Speaker 1 (07:50):
No, but so here's the thing.
I've gone live with Epic twotimes in my career so far.
Hopefully this will be a lot oftime.
I think we should establishsomething.
Speaker 2 (08:00):
first, though Epic is a medical record system yes,
and it's an EMR.
Speaker 1 (08:06):
But it's also got all of the underlying architecture
for everything else as far asrunning the hospital is
concerned, like for the codingand the billing and the
registration.
And so now, like before, we hada situation where you had like
one system was for registrationand there was another system
that kind of talked to that thatwas for billing, and there was
(08:27):
another system that sort oftalked to that for the, for the
medical record, but though thatwasn't the one that they used in
the intensive care units, sothey had something else that
kind of talked to that.
Now it's all one unified system.
So this is actually a good thingokay but the last time I went
(08:48):
live at a different hospitalsystem with epic with epic, the
amount of meetings, and then youhad to go someplace.
They had to get everybody liketwo dozen people in a room
together for a meeting to learnabout epic to plan so we've been
(09:09):
planning now for a year and ahalf.
Wow, right.
So every little piece, think ofevery little thing that you
have to do, like the labels.
You know the little labels theyprint out when you give blood,
when you, when you give bloodfor a test, right, and they
print out a little label and itgoes on the vial.
Well, that little label has tobe connected to a computer
(09:32):
system to get that little label.
Speaker 2 (09:35):
Are vampires involved ?
Speaker 1 (09:36):
Well, you know they should be.
Speaker 2 (09:38):
Right.
Speaker 1 (09:39):
Because if they, want the blood and your medical,
then they want to make itefficient.
Speaker 2 (09:43):
Your EMR isn't dedicated yet Exactly.
Thank you.
Speaker 1 (09:46):
Exactly right.
So you know you've got to keep.
Here's the vampire's share.
Here's the part that's going tothe testing lab.
Speaker 2 (09:55):
What's this code?
Here?
It's BLDVMP.
What's the VMP part?
Speaker 1 (10:02):
Oh, that's vampire.
Vampire, yes, yeah, okay, okay,I have never been in so many
meetings.
They were all necessary too.
It's not like.
Speaker 2 (10:15):
Not wasted time no.
Speaker 1 (10:17):
No, because there was so much to do, and I was saying
this to someone the other day.
We have actually a really goodculture of meetings where I work
right now, which is that it isdisrespectful to arrive to a
meeting late unless you've letthe person know in advance I'm
gonna have to be late, um or orlike if you said you couldn't
(10:38):
make it and then all of a suddenyou could and it's like, hey,
it turned out I could make thelast 20 minutes, that's okay.
But if you said, yes, you'regoing to be there, then you're
going to be there.
When you say it's going, tostart.
And when it's supposed to end,it ends.
It's like we had a 30-minutemeeting.
We still have a couple thingsto talk about.
(11:00):
If people aren't available tostay, meeting ends and you res
and you schedule something forthat thing that didn't get done.
It's not like this, meanderingmeetings.
No, it's like here's our agendahere's what we have to talk
about yeah, I really appreciatethat that's really about where I
work, because it's like this iswhat we've got, this is what we
have to accomplish.
Uh-oh, we're almost done.
(11:21):
Can everyone stay for 10 moreminutes?
Nope, okay, I guess we have toyep, you know very good it's
like you know so okay, there'sthere's so many of them for epic
and the reason why there's somany meetings for epic is
because.
Speaker 2 (11:37):
is it because epic isn't designed to be user
friendly, or is the userinterface too complicated, or is
it that that's?
Speaker 1 (11:47):
true of all of them.
Okay, I mean it's true of allof them, but it's just.
There's so many parts to it andevery hospital is different.
Speaker 2 (11:56):
I see.
Speaker 1 (11:57):
Now you think about a hospital system, because this
is going live in a hospitalsystem.
We have multiple hospitals alldoing things in different ways.
There were some hospitals thathad been on a prior version of
Epic, but our hospital had beenon this older system, this
legacy system, for like 30 years.
(12:18):
And then there was anotherhospital in the system, a
smaller hospital that was stillon paper.
Speaker 2 (12:25):
They were still using paper.
Speaker 1 (12:27):
Paper.
Speaker 2 (12:28):
Papyrus.
Speaker 1 (12:30):
Yeah, I think they had quill pens.
Quill pens, oh, not quilt.
Speaker 2 (12:33):
Quill, quilt pens.
It's not writing very well.
Speaker 1 (12:38):
I know, but it's really nice looking.
Ink wells they're dipping it inthe ink well, it's very warm.
Ink wells they're dipping it inthe ink well, it's very warm so
an.
Emr like Epic takes what?
(12:58):
Two years to implement?
Well-ish, I mean, they've beenso.
They had, I believe, honestlystarted planning some of this at
the highest levels before thepandemic and then they had to
pause it.
So really we're probablylooking more at like an
end-to-end, maybe a five-yearprocess.
Speaker 2 (13:14):
Five years Now.
At the end of that five years,what if Epic has updated to its
new version and everyone's gotto move to that?
Speaker 1 (13:23):
They're just more meetings well, there are certain
, there are certain updates thatyou have to take.
So I just learned actuallyrecently, this brand new
information to me anyway thattwice a year there are
regulatory updates okay, so forexample, it's like so by
contract when you sign up forepic, you have to accept the
(13:46):
regulatory updates.
Now there are other updates thatcome down the pike, some of
which are systemic updates andsome of which are updates that
are called optimization for yourparticular one.
So it's like it's.
It's like it's got thefoundational system, they call
it, but then it's customizedalso to each.
(14:09):
So client.
Speaker 2 (14:11):
So walk me through it .
Have a patient.
I and I.
I know quite a bit about emrsonly because many years ago, as
you know, I used to producetraining and marketing and sales
demo videos for softwarecompanies that wrote EMR systems
.
This is, you know, 20 years ago.
(14:31):
Of course, a lot has changedsince then.
Just to kind of help themunderstand the complexities when
you walk into a hospital, whenyou enter a hospital, what you
see as a patient.
Speaker 1 (14:51):
Oh man, you don't even see like a tenth of it.
Speaker 2 (14:53):
So you might get frustrated by the fact that the
pen that you use to sign yourname you know when you sign that
name.
Yeah, and you have no idea likewhat you're actually signing.
Speaker 1 (15:03):
You could be signing away your left kidney.
Speaker 2 (15:04):
You have no idea exactly that actually makes me
mad right.
Speaker 1 (15:08):
So you sign it because you know you know it
should be it should be like anipad or something, so you can
see the document that you'reseeing, not just a little
signature pad exactly trust me,this is the consent to treat
right exactly.
Speaker 2 (15:19):
So you sign this thing and then they tell you
where to go and you wait thereand then you walk up to your
name.
Okay, so you're signed in,everything is set, the doctor
will be with you in a minute andthen the rest of it is just
your experience at the hospital,as it would be at a department
store or a restaurant orwhatever.
Speaker 1 (15:39):
You get like blood transfusions at Macy's.
Speaker 2 (15:45):
Fifth floor transfusions, women's shoes,
basement, heart surgery what's?
Speaker 1 (15:54):
that Women's shoes and IVs.
No no, you don't.
I mean you don't see.
Speaker 2 (16:07):
Right, you don't.
