Wednesday, November 28, 2007

Archive of EHR / EMR Posts

I will not have to administer, train, or even look at an electronic medical record in my new job. After 5 years as an EMR trainer, you have NO IDEA how much this excites me!!!!!! The new job should provide more exciting tools to play with.

This series of posts is essentially a diary of a major upgrade project. With all of the ups and downs high-stakes projects entail. I've divided the posts up into sections for easier searching.

Preparation / Planning

So Why is the LMS Such a Big Deal?

What Keeps Me Up At Night

Adventures in Customer Service

Further Adventures in Customer Service

Gearing Up for the Big Project

So Much for my New Years Resolution

A Political Monster Gets Real

Grappling with Demotivation

Defining the SuperUser

Thanks Karyn!

Reducing my Scope and Checking the Box

How Intuitive Is It?

Meeting with Practice Administrators

Joining Me on My Planet

Letting Go

The Train Derails

Piloting Clinician Training

Jackhammers and Spoons

From Theory to Practice

Promising Trends in Health Care

Experimenting with Letting Go

When Will They Go Away!!!!

Oldsters vs. Youngsters

Working in Parallel

Big Bang Implementations

5 EHR Training Tips

Perspective Smacks Us In The Head

Working in Circles

More Training Pilots

Working Past Overwhelm

Results of the Staff Training Pilots

Disconnecting Input and Output

Evolving Meetings


More Hoops of Fire

Cold Feet


Working with Contract Trainers

Starting Shorhanded

Week 1 Day 1 - Losing the Beginner's Eye

Week 1 Day 2 - Deer in Headlights

Week 1 Day 3 - The Calm Before the Storm

Week 1 Day 4 - The Freaks and the Procrastinators

Week 1 Day 5 - Flexibility and Goodwill

Week 2 Day 1 - Where Did Everyone Go?

Week 2 Day 2 - Getting Informal

Week 2 Day 3 - Mucky Muck Visit 1

Week 2 Day 4 - Mucky Muck Visit 2

Week 2 Day 5 - Successful Benchmark

Go Live Week

Go Live Weekend

Support Day 1 - Did It Stick?

Support Days 2 and 3 - Fighting Back


Post Upgrade - Groundhog Day

2 Weeks Later - Things Forgotten

The Dog and Pony Show

The Organization Gets Serious

EHR Upgrade: One Month Later

Motivational Problems

Opportunities for Comparison

Bonding Between Sides


Final Thoughts - I hope I NEVER have to do a project of this sort again. Completely personal opinion here that will not be popular with my ex co-workers (but they are already aware of this, so I don't feel so bad about putting it out there:

Rushing major upgrades of mission critical systems may look glamorous but you can cause serious long-term damage. To the morale of the IT team, to the goodwill of the end user. And to the system itself if you have a partially finished product.

It has taken months and they still have not recovered. No one's fault, but very preventable.

Archive of Moodle Posts

My new job will not use Moodle. They are transitioning from a home-grown, simple web page with a database to Skill Soft. This transition should make great writing fodder in the future

Here's the Moodle implementation - start to finish:

Implementing Moodle

Moodle from Local Host to DNS

Convincing the Boss

Convincing the Boss - the Demo Courses

Convincing the Boss - a Successful First Benchmark

Next Step - Convincing Senior Staff

Arguments for Open Source in a Corporate Environment

Finding Talent Right in Front of You

Stupid Moodle Tricks - Setting Up LDAP

Moodle Human Issues - User Accounts

Decisions Part 1 - User Accounts

Stupid Moodle Tricks - Moodle Videos

Breaking the Impasse

Moodle Benchmark 2 - Convincing the IT Staff

Moodle Benchmark 2.5 - Checking in with the Boss

Issues of Trust

Training Pilots

Crashing Moodle

The Senior Management Un-Meeting

The Middle Manager Meeting

Talk vs. Action

Physician Reaction

Update: Talk vs Action

Practicing Subversion

Preparing for the Moodle Upgrade

While My Moodle Server Weeps

Final Thoughts: Because our EMR implementation was so rushed, and my priorities wound up on projects for sale outside of the organization, we lost a fantastic opportunity to really implement Moodle effectively as a support and teaching tool.

