The picture above is what one wall in my office currently looks like. I know you are jealous of the 1970′s wallpaper and asking why I would obstruct its beauty with notes. Have I gone ‘postal?’ Not yet.
This is actually my way of working through a lean process to make changes to our current order set development process. I have been working on how to incorporate the new electronic system we have to create order sets into the current process of building order sets on paper.
But let me take a step back and explain how I, a medical librarian, got involved. I have been involved with clinical informatics, EMR training, order set development, EBM research, etc. I am very fortunate as a medical librarian to have such an active role but I also think it is a perfect fit for many medical librarians and more could be involved with these processes.
Think about it. Many medical librarians are organized, detailed oriented (think of complex searches & cataloging), understand how to structure systems (librarians code websites and work with meta data), ability to use or make the tools available work, etc. I have also noticed some librarians have a keen eye for seeing the big picture.
You have no time you say? I completely understand. I am a solo hospital librarian who supports 3 hospitals, multiple residency programs, coordinates CME, and currently I have no volunteers. I am not trying to brag or say look at me. I am just trying to show that I understand the time issue. I have had to completely re-evaluate the library and what the top priorities are for the library and my institution. Yes I still do all the normal library stuff: licensing negotiations, ordering & checking in journals, 10+ research requests a week, article request, Docline, etc. What I don’t do is check the mail everyday. Research request take longer to complete than I would like but it is a juggling act. It also means I sometimes work late, come in early and once or twice have worked on Saturday (which is one reason this blog has suffered and I apologize to my readers). It is all sacrifices I am willing to make for the time being because I know how important this is to my institution.
I have learned a great deal over the last 18 months or so. Besides it has also drastically increased library usage across the board. I haven’t really promoted the library in a year due to the workload yet I am constantly getting calls for research or being asked to present. I have become part of the team and others see I am a team player. Without making some sacrifices and stepping outside the library this would not have been possible. I want to show other librarians, especially solos, that it is possible. And I want to learn about how others are involved.
Before I posted this I actually asked other librarians if any are involved with their institutions EMR, CPOE, or order set development. Sadly I could not find anyone else. If you are involved please post a comment below.
Back to the picture above. What am I doing besides trying to replace the beautiful wallpaper? It involves incorporating new technology, EBM practices, automation, and other things into our order set development process. Most institutions have a process in place to review and develop order sets, ours just needs a little tweaking to account for some new technology.
Since I have been the primary person researching and building the order sets in the new system, I was assigned the task of reviewing the development process. Of course this is being reviewed by clinical informatics … yes even in the state it is now on my wall.
Posting this on the wall was actually part of the plan. I needed a way to easily see the entire process without squinting to see it on a computer, and a way to easily move pieces. I had to see the big picture to know how it all works together. Putting it on the wall has also allowed me to easily work on it between other tasks and not forget about it. I have even had people in my office walking through the process together.
So doing this ‘old school’ has been very beneficial to me even though I really wanted to just start developing the process on the computer. Taking time to reflect has really helped. Today it will move from the wall to the computer. I admit I will miss it.
Are there projects that you have worked like this? Do you think there are benefits to this type of process? Are you involved with order sets, EBM, COPE, or EMR? Are you a Lean Librarian?
Amy Donahue
January 6, 2012 at 3:27 pm
Hey Alisha! I love everything you do – and as another semi-solo med lib (lucky to be part of a system with multiple librarians spread across), I really appreciate that you share your experiences. And I have so much in my e-reader anyway that it’s nice to have your quality posts appear like gifts in my feed whenever they do!
I’m working on getting involved in our EMR, and you’ve given me lots of ideas. I was trained a bit on the physicians’ and nurses’ portals (we use Epic and have since our brand new hospital opened, and the rest of the system is in the process of switching). The hope was that the clinicians would come in and practice on the computers here and I’d be available to help them. That hasn’t really happened, but I consider it my foot in the door. I’m also doing what I can to support our systems/business analyst librarian, who is working on getting MedlinePlus Connect integrated. And last but not least, we were able to push for our own portal to go in and chart when we provide patients with information, to support meaningful use of the EHR. No order set work yet, but I’m pretty sure some of my recent research requests were somewhat related, so I’m going to keep that foot in and see if at some point I can push it a bit wider! There are some challenges since I’m only at this one smaller community hospital (also supporting several clinics and other medical services in the area), but I know my colleagues at some of the larger, urban hospitals are also interested in this, so we’ll see what happens!
Keep up the great work, and happy new year!
alisha764
January 12, 2012 at 5:18 am
I am so glad the posts are beneficial to you! You are correct it is about quality and not quantity, even if that does mean posts are sporadic at best.
I was excited to get the sticky notes translated into a visual document (it looked like engineering schematics when I finished) and that it was highly received by my team mates on the order set committee. I think the best thing that has helped me is pitching in anytime they need help even if it means I stay late. It has showed I am part of the team and right there in the thick of it with them. Of course, we always have to remember there is a such a thing as too much work.
It is great that you have access to your hospital’s EMR and are working on integrating MedlinePlus Connect. I know how hard it is to get physicians into the library to train. I did have some success with this when we were training on part of the new EMR system, but it was mostly the physicians I knew very well who came to the library for a demonstration. I would suggest you see about demonstrating the system in the physician’s lounge (if your hospital has one). This is normally a big success and even if you do not train many physicians you will at least get to see several!
Now with order sets, if your hospital has Zynx or Provation then you probably will not have many requests. If your hospital does not then I would highly suggest seeing if there is a committee over the order sets and trying to get permission to attend the meetings. Normally if you tell them you can save them time by you doing the searches for them, they are eager to invite you to every meeting
I will be posting here soon about some more upcoming training experience and order set development.