Speaker 1 (16:08):
I mean you don't see, but right you you don't, you
don't and you shouldn't, becauseif you were to see the guts of
it no, you don't want to itwould scare you away.
Speaker 2 (16:12):
Well, I mean, hospitals are scary enough even
if you saw your own guts, itmight.
Speaker 1 (16:16):
That would definitely scare you away but, like you,
most people don't even realizelike so, when you're given
medications at a hospital, themedications are locked up in
this system, like it's literallylocked and everything that's in
that case.
That big case is counted.
So when you need to get amedication for a patient, you to
(16:43):
scan their in the system, youpull up their medical record.
It knows what the medicalrecord should be.
Then you it dispenses themedications that they're
supposed to have and you have tocheck.
This is the nurse that doesthis.
The nurse has to check it alland then they bring it in and
they have to double identify andnow I think there's a little
(17:08):
boop, a little scanner, so thatthey scan to make sure, okay,
yeah, I recognize that soundyeah, exactly, and they boop,
they boop you okay and and thenthey know that the right meds
are going to the right person.
But like you don't realize, soyou know the the nurse comes in
(17:29):
with the meds.
You don't see all thatnecessarily.
I mean you might see it if youjust happen to be in the bed
near the place where that littlecart is stored.
But yeah, I mean there's,there's so much, and most of it
you know, 90% of it's safetyrelated.
Speaker 2 (17:46):
Do you think that Epic, or any EMR system like
that, is capable of supporting amajority of American patients
and healthcare providers?
Speaker 1 (18:07):
What do you mean by support?
Speaker 2 (18:11):
That's a good.
That's a good-.
Speaker 1 (18:13):
Because there's different ways you can take that
.
Speaker 2 (18:16):
So what I'm saying is we don't have an integrated
healthcare system, right, andmany people don't even have
insurance, and many people don'thave access to doctors and uh,
you know, care as as they wouldneed because of disparities and
(18:40):
location things well, an emrcan't help that, no emr, emr
can't help that, but a systemlike epic is growing
exponentially, partly because,even though it has its flaws, it
(19:02):
is still functioning betterthan what we used to have.
Speaker 1 (19:07):
Oh, yeah, right.
Speaker 2 (19:09):
Because of that, the the growth is only expected to
to to become part of otherhospitals or clinics, even small
clinics.
Speaker 1 (19:21):
I mean, if I think I see where you're getting to.
I mean, the thing is, I dothink there should be more
competition in this space thanthere is.
Should be more competition inthis space than there is.
But what happened way back, ifyou go back like 20 years?
The government wasincentivizing doctors and
(19:43):
hospital systems to pick upelectronic medical records
because it is better.
I mean the phenomenon peoplejoke about, about not being able
to read doctor's writings.
It was actually reallydangerous.
Speaker 2 (19:55):
Like people would get wrong medications.
Speaker 1 (19:57):
You wouldn't be able to read the diagnosis.
Like how many times early in mycareer was I trying to, you
know, figure out what aneurologist said and I'm like
you know it was maddening, likeit was not okay.
So we are safer withelectronical medical records
than we were before.
But in rolling this out thegovernment gave some incentives
(20:20):
because, it's expensive, youknow it really is.
And so they were incentivizingpeople to spend the money on
that and systems to spend themoney on that, and they created
something called meaningful useon that and systems to spend the
money on that, and they createdsomething called meaningful use
.
And so meaningful use meantokay, you can't just like amp up
Microsoft Word and pretend it'san EMR, right, it's got to have
(20:40):
certain features in order tocount toward the incentive,
which makes sense.
And they would have things likeit has to have a communication
portal with patients.
It has to be capable oftracking allergies, whether
they're medication, you know,especially medication allergies.
It has to be able toaccommodate certain types of
data, right, so they would setup these things.
(21:01):
But what they never did set upas a meaningful use criteria was
interoperability.
Speaker 2 (21:10):
Right.
Speaker 1 (21:10):
The ability to read the medical records from another
system.
And so what happened is eachone decided we're going to try
and make ours the one right.
You know it's going to be likethe standard, and so Epic, I
believe, is winning right, butit's still like it sets up a
(21:33):
monopoly situation, and thisisn't anything against Epic per
se.
They're just doing whatAmerican businesses do, right
like they.
They're setting up a situationwhere they're delivering a
product that any hospital thathas Epic if the information
matches the name and the date ofbirth and like something else.
Speaker 2 (21:54):
Girth.
Speaker 1 (21:55):
Yeah, right, then I can read the medical records
from that system.
It could be in Florida, itcould be in Maryland, it could
be in Montana, it doesn't matterwhere it is.
If they have Epic and theidentifiers, the key identifiers
match, I can see it.
And that, again, it's a hugesafety thing.
(22:16):
Imagine you are from Minnesotaand you are admitted in
Massachusetts because of anemergency right.
All of your medical records arein Minnesota.
We don't know, like your entiremedical history, we don't know
what meds you're on, we don'tknow what you're allergic to and
, yeah, you, you can getsomething from a history so
(22:39):
you're telling me that peoplefrom Minnesota should stay in
Minnesota?
no but I'm saying that theyshould they should use Epic so
that then when they're here inMassachusetts, because the, the,
the honestly now now three ofthe biggest medical systems here
in Massachusetts are all onEpic.
Make sure you're in Epic there,because then we can see your
(23:01):
stuff.
Right, we can know.
But that was my question Iasked earlier.
Speaker 2 (23:05):
The fundamental question is is Epic capable of
interoperability with itself?
Speaker 1 (23:15):
But that's the problem.
Speaker 2 (23:16):
The government never set up that incentive to really
make it interoperable with othersystems.
Speaker 1 (23:22):
But it's not interoperable with, like Athena.
Health or eClinical Works orother Right.
So I think that America missedan opportunity.
Speaker 2 (23:31):
And that was my question.
That was actually my question.
We missed an opportunity.
And that was my question.
That was actually my question.
We missed an opportunity.
Speaker 1 (23:37):
Because it doesn't have to be the same right, but
in order to get the spirit ofcompetition and getting people
fighting to introduce newfeatures and things like that,
if right from the get-go they'dsaid, hey, one of your criteria
is you have to be able to readeach other's stuff, then that
(23:58):
would have preserved a marketthat I think would have been a
little bit more forward-facing.
Speaker 2 (24:04):
Again.
Speaker 1 (24:04):
Epic is fine.
Epic is.
You know.
Who knows, maybe, sincekeywords right, someone from
Epic is going to be listening toit.
Epic is fine.
It's so much better than whatwe had before.
Speaker 2 (24:15):
Yeah.
Speaker 1 (24:16):
But it is becoming a monopoly.
I see Right, and it's becominga monopoly because of the way
that it was set up.
Speaker 2 (24:23):
So remember in the last episode we were talking
about my trip to Japan and thecommunication between people
from different countries inJapan and that there was this
kind of like a, not a system Iforgot the word I used, but it
had to do with the outer layerof how we communicate and you
said why don't you just hold upa sign that directs you to the
(24:46):
way in which you're supposed tocommunicate with the person?
Speaker 1 (24:48):
in front of you, right.
Speaker 2 (24:49):
Right, I mean funny, but there is some truth supposed
to communicate with the personin front of you, right?
Right, um, I mean funny, butthere is some truth to to the
need for clarity when it comesto interoperability and
different systems.
When it comes to people'shealth, yeah, because americans
move more than you would expect.
