An "Epic" Transformation

Are there monster truck rallies in Madison, Wisconsin? Maybe. But there's definitely Epic - and now Barbara's medical center has Epic too! Does that make us Epic?

In this episode, Barbara and Teja talk about the two-year transformation of her medical center from the Southwest Airlines of medical technology into a jet fighter.

Integration of all those systems feels good, but how should we prepare our clicker fingers for all the extra activity? How do patients benefit from it all? And why don't any of these systems talk to each other? What about AI.

Be Epic with us today on Living Forward!

Follow us on Instagram @wearelivingforward

Transcript

Speaker 1 0:03

Live from Massachusetts. It's Barbara and Taya with Living Forward. Forward, forward, forward forward, forward, forward forward, and Monster Trucks Trucks trucks, trucks, trucks, trucks, trucks.

Speaker 2 0:16

Actually, I would love to go just to see Monster Trucks, at least once.

Speaker 1 0:22

Really yeah, yeah. You know I want to get'm going to eat a hot dog, have some cheap beer.

Speaker 2 0:28

Watch a monster rally truck thing a monster truck rally thing. I see I want to see one of those things overturn bounce around yeah. And then drag race or whatever, and then I'll be done, oh okay, yeah, cool, all right. And then I'll be done.

Speaker 1 0:43

Oh okay, yeah Cool, all right, because they used to have them at the Centrum.

Speaker 2 0:46

Centrum. Did they really? They used to. Oh, wait a minute, they did, right, what?

Speaker 1 0:50

happened? I don't know. I haven't seen an ad for one of those in a long time.

Speaker 2 0:58

I don't know what happened.

Speaker 1 0:59

You should bring that back.

Speaker 2 1:00

Yeah, I don find one, I'm sure there there is one somewhere, maybe even in madison, wisconsin, let's do it because you know what's in madison, wisconsin, don't you? Uh, no, what's in madison wisconsin. Why do I want to know?

Speaker 1 1:17

oh no, you look on your face, you know what's in madison, wisconsin al franken I uh, I don't, I wouldn't know sir, I couldn't possibly say sir Madison Wisconsin.

Speaker 2 1:33

I don't know.

Speaker 1 1:34

Epic.

Speaker 2 1:36

Oh, is that where they're from? Yes, Epic the company is in Madison, Wisconsin.

Speaker 1 1:43

Yes, epic, the medical record company. Why did I always think they were?

Speaker 2 1:45

silicon valley types? No, I guess not.

Speaker 1 1:48

Huh no wow fascinating madison wisconsin lower taxes I don't know, I don't know, I don't know, actually, when the company started so most of you probably have some idea, peripherally, subconsciously. Maybe you don't, but you do have a connection to a company called epic yeah, whether you know it or not, chances are your data is in epic somewhere they know everything about you your girth, your birth oh, wow I was gonna come up with a third one.

Speaker 1 2:27

I couldn't, you couldn't oh okay, yes, epic is a medical record system. Oh, everybody has a smurf. I remember this.

Speaker 2 2:40

I loved the smurf there's a little Grossman's in you.

Speaker 1 2:49

They have an ICD-10 code for that. Icd-10 code A39.AZX is Grossman in, you Get it out. It burns. Yeah, so we went live with a new electronic medical record system called epic, uh on june. First I see epic epic because it is epic and it is an epic. Um yeah, no potential yeah, uh, it's.

Speaker 1 3:24

It's hard to change systems in a hospital. Let's just put it. Let's just put that right out there to start out with it. It is just hard, honestly, no matter what you're going from or to. And on top of that, not only did our hospital system go live, but another hospital system in the Boston area also went live on Epic on the same day.

Speaker 2 3:54

What is the primary reason for it being so difficult to change systems systems?

Speaker 1 4:00

oh well, okay. So imagine all of the functions of a hospital every department, every. You've got inpatients, you've got outpatients, you've got every type of staff member you could imagine. You've got people who handle the billing and the registration. You've got um, everything has got to happen and it has to happen securely. It has to happen securely and ideally in a single system. You see, that that's the thing. Okay, our last system, when it was developed, was like amazing, but it was developed like 30 years ago.

Speaker 2 4:50

Was it amazing 30 years ago? And it was no longer amazing. It was no longer amazing.

