EMR Study. productivity goes down

[EMEDPA]

no surprise here. the only surprise to me is that it didn't go down more. my experience at 3 facilities going from paper or dictation to EMR has been a 50% decline in productivity which never gets better. this study only found 30%:

3. Resident’s Use of EHR

Dec 16, 2013

Talk about your ship of fools.  As if almost surprised, a researcher claims a survey of 122 family medicine residents found that documentation time increased by about 16 minutes per patient encounter following implementation of an electronic health record system at two academic medical institutions in Southern California.  Also reported was:

1. An overall decrease in resident productivity at both academic institutions following implementation of the EHR: a 30% decrease at RCRMC and a 20% decrease at PVHMC.
2. The residents also reported missing an average of two educational didactic lecture sessions per month in order to complete EHR notes.
3. In addition to missing didactic lectures, residents from both institutions used an average of 45 minutes of personal time to complete notes for a typical half-day clinic.

So, EHRs add work and take away from the practice of medicine and your personal life?  No shit.  Welcome to the real world, residents, except it gets exponentially worse because you get to see a lot more patients when you get out.  :)

 

 

 

source: http://authenticmedicine.com/authentic-medicine-gazette/

[skyblu]

I'm not surprised. I saw this article about EM physicians (can extrapolate to PA's, since I personally do just as much if not more EMR stuff than our docs) and the huge percentage of time spent on this vs direct patient care:

 

http://www.ajemjournal.com/article/S0735-6757(13)00405-1/abstract

[Gopherfan23]

I have used paper charts in the past, and I can say with 100% certainty that I prefer EMR over paper charts.  I started with EPIC EMR 4-5 years ago with the understanding that EMR isn't going anywhere.  There are some dinosaurs in my practice who refuse to adapt with change.  I've worked to build templates and order sets to decrease the number of clicks I need to make per patient.  I feel like I have plenty of time to meet with patients and get my notes done in the confines of my shift.  I run a website that contains all my smart phrases and note templates, but I don't want to post it here for fear of getting banned.

[LKPAC]

I also prefer the EMR.  I use Dragon to dictate and everything is at my fingertips, no more searching through stacks of paper in a folder.  The EMR helps me remember important items such as who needs a flu or pneumonia vaccine, last mammogram, next colonoscopy, etc.  I am just as efficient time-wise as I was before, seeing a patient every 10-15 minutes.  I've been a PA for over 25 years, the last three on EMR and I wouldn't go back.

 

E-Clinical Works in office, Cerner at hospital.  Yes, they talk to each other.  My labs and DIs get placed in my chart and on my virtual desktop automatically.  My Rx refills are a breeze.

[EMEDPA]

I like exit care for writing rxs and after visit summaries. one place I work used this along with paper or dictation before going to epic.

I think that was the best of both worlds: quick documentation with legible rxs and instructions.

as far as the available emrs out there for em I have used many at this point. none are great but the trend at least for me is this:

electronic T-system>cerner>epic>meditech.

most places are going to epic even though it is at best the 3rd place em emr out there in terms of usability because it is in essence a primary care system being forced on em providers. . so much extra crap built into the templates which is totally not needed like a full page procedure note to drain a paronychia with betadine and an 18g needle. I can see using epic for primary care stuff. a dm or htn