(25:11):
Right, the average Americanmoves out of state often enough
where they have to completelyredo who they are within a
medical record system.
Speaker 1 (25:22):
Most medical problems and errors and things come from
communication issues and errorsand things come from
communication issues.
Speaker 2 (25:31):
Right, exactly, yep, that's what I'm saying.
It is in these meetings thatyou have is some of the
preparation about how to ensure,how to ensure that the yeah, I
mean an electronic medicalrecord puts guardrails around
(25:52):
things, right, there becomes away you do things right.
Speaker 1 (25:57):
So even one thing that's handy, for example, is
doctors can have somethingcalled order sets and I'm sure
they can do this in other recordsystems as well is where it's
like okay, if I know that, ifI'm suspecting, if I'm working
up congestive heart failure,there are these three or four
tests that I run, I can clickone button and this set will
(26:19):
open up that will say, yep, thisis my congestive heart failure
set of orders, right, so we cansave time, right.
The downside to that is thatlet's say, oh, I forgot, there
was something else I'm lookingat too, and you now, you forgot
to add on that extra test, youknow, and so it gets tough.
(26:40):
Or like in our area of thefield right, there's, there's
something called a modifiedbarium swallow study.
Okay, so this is a study thatis done with a speech
pathologist and radiologist andit looks at the physiology of
swallowing, because theesophagus, where the food goes,
and the trachea, where the airgoes, are right next to each
(27:03):
other, and so if that startsmalfunctioning, instead you have
food and liquid go into yourlungs which is we'll just say
bad.
So that's a modified bariumswallow.
There is also a test called abarium swallow.
Speaker 2 (27:19):
Which is not modified .
That has nothing to do withswallowing.
Speaker 1 (27:22):
It's a GI study looking at the esophagus.
Speaker 2 (27:25):
Okay.
Speaker 1 (27:26):
So what you then get is, like some doctors aren't
sure which to order, and thenthey order the wrong one.
Speaker 2 (27:34):
Well, a doctor should not be, never mind.
Speaker 1 (27:36):
Right, but especially like we're an academic medical
center right.
I was telling you how, on July1st, you know, I had the long,
long line of people outsidesecurity.
I was like what's going on?
Oh, it's July 1st.
All the new residents.
Speaker 2 (27:56):
All the new residents , okay, and interns, like all
the new residents all the newinterns are coming in, so like.
Wouldn't an EMR if it was smartright?
Speaker 1 (28:08):
If it was smart, if AI played a role.
Right.
Speaker 2 (28:11):
Wouldn't an EMR know intrinsically that if you had
just done, if you had justtalked to a patient and the
notes are in there this is whatI talked to a patient about.
Speaker 1 (28:22):
Well, there's no AI in there yet.
Speaker 2 (28:24):
Yet.
But I mean, wouldn't that begreat.
A doctor talks to a patient,notes are taken.
Speaker 1 (28:29):
They're already talking about how to bring AI
into the system.
Speaker 2 (28:33):
The system should generate a suggestion.
Like well, in this case amodified barium swallow and
right.
Wouldn't that be the protocol?
Wouldn't that be a protocol?
Speaker 1 (28:49):
For certain things.
Yeah, wouldn't that be theprotocol?
Wouldn't that be a protocol?
And it's not things.
Yeah, and again, usually itworks pretty it, usually people
know it, but it's it's like inthe system.
So for us going to this newelectronic medical record system
like there's actually more thanone name for this test that we
do, so the modified bariumswallow is sometimes called a
(29:09):
video swallow study or a videofluoroscopic study of swallowing
.
So historically that's whatwe've called it in order that it
didn't have confusion.
So we would call it, and in ourorder sets it was always called
a video swallow study or avideo fluoroscopic study of
(29:29):
swallowing.
Well, in the Epic system I meanmost places in the country, and
even when you read theliterature they're calling it a
modified barium swallow.
So in Epic it's called amodified barium swallow.
So now all of our providers whoare used to looking for either
a barium swallow or a videoswallow study are now having to
reorient and think about abarium swallow or a modified
barium swallow or a videoswallow study, are now having to
(29:50):
reorient and think about abarium swallow or a modified
barium swallow.
So you see how that can goterribly wrong.
Speaker 2 (29:55):
And that's just your department.
And then there are many, manydepartments, Exactly so.
Speaker 1 (30:00):
You see the that's why you see the minutia.
That's why it takes five yearsand more meetings than you can
conceptualize years and moremeetings than you can
conceptualize.
Wow, do they serve coffee andsnacks during these meetings?
People tend to bring their ownbecause they are virtual
(30:21):
meetings.
Oh, but I was so.
Speaker 2 (30:23):
So, people, I see where you were before the place
you were before that's when youhad your in-person yeah, yeah,
no, but see, this is why again,pandemic.
Speaker 1 (30:31):
Thank you, covid.
Speaker 2 (30:33):
Thank you, covid.
I've not heard that phrase ever.
Thank you, covid.
Speaker 1 (30:39):
Wow, because I got a sit-stand desk for my desktop so
that I can be sitting sometimesand standing sometimes.
And then I've got my coffee andwater and your modified barium
coffee.
Speaker 2 (30:56):
You know your modified barium juice.
Speaker 1 (30:58):
Disgusting no no, no, so it's been something mmm so
then we went live and it wasjust like all these things were
wrong and it's like, no matterhow much you planned, it's just
like there's things were wrongand it's like, no matter how
much you planned, it's just likethere's so much that's going on
and it was, it was it's like memaking an omelet.
Speaker 2 (31:17):
It never is the same, never.
I've never made an omelet thesame way I try.
Speaker 1 (31:22):
Yeah, I exactly same technique like what if you had
an emr for that, would you like?
Well, if I use modium I cangive you a speech evaluation you
could give me a modified bariumswallow, that would explain.
Speaker 2 (31:39):
No, just a barium swallow no, because that's for
swallowing.
It's a totally different cptcode okay, speaking of CPT code,
yeah, go for it.
Speaker 1 (31:51):
I rebooted my YouTube channel.
Speaker 2 (31:53):
Rebooted your YouTube channel.
Speaker 1 (31:55):
Yes, Because I had been putting up a few.
Speaker 2 (31:57):
What's it got to do with CPT code?
Speaker 1 (31:59):
Because I had been focusing on putting some videos
up about voice thingsspecifically, and then I
discovered what I feel is alittle bit more important and
something that I'm good at,which is educating people about
health care.
So I have a video about thecodes.
Speaker 2 (32:18):
Oh right, that's right.
Speaker 1 (32:20):
So CPT codes are in there, as are ICD codes, and I
have a video on my channel,barbara Wilson Arboleta
voice-wise.
Speaker 2 (32:31):
Barbara Wilson Arboleta.
Speaker 1 (32:34):
Voice-wise.
Speaker 2 (32:34):
Voice-wise.
Speaker 1 (32:35):
V-O-I-C-E, w-i-z-e, and so if you put those in as
your keywords, you should see mychannel and I'm going to be
doing more Great Abouthealthcare communication Because
, again, we can joke about theelectronic medical record system
, but it's true, like somethinglike epic does help.
(32:55):
It helps because there arebuckets for everything, but it's
still there are so many people.
There are, I think, 22 000people that work for us like
herding cats we were jokingabout, right, like trying to
keep 22,000 people on the samepage.
(33:16):
Our hospital alone, not justthe whole system, our hospital
alone has 850 beds wow, ish.