Speaker 1 4:55

And then the tech stack that they had to grow around that to support it. I think honestly they had people sometimes working on that system who otherwise would have wanted to retire, but they asked them, or probably cajoled them, to stay on because nobody studies that programming language anymore, kind of thing.

Speaker 2 5:18

Yeah, that's how old it was what would be a good analogy for? Could it be something like?

Speaker 1 5:25

A 36-year-old cat.

Speaker 2 5:29

If you can't herd cats and if all the cats are 36 years old.

Speaker 1 5:36

Yeah, see, there are no 36-year-old cats.

Speaker 2 5:38

Okay so.

Speaker 1 5:40

Yeah, that's what I'm trying to. That's not a very nice analogy.

Speaker 2 5:44

But so, for example, what about like an air traffic controller or a unit of air traffic controllers?

Speaker 1 5:52

Well, actually, let's think about it.

Speaker 2 5:54

And if all the planes change, if all the airports change, their direction and the language they use changes and their computer systems change? Is that what we're talking about?

Speaker 1 6:07

Kind of. But also, if you don't change, then you get into, to continue the airplane scenario. You get into the Southwest system, right? Remember when Southwest just completely fell? Apart because some part of their elderly communication, their elderly computer system, broke down and next thing you know there's thousands of canceled flights.

Speaker 2 6:29

Right.

Speaker 1 6:30

So canceling a flight is not quite as life altering, shall we say, as the entire hospital system going down while you're admitted. See, that would be terrible.

Speaker 2 6:42

And especially, that would be what would be called a disaster.

Speaker 1 6:51

If what if it was during covid? Well see, I think we would have gone live sooner if it weren't for covid, because they were planning it. And then they're like okay, we've got to wait for covid to go, yeah, yeah, no, that that would, that would have if we. You just made me think of a way in which it could have been worse.

Speaker 2 7:07

You know, I'm always here for you to imagine the worst possible case scenarios.

Speaker 1 7:13

Yeah, actually, honestly, I think COVID helped. You know why? Guess why?

Speaker 2 7:22

Okay, let me see COVID helped because people were, more people were working. Why? Okay, let me see COVID helped because more people were working remote Okay. So there was a need for patients, doctors, care providers to be able to communicate, log on and get people's data very quickly.

Speaker 1 7:42

No.

Speaker 2 7:43

Okay.

Speaker 1 7:45

Because of the meetings.

Speaker 2 7:48

The meetings. Yes, who likes meetings?

Speaker 1 7:50

No, but so here's the thing. I've gone live with Epic two times in my career so far. Hopefully this will be a lot of time. I think we should establish something.

Speaker 2 8:00

first, though Epic is a medical record system yes, and it's an EMR.

Speaker 1 8:06

But it's also got all of the underlying architecture for everything else as far as running the hospital is concerned, like for the coding and the billing and the registration. And so now, like before, we had a situation where you had like one system was for registration and there was another system that kind of talked to that that was for billing, and there was another system that sort of talked to that for the, for the medical record, but though that wasn't the one that they used in the intensive care units, so they had something else that kind of talked to that. Now it's all one unified system.

Speaker 1 8:44

So this is actually a good thing okay but the last time I went live at a different hospital system with epic with epic, the amount of meetings, and then you had to go someplace. They had to get everybody like two dozen people in a room together for a meeting to learn about epic to plan so we've been planning now for a year and a half.

Speaker 1 9:12

Wow, right. So every little piece, think of every little thing that you have to do, like the labels. You know the little labels they print out when you give blood, when you, when you give blood for a test, right, and they print out a little label and it goes on the vial. Well, that little label has to be connected to a computer system to get that little label.

Speaker 2 9:35

Are vampires involved?

Speaker 1 9:36

Well, you know they should be.

Speaker 2 9:38

Right.

Speaker 1 9:39

Because if they, want the blood and your medical, then they want to make it efficient.

Speaker 2 9:43

Your EMR isn't dedicated yet Exactly. Thank you.

Speaker 1 9:46

Exactly right. So you know you've got to keep. Here's the vampire's share. Here's the part that's going to the testing lab.

Speaker 2 9:55

What's this code? Here? It's BLDVMP. What's the VMP part?

Speaker 1 10:02

Oh, that's vampire. Vampire, yes, yeah, okay, okay, I have never been in so many meetings. They were all necessary too. It's not like.

