Complex Adaptive Coalitions (NYTimes), and personal sanity

I just spent some time on the phone with an informatics colleague going through a particularly tough time with an EHR replacement and upgrade. Some bad things had happened at the organization: a major visionary physician leader had quit, a department chair had assumed control and was tightening the control on “physician productivity”. Furthermore, a major EHR upgrade had gone wrong, with a major multi-day outage and some glaring gaps in “down-time procedures.” Morale was very low.

This physician informaticist questioned “Am I still up for confronting all the challenges of this job?” This person pointed out that “decisions are made and I’m left holding the bag.” “Physicians are angry and I have no good news to tell them and no resources to do anything about it.”

AND YET.

I asked “Is it time for you to quit?” In response:

“Actually, even if they asked me to step down from this informatics position, I LOVE getting in there and solving complicated problems so much I would probably still do this work. Even for free.”

I don’t know of any more eloquent statement that explains the core of a physician informaticist more than this.

Friedman, in the NYtimes article above, talks about the triple acceleration: climate change, globalization, technology acceleration, that are upending our world, rewriting the rules, and causing us to re-evaluate everything we thought we knew.

Informatics work in healthcare is very similar. The rules change all the time, leaders change, visions change. Informaticists are the nexus between IT and clinicians, and are often blamed for anything that goes wrong. True story: when the WannaCry virus struck and took out the server farms at our Transcription vendor last year (for SEVERAL WEEKS, our physicians and surgeon could not dictate their notes), the rumor spread that

“You know, I heard that CT Lin shut that down because he just wants us to TYPE in his  #*$&#$’ing  EHR.”

Would that I were so powerful. We often deal with problems not of our own making, and with no resources. “What can I do?” “I don’t have anything new to say.” Here’s what I said:

  1. Being a physician informaticist (PI) is often a thankless job. The quiet work we do: creating collaboration, understanding both IT and healthcare deeply, we translate and often avert disasters (avoiding bad design in templates, order sets, automated tools) that only we can see. When it works, the response is “Of course it was going to work. It is so simple.” When it doesn’t work, everyone knows it was you, even if it wasn’t.
  2. Your value to the leadership of the organization can be incalculable. When the PI stands up and helps calm the masses, when the PI can send email broadcasts or go to meetings and explain WHAT happened, and more importantly WHY and what is going to be done about it, he/she is usually more clear than the technologists and can speak the medical language of clinicians and patients. Over time, his/her value grows from being clear, steadfast, and a calming influence. Maybe the executives start including him/her in higher level decisions because they remember that value.
  3. Your value to the front line physicians and nurses is also incalculable. One time, a physician presumed that “Oh, the EHR project is going terribly… see how CT was walking with his head down and with that frown. Bad news.” On the other hand, being a clear explainer (even if you can’t fix it) and being transparent about what is happening now and why, allows the PI to be a beacon in a storm, and the go-to person for clarity. PI’s often become a valued representative for physician interests.

As we talked this week, I had flashbacks to my years on the front line doing this work. Over time, these memories are less like PTSD attacks and more like valued battle scars that one shows off proudly.

CMIO’s take? We don’t often talk about our histories in informatics. Our nascent field has grown from battle scars just like these, and we are all better for it. Although I did not feel like this at the time, I am grateful for everything I’ve learned and now apply for the benefit of our colleagues, our field, and importantly for my own sanity.

Author: CT Lin

CMIO, UCHealth (Colorado); Professor, University of Colorado School of Medicine

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