And then all the outpatient Wow.
Speaker 2 (33:29):
So if you get tired and fall asleep, you've got a
lot of choices there.
Speaker 1 (33:32):
Yeah Well, except that it's usually full.
Speaker 2 (33:36):
Well, you didn't say that, you just said there are
850 beds.
Speaker 1 (33:39):
Yeah, but I could grab some sheets and lay on the
floor.
Speaker 2 (33:44):
Which was tempting the hours that you work, which
was tempting in the last fewweeks before Gola.
Speaker 1 (33:49):
I was just, can I just?
Speaker 2 (33:50):
curl up in fetal position underneath my desk
Before please.
Speaker 1 (33:58):
Yeah Well, but we're clicking along.
Now we're getting there.
Speaker 2 (34:00):
I'm glad you went live.
Speaker 1 (34:02):
Me too.
Speaker 2 (34:03):
And I'm glad because I remember the day.
Live from Boston, massachusetts, live from Boston.
It's epic.
Speaker 1 (34:09):
Yes.
Wow Well all the power to you.
Yeah, you know, someday therewill be a television show all
about working for an EMR, youknow how they have like the
behind the scenes, things theyhave like, shows about kitchens,
you know, like the chef and thecooks and stuff like that they
(34:29):
should do like the it departmentof a hospital it's episodic
cool yes, cool cool, cool, cool.
Yes, I had, I had, um I got.
I bought one of those cameosfor my team.
Speaker 2 (34:51):
Oh, that's right.
With Dr Glaukom Flecken who welove so much, dr Glaukom Flecken
yes, and yeah, so he did alittle.
Welcome to Epic video for us,thank you, doctor, that I
disseminated to our team.
Thank you.
Speaker 1 (35:05):
Dr Glaukom Flecken, we love you All right.
Speaker 2 (35:12):
Very good.
Speaker 1 (35:13):
That's about all the damage that I can do talking
about health care today.
Speaker 2 (35:17):
Well, you're doing a great job there and as long as
you get your modified bariumswallow and barium swallows all
figured out, yes, well, we'rehoping they can put in a little
flag, all figured out.
Speaker 1 (35:29):
Yes, well, we're hoping they can put in a little
flag, meaning that, like whensomebody goes to order one it
says you know that, similarwarning, similar test.
Speaker 2 (35:38):
Right.
It's like when you go toStarbucks and you the drive-thru
and you've ordered your mochalatte, but with soy milk, right,
and they give you oat milk, oatmilk it's.
Speaker 1 (35:48):
It's like you can't drive around come back.
Speaker 2 (35:52):
Just can't, you know.
You're driving home and thenyou're, just you know, bloated
and yeah, you're gonna drive toomuch fiber.
Speaker 1 (36:01):
And then you gotta go to the hospital.
Where epic exactly?
Speaker 2 (36:05):
you gotta get a barium swallow because your
esophagus is.
Speaker 1 (36:09):
You know, the fiber gets you going and the barium
stops you up.
So there you go.
Speaker 2 (36:16):
Full circle.
Speaker 1 (36:17):
Okay, yeah, I think, yeah, that's about enough of
this, that was epic.
Yeah, this was an epic episodeEpic episode.
Speaker 2 (36:25):
It was an epic-sode.
Speaker 1 (36:26):
Oh yes, Well, we hope you found that amusing.
I'm sure we'll be on to otherfabulous topics.
You know what we should do?
A media topic again next time.
Speaker 2 (36:37):
Let's do a media topic.
Let's talk about something wejust watched, something we're
watching, or something like that.
Speaker 1 (36:40):
That'd be fun, absolutely, yeah, yeah.
And you know, any ideas thatanybody has of what they'd like
us to chat about, we're happy toentertain the idea.
Entertain, because we are hereto entertain, after all.
Do please give us a wonderfulfive star review, pretty please,
(37:00):
five out of five and subscribeand listen and pass this on and
tell everyone how like wonderfulwe are and all that and you've
got great hair too thank you somuch, until next time all right.
Live from Massachusetts.
It's Barbara and Taya withLiving Forward.
Forward, forward, forwardforward, forward, forward
forward, and Monster TrucksTrucks trucks, trucks, trucks,
trucks, trucks.
Speaker 2 (00:16):
Actually, I would love to go just to see Monster
Trucks, at least once.
Speaker 1 (00:22):
Really yeah, yeah.
You know I want to get'm goingto eat a hot dog, have some
cheap beer.
Speaker 2 (00:28):
Watch a monster rally truck thing a monster truck
rally thing.
I see I want to see one ofthose things overturn bounce
around yeah.
And then drag race or whatever,and then I'll be done, oh okay,
yeah, cool, all right.
And then I'll be done.
Speaker 1 (00:43):
Oh okay, yeah Cool, all right, because they used to
have them at the Centrum.
Speaker 2 (00:46):
Centrum.
Did they really?
They used to.
Oh, wait a minute, they did,right, what?
Speaker 1 (00:50):
happened?
I don't know.
I haven't seen an ad for one ofthose in a long time.
Speaker 2 (00:58):
I don't know what happened.
Speaker 1 (00:59):
You should bring that back.
Speaker 2 (01:00):
Yeah, I don find one, I'm sure there there is one
somewhere, maybe even in madison, wisconsin, let's do it because
you know what's in madison,wisconsin, don't you?
Uh, no, what's in madisonwisconsin.
Why do I want to know?
Speaker 1 (01:17):
oh no, you look on your face, you know what's in
madison, wisconsin al franken Iuh, I don't, I wouldn't know sir
, I couldn't possibly say sirMadison Wisconsin.
Speaker 2 (01:33):
I don't know.
Speaker 1 (01:34):
Epic.
Speaker 2 (01:36):
Oh, is that where they're from?
Yes, Epic the company is inMadison, Wisconsin.
Speaker 1 (01:43):
Yes, epic, the medical record company.
Why did I always think theywere?
Speaker 2 (01:45):
silicon valley types?
No, I guess not.
Speaker 1 (01:48):
Huh no wow fascinating madison wisconsin
lower taxes I don't know, Idon't know, I don't know,
actually, when the companystarted so most of you probably
have some idea, peripherally,subconsciously.
Maybe you don't, but you dohave a connection to a company
(02:10):
called epic yeah, whether youknow it or not, chances are your
data is in epic somewhere theyknow everything about you your
girth, your birth oh, wow I wasgonna come up with a third one.
I couldn't, you couldn't oh okay, yes, epic is a medical record
(02:34):
system.
Oh, everybody has a smurf.
I remember this.
Speaker 2 (02:40):
I loved the smurf there's a little Grossman's in
you.
Speaker 1 (02:49):
They have an ICD-10 code for that.
Icd-10 code A39.AZX is Grossmanin, you Get it out.
It burns.
Yeah, so we went live with anew electronic medical record
(03:11):
system called epic, uh on june.
First I see epic epic becauseit is epic and it is an epic.
Um yeah, no potential yeah, uh,it's.
It's hard to change systems in ahospital.
Let's just put it.
Let's just put that right outthere to start out with it.
(03:32):
It is just hard, honestly, nomatter what you're going from or
to.
And on top of that, not onlydid our hospital system go live,
but another hospital system inthe Boston area also went live
on Epic on the same day.
Speaker 2 (03:54):
What is the primary reason for it being so difficult
to change systems systems?