Speaker 2 10:15

Not wasted time no.

Speaker 1 10:17

No, because there was so much to do, and I was saying this to someone the other day. We have actually a really good culture of meetings where I work right now, which is that it is disrespectful to arrive to a meeting late unless you've let the person know in advance I'm gonna have to be late, um or or like if you said you couldn't make it and then all of a sudden you could and it's like, hey, it turned out I could make the last 20 minutes, that's okay. But if you said, yes, you're going to be there, then you're going to be there. When you say it's going, to start.

Speaker 1 10:51

And when it's supposed to end, it ends. It's like we had a 30-minute meeting. We still have a couple things to talk about. If people aren't available to stay, meeting ends and you res and you schedule something for that thing that didn't get done. It's not like this, meandering meetings.

Speaker 1 11:10

No, it's like here's our agenda here's what we have to talk about yeah, I really appreciate that that's really about where I work, because it's like this is what we've got, this is what we have to accomplish. Uh-oh, we're almost done. Can everyone stay for 10 more minutes? Nope, okay, I guess we have to yep, you know very good it's like you know so okay, there's there's so many of them for epic and the reason why there's so many meetings for epic is because.

Speaker 2 11:37

is it because epic isn't designed to be user friendly, or is the user interface too complicated, or is it that that's?

Speaker 1 11:47

true of all of them. Okay, I mean it's true of all of them, but it's just. There's so many parts to it and every hospital is different.

Speaker 2 11:56

I see.

Speaker 1 11:57

Now you think about a hospital system, because this is going live in a hospital system. We have multiple hospitals all doing things in different ways. There were some hospitals that had been on a prior version of Epic, but our hospital had been on this older system, this legacy system, for like 30 years. And then there was another hospital in the system, a smaller hospital that was still on paper.

Speaker 2 12:25

They were still using paper.

Speaker 1 12:27

Paper.

Speaker 2 12:28

Papyrus.

Speaker 1 12:30

Yeah, I think they had quill pens. Quill pens, oh, not quilt.

Speaker 2 12:33

Quill, quilt pens. It's not writing very well.

Speaker 1 12:38

I know, but it's really nice looking. Ink wells they're dipping it in the ink well, it's very warm. Ink wells they're dipping it in the ink well, it's very warm so an. Emr like Epic takes what? Two years to implement? Well-ish, I mean, they've been so. They had, I believe, honestly started planning some of this at the highest levels before the pandemic and then they had to pause it. So really we're probably looking more at like an end-to-end, maybe a five-year process.

Speaker 2 13:14

Five years Now. At the end of that five years, what if Epic has updated to its new version and everyone's got to move to that?

Speaker 1 13:23

They're just more meetings well, there are certain, there are certain updates that you have to take. So I just learned actually recently, this brand new information to me anyway that twice a year there are regulatory updates okay, so for example, it's like so by contract when you sign up for epic, you have to accept the regulatory updates.

Speaker 1 13:48

Now there are other updates that come down the pike, some of which are systemic updates and some of which are updates that are called optimization for your particular one. So it's like it's. It's like it's got the foundational system, they call it, but then it's customized also to each. So client.

Healthcare Interoperability and Epic Monopoly

Speaker 2 14:11

So walk me through it. Have a patient. I and I. I know quite a bit about emrs only because many years ago, as you know, I used to produce training and marketing and sales demo videos for software companies that wrote EMR systems. This is, you know, 20 years ago. Of course, a lot has changed since then. Just to kind of help them understand the complexities when you walk into a hospital, when you enter a hospital, what you see as a patient.

Speaker 1 14:51

Oh man, you don't even see like a tenth of it.

Speaker 2 14:53

So you might get frustrated by the fact that the pen that you use to sign your name you know when you sign that name. Yeah, and you have no idea like what you're actually signing.

Speaker 1 15:03

You could be signing away your left kidney.

Speaker 2 15:04

You have no idea exactly that actually makes me mad right.

Speaker 1 15:08

So you sign it because you know you know it should be it should be like an ipad or something, so you can see the document that you're seeing, not just a little signature pad exactly trust me, this is the consent to treat right exactly.

Speaker 2 15:19

So you sign this thing and then they tell you where to go and you wait there and then you walk up to your name. Okay, so you're signed in, everything is set, the doctor will be with you in a minute and then the rest of it is just your experience at the hospital, as it would be at a department store or a restaurant or whatever.

