CERNER....

[Boatswain2PA]

Is the absolute worst EMR I have ever seen.

 

I just told the nurse (great nurse) that I'm done fighting with the damn thing and wrote out admission orders on paper.

 

End of rant....thank you!

[ventana]

sometimes the output is worse then the input

 

just admitted a patient in a LTC from an out of area hospital

 

The printed out stack of paper was just over 1" thick..........  ALL except for 2 pages were total garbage - I spent almost 15 minutes sorting through nothing but stupid print outs to merely find one 1.5 page D/C that had obviously been free texted into it (so I suspect that even their employees don't like the forms...)

 

I can only hope that as the incentive $$ dries up and a few years goes by that they get better as I agree with you - most stink right now

[Boatswain2PA]

I can muddle my way through an ED note in Cerner, but when it comes to writing orders (and many other things) it is simply ridiculous.

 

I'm gonna run out and buy my nurses some chocolate for putting all the orders in for me!

[gbrothers98]

We use Cerner.

I use it in the ED.

The ONLY way to make it work is to spend time with it, make macros, precompleted notes, autotext, favorite orders or use ordersets.

Integrated EMRs need several days of training for a provider to be proficient with periodic revisits.

Our hospitalists primarily use ordersets for everything. All the order details set, most everything preselected, just have to initiate and sign.

I just went to Kansas City for Cerner's health conference. 

Cerner runs that town.

They have some pretty neat stuff coming over the next year or so, much better than what they have now.

Currently though there is a steep learning curve and if you are thrown in front of it with a quick hour orientation to it, you are destined for failure.

If you are spending more time at this place, tell them you need some sit down time with their superuser to get up to speed.

One question for you, does the place you are at have Cerner CommunityWorks or does it have "Big" Cerner?

Good luck.

G Brothers PA-C

[EMEDPA]

I actually like it better than epic for ED documentation. have not used the inpt interface.

[UGoLong]

We have to use 6 different EMRs: Orb, (soon to be) two different flavors of EPIC, Centricity, HMS, and Cerner. In Cerner, I mostly use a precompleted SOAP note and then cut and paste the problem list in from the previous day, making changes to it and the vanilla physical exam. The orders aren't too bad, but not my favorite. The lookup of previous cardiac studies is reasonably good, compared to the other systems.

 

I've had to discharge from Cerner and it was not too bad. I've never had to admit through it, but generally just dictate our consults which then appear in the system.

 

I agree with the comments above; spend some time with a super user and precomplete the forms you need. It is the classic example of a little time planning and scheming saving lots of time actually working.

 

Good luck!

[EMEDPA]

the reason I like cerner> epic is you can do the whole chart from one page and not have to bounce around like you do in epic. it flows well from c/c to d/c. In epic you go looking for nurses notes(thank you epic for our first ebola miss...). in cerner they are right there on the same page with provider notes.

I have used 3 generations of epic over 15 years...and still hate it. I have used cerner for 18 months and although it will never replace paper or dictation, it's the most user friendly system I have found so far.

[coloradopa]

Is the absolute worst EMR I have ever seen.

 

I just told the nurse (great nurse) that I'm done fighting with the damn thing and wrote out admission orders on paper.

 

End of rant....thank you!

If your hospital has done some work on it, Cerner works well. If you haven't it doesn't. We have extensive order sets for most conditions. Even the generic admit order set is pretty good. Basically go through and check the boxes you need. Does a good job of prompting for DVT prophylaxis etc. 

 

Most of our issues are with the way pharmacy implemented things. For example if I want double strength Precedex one would think that it would be under Precedex. But no, its under double for double strength. That being said, I would never go back to paper orders and having someone else put in my orders. 

 

Also, there are favorites that you can either put in a specific order or put in categories. 95% of my orders are in my favorites. 

[Boatswain2PA]

I'm sure the issue is since I'm Locums I only work here every couple of months.  I did several weeks here in Aug through October, but then haven't been here since then.  But even the docs who use it every day in the hospital and the clinic say it sucks their time into a black hole.