The best opportunity we had was during the training weeks for the EMR Upgrade. I didn't have a chance....

I have finished most of the tutorials for getting through the clinic visits. Administrative workflows are still not finalized so I couldn't build those tutorials, and the Vital Sign function only started working last month. Sadly - I won't have the time to start the sales pitch on the new tutorials.

I've pretty much left Moodle in a position where it can be ignored for awhile until someone decides to take ownership and start the reintroduction process. I don't see that happening anytime soon.

The organization still needs to get through 1 more major system upgrade (the EMR upgrade screwed up our system so badly that the Business Systems vendor REFUSES to start the project until our systems are stable). They have a project on the books that has them absorbing another hospitals IT systems and bringing them up on our EMR (the hospital is as big as we are...and has a whole 'nother set of issues). And I'm hoping they will be able to stop the groundhog day rounds: taking help desk calls, trying to fix them, reporting them to the vendor, testing the fix, reporting new bugs, taking help desk calls, repeat.

Oh yeah - and they are still going to be short-handed. According to the boss, they are bringing at least 4 people, not including my position, a system administrator position that has been vacant for 18 months, and an interface specialist who is leaving in January. I hope those people come soon......

Tuesday, November 27, 2007

Discovering Guitar Hero

Discovering Guitar Hero

My brother is a bad, bad man.

Hey Wendy, I got Guitar Hero III for the Xbox 360. Wanna play?

Of course!!!!

Guitar Hero strikes me as a fancy version of Simon with much better sound.

For us non-musicians - this thing is harder than it appears.

If you know the song - it's much easier to predict where the song is going.

After 2 separate encounters, I can report the following:

- I managed to get through Pat Benatar's Hit Me with your Best Shot on the first try. Yes - I like Pat Benatar. Whatsittoya......

- Foghat's Slow Ride took me about 3 tries. I forgot how great this song was.

- Heart's Barracuda took me 2 tries. Thank goodness for those long chords....

- I am shamed that I am embarrasingly bad at Kiss' Rock and Roll All Night and Rage Against the Machines' Bulls on Parade.

- This thing is almost embarrasingly addictive. Because dangit - I'm gonna figure out that riff!!!!

I talked to my Dad and Brother about how this might translate into learning how to play music. Their consensus - it doesn't.

Dad's Take (he plays trumpet and ukelele): You get good at a specific skill - getting good at Guitar Hero. But there really isn't a translation between this and playing music.

Bro's take (he plays drums, ukelele and bass): It might help with rhythm a bit - but that's about it. Sometimes the riffs are different from what you expect from the music. I suspect that's why it doesn't translate to real life quickly.

Thankfully - Dad and Bro have the family music ability so I don't have to.

So now I have a weird new addiction. My next goal - find Guitar Hero III for the Wii, so I can spend endless hours trying to get through Bulls on Parade.


Karl Kapp's wife has also discovered Guitar Hero. And I agree with her - the interface is a lot of fun....

Spit-Takes and Good News

Nothing like having a shock that winds up shooting Starbucks out your nose....(BTW - not a pleasant experience....)

Cruising through my feed reader, I found this from Tony Karrer.

I generally trust what he has to say, but this was so out there I had to check it out. Danged if he wasn't right.

Oh yeah - I voted for Tony. Because he's one of those folks who keep me informed about what's going on outside of my cubicle and takes the time to send me thoughtful feedback. The other blogs are fantastic too (can't we have check boxes so I can choose all of them ?????) and deserve a place in my reader.


Second piece of good news: I'm changing jobs!!!!!!!!

This turn of events is a direct result of my blogging. Let me explain....

Tony Karrer found my blog when I first started. Other, highly educated people started reading and I developed some fantastic contacts.

This summer, Dr. Karrer was kind enough to ask me to contribute to an article on blogging for Training and Development, September 2007.

JM, one of the trainers on the academic side, read the article and decided to contact me.

One thing led to another and, next thing I know, I'm leaving health care and going back to higher education. Literally moving across the street....