Speaker 1 (04:00):
oh well, okay.
So imagine all of the functionsof a hospital every department,
every.
You've got inpatients, you'vegot outpatients, you've got
every type of staff member youcould imagine.
You've got people who handlethe billing and the registration
(04:24):
.
You've got um, everything hasgot to happen and it has to
happen securely.
It has to happen securely andideally in a single system.
You see, that that's the thing.
Okay, our last system, when itwas developed, was like amazing,
(04:45):
but it was developed like 30years ago.
Speaker 2 (04:50):
Was it amazing 30 years ago?
And it was no longer amazing.
It was no longer amazing.
Speaker 1 (04:55):
And then the tech stack that they had to grow
around that to support it.
I think honestly they hadpeople sometimes working on that
system who otherwise would havewanted to retire, but they
asked them, or probably cajoledthem, to stay on because nobody
studies that programminglanguage anymore, kind of thing.
Speaker 2 (05:18):
Yeah, that's how old it was what would be a good
analogy for?
Could it be something like?
Speaker 1 (05:25):
A 36-year-old cat.
Speaker 2 (05:29):
If you can't herd cats and if all the cats are 36
years old.
Speaker 1 (05:36):
Yeah, see, there are no 36-year-old cats.
Speaker 2 (05:38):
Okay so.
Speaker 1 (05:40):
Yeah, that's what I'm trying to.
That's not a very nice analogy.
Speaker 2 (05:44):
But so, for example, what about like an air traffic
controller or a unit of airtraffic controllers?
Speaker 1 (05:52):
Well, actually, let's think about it.
Speaker 2 (05:54):
And if all the planes change, if all the airports
change, their direction and thelanguage they use changes and
their computer systems change?
Is that what we're talkingabout?
Speaker 1 (06:07):
Kind of.
But also, if you don't change,then you get into, to continue
the airplane scenario.
You get into the Southwestsystem, right?
Remember when Southwest justcompletely fell?
Apart because some part oftheir elderly communication,
their elderly computer system,broke down and next thing you
(06:27):
know there's thousands ofcanceled flights.
Speaker 2 (06:29):
Right.
Speaker 1 (06:30):
So canceling a flight is not quite as life altering,
shall we say, as the entirehospital system going down while
you're admitted.
See, that would be terrible.
Speaker 2 (06:42):
And especially, that would be what would be called a
disaster.
Speaker 1 (06:51):
If what if it was during covid?
Well see, I think we would havegone live sooner if it weren't
for covid, because they wereplanning it.
And then they're like okay,we've got to wait for covid to
go, yeah, yeah, no, that thatwould, that would have if we.
You just made me think of a wayin which it could have been
worse.
Speaker 2 (07:07):
You know, I'm always here for you to imagine the
worst possible case scenarios.
Speaker 1 (07:13):
Yeah, actually, honestly, I think COVID helped.
You know why?
Guess why?
Speaker 2 (07:22):
Okay, let me see COVID helped because people were
, more people were working.
Why?
Okay, let me see COVID helpedbecause more people were working
remote Okay.
So there was a need forpatients, doctors, care
providers to be able tocommunicate, log on and get
people's data very quickly.
Speaker 1 (07:42):
No.
Speaker 2 (07:43):
Okay.
Speaker 1 (07:45):
Because of the meetings.
Speaker 2 (07:48):
The meetings.
Yes, who likes meetings?
Speaker 1 (07:50):
No, but so here's the thing.
I've gone live with Epic twotimes in my career so far.
Hopefully this will be a lot oftime.
I think we should establishsomething.
Speaker 2 (08:00):
first, though Epic is a medical record system yes,
and it's an EMR.
Speaker 1 (08:06):
But it's also got all of the underlying architecture
for everything else as far asrunning the hospital is
concerned, like for the codingand the billing and the
registration.
And so now, like before, we hada situation where you had like
one system was for registrationand there was another system
that kind of talked to that thatwas for billing, and there was
(08:27):
another system that sort oftalked to that for the, for the
medical record, but though thatwasn't the one that they used in
the intensive care units, sothey had something else that
kind of talked to that.
Now it's all one unified system.
So this is actually a good thingokay but the last time I went
(08:48):
live at a different hospitalsystem with epic with epic, the
amount of meetings, and then youhad to go someplace.
They had to get everybody liketwo dozen people in a room
together for a meeting to learnabout epic to plan so we've been
(09:09):
planning now for a year and ahalf.
Wow, right.
So every little piece, think ofevery little thing that you
have to do, like the labels.
You know the little labels theyprint out when you give blood,
when you, when you give bloodfor a test, right, and they
print out a little label and itgoes on the vial.
Well, that little label has tobe connected to a computer
(09:32):
system to get that little label.
Speaker 2 (09:35):
Are vampires involved ?
Speaker 1 (09:36):
Well, you know they should be.
Speaker 2 (09:38):
Right.
Speaker 1 (09:39):
Because if they, want the blood and your medical,
then they want to make itefficient.
Speaker 2 (09:43):
Your EMR isn't dedicated yet Exactly.
Thank you.
Speaker 1 (09:46):
Exactly right.
So you know you've got to keep.
Here's the vampire's share.
Here's the part that's going tothe testing lab.
Speaker 2 (09:55):
What's this code?
Here?
It's BLDVMP.
What's the VMP part?
Speaker 1 (10:02):
Oh, that's vampire.
Vampire, yes, yeah, okay, okay,I have never been in so many
meetings.
They were all necessary too.
It's not like.
Speaker 2 (10:15):
Not wasted time no.
Speaker 1 (10:17):
No, because there was so much to do, and I was saying
this to someone the other day.
We have actually a really goodculture of meetings where I work
right now, which is that it isdisrespectful to arrive to a
meeting late unless you've letthe person know in advance I'm
gonna have to be late, um or orlike if you said you couldn't
(10:38):
make it and then all of a suddenyou could and it's like, hey,
it turned out I could make thelast 20 minutes, that's okay.
But if you said, yes, you'regoing to be there, then you're
going to be there.
When you say it's going, tostart.
And when it's supposed to end,it ends.
It's like we had a 30-minutemeeting.
We still have a couple thingsto talk about.
(11:00):
If people aren't available tostay, meeting ends and you res
and you schedule something forthat thing that didn't get done.
It's not like this, meanderingmeetings.
No, it's like here's our agendahere's what we have to talk
about yeah, I really appreciatethat that's really about where I
work, because it's like this iswhat we've got, this is what we
have to accomplish.
Uh-oh, we're almost done.
(11:21):
Can everyone stay for 10 moreminutes?
Nope, okay, I guess we have toyep, you know very good it's
like you know so okay, there'sthere's so many of them for epic
and the reason why there's somany meetings for epic is
because.
Speaker 2 (11:37):
is it because epic isn't designed to be user
friendly, or is the userinterface too complicated, or is
it that that's?
Speaker 1 (11:47):
true of all of them.
Okay, I mean it's true of allof them, but it's just.
There's so many parts to it andevery hospital is different.
Speaker 2 (11:56):
I see.
Speaker 1 (11:57):
Now you think about a hospital system, because this
is going live in a hospitalsystem.
We have multiple hospitals alldoing things in different ways.
There were some hospitals thathad been on a prior version of
Epic, but our hospital had beenon this older system, this
legacy system, for like 30 years.