 

My biggest issue is how counter-intuitive everything is.  Sometimes you click, sometimes you double click, and sometimes you have to right click.  But when you're done specifying your order, you don't click, double click, or right click, but rather minimize that screen.....wha wha wha whaaaat!?!?

 

I did find a work around though.....being very nice to the nurses and buying them chocolate = they will put in my admission orders for me!

 

I started at another hospital five weeks ago that uses Meditech.  It took me an hour and I was up and running.  While there are some frustrations with that (can never remember how to get prescriptions to print, and there are too many unnecessary "clicks"), it is at least relatively intuitive to use.    I have not used Epic, but I've heard it is just as bad/worse as Cerner.

 

G.  This is a very small hospital, I'm sure they have the smaller package deal. 

 

I miss T-sheets......

[SocialMedicine]

eclinical works was decent for the primary care out patient setting.

 

EPIC is a real beast. It is designed for outpatient and inpatient use. Takes a few weeks to get comfortable with.

[True Anomaly]

If your hospital has done some work on it, Cerner works well. If you haven't it doesn't. We have extensive order sets for most conditions. Even the generic admit order set is pretty good. Basically go through and check the boxes you need. Does a good job of prompting for DVT prophylaxis etc. 

 

Most of our issues are with the way pharmacy implemented things. For example if I want double strength Precedex one would think that it would be under Precedex. But no, its under double for double strength. That being said, I would never go back to paper orders and having someone else put in my orders. 

 

Also, there are favorites that you can either put in a specific order or put in categories. 95% of my orders are in my favorites. 

This- my old hospital had a dedicated Cerner group who were able to tailor the EMR for our system, and with the further customization that you can normally do with favorite orders and macros, it does make it a smoother experience.  Once I was familiar with Cerner I could do a fast track shift seeing 40+ patients and have all documentation done before the shift was even over

[gbrothers98]

Likely the place has community works which is cerner lite. So have to put more work into it. Find the facility Ed superuser and spend some time with them. You can make it work, just have to invest in it. Macros, favorites and order sets will save you. Other problem is you wrote orders for the floor from ED. One would think it should bed easy but it's not. Some places continue the encounter as a separate thing others continue it as one continued visit from ED to floor. So particular ways to order for each. We run into problems all the time with folks that use infrequently, keep repeating the learning curve. We also ran into all sorts of cpoe problems but have gotten a lot of those figured out over 2 years. Pharmacy, lab & radiology all contributed to the discord with lack of communication. Then tried to tell us it was our ordering fault. Bottom line is these integrated record are only going to be more ubiquitous. I try to appreciate their upside and work through the downside.

GB PA-C

 

 

Sent from my iPhone using Tapatalk

[coloradopa]

I'm sure the issue is since I'm Locums I only work here every couple of months.  I did several weeks here in Aug through October, but then haven't been here since then.  But even the docs who use it every day in the hospital and the clinic say it sucks their time into a black hole.

 

My biggest issue is how counter-intuitive everything is.  Sometimes you click, sometimes you double click, and sometimes you have to right click.  But when you're done specifying your order, you don't click, double click, or right click, but rather minimize that screen.....wha wha wha whaaaat!?!?

 

I did find a work around though.....being very nice to the nurses and buying them chocolate = they will put in my admission orders for me!

 

I started at another hospital five weeks ago that uses Meditech.  It took me an hour and I was up and running.  While there are some frustrations with that (can never remember how to get prescriptions to print, and there are too many unnecessary "clicks"), it is at least relatively intuitive to use.    I have not used Epic, but I've heard it is just as bad/worse as Cerner.

 

G.  This is a very small hospital, I'm sure they have the smaller package deal. 

 

I miss T-sheets......

