Habush Habush and Rottier

Thursday, October 12, 2017

Another Reason to Sue Epic?

A coworker of mine alerted me to this: Mayo Clinic Health Information Offered Through Epic Patient Apps


The article is from (late) April of this year, so it's not exactly breaking news. The article states that Mayo Clinic and Epic are partnering to include health education content published/created by Mayo through Epic's MyChart application.


Because I'm trying not to be a hack, I searched for other articles for confirmation. I found this one on Healthcare IT News: http://www.healthcareitnews.com/news/epic-mayo-clinic-team-integrate-symptom-checker-mychart-patient-portal. This article suggests that Epic will soon jump into the auto-diagnosis RoboDoc market. (I need a jpg of Robocop in a lab coat, now).


Being an Old Fart, I remember Microsoft getting in trouble for bundling MS Office software with its OS. Other health content vendors are available--Staywell, Relay Health, among others. If Mayo content gets provided with the software, how is that any different than the Microsoft antitrust lawsuit? If Corel was pissed then, Staywell should be livid now.

Wednesday, October 11, 2017

Epic at the Supreme Court

If you're interested, here's the oral arguments from the Epic's Supreme Court case.


text (78 page pdf)


downloadable audio file


Habush Habush and Rottier don't expect SCOTUS to make a final decision until winter or spring.

Tuesday, October 3, 2017

The Blacklist


(burying the lede)
Currently, the Supreme Court is deciding on the legality of Epic's clause in their employment contract that all disputes must be handled by individual arbitration--an action that Epic instituted to prevent all the class action lawsuits that they've been getting over the last few years. Here's a link to an article: TL;DR: SCOTUS is undecided, but not every justice has weighed in.




Lede:
I met a person who was actually affected by the heretofore-existed-only-in-threats-and-rumors Epic Blacklist. He was employed as an implementation analyst at a customer site (never an Epic employee) who was involved in various go-lives at that organization. We'll call him Ray.






After working with this customer and finishing a major go-live, Ray decided to leave the organization for some legitimate life reason, probably family related. His employer was cool with this, and it was an amicable separation. Ray wasn't fired, is what I'm saying. The employer liked him, was sorry to see him go, but was supportive of his future endeavors.

Ray got a job with an Epic-preferred consulting agency, and the agency asked Epic about his eligibility. Depending on which consulting firm agent asked which Epic employee, the firm received various answers as to when they could hire Ray--right now, a few months from now, or a calendar year after the hospital's go-live. The consulting firm found a placement for Ray at a new organization, but when it came time to actually get him working, the new org said it would cost them their "Good Install" to hire him. Ray ended up doing non-epic work until a year had elapsed.

It's real, people. And Epic enforces it by reaching into its customers' pocket books. Ray spoke to his consulting firm during all this, and the firm said that Epic set up Good Install/Good Maintenance as a way to have control over who gets to work on Epic products, without hairy legal issues. In effect, an Epic Client can hire whoever they want, but Epic might charge extra for the privilege of hiring certain people.

update:
A reader posted this on another page here:
How does leaving during an active implementation and/or go-live as a consultant/contractor affect your future job prospects? Can you be blacklisted for leaving a client abruptly? Not to pursue another client, but to take a long break.
Based on an N of 1, the blacklist is time-limited. If you leave during an active implementation, odds are good that you WILL get blacklisted. But the blacklist will probably only last a year. If your break is a year, then you shouldn't have any major consequences. If your break is a couple of months, you'll need to find some non-Epic work to do, or an Epic customer who doesn't mind pissing Judy off. Sutter Health comes to mind.

Friday, March 24, 2017

Talking Union



A person can learn a lot from folk songs. Email unionizeepic@gmail.com if you're interested. From the man himself, when I asked if there are any current organization activities going on:

I don't know of anything actively going on. I know a small handful interested in actively pursuing it, but I talk to people about it often and am surprised by the level of passive support. However, we haven't taken any action yet. I'm hoping to get something going in January [2017--I'm not prompt. Don't sue me--Admin].