(12:18):
And then there was anotherhospital in the system, a
smaller hospital that was stillon paper.
Speaker 2 (12:25):
They were still using paper.
Speaker 1 (12:27):
Paper.
Speaker 2 (12:28):
Papyrus.
Speaker 1 (12:30):
Yeah, I think they had quill pens.
Quill pens, oh, not quilt.
Speaker 2 (12:33):
Quill, quilt pens.
It's not writing very well.
Speaker 1 (12:38):
I know, but it's really nice looking.
Ink wells they're dipping it inthe ink well, it's very warm.
Ink wells they're dipping it inthe ink well, it's very warm so
an.
Emr like Epic takes what?
(12:58):
Two years to implement?
Well-ish, I mean, they've beenso.
They had, I believe, honestlystarted planning some of this at
the highest levels before thepandemic and then they had to
pause it.
So really we're probablylooking more at like an
end-to-end, maybe a five-yearprocess.
Speaker 2 (13:14):
Five years Now.
At the end of that five years,what if Epic has updated to its
new version and everyone's gotto move to that?
Speaker 1 (13:23):
They're just more meetings well, there are certain
, there are certain updates thatyou have to take.
So I just learned actuallyrecently, this brand new
information to me anyway thattwice a year there are
regulatory updates okay, so forexample, it's like so by
contract when you sign up forepic, you have to accept the
(13:46):
regulatory updates.
Now there are other updates thatcome down the pike, some of
which are systemic updates andsome of which are updates that
are called optimization for yourparticular one.
So it's like it's.
It's like it's got thefoundational system, they call
it, but then it's customizedalso to each.
(14:09):
So client.
Speaker 2 (14:11):
So walk me through it .
Have a patient.
I and I.
I know quite a bit about emrsonly because many years ago, as
you know, I used to producetraining and marketing and sales
demo videos for softwarecompanies that wrote EMR systems
.
This is, you know, 20 years ago.
(14:31):
Of course, a lot has changedsince then.
Just to kind of help themunderstand the complexities when
you walk into a hospital, whenyou enter a hospital, what you
see as a patient.
Speaker 1 (14:51):
Oh man, you don't even see like a tenth of it.
Speaker 2 (14:53):
So you might get frustrated by the fact that the
pen that you use to sign yourname you know when you sign that
name.
Yeah, and you have no idea likewhat you're actually signing.
Speaker 1 (15:03):
You could be signing away your left kidney.
Speaker 2 (15:04):
You have no idea exactly that actually makes me
mad right.
Speaker 1 (15:08):
So you sign it because you know you know it
should be it should be like anipad or something, so you can
see the document that you'reseeing, not just a little
signature pad exactly trust me,this is the consent to treat
right exactly.
Speaker 2 (15:19):
So you sign this thing and then they tell you
where to go and you wait thereand then you walk up to your
name.
Okay, so you're signed in,everything is set, the doctor
will be with you in a minute andthen the rest of it is just
your experience at the hospital,as it would be at a department
store or a restaurant orwhatever.
Speaker 1 (15:39):
You get like blood transfusions at Macy's.
Speaker 2 (15:45):
Fifth floor transfusions, women's shoes,
basement, heart surgery what's?
Speaker 1 (15:54):
that Women's shoes and IVs.
No no, you don't.
I mean you don't see.
Speaker 2 (16:07):
Right, you don't.
Speaker 1 (16:08):
I mean you don't see, but right you you don't, you
don't and you shouldn't, becauseif you were to see the guts of
it no, you don't want to itwould scare you away.
Speaker 2 (16:12):
Well, I mean, hospitals are scary enough even
if you saw your own guts, itmight.
Speaker 1 (16:16):
That would definitely scare you away but, like you,
most people don't even realizelike so, when you're given
medications at a hospital, themedications are locked up in
this system, like it's literallylocked and everything that's in
that case.
That big case is counted.
So when you need to get amedication for a patient, you to
(16:43):
scan their in the system, youpull up their medical record.
It knows what the medicalrecord should be.
Then you it dispenses themedications that they're
supposed to have and you have tocheck.
This is the nurse that doesthis.
The nurse has to check it alland then they bring it in and
they have to double identify andnow I think there's a little
(17:08):
boop, a little scanner, so thatthey scan to make sure, okay,
yeah, I recognize that soundyeah, exactly, and they boop,
they boop you okay and and thenthey know that the right meds
are going to the right person.
But like you don't realize, soyou know the the nurse comes in
(17:29):
with the meds.
You don't see all thatnecessarily.
I mean you might see it if youjust happen to be in the bed
near the place where that littlecart is stored.
But yeah, I mean there's,there's so much, and most of it
you know, 90% of it's safetyrelated.
Speaker 2 (17:46):
Do you think that Epic, or any EMR system like
that, is capable of supporting amajority of American patients
and healthcare providers?
Speaker 1 (18:07):
What do you mean by support?
Speaker 2 (18:11):
That's a good.
That's a good-.
Speaker 1 (18:13):
Because there's different ways you can take that
.
Speaker 2 (18:16):
So what I'm saying is we don't have an integrated
healthcare system, right, andmany people don't even have
insurance, and many people don'thave access to doctors and uh,
you know, care as as they wouldneed because of disparities and
(18:40):
location things well, an emrcan't help that, no emr, emr
can't help that, but a systemlike epic is growing
exponentially, partly because,even though it has its flaws, it
(19:02):
is still functioning betterthan what we used to have.
Speaker 1 (19:07):
Oh, yeah, right.
Speaker 2 (19:09):
Because of that, the the growth is only expected to
to to become part of otherhospitals or clinics, even small
clinics.
Speaker 1 (19:21):
I mean, if I think I see where you're getting to.
I mean, the thing is, I dothink there should be more
competition in this space thanthere is.
Should be more competition inthis space than there is.
But what happened way back, ifyou go back like 20 years?
The government wasincentivizing doctors and
(19:43):
hospital systems to pick upelectronic medical records
because it is better.
I mean the phenomenon peoplejoke about, about not being able
to read doctor's writings.
It was actually reallydangerous.
Speaker 2 (19:55):
Like people would get wrong medications.
Speaker 1 (19:57):
You wouldn't be able to read the diagnosis.
Like how many times early in mycareer was I trying to, you
know, figure out what aneurologist said and I'm like
you know it was maddening, likeit was not okay.
So we are safer withelectronical medical records
than we were before.
But in rolling this out thegovernment gave some incentives
(20:20):
because, it's expensive, youknow it really is.
And so they were incentivizingpeople to spend the money on
that and systems to spend themoney on that, and they created
something called meaningful useon that and systems to spend the
money on that, and they createdsomething called meaningful use
.
And so meaningful use meantokay, you can't just like amp up
Microsoft Word and pretend it'san EMR, right, it's got to have
(20:40):
certain features in order tocount toward the incentive,
which makes sense.
And they would have things likeit has to have a communication
portal with patients.
It has to be capable oftracking allergies, whether
they're medication, you know,especially medication allergies.
It has to be able toaccommodate certain types of
data, right, so they would setup these things.
(21:01):
But what they never did set upas a meaningful use criteria was
interoperability.
Speaker 2 (21:10):
Right.
Speaker 1 (21:10):
The ability to read the medical records from another
system.
And so what happened is eachone decided we're going to try
and make ours the one right.