Oh - and the new job is going to allow me to go to eLearning conferences without having to grovel!!!!! I'm so excited I can barely stand it!!!!!! I'll finally get a chance to meet some of you!!!!!!

None of this would have happened (this easily) if I didn't start blogging.

I start next Monday. Hence my silence - I'm trying to wrap things up in the old job.

Thursday, November 22, 2007

The Cat/Dog Experiment Round 2


Kaia (boyfriend's dog) has come to visit for Thanksgiving. Spike and Chainsaw (the cats) are handling the interloper visitor with their trademark combination of caution, studied nonchalance and moderate alarm.

Spike and Chainsaw have become much more comfortable with their surroundings since Kaia's last visit. The obligatory layer of cat fur has been placed around the apartment. Daily patterns have been adapted to the new environment and stabilized. As a result, the cats feel better prepared to handle any challenge.

They have also seen this particular interloper before and remember some things about dealing with her:

- Chainsaw is large enough that Kaia won't go after him. Therefore, Chainsaw plays the role of "defender" when Kaia notices Spike and decides she wants to "interact" (i.e chase Spike). Thankfully - all parties are so old (Chainsaw is 15, Spike is 14, Kaia is 13) that this doesn't happen very often.

- Kaia is losing her eyesight. Therefore, Spike figures if he moves real slow - she won't notice. He also takes advantage of his grey coat - using high spots, dark areas, and feeder woman (me) as cover.

- All parties have established their optimum "hang out" locations. Kaia has claimed underneath the coffee table and an area by the front door. She also has the main bedroom. Spike and Chainsaw have the top of the couch (the perfect location to keep an eye on the dog) and the guest bedroom.

Despite the intrusion, Spike and Chainsaw insist on maintaining their daily patterns. Spike still gives the morning and afternoon state-of-the-beastie address. Chainsaw MUST have his humidifier treatment and morning shower (which consists of him sitting next to the shower, waiting patiently for me to get out of the shower, then hopping into the bathtub and rolling around on the wet porcelain - much more effective than licking fur). And, as long as the dog doesn't try to eat their food (Kaia loves cat food), they are perfectly content.

The familiarity with the environment and prior knowledge of the interloper has made this particular visit less stressful on all parties.

Tuesday, November 20, 2007

Dipping in the Sample Cabinet

Psych departments in multi-specialty practices have the best sample cabinets. (We keep trying to convince them to share...but they are very protective of their stash.)

It figures that a Psychopharmacologist would dip into that cabinet to come up with this video:

I will never be a psychopharmacologist - but I suspect Dr. Stephen Stahl is a heck of a teacher.

Found by the nice folks at The OmniBrain

PG-13 Sesame Street

Maybe I'm just over-reacting...but does anyone else find this disturbing?

According to an earnest warning on Volumes 1 and 2, “Sesame Street: Old School” is adults-only: “These early ‘Sesame Street’ episodes are intended for grown-ups, and may not suit the needs of today’s preschool child.”

Have we become that fearful as a society?!?!?!?!?!?!?!?!

I am going to seek this out for my 1 year old nephew (along with unedited versions of old-school Warner Brothers cartoons).

I think his parents will approve.

Monday, November 19, 2007

Sound Familiar?

....Life in America feels like perpetually rushing to five-alarm emergencies in an ambulance pulled by stoned cats
- Martha Beck - WebMd

I'm glad it's not just me.......

Thursday, November 15, 2007

Random Grab Bag of Unrelated Ideas

Courtesy of Dave Snowden:

Any writer who can use the image of Paris Hilton as a researcher to make her point has my utmost respect. Jennifer Ouellette must have been inspired by Ms. Hilton's charitable work towards saving the drunk elephants. Cocktail Party Physics is highly entertaining reading.


I share Karen's mixed feelings. On the one hand - I'm thrilled that anyone with an elementary school education can read me (though much of the subject matter would probably bore them to tears). On the other hand - I'm cowed by those who write at a higher level. Especially when they use the "big words" (e.g zeitgeist, paradigm, any -ology or -onomy) correctly.

cash advance

Then I remember the rant I would give my students when I taught University-level history: If a 3rd grader can't understand what you are saying - how do I know that you know what you are talking about?