Sounds like you are using a very different product than we use. There is no right clicking or double clicking. Most of our computers run off dumb terminals so not even sure if right clicking works in most things outside of office. The two things that people forget is that if you are charting you have to hit the checkbox in the upper left corner to complete it (maybe thats what you a referring to when you say minimize the screen). The other is for order sets. To finalize an order set you have to initiate it and sign it. Otherwise it just sits there. In theory you can sign and the nurses initiate it when the patient gets to the floor. Never seen it work here. 

 

From the ICU side its a lifesaver. When we have an acute hepatic failure come in for example you have to order around 60 different lab tests. They are pre selected in the powerplan. All I do is initiate and sign and everything gets done. Not sure how long it would take to put all those in by hand but I'm guessing longer than 1-2 minutes. 

[cinntsp]

Yep...macros, templates, and power plans are the key.  I'm still working on building up my favorites but some of the folks I work with have meticulously organized folders with everything they might need for an admission.  It takes less than 5 mins to get everything ordered and initiated.  Notes can be typed or dictated via either phone or dragon.  Typing them works best if you have templates set up.

[cbrsmurf]

Cerner for inpatient is great, not too many complaints there.

 

But we also use it for outpatient clinic and makes me want to throw my laptop down the hall.  As my younger patients would say, 'I can't even.'

[EMEDPA]

I like that the cerner EM module flows chronologically from c/c to d/c on a single page. my intro to this system was watching a doc input a few pts and by the end of my first shift I could navigate it as well or better than the pile of crap which is epic after 15 yrs of use.

[gbrothers98]

Right clicking exists on the ED and inpatient side. Brings up a drop down menu. For example, from tracking list in ED, can right click on pt name and access sections of chart direct or add an order. New product that Cerner is rolling out is ED Launchpoint, a tracking list on steroids. Very slick and more intuitive. Can use right click within templates and also in orders to clear, add, make macros and autotext, refill, renew, d/c, make a prescription from an inpt order. 

 

Favorites have a downside. When you build up all those nested folders, if you are remote hosted and can increase access time. You get the lil watch that spins aka dying slowly in front of a computer. Favorites also have to be maintained by the individual end user while ordersets are maintained by IT and Cerner.

 

I actually think that for documenting, the clinic would be easier. Can use precompleted notes, for example a snot rocket note, a htn note, a uti note, a dm note. Much of the same data gets entered time and time again. Let the precompleted note do the heavy lifting. 

For your chronic pts in the clinic there is the copy to new note function. So your pt that you see quarterly for chronic issues, just copy the last note to the new and change what you need.

 

Downside on clinic side is CPOE. We were told no ordersets in clinic but that can be overcome by favorites and I think we were told that in 2012 cause they did not have manpower to make them. I would suggest identifying the throw the laptop down the hall issues and task the practice manager and the clinic medical director to fix them. 

 

My personal experience at our place is that there are 2 root causes to difficulties. One is training. A clinician needs 6-8 hrs training minimum through mock patients to be proficient. That is after a few hours just orienting to the whole thing. Then there needs to be support for at least a week or two after with easy access to IT or superuser that KNOWS WHAT THEY ARE DOING. This gets short thrift for many reasons. 2nd is just plain tech phobia. Most of us know how to order from amazon and use our iphones. There has been years of IT development to do that and billions spent. Healthcare IT has been a very disjointed industry for decades. With HITECH, it now has a captive audience and revenue stream to get it's sh8t together. 

 

I saw some pretty cool stuff at Cerner this past fall. Their clinic ipad app looks very functional. Structured dynamic documentation for both in and oupt areas looks like a real improvement. I hope so cause there is a crapload of money being spent.