You know it's going to be likethe standard, and so Epic, I
believe, is winning right, butit's still like it sets up a
(21:33):
monopoly situation, and thisisn't anything against Epic per
se.
They're just doing whatAmerican businesses do, right
like they.
They're setting up a situationwhere they're delivering a
product that any hospital thathas Epic if the information
matches the name and the date ofbirth and like something else.
Speaker 2 (21:54):
Girth.
Speaker 1 (21:55):
Yeah, right, then I can read the medical records
from that system.
It could be in Florida, itcould be in Maryland, it could
be in Montana, it doesn't matterwhere it is.
If they have Epic and theidentifiers, the key identifiers
match, I can see it.
And that, again, it's a hugesafety thing.
(22:16):
Imagine you are from Minnesotaand you are admitted in
Massachusetts because of anemergency right.
All of your medical records arein Minnesota.
We don't know, like your entiremedical history, we don't know
what meds you're on, we don'tknow what you're allergic to and
, yeah, you, you can getsomething from a history so
(22:39):
you're telling me that peoplefrom Minnesota should stay in
Minnesota?
no but I'm saying that theyshould they should use Epic so
that then when they're here inMassachusetts, because the, the,
the honestly now now three ofthe biggest medical systems here
in Massachusetts are all onEpic.
Make sure you're in Epic there,because then we can see your
(23:01):
stuff.
Right, we can know.
But that was my question Iasked earlier.
Speaker 2 (23:05):
The fundamental question is is Epic capable of
interoperability with itself?
Speaker 1 (23:15):
But that's the problem.
Speaker 2 (23:16):
The government never set up that incentive to really
make it interoperable with othersystems.
Speaker 1 (23:22):
But it's not interoperable with, like Athena.
Health or eClinical Works orother Right.
So I think that America missedan opportunity.
Speaker 2 (23:31):
And that was my question.
That was actually my question.
We missed an opportunity.
And that was my question.
That was actually my question.
We missed an opportunity.
Speaker 1 (23:37):
Because it doesn't have to be the same right, but
in order to get the spirit ofcompetition and getting people
fighting to introduce newfeatures and things like that,
if right from the get-go they'dsaid, hey, one of your criteria
is you have to be able to readeach other's stuff, then that
(23:58):
would have preserved a marketthat I think would have been a
little bit more forward-facing.
Speaker 2 (24:04):
Again.
Speaker 1 (24:04):
Epic is fine.
Epic is.
You know.
Who knows, maybe, sincekeywords right, someone from
Epic is going to be listening toit.
Epic is fine.
It's so much better than whatwe had before.
Speaker 2 (24:15):
Yeah.
Speaker 1 (24:16):
But it is becoming a monopoly.
I see Right, and it's becominga monopoly because of the way
that it was set up.
Speaker 2 (24:23):
So remember in the last episode we were talking
about my trip to Japan and thecommunication between people
from different countries inJapan and that there was this
kind of like a, not a system Iforgot the word I used, but it
had to do with the outer layerof how we communicate and you
said why don't you just hold upa sign that directs you to the
(24:46):
way in which you're supposed tocommunicate with the person?
Speaker 1 (24:48):
in front of you, right.
Speaker 2 (24:49):
Right, I mean funny, but there is some truth supposed
to communicate with the personin front of you, right?
Right, um, I mean funny, butthere is some truth to to the
need for clarity when it comesto interoperability and
different systems.
When it comes to people'shealth, yeah, because americans
move more than you would expect.
(25:11):
Right, the average Americanmoves out of state often enough
where they have to completelyredo who they are within a
medical record system.
Speaker 1 (25:22):
Most medical problems and errors and things come from
communication issues and errorsand things come from
communication issues.
Speaker 2 (25:31):
Right, exactly, yep, that's what I'm saying.
It is in these meetings thatyou have is some of the
preparation about how to ensure,how to ensure that the yeah, I
mean an electronic medicalrecord puts guardrails around
(25:52):
things, right, there becomes away you do things right.
Speaker 1 (25:57):
So even one thing that's handy, for example, is
doctors can have somethingcalled order sets and I'm sure
they can do this in other recordsystems as well is where it's
like okay, if I know that, ifI'm suspecting, if I'm working
up congestive heart failure,there are these three or four
tests that I run, I can clickone button and this set will
(26:19):
open up that will say, yep, thisis my congestive heart failure
set of orders, right, so we cansave time, right.
The downside to that is thatlet's say, oh, I forgot, there
was something else I'm lookingat too, and you now, you forgot
to add on that extra test, youknow, and so it gets tough.
(26:40):
Or like in our area of thefield right, there's, there's
something called a modifiedbarium swallow study.
Okay, so this is a study thatis done with a speech
pathologist and radiologist andit looks at the physiology of
swallowing, because theesophagus, where the food goes,
and the trachea, where the airgoes, are right next to each
(27:03):
other, and so if that startsmalfunctioning, instead you have
food and liquid go into yourlungs which is we'll just say
bad.
So that's a modified bariumswallow.
There is also a test called abarium swallow.
Speaker 2 (27:19):
Which is not modified .
That has nothing to do withswallowing.
Speaker 1 (27:22):
It's a GI study looking at the esophagus.
Speaker 2 (27:25):
Okay.
Speaker 1 (27:26):
So what you then get is, like some doctors aren't
sure which to order, and thenthey order the wrong one.
Speaker 2 (27:34):
Well, a doctor should not be, never mind.
Speaker 1 (27:36):
Right, but especially like we're an academic medical
center right.
I was telling you how, on July1st, you know, I had the long,
long line of people outsidesecurity.
I was like what's going on?
Oh, it's July 1st.
All the new residents.
Speaker 2 (27:56):
All the new residents , okay, and interns, like all
the new residents all the newinterns are coming in, so like.
Wouldn't an EMR if it was smartright?
Speaker 1 (28:08):
If it was smart, if AI played a role.
Right.
Speaker 2 (28:11):
Wouldn't an EMR know intrinsically that if you had
just done, if you had justtalked to a patient and the
notes are in there this is whatI talked to a patient about.
Speaker 1 (28:22):
Well, there's no AI in there yet.
Speaker 2 (28:24):
Yet.
But I mean, wouldn't that begreat.
A doctor talks to a patient,notes are taken.
Speaker 1 (28:29):
They're already talking about how to bring AI
into the system.
Speaker 2 (28:33):
The system should generate a suggestion.
Like well, in this case amodified barium swallow and
right.
Wouldn't that be the protocol?
Wouldn't that be a protocol?
Speaker 1 (28:49):
For certain things.
Yeah, wouldn't that be theprotocol?
Wouldn't that be a protocol?
And it's not things.
Yeah, and again, usually itworks pretty it, usually people
know it, but it's it's like inthe system.
So for us going to this newelectronic medical record system
like there's actually more thanone name for this test that we
do, so the modified bariumswallow is sometimes called a
(29:09):
video swallow study or a videofluoroscopic study of swallowing
.
So historically that's whatwe've called it in order that it
didn't have confusion.
So we would call it, and in ourorder sets it was always called
a video swallow study or avideo fluoroscopic study of
(29:29):
swallowing.
Well, in the Epic system I meanmost places in the country, and
even when you read theliterature they're calling it a
modified barium swallow.
So in Epic it's called amodified barium swallow.
So now all of our providers whoare used to looking for either
a barium swallow or a videoswallow study are now having to
reorient and think about abarium swallow or a modified
barium swallow or a videoswallow study, are now having to
(29:50):
reorient and think about abarium swallow or a modified
barium swallow.