Speaker 1 15:39

You get like blood transfusions at Macy's.

Speaker 2 15:45

Fifth floor transfusions, women's shoes, basement, heart surgery what's?

Speaker 1 15:54

that Women's shoes and IVs. No no, you don't. I mean you don't see.

Speaker 2 16:07

Right, you don't.

Speaker 1 16:08

I mean you don't see, but right you you don't, you don't and you shouldn't, because if you were to see the guts of it no, you don't want to it would scare you away.

Speaker 2 16:12

Well, I mean, hospitals are scary enough even if you saw your own guts, it might.

Speaker 1 16:16

That would definitely scare you away but, like you, most people don't even realize like so, when you're given medications at a hospital, the medications are locked up in this system, like it's literally locked and everything that's in that case. That big case is counted. So when you need to get a medication for a patient, you to scan their in the system, you pull up their medical record. It knows what the medical record should be. Then you it dispenses the medications that they're supposed to have and you have to check. This is the nurse that does this. The nurse has to check it all and then they bring it in and they have to double identify and now I think there's a little boop, a little scanner, so that they scan to make sure, okay, yeah, I recognize that sound yeah, exactly, and they boop, they boop you okay and and then they know that the right meds are going to the right person.

Speaker 1 17:26

But like you don't realize, so you know the the nurse comes in with the meds. You don't see all that necessarily. I mean you might see it if you just happen to be in the bed near the place where that little cart is stored. But yeah, I mean there's, there's so much, and most of it you know, 90% of it's safety related.

Speaker 2 17:46

Do you think that Epic, or any EMR system like that, is capable of supporting a majority of American patients and healthcare providers?

Speaker 1 18:07

What do you mean by support?

Speaker 2 18:11

That's a good. That's a good-.

Speaker 1 18:13

Because there's different ways you can take that.

Speaker 2 18:16

So what I'm saying is we don't have an integrated healthcare system, right, and many people don't even have insurance, and many people don't have access to doctors and uh, you know, care as as they would need because of disparities and location things well, an emr can't help that, no emr, emr can't help that, but a system like epic is growing exponentially, partly because, even though it has its flaws, it is still functioning better than what we used to have.

Speaker 1 19:07

Oh, yeah, right.

Speaker 2 19:09

Because of that, the the growth is only expected to to to become part of other hospitals or clinics, even small clinics.

Speaker 1 19:21

I mean, if I think I see where you're getting to. I mean, the thing is, I do think there should be more competition in this space than there is. Should be more competition in this space than there is. But what happened way back, if you go back like 20 years? The government was incentivizing doctors and hospital systems to pick up electronic medical records because it is better. I mean the phenomenon people joke about, about not being able to read doctor's writings. It was actually really dangerous.

Speaker 2 19:55

Like people would get wrong medications.

Speaker 1 19:57

You wouldn't be able to read the diagnosis. Like how many times early in my career was I trying to, you know, figure out what a neurologist said and I'm like you know it was maddening, like it was not okay. So we are safer with electronical medical records than we were before. But in rolling this out the government gave some incentives because, it's expensive, you know it really is.

Speaker 1 20:23

And so they were incentivizing people to spend the money on that and systems to spend the money on that, and they created something called meaningful use on that and systems to spend the money on that, and they created something called meaningful use. And so meaningful use meant okay, you can't just like amp up Microsoft Word and pretend it's an EMR, right, it's got to have certain features in order to count toward the incentive, which makes sense. And they would have things like it has to have a communication portal with patients. It has to be capable of tracking allergies, whether they're medication, you know, especially medication allergies. It has to be able to accommodate certain types of data, right, so they would set up these things. But what they never did set up as a meaningful use criteria was interoperability.

Speaker 2 21:10

Right.

Speaker 1 21:10

The ability to read the medical records from another system. And so what happened is each one decided we're going to try and make ours the one right. You know it's going to be like the standard, and so Epic, I believe, is winning right, but it's still like it sets up a monopoly situation, and this isn't anything against Epic per se. They're just doing what American businesses do, right like they. They're setting up a situation where they're delivering a product that any hospital that has Epic if the information matches the name and the date of birth and like something else.

Speaker 2 21:54

Girth.

