Moderator EMEDPA Posted July 28, 2015 Moderator Share Posted July 28, 2015 I use cerner at a per diem job and find it more streamlined than epic. everything can be done from the home screen without bouncing all over. I guess I'm just old school, but prefer dictation>paper>any emr. Link to comment Share on other sites More sharing options...
RealityCheck Posted July 28, 2015 Share Posted July 28, 2015 If you were trained to handwrite an H&P or even chart note then EMRs lose all continuity, flow and meaning. I can still type an H&P faster than any EMR. Have always done them in the same order every time and know the flow. Same as writing admit orders. Learned the mnemonic yrs ago and it has never failed me. I hate to see my students now not REALLY knowing how to put their thoughts into flow and learning that you can still chart w computer failure. I have found a completely unresolved problem in every EMR I have ever seen - the cc of notes. Unless an inside user provider, There is no queue for cc'ing notes to anyone - specialists, workers comp, etc. I still end up printing my note myself and attaching a sticky note to send it to so and so via fax. Epic has an internal fax but it is one thing at a a time - thus 18 fax cover sheets wasted to get a consult request sent. Easier and more professional looking to make a custom cover sheet and send all docs together. Epic also has a huge bungle in billing crossover. If a patient is not on a schedule for an encounter and you do a billable encounter - workers comp has a lot of them - the billing will never cross because the encounter was not built from a schedule. The billing sits indefinitely. So, no perfect system. Just hope we never lose the art of medicine for the sake of clicking. Link to comment Share on other sites More sharing options...
Guest Paula Posted July 28, 2015 Share Posted July 28, 2015 My EHR is a mix of macros, dictation and ability to type in what I need. We can send CC to others via request per dictation as we still hire transcriptionists. There are glitches. I like the macros for well child/sports physicals as the majority of those exams are normals and the MA collects all the info such as immunization status, diet, exercise, safety, tobacco, alcohol use, etc. Unfortunately, the EHR we have was locally developed 20 years ago and used only by the 2 larger clinics/hospital systems in my area. It is nice to see all the notes, labs, radiology, consult reports from the providers in the 2 systems. Those two systems are parting ways and the EHR is being buried after the divorce happens. My new system training will start in 2016 and will be a cloud based system....not sure of the name of it. Will be interesting. No more access to patient's info if they get referred out to the other system. Another breakdown in this wonderful system of brokenness of medical records. Link to comment Share on other sites More sharing options...
RealityCheck Posted July 28, 2015 Share Posted July 28, 2015 I have often wished for a chip in my neck (like my dogs) that contains my UPIN, Medicare, Medicaid, NPI, DEA, L&I and every other number I am identified as - just scan my neck and get the numbers. That and use my retina or fingerprint for the 9000 passwords I can't ever remember. I see a future where patients carry around ALL their info on a chip - implanted or not - and we just scan them. Yeah, kinda creepy and Orwellian and all, but it beats trying to figure stuff out at 3 am with a patient who can't remember anything and is super complicated or who travels a lot. Looking at all the healthcare apps available on iTunes is interesting as well. Wish I had written one for $2.99 a pop................. Maybe someday we will have an EMR that is universal or at least accessible. Link to comment Share on other sites More sharing options...
SCPA Posted July 29, 2015 Share Posted July 29, 2015 Has anyone used Greeway SuccessEHS? I seriously cannot imagine a worse EMR. Link to comment Share on other sites More sharing options...
Evolute Posted July 29, 2015 Share Posted July 29, 2015 E, I use very few macros as well for that very reason. mostly free type and dot phrases. never used cerner Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted July 29, 2015 Moderator Share Posted July 29, 2015 E, I use very few macros as well for that very reason. mostly free type and dot phrases. never used cerner I learned cerner in one day. for me it is much more intuitive and flows better. I have used epic for 15 years at 4 places and hated every interaction with it. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted August 2, 2015 Moderator Share Posted August 2, 2015 Well today was our drop dead day for epic. 6+ hour waits. LWBS too many to count. I have used epic for 15+ years and was the most productive staff member with it today and saw almost 3/hr (compared to up to 6/hr on paper). most of my colleagues were seeing 1.5/hr. time to hire more staff. a lot more. I don't have the official #s yet, but am pretty sure I won our epic pool. my bet was 6 hr waits and 30 lwbs/shift. Link to comment Share on other sites More sharing options...