Please post this email if you write about unionizing at all. I'm hoping to get things going after the new year or so.

If you know anyone still at Epic interested send them my way, please. Especially, if they would be interested in organizing and/or recruiting.

There you have it. Go forth and organize. Every movement starts somewhere, and listening to the soundtrack of the labor movement isn't a bad way to prepare.


Friday, March 10, 2017

A Book Review (of sorts)

I just finished reading Procrastinate on Purpose, by Rory Vaden. In an effort to organize my thoughts and determine how to apply the lessons to healthcare IT, here's this post.


The main points of the book are "work double-time part-time now, in order to have full-time free time later"; and the Focus Funnel (source):


The focus funnel goes hand-in-hand with the Eisenhower Decision Matrix (ugent vs important--"what is urgent is seldom important, and what is important is seldom urgent"). Vaden adds a Z-axis to the decision matrix for Significance. If Urgent asks "how soon does this matter," and Important asks "How much does this matter," then Significance asks "How long will this matter."


The Focus Funnel then asks the user to eliminate those tasks of no significance, automate any repeatable tasks, and delegate tasks that don't require the user's particular set of skills. If the task makes it through to the bottom of the funnel, then a decision needs to be made: Is this task the most significant thing I should be working on right now? If yes, do it. If not, put it back at the top of the funnel.


I grok at a visceral level how effective this is for those in control of their own task list. What I don't understand is how to apply it to my situation, where my workload is partially at my own discretion, but primarily driven by management--and the managers historically don't appreciate automation or delegation, and never eliminate anything. Healthcare IT is also plagued by IT-style busywork, compliance CYA, and patient care criticality. In addition to my actual work, I have to track it for data-driven bean counters, wrap it up in red tape to protect from malpractice suits, and do it all right now because lives are at stake.



I can apply Vaden's method to those tasks where I'm in full control, but I have limited empowerment to delegate. Let's say I'm assigned a task that can be done by anyone on the team, including fresh new hires. By assigning that work to me, it takes away time that I can spend on tasks where I have unique expertise.



Automating is similarly difficult. A task that costs an hour a day, every day, may require 40 hours to automate a permanent fix. The daily maintenance is urgent, as most things in health care IT are, so it still has to be performed alongside the permanent fix.



Eliminating tasks is easy. Managers have even less time than the grunts, so unless the managers are specifically measuring a task, eliminating the pointless stuff will most likely go completely unnoticed. (That only works if the task is truly without benefit.) Managers have limited insight into how one actually prioritizes, so the Concentrate/Procrastinate portion of the funnel is entirely up to me.



The problem then, is with the middle portion of the funnel--that takes a team. And I can't control my team. Without buy-in from the entire team and from management, delegation is unworkable. Without informed prioritization, getting permission to spend time on automation is difficult, but not impossible--I guess this is where the "work double time part time" comes in--if one 80-hour week saves an hour a day forever, that's an extra 250 hours a year that were just freed for more significant things. It also makes me look awesome in the eyes of management.


I encouraged my immediate supervisor to read it, and he might. Maybe change will happen from middle management outward. In the meantime, I work on the things that I can control, and prioritize based on a task's significance to my workload.

Wednesday, January 18, 2017

Supreme Court, Epic, and Arbitration

Over the last few weeks, I've seen a bunch of articles popping up about all the lawsuits that Epic is involved in. Read the links, they say it better than I could, but in summary:


Epic got sued a while back over lack of overtime pay. Epic settled, and then changed its employment agreement to require arbitration rather than lawsuits. Epic got sued again, lost, appealed, and the court of appeals said that forcing employees into arbitration was Not Good. Due to variances in different courts (7th Circuit vs 5th Circuit), people have asked the Supreme Court to give its opinion.


Epic: With the Patient at the Heart*


In other news, I thought this was pretty cool: Flint Doctor uses Epic to Expose Lead Crisis. It's almost a year old, but this is the good stuff that Epic should be doing (and getting credit for) all the time.


*and the Employee in the Lower GI Tract