Coursing the Scene

Posted by Michael on April 15, 2013

By Robert Gonzalez

The scene, we were all told back in October 2012, is the thing. If there's one thing narrative non-fiction relies on, it's dynamic, descriptive, carefully (but accurately) crafted scene. For months now, Nick Genes and I have been hunting for a very specific scene to serve as the centerpiece for our essay on electronic health records (EHR), their usability (or lack thereof), and the challenges that physicians face in switching from physical, paper-and-pen paper records to digitized ones. Last weekend, we finally cornered our quarry.

The term "go-live" is doctor-speak for the exact moment when a hospital transitions from paper (or some other system) to a new, electronic health record system. Go-lives usually take place in the wee hours of a Saturday or Sunday morning. This is when patient arrival rates are at their lowest, leaving some leeway for error, troubleshooting, questions, confusion, and so on. All of these issues tend to crop up a lot in hospitals equipped with EHRs – they're just usually felt more keenly in the hours, days and weeks following a hospital's transition.

It seemed obvious to us both, early in the writing process, that our piece would hinge largely on scenes and descriptions from an actual go-live. Watching one unfold in real time would give Nick and I  a chance to reconstruct action-driven scenes – of doctors navigating new software, of nurses tending to the very first patient to come through the doors of the hospital who will have her records committed to ones and zeros, rather than paper – as accurately as possible.

The end-goal, of course, was immersion, and with it a level of understanding that would add substantially to any details that might be gleaned from interviews and first-hand accounts of a hospital's go-live. The immersion was more for my sake than Nick's. After all, he's a physician in the Department of Emergency Medicine at Mount Sinai School of Medicine in NYC, so a large chunk of his time is already spent being an actual, working component in the health care machine. He's also been involved in a few go-lives, himself. I, on the other hand, am a science writer who spends the vast majority of his days hunched over a desk. It made sense to sit me down in the middle of a hospital on the day it made the switch to electronic records, so I could watch things unfold with my own eyes. Immersion, we thought, was key. Then the scenes would come.

But nailing down a date to attend a go-live in person proved more difficult than either of us had imagined. Our original plan was to be at NYU Medical Center on the morning of December 2nd, as it made the switch from paper to electronic. Then Hurricane Sandy happened. One of NYC's top medical centers was reduced to a whiffy, watery mess, and suddenly we were missing the linchpin component of our piece.

We decided to attend Yale-New Haven Hospital's go-live instead. Nick pulled the necessary strings, even dispensing some free consulting advice to the hospital, and got us approved to sit in for the midnight rollout on February 1st. Then came more bad news. Around the middle of January, the Yale director emailed to tell us a vice president at Epic (the company whose EHR software was being rolled out at the hospital) had put the kibosh on the whole deal. With no big go-lives on the horizon, we were SOL.

Or rather, we were almost SOL. Nick, himself, would soon be leading a go live at Mount Sinai's branch in Queens. The problem: the switchover was scheduled for early April. We'd known about this go-live for some time, but had written it off on account of it happening just one month before TTTWTP was scheduled to reconvene in AZ. To be honest, I'm not sure we ever even thought of it as a last-ditch option – April was just too late in the game to consider Mt Sinai Queen's go live as a viable solution. But when our chance to sit in at Yale fell to pieces, it wound up being our only recourse.

I was present for MSQ's go live last week, after touring Mount Sinai Manhattan with Nick, and speaking to hospital staff about the pitfalls of electronic health records. It was certainly a long (and late) time coming, but it was the right decision to wait it out and sit in at Queens.

Now… to finish this damned manuscript.