JED617 Posted August 2, 2015 Share Posted August 2, 2015 Well today was our drop dead day for epic. 6+ hour waits. LWBS too many to count. I have used epic for 15+ years and was the most productive staff member with it today and saw almost 3/hr (compared to up to 6/hr on paper). most of my colleagues were seeing 1.5/hr. time to hire more staff. a lot more. I don't have the official #s yet, but am pretty sure I won our epic pool. my bet was 6 hr waits and 30 lwbs/shift. In our clinic, Epic caused a lot of problems. (waiting, waiting waiting....computer crashes, Rx printing was a disaster, having access to previous notes...etc, etc) Not a PA (yet) but the PA and surgeon I work with remain confused- even after two months of using it. I know they encourage real-time entry, but I always feel like I'm ignoring the patient when I look at a computer screen. So, I still write vitals down. Love talking to patients face to face! Also, Epic seems to be designed for a primary care setting. We work in a multi-specialty clinic, and the program doesn't flow with us all that well. Oh and billing is a nightmare too. It's so easy to mess that up. Not sure if I trust the ICD-9 codes in Epic. Pretty sure this billion dollar switch caused our company to go broke. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted August 2, 2015 Moderator Share Posted August 2, 2015 FIRST RULE OF ANY EMR IS FOLLOW THE RULE OF ABC (always be charting). any time you have a free minute you need to ask yourself if you can write anything in anyone's note. on hold with a consultant? type an MDM. waiting for a nurse to vital your next patient and do the 20 min prep for you to see them? write more notes... I refuse to chart after my shift or from home. that's called working for free. not going to do it. Link to comment Share on other sites More sharing options...
cinntsp Posted August 2, 2015 Share Posted August 2, 2015 I use Cerner now as well as when I was in school and find it very easy to use. Everything is easily accessed from the home screen. Templates can be made to speed things up greatly, i.e. a progress note template that automatically pulls in the last 24hrs of labs/vitals, meds, radiology studies, etc. Update the subjective, click the physical exam findings, make plan updates...and done! I do tend to dictate via phone for admits/discharges though. Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted August 2, 2015 Share Posted August 2, 2015 At our snot/cough clinic using Cerner I type everything with macro's as opposed to the point/clink templates. I'm faster that way. Finding what I want to click and select takes too much time which I think is why they added the free-text option within the program (actually two in one). Sometimes, for whatever reason, the billing doesn't pull up the diagnosis though one is selected and I have to go back and re-enter the selection. Link to comment Share on other sites More sharing options...
normalnancy Posted August 3, 2015 Share Posted August 3, 2015 We use Amazing Charts at our practice. It's VERY simple and user friendly. Sometimes it's too simple (like it doesn't have the capability of telling you what time a patient checks in and how long they've been waiting--like eClinical Works does, which I've used as well). I like that about eClinical but other than that I found it to be too complex. We have also used Practice Fusion and I do not like that it is web-based and also much less user friendly than what we have now. Link to comment Share on other sites More sharing options...
RealityCheck Posted August 5, 2015 Share Posted August 5, 2015 The key to Epic is "at the elbow" support and a good strong team for that. One of the few benefits of corporate medicine is having a massive Gaggle of Geeks who come to help when anything stunning happens. I have a guy on instant messaging from the Epic support center who answers my every call and logs into my computer and fixes things in real time. No service orders or emailing the help desk. The corporate medicine philosophy is that a provider not producing is not producing. Keep the minions working and making $$$$. I am thankful for having the real time support and a good person but it doesn't outweigh all of the corporate medicine BS that I have to put up with. In a small organization it is really hard to get awesome on sight help on a go-live. I got to start training a week before I even saw a patient in the system and used a ton of fake patients to create encounters and order junk and make mistakes and all the time had this guy at my elbow - patience of a saint this one - to help me start seeing patients. All I can say is Push for Support and training, find a super-user and keep explaining to patients that someone other than you is making decisions and I can do right by them medically but have little control over the paper trail and data entry. I still have REAL Rx pads stashed for the inevitable moment when the system fails me miserably. I can still get the patient out the door. Link to comment Share on other sites More sharing options...
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