Speaker 1 21:55

Yeah, right, then I can read the medical records from that system. It could be in Florida, it could be in Maryland, it could be in Montana, it doesn't matter where it is. If they have Epic and the identifiers, the key identifiers match, I can see it. And that, again, it's a huge safety thing. Imagine you are from Minnesota and you are admitted in Massachusetts because of an emergency right. All of your medical records are in Minnesota. We don't know, like your entire medical history, we don't know what meds you're on, we don't know what you're allergic to and, yeah, you, you can get something from a history so you're telling me that people from Minnesota should stay in Minnesota?

Speaker 1 22:42

no but I'm saying that they should they should use Epic so that then when they're here in Massachusetts, because the, the, the honestly now now three of the biggest medical systems here in Massachusetts are all on Epic. Make sure you're in Epic there, because then we can see your stuff. Right, we can know. But that was my question I asked earlier.

Speaker 2 23:05

The fundamental question is is Epic capable of interoperability with itself?

Speaker 1 23:15

But that's the problem.

Speaker 2 23:16

The government never set up that incentive to really make it interoperable with other systems.

Speaker 1 23:22

But it's not interoperable with, like Athena. Health or eClinical Works or other Right. So I think that America missed an opportunity.

Speaker 2 23:31

And that was my question. That was actually my question. We missed an opportunity. And that was my question. That was actually my question. We missed an opportunity.

Speaker 1 23:37

Because it doesn't have to be the same right, but in order to get the spirit of competition and getting people fighting to introduce new features and things like that, if right from the get-go they'd said, hey, one of your criteria is you have to be able to read each other's stuff, then that would have preserved a market that I think would have been a little bit more forward-facing.

Speaker 2 24:04

Again.

Speaker 1 24:04

Epic is fine. Epic is. You know. Who knows, maybe, since keywords right, someone from Epic is going to be listening to it. Epic is fine. It's so much better than what we had before.

Speaker 2 24:15

Yeah.

Speaker 1 24:16

But it is becoming a monopoly. I see Right, and it's becoming a monopoly because of the way that it was set up.

Speaker 2 24:23

So remember in the last episode we were talking about my trip to Japan and the communication between people from different countries in Japan and that there was this kind of like a, not a system I forgot the word I used, but it had to do with the outer layer of how we communicate and you said why don't you just hold up a sign that directs you to the way in which you're supposed to communicate with the person?

Speaker 1 24:48

in front of you, right.

Speaker 2 24:49

Right, I mean funny, but there is some truth supposed to communicate with the person in front of you, right? Right, um, I mean funny, but there is some truth to to the need for clarity when it comes to interoperability and different systems. When it comes to people's health, yeah, because americans move more than you would expect. Right, the average American moves out of state often enough where they have to completely redo who they are within a medical record system.

Speaker 1 25:22

Most medical problems and errors and things come from communication issues and errors and things come from communication issues.

Navigating Epic System Challenges

Speaker 2 25:31

Right, exactly, yep, that's what I'm saying. It is in these meetings that you have is some of the preparation about how to ensure, how to ensure that the yeah, I mean an electronic medical record puts guardrails around things, right, there becomes a way you do things right.

Speaker 1 25:57

So even one thing that's handy, for example, is doctors can have something called order sets and I'm sure they can do this in other record systems as well is where it's like okay, if I know that, if I'm suspecting, if I'm working up congestive heart failure, there are these three or four tests that I run, I can click one button and this set will open up that will say, yep, this is my congestive heart failure set of orders, right, so we can save time, right.

Speaker 1 26:28

The downside to that is that let's say, oh, I forgot, there was something else I'm looking at too, and you now, you forgot to add on that extra test, you know, and so it gets tough. Or like in our area of the field right, there's, there's something called a modified barium swallow study. Okay, so this is a study that is done with a speech pathologist and radiologist and it looks at the physiology of swallowing, because the esophagus, where the food goes, and the trachea, where the air goes, are right next to each other, and so if that starts malfunctioning, instead you have food and liquid go into your lungs which is we'll just say bad.

Speaker 1 27:10

So that's a modified barium swallow. There is also a test called a barium swallow.

Speaker 2 27:19

Which is not modified. That has nothing to do with swallowing.

Speaker 1 27:22

It's a GI study looking at the esophagus.

Speaker 2 27:25

Okay.

Speaker 1 27:26

So what you then get is, like some doctors aren't sure which to order, and then they order the wrong one.