Understand that the above rant is directed at kids right out of high school - NOT the eloquent bloggers who populate my Google Reader and who are willing to engage me at their level and let me know that I am not completely out of my mind....
(Thanks again, Tom!)


So THAT'S why I've sprouted more gray hair this year!!!


This post from gapingvoid makes me revisit if there truly is a difference between "education" and "marketing". How many vendor tutorials look like lengthy sales pitches? How much time are you spending in your classes "selling" your topic?


Wednesday, November 14, 2007

The Effects of a Lengthy Vacation

I just completed my first few days of work in over 3 weeks. Though I was sick for part of that time - I am finding myself coming back to my job with more focus. Some of the focus is directly related to the vacation. The rest of the focus is related to an exciting change I will announce in the coming weeks....

- Time off and AWAY FROM WORK (not checking e-mails, etc) gives you a new perspective on what you do. I find that it is very difficult to get that perspective when I am at home but still working. I suspect this is because in our hyper-connected world - you never quite get away unless you completely unplug. And having reduced everyone's expectations - I'm noticing my phone is much quieter upon this return than it was after previous vacations. I've gotten more space to catch up. (BTW: from reading my hundreds of e-mails - looks like I didn't miss much....)

- Things work just fine without me there. And that's OK...... Over the years, I've learned that it is much easier to move on and gain the space to learn new things when you are replaceable in your current position. If I improve what I have and share my knowledge with others to the point where I'm not needed - that's a victory. If I continue to generate results - I'm OK.

- The extended time off allows me to do some planning. What do I want my career to look like? What type of relationships do I want with my co-workers? What changes do I need to make in the way I operate to be more efficient and effective and nicer to be around?

- It's easier to practice ways of coping with the inevitable pressures of work when you are not under intense stress all the time. With enough practice when stress-reduction strategies are NOT needed, I hope I can use those practices successfully when do I need them. Except for 1 slip (which was justified - I have a practice manager who refuses to take responsibility for anything and I finally called her out, with the approval of my boss of course) - I've done OK. Now I just have to learn to turn off when I get home...

- I've discovered that I've hit the point in my life that taking 3 weeks off and doing very little physical activity (plus having the refrigerator right there and lots of time to cook) is a great way to ensure that my work clothes fit snuggly upon my return. OK - I was sick for about 1/2 of that time, but still....

I consider myself very fortunate to have had the ability to take 3 whole weeks off without worrying about a paycheck or whether I have enough vacation days to cover the time.

There are some big changes afoot over the next month. I'll announce these changes after Thanksgiving. If I can contain my excitement for that long....

Saturday, November 10, 2007

The 16-second Challenge

Any visit to Daytona Beach has to include a visit to Daytona International Speedway - mecca for all things NASCAR.

Any iconic American tourist destination has to have it's special museum. The Daytona Speedway has Daytona USA.

One of the attractions is the 16-second Pit Stop Challenge. Essentially, 3 people are chosen from the crowd to change a tire. 1 person retrieves and lifts the tire, 1 person mans the air gun, 1 person mans the lift and removes the old tire. Ideally - they would beat the time of the house "Pit Crew".

Watching this made me wonder - how quickly can someone learn a new task?

Prerequisites to the experience: Ostensibly, none. But I have a feeling the majority of the folks selected to participate in the experience have watched pit crews on television. And I have a feeling most of those selected have also changed a tire at least once. Because of the size and weight of the tires and the type of equipment used during the demonstration, I doubt that kids are selected.

Demonstration: The show starts with the house pit crew changing the tire. This provides a benchmark for the selected team as well as a demonstration of the task.

Training: The standard video is played. But for the actual participants - this serves as background noise as the pit crew quickly shows them how to use the equipment. How to use the jack and it's quirks. The on/off and directional switches for the air gun. Optimum placement and strategies for changing the tire. I wonder if this multi-pronged approach helped the participants or distracted them.

