Leaders' work: Removing barriers to success

Don't it always seem to go 

That you don't know what you've got 

'Til its gone

Big Yellow Taxi

Joni Mitchell

This summer, I rediscovered the joy  of cycling.

Last weekend, I went for a long ride with my neighbor, an experienced cyclist. As we were returning home, it began to cloud over and the wind picked up.

"Why don't you try riding about 8 inches behind me," Bruce suggested.

As I experienced drafting for the first time, I immediately found that riding was easier. Because Bruce was blocking the wind for me, I went faster using the same energy.  I realized how much extra effort it had been to fight the head wind.

It was a much more enjoyable ride after that.

This week, I rediscovered the joy of using technology in my work.

Our urology clinic has used electronic medical records (EMR) for many years. Among the many benefits, having remote access to our records is one of the most useful. This is particularly helpful for specialists who split their time between various physical sites such as an office and  the hospital. 

Prior to converting to using an EMR, we would transcribe notes from the paper chart in our office so that we could refer to them the next day at the hospital. (We had a policy prohibiting removal of paper charts from the office, both to maintain chart security and also to give our office staff access to the charts for record keeping and billing purposes.) Not only was this time-consuming, but we had no access to the original chart once we left the office.

Now that we have remote access to our EMR, we can check patient information, lab results and staff communication from any site. We even have access using our smart phones.   This has become such an integral part of our practice that it's hard to imagine what work was like before the EMR. That is, until the technology fails.

Over the last few months, remote access to our EMR has been painfully slow.  At a typical cystoscopy clinic at the hospital, I would see up to 15 patients during the course of a morning, each scheduled in a 15-minute slot.  That 15 minutes includes time for preparing the examination room, greeting the patient, discussing their problem and the cystoscopy procedure, performing the cystoscopy, discussing the results and treatment, dictating a consultation letter to the referring physician, then reviewing the next patient's records.  

My laptop connects to our office via the hospital's wireless network to the internet and then to our office server.  When something is awry in that connection, loading each patient's record can take several minutes.  No amount of hammering on the keyboard changes this.  Many times, the nurse will already have brought the next patient to the cystoscopy room, at which time we all wait for the EMR to work its laborious magic.  At one point, I reverted back to old-fashioned note-making the night before a cystoscopy clinic.  (Blasphemy!)

During the summer, we overhauled our office's computer system with a faster server and upgraded laptops.  This seemed to make a difference initially, but then the problem recurred.  Two weeks ago, in a last ditch effort, we replaced our modem.  Hallelujah!  We now have remote EMR access at almost the same speed as when we're plugged directly into our office network.  Now, I can review my next patient's chart and still have time to review incoming labwork, reports and consultation requests - all while the nurse prepares the cystoscopy room and brings in the next patient.  

Once again, it is a pleasure to let the EMR make my work easier.

On our bike ride, Bruce recognized that, in order to reach our goal (get home before it started raining), we needed to move faster.  He could have encouraged me to work harder and pedal faster, but I was already tired and wouldn't have been able to maintain additional effort.  Also, I would have felt badly for letting him down.  Instead, he found a way to remove the barrier that was preventing me from achieving our mutual goal.

That's great leadership!