Spo-reflections on a new EHR (or) the four stages of encountering something new

Last Friday a minion from The Overlords came to town to give instruction on the upcoming new electronic health care (EHR) system. The drama personae were two counselors from our place (W and X) and two more from some other clinic in town. Y was a also counselor and Z was a prescriber – a nurse perhaps – who was well over four feet. I know Z was a prescriber as she made it clear she was and didn’t need to know how to write therapy notes.

It is human nature when presented with something new and unfamiliar not to approach it with curiosity and excitement but with suspicion. It is my personal nature when someone else in the room being emotional I am not. It is almost as if I see there is a designated agitated person who allows me to be the calm one. It also allows me to sit back as it were like Margaret Mead among the Bantus observing tribal behavior.

The new EHR is different but not too much; it is mostly about finding where things are located. The EHR, called Athena, comes with a lot of add-ons such as patient portal and having to sign off the note with a billing code. Valant, the old system, will be available to refer to and cut and paste notes to make new macros.  It was overwhelming but there will be help and in time we will settle in to how it works and what parts of Athena aren’t needed.  This all happened before when we went from paper charts to Valant.

Encountering something new has four stages:

1. Panic. the emotional sense of fear and anxiety not understanding right away what to do.
2. Adaptation. You slowly get familiar or used to the strange new world.
3. The new norm. It becomes the way and the old way is often forgotten or just a vague memory.
4. “Would not have it any other way”. With luck you like the new system and wonder how on earth did we live before we had this. I saw this with calculators, the microwave, electronic prescriptions (remember paper ones?), and trying to contact someone by leaving a message on their home answering machine.

If we are conscious of the process in Stage 1 we will remember this is just the first step and it will pass.

The other four at the table took a different approach. They quickly formed an orchestra of scorched cats.  X more of less shut down and looked like she was orbiting the moons of Jupiter, possibly contemplating this is what will get her to retire. Y took the verbal approach to let the speaker know with each step she was not happy with it all.* Z, apparently used to having things go her way, objected to things by telling the speaker she won’t be doing that. The speaker in turn had to find a nice way to say your employer has you doing this so learn it as it isn’t an option. 

I decided not to remind the others about the four stages and once upon a time they all felt this way going to the EHR they now have. I would have been seen as medical mansplaining and in the tension of the room Bacchae-like I would have been ripped to pieces.  During times of kvetch I went online and renewed prescriptions. 

Afterwards I asked the speaker about the her experience of the seminar. She said she gets this sort of audience response all the time and our group was tame compared to some she’s recently taught. One was like going to a Trump rally to convince them to vote blue where there were ructions.

No one likes new things, at least not right away. Through adaptation new systems become the new norm and hopefully a better one – until something else comes along and the cycle repeats. 11 June is when Athena officially starts and it will probably be a mess.  I don’t know if the patients have been informed of the new system with the patient portal and I don’t know yet what to do with the said portal.  Come back on July 11 and I will be fine. Maybe don’t check in on 12 June; I won’t be so jolly. 

*I’ve learned when Y doesn’t like to do something or a patient she doesn’t want to work with she states due to ‘ethics’ she can’t do it.