 

GB PA-C

[burnpac]

I have been a Cerner super user for for a long time, and use it in both the hospital inpatient and outpatient environment. I used to have a lot of pre completed PNs as I work in surgery and do a lot of the same things over and over. This changed with the advent of concern over record cloning and fraud, and the institution of enterprise level Dragon medical dictation. I use a lot of macros for ROS and PE, stratified by age / condition. Prior to Dragon, I used a lot of "." text macros, that allowed me to type ".orbit" and put in a detailed informed consent, etc. Now  with Dragon, I dictate rapidly and accurately in every part of the chart that allows text entry. I rarely type in the record now, even though I can type at 50-60 WPM. I especially like CPOE as I have taken the order shells available in our system and customized a whole variety of admit and post op orders specific to the type of surgery we happened to be doing that day. Complex admits and post-op orders now take me a lot less time than it used to with paper order sets. I use Citrix Receiver on my iPad to access the EHR on the fly, and sometimes chart on the iPad now that you can use SIRI to dictate into Cerner.

 

If you do a lot of inpatient consulting, Cerner's gathering of existing chart data (labs, social history, diagnostics, etc.) makes creating high-level documents a lot easier and effortless. At the start of the document creation process, you are presented with a dialogue that allows you to pick and choose the data you want to include in your unique document. I also like the ability to quickly and effortlessly look at trending data. Try that with a paper record.

 

I feel people's pain, and I know that Cerner and other hospital based EHRs have a very steep learning curve. However,  they can be a time saver if you have the right mix of tools. Dragon is essential to the EHR in my opinion. This is the era in which we live, and we had better get used to it because it is rapidly becoming the norm rather than the exception. Avail yourself of whatever training your facility offers, and ask a lot of questions of folks who seem to get it. I know that I'm happy to help my medical staff colleagues become proficient with the EHR.

[burnpac]

GB - Search in add orders for any routine "shell" order set. I can't imagine that basic Cerner does not include at least one generic shell. You can then take that shell (it doesn't matter what it is for), add what you need and uncheck what you don't need for a specific order set, and save it and rename it in your favorites for easy access. We are fortunate at our facility in that we have strong Cerner IT support and people who are willing to make shells for providers. I prefer to do it myself once I learned how. I tweak and update my order sets on the fly all the time without difficulty.

 

I totally agree with you on training time. We only had two hours Powernote and two hours CPOE training at our facility. The problem was, they did the training too far in advance of the implementation date of CPOE, and the first 48 hours could only be described as pandemonium. Corp had about 30 people onsite at the hospital for two months roaming the halls, helping medical and nursing staff, which helped greatly. It was still painful. It was abupt. At midnight one July, paper orders were forbidden in the hospital. Everyone came around eventually.... :-)

 

I'm on call a lot, and I love being able to access the record from home with Citrix Receiver on my desktop and look at lab, CT scans, etc. directly and not rely on someone else's interpretation of the situation.

[gbrothers98]

I have heard the same concern about precompleted notes. I guess if someone wants to question my integrity about if I actually did what I documented, I am more than happy to tell them to go pound sand. But I only use precompleted notes for simple things in the ED like URI, UTI, suture removal, etc.

 

Enterprise dragon is a great idea if you can afford it. My little critical access hospital struggles financially enough. They will get individual licenses for dragon per provider but that is also expensive. My place survives on the thinnest of margins, spending 10k to put several ED providers on Dragon would not be seen as a good use of resources.

 

We dont have order shells. We are involved in CommunityWorks with Cerner. Basically a lot of other small hospitals that are lumped into server domains. Basically you could look at it as Cerner in a box. The inpatient side was given the opportunity to have 15 ordersets at go live. I was able to get 7 of those for the ED. There are no 'shell' order sets. But one could take one of those, use some of the existing orders, add others 'to phase' and then save as a favorite. Again the downside to favorites is that the individual has to maintain rather than IT or Cerner.

 

One of our guys just told us about the dictation feature in the iPad. I thought I was going to be able to use the iPad quite a bit but it didnt go over well initially for a variety of reasons but this makes me think have to give another shot. Now if I can only get my iPad away from my son......

 

Sounds like you had and have much more IT and Cerner support than we do. Many local obstacles that keep it from being the help it could be including provider apathy. I see newer, younger providers getting more involved and taking on the challenge of the integrated EMR, they just have obstacles at our place that can be insurmountable at times including lack of time, money and interest in many aspects. 

 

GB PA-C