Speaker 2 27:34

Well, a doctor should not be, never mind.

Speaker 1 27:36

Right, but especially like we're an academic medical center right. I was telling you how, on July 1st, you know, I had the long, long line of people outside security. I was like what's going on? Oh, it's July 1st. All the new residents.

Speaker 2 27:56

All the new residents, okay, and interns, like all the new residents all the new interns are coming in, so like. Wouldn't an EMR if it was smart right?

Speaker 1 28:08

If it was smart, if AI played a role. Right.

Speaker 2 28:11

Wouldn't an EMR know intrinsically that if you had just done, if you had just talked to a patient and the notes are in there this is what I talked to a patient about.

Speaker 1 28:22

Well, there's no AI in there yet.

Speaker 2 28:24

Yet. But I mean, wouldn't that be great. A doctor talks to a patient, notes are taken.

Speaker 1 28:29

They're already talking about how to bring AI into the system.

Speaker 2 28:33

The system should generate a suggestion. Like well, in this case a modified barium swallow and right. Wouldn't that be the protocol? Wouldn't that be a protocol?

Speaker 1 28:49

For certain things. Yeah, wouldn't that be the protocol? Wouldn't that be a protocol? And it's not things. Yeah, and again, usually it works pretty it, usually people know it, but it's it's like in the system.

Speaker 1 28:58

So for us going to this new electronic medical record system like there's actually more than one name for this test that we do, so the modified barium swallow is sometimes called a video swallow study or a video fluoroscopic study of swallowing. So historically that's what we've called it in order that it didn't have confusion. So we would call it, and in our order sets it was always called a video swallow study or a video fluoroscopic study of swallowing. Well, in the Epic system I mean most places in the country, and even when you read the literature they're calling it a modified barium swallow. So in Epic it's called a modified barium swallow. So now all of our providers who are used to looking for either a barium swallow or a video swallow study are now having to reorient and think about a barium swallow or a modified barium swallow or a video swallow study, are now having to reorient and think about a barium swallow or a modified barium swallow. So you see how that can go terribly wrong.

Speaker 2 29:55

And that's just your department. And then there are many, many departments, Exactly so.

Speaker 1 30:00

You see the that's why you see the minutia. That's why it takes five years and more meetings than you can conceptualize years and more meetings than you can conceptualize. Wow, do they serve coffee and snacks during these meetings? People tend to bring their own because they are virtual meetings. Oh, but I was so.

Speaker 2 30:23

So, people, I see where you were before the place you were before that's when you had your in-person yeah, yeah, no, but see, this is why again, pandemic.

Speaker 1 30:31

Thank you, covid.

Speaker 2 30:33

Thank you, covid. I've not heard that phrase ever. Thank you, covid.

Speaker 1 30:39

Wow, because I got a sit-stand desk for my desktop so that I can be sitting sometimes and standing sometimes. And then I've got my coffee and water and your modified barium coffee.

Speaker 2 30:56

You know your modified barium juice.

Speaker 1 30:58

Disgusting no no, no, so it's been something mmm so then we went live and it was just like all these things were wrong and it's like, no matter how much you planned, it's just like there's things were wrong and it's like, no matter how much you planned, it's just like there's so much that's going on and it was, it was it's like me making an omelet.

Speaker 2 31:17

It never is the same, never. I've never made an omelet the same way I try.

Speaker 1 31:22

Yeah, I exactly same technique like what if you had an emr for that, would you like? Well, if I use modium I can give you a speech evaluation you could give me a modified barium swallow, that would explain.

Speaker 2 31:39

No, just a barium swallow no, because that's for swallowing. It's a totally different cpt code okay, speaking of CPT code, yeah, go for it.

Speaker 1 31:51

I rebooted my YouTube channel.

Speaker 2 31:53

Rebooted your YouTube channel.

Speaker 1 31:55

Yes, Because I had been putting up a few.

Speaker 2 31:57

What's it got to do with CPT code?

Speaker 1 31:59

Because I had been focusing on putting some videos up about voice things specifically, and then I discovered what I feel is a little bit more important and something that I'm good at, which is educating people about health care. So I have a video about the codes.

Speaker 2 32:18

Oh right, that's right.

Speaker 1 32:20

So CPT codes are in there, as are ICD codes, and I have a video on my channel, barbara Wilson Arboleta voice-wise.