Testing: Soon after the video ended, the newbie pit crew was expected to perform. The participants in our show managed to change the tire in 14.23 seconds. Best time of the day (12:30pm). Not sure if anyone beat them that day - but for three guys who obviously did not know each other and had only learned the material right then and there - they performed respectably.

I guess the real test would be to bring those same 3 guys back a day later, then a week later to see whether the information stuck. I would also be curious to see what impact a delay between training and performance would cause.

The show is a lot like many of our training programs. It is much easier to demonstrate performance improvement directly after the fact than it is after a delay of any sort. Depending on how much related prior experience those 3 gentlemen came in with - they may have quickly forgotten what they did to change the tire. They will remember the emotions and the story....


Two other questions came up while I watched the 16-second Pit Stop Challenge:

Are spending way too much time on the explanation / demonstration piece and not enough time on the practice piece? What is the minimum we need to do? How much of our explanation / demonstration time is really CYA?

Would playing information related to the material in the background (while the students are fully concentrated on another task) improve immediate and long-term retention?


Yes - it's been a great 3 weeks away from work.....

Thursday, November 08, 2007

Taureaux Piscine (Bulls and Swimming Pools)

Those crazy French....

One of the beautiful things about a computer moratorium is the necessary rediscovery of books.

For whatever reason, I find myself in ruts when most of my life is on a computer. Meandering through libraries and random reading help me broaden my knowledge pool of odd trivia.

Case in point - Taureaux Piscine. Discovered while reading Calvin Trillin's Travels with Alice on the 6am flight from DC to Orlando.

The entire point of the exercise - stand in the makeshift pool with the bull. Do so - you win. Do it again, win again.

Trillin interviewed the "inventor" of Taureax Piscine, Emile Bilhau who said that the "sport" was meant to be a replacement for the boring amateur events during bullfights.

So why combine bulls and swimming pools?

"I wanted to find the comical point of view. What is there that's comical? There's water. There's a custard pie." - Emile Bilhau

There are other variants as well:

Taureaux Football - soccer in a bullring with a bull in it. 'Nuff said....

Taureaux Pasteque (Bull and Watermelon) - Competitors are seated at a bench with a piece of watermelon to eat - in a bullring with a bull. They must eat the watermelon only at the bench. Those eating contests would be much more interesting to watch if the competitors had to worry about being gored.

I would sincerely like to see what Taureaux Custard Pie might look like....

So much of what we do is a variant of other stuff we already do. It's easy to get into a rut. Mr Bilhau took something common (in his culture at least) - bullfighting - and added an element that created a new sport (of a sort).

What simple thing can you add to your project that will make it out of the ordinary?

Wednesday, November 07, 2007

Watching Surfers

Last Saturday, I spent the afternoon on the Cocoa Beach Pier watching the surfers.

The surf is not particularly high at Cocoa Beach on a normal day. Maybe a couple of feet. With Hurricane Noel spinning in the Atlantic this weekend, the surf was 8-10 feet with higher swells. Surfer's dream.

The Cocoa Beach surfers were out in force on Saturday - many of them hovering around the pier, where the sand bars created the best swells. Watching the surfers, I spied a couple of strategies:

Catch every wave you can

These surfers would swim out to the end of the pier, sit for 2 waves to catch their breath, then attempt to catch the next wave. Once successfully caught - they would swim back out to the end of the pier and repeat the process.

These kids do more actual "surfing". But it's not always quality. Often, they are trying to make their way back to the pier when the big ones come. And they tire out early - especially if they are getting hit by the big ones while they are trying to swim out. I noticed these kids are out of the water after an hour.

Wait for the big ones

These surfers would swim out, and wait. It looks like they are not doing much. Just sitting on their boards....waiting....watching....looking for patterns. When the situation looks just right, they surf.

Some of these surfers misjudge the wave and find themselves on a dud. Some of these surfers don't quite catch the wave because they start paddling a bit late. But a lucky few catch the big ones.

These surfers are able to stay out longer. And they seem more rested. If they misjudge a wave, they swim back out and wait. Eventually, they catch one of the good ones. Some of the surfers using this strategy were out the entire afternoon.

So what's your strategy?