So you see how that can goterribly wrong.
Speaker 2 (29:55):
And that's just your department.
And then there are many, manydepartments, Exactly so.
Speaker 1 (30:00):
You see the that's why you see the minutia.
That's why it takes five yearsand more meetings than you can
conceptualize years and moremeetings than you can
conceptualize.
Wow, do they serve coffee andsnacks during these meetings?
People tend to bring their ownbecause they are virtual
(30:21):
meetings.
Oh, but I was so.
Speaker 2 (30:23):
So, people, I see where you were before the place
you were before that's when youhad your in-person yeah, yeah,
no, but see, this is why again,pandemic.
Speaker 1 (30:31):
Thank you, covid.
Speaker 2 (30:33):
Thank you, covid.
I've not heard that phrase ever.
Thank you, covid.
Speaker 1 (30:39):
Wow, because I got a sit-stand desk for my desktop so
that I can be sitting sometimesand standing sometimes.
And then I've got my coffee andwater and your modified barium
coffee.
Speaker 2 (30:56):
You know your modified barium juice.
Speaker 1 (30:58):
Disgusting no no, no, so it's been something mmm so
then we went live and it wasjust like all these things were
wrong and it's like, no matterhow much you planned, it's just
like there's things were wrongand it's like, no matter how
much you planned, it's just likethere's so much that's going on
and it was, it was it's like memaking an omelet.
Speaker 2 (31:17):
It never is the same, never.
I've never made an omelet thesame way I try.
Speaker 1 (31:22):
Yeah, I exactly same technique like what if you had
an emr for that, would you like?
Well, if I use modium I cangive you a speech evaluation you
could give me a modified bariumswallow, that would explain.
Speaker 2 (31:39):
No, just a barium swallow no, because that's for
swallowing.
It's a totally different cptcode okay, speaking of CPT code,
yeah, go for it.
Speaker 1 (31:51):
I rebooted my YouTube channel.
Speaker 2 (31:53):
Rebooted your YouTube channel.
Speaker 1 (31:55):
Yes, Because I had been putting up a few.
Speaker 2 (31:57):
What's it got to do with CPT code?
Speaker 1 (31:59):
Because I had been focusing on putting some videos
up about voice thingsspecifically, and then I
discovered what I feel is alittle bit more important and
something that I'm good at,which is educating people about
health care.
So I have a video about thecodes.
Speaker 2 (32:18):
Oh right, that's right.
Speaker 1 (32:20):
So CPT codes are in there, as are ICD codes, and I
have a video on my channel,barbara Wilson Arboleta
voice-wise.
Speaker 2 (32:31):
Barbara Wilson Arboleta.
Speaker 1 (32:34):
Voice-wise.
Speaker 2 (32:34):
Voice-wise.
Speaker 1 (32:35):
V-O-I-C-E, w-i-z-e, and so if you put those in as
your keywords, you should see mychannel and I'm going to be
doing more Great Abouthealthcare communication Because
, again, we can joke about theelectronic medical record system
, but it's true, like somethinglike epic does help.
(32:55):
It helps because there arebuckets for everything, but it's
still there are so many people.
There are, I think, 22 000people that work for us like
herding cats we were jokingabout, right, like trying to
keep 22,000 people on the samepage.
(33:16):
Our hospital alone, not justthe whole system, our hospital
alone has 850 beds wow, ish.
And then all the outpatient Wow.
Speaker 2 (33:29):
So if you get tired and fall asleep, you've got a
lot of choices there.
Speaker 1 (33:32):
Yeah Well, except that it's usually full.
Speaker 2 (33:36):
Well, you didn't say that, you just said there are
850 beds.
Speaker 1 (33:39):
Yeah, but I could grab some sheets and lay on the
floor.
Speaker 2 (33:44):
Which was tempting the hours that you work, which
was tempting in the last fewweeks before Gola.
Speaker 1 (33:49):
I was just, can I just?
Speaker 2 (33:50):
curl up in fetal position underneath my desk
Before please.
Speaker 1 (33:58):
Yeah Well, but we're clicking along.
Now we're getting there.
Speaker 2 (34:00):
I'm glad you went live.
Speaker 1 (34:02):
Me too.
Speaker 2 (34:03):
And I'm glad because I remember the day.
Live from Boston, massachusetts, live from Boston.
It's epic.
Speaker 1 (34:09):
Yes.
Wow Well all the power to you.
Yeah, you know, someday therewill be a television show all
about working for an EMR, youknow how they have like the
behind the scenes, things theyhave like, shows about kitchens,
you know, like the chef and thecooks and stuff like that they
(34:29):
should do like the it departmentof a hospital it's episodic
cool yes, cool cool, cool, cool.
Yes, I had, I had, um I got.
I bought one of those cameosfor my team.
Speaker 2 (34:51):
Oh, that's right.
With Dr Glaukom Flecken who welove so much, dr Glaukom Flecken
yes, and yeah, so he did alittle.
Welcome to Epic video for us,thank you, doctor, that I
disseminated to our team.
Thank you.
Speaker 1 (35:05):
Dr Glaukom Flecken, we love you All right.
Speaker 2 (35:12):
Very good.
Speaker 1 (35:13):
That's about all the damage that I can do talking
about health care today.
Speaker 2 (35:17):
Well, you're doing a great job there and as long as
you get your modified bariumswallow and barium swallows all
figured out, yes, well, we'rehoping they can put in a little
flag, all figured out.
Speaker 1 (35:29):
Yes, well, we're hoping they can put in a little
flag, meaning that, like whensomebody goes to order one it
says you know that, similarwarning, similar test.
Speaker 2 (35:38):
Right.
It's like when you go toStarbucks and you the drive-thru
and you've ordered your mochalatte, but with soy milk, right,
and they give you oat milk, oatmilk it's.
Speaker 1 (35:48):
It's like you can't drive around come back.
Speaker 2 (35:52):
Just can't, you know.
You're driving home and thenyou're, just you know, bloated
and yeah, you're gonna drive toomuch fiber.
Speaker 1 (36:01):
And then you gotta go to the hospital.
Where epic exactly?
Speaker 2 (36:05):
you gotta get a barium swallow because your
esophagus is.
Speaker 1 (36:09):
You know, the fiber gets you going and the barium
stops you up.
So there you go.
Speaker 2 (36:16):
Full circle.
Speaker 1 (36:17):
Okay, yeah, I think, yeah, that's about enough of
this, that was epic.
Yeah, this was an epic episodeEpic episode.
Speaker 2 (36:25):
It was an epic-sode.
Speaker 1 (36:26):
Oh yes, Well, we hope you found that amusing.
I'm sure we'll be on to otherfabulous topics.
You know what we should do?
A media topic again next time.
Speaker 2 (36:37):
Let's do a media topic.
Let's talk about something wejust watched, something we're
watching, or something like that.
Speaker 1 (36:40):
That'd be fun, absolutely, yeah, yeah.
And you know, any ideas thatanybody has of what they'd like
us to chat about, we're happy toentertain the idea.
Entertain, because we are hereto entertain, after all.
Do please give us a wonderfulfive star review, pretty please,
(37:00):
five out of five and subscribeand listen and pass this on and
tell everyone how like wonderfulwe are and all that and you've
got great hair too thank you somuch, until next time all right.
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