Speaker 2 32:31

Barbara Wilson Arboleta.

Speaker 1 32:34

Voice-wise.

Speaker 2 32:34

Voice-wise.

Speaker 1 32:35

V-O-I-C-E, w-i-z-e, and so if you put those in as your keywords, you should see my channel and I'm going to be doing more Great About healthcare communication Because, again, we can joke about the electronic medical record system, but it's true, like something like epic does help. It helps because there are buckets for everything, but it's still there are so many people. There are, I think, 22 000 people that work for us like herding cats we were joking about, right, like trying to keep 22,000 people on the same page. Our hospital alone, not just the whole system, our hospital alone has 850 beds wow, ish. And then all the outpatient Wow.

Speaker 2 33:29

So if you get tired and fall asleep, you've got a lot of choices there.

Speaker 1 33:32

Yeah Well, except that it's usually full.

Speaker 2 33:36

Well, you didn't say that, you just said there are 850 beds.

Speaker 1 33:39

Yeah, but I could grab some sheets and lay on the floor.

Speaker 2 33:44

Which was tempting the hours that you work, which was tempting in the last few weeks before Gola.

Speaker 1 33:49

I was just, can I just?

Speaker 2 33:50

curl up in fetal position underneath my desk Before please.

Speaker 1 33:58

Yeah Well, but we're clicking along. Now we're getting there.

Speaker 2 34:00

I'm glad you went live.

Speaker 1 34:02

Me too.

Speaker 2 34:03

And I'm glad because I remember the day. Live from Boston, massachusetts, live from Boston. It's epic.

Speaker 1 34:09

Yes. Wow Well all the power to you. Yeah, you know, someday there will be a television show all about working for an EMR, you know how they have like the behind the scenes, things they have like, shows about kitchens, you know, like the chef and the cooks and stuff like that they should do like the it department of a hospital it's episodic cool yes, cool cool, cool, cool. Yes, I had, I had, um I got. I bought one of those cameos for my team.

Speaker 2 34:51

Oh, that's right. With Dr Glaukom Flecken who we love so much, dr Glaukom Flecken yes, and yeah, so he did a little. Welcome to Epic video for us, thank you, doctor, that I disseminated to our team. Thank you.

Speaker 1 35:05

Dr Glaukom Flecken, we love you All right.

Speaker 2 35:12

Very good.

Speaker 1 35:13

That's about all the damage that I can do talking about health care today.

Speaker 2 35:17

Well, you're doing a great job there and as long as you get your modified barium swallow and barium swallows all figured out, yes, well, we're hoping they can put in a little flag, all figured out.

Speaker 1 35:29

Yes, well, we're hoping they can put in a little flag, meaning that, like when somebody goes to order one it says you know that, similar warning, similar test.

Speaker 2 35:38

Right. It's like when you go to Starbucks and you the drive-thru and you've ordered your mocha latte, but with soy milk, right, and they give you oat milk, oat milk it's.

Speaker 1 35:48

It's like you can't drive around come back.

Speaker 2 35:52

Just can't, you know. You're driving home and then you're, just you know, bloated and yeah, you're gonna drive too much fiber.

Speaker 1 36:01

And then you gotta go to the hospital. Where epic exactly?

Speaker 2 36:05

you gotta get a barium swallow because your esophagus is.

Speaker 1 36:09

You know, the fiber gets you going and the barium stops you up. So there you go.

Speaker 2 36:16

Full circle.

Speaker 1 36:17

Okay, yeah, I think, yeah, that's about enough of this, that was epic. Yeah, this was an epic episode Epic episode.

Speaker 2 36:25

It was an epic-sode.

Speaker 1 36:26

Oh yes, Well, we hope you found that amusing. I'm sure we'll be on to other fabulous topics. You know what we should do? A media topic again next time.

Speaker 2 36:37

Let's do a media topic. Let's talk about something we just watched, something we're watching, or something like that.

Speaker 1 36:40

That'd be fun, absolutely, yeah, yeah. And you know, any ideas that anybody has of what they'd like us to chat about, we're happy to entertain the idea. Entertain, because we are here to entertain, after all. Do please give us a wonderful five star review, pretty please, five out of five and subscribe and listen and pass this on and tell everyone how like wonderful we are and all that and you've got great hair too thank you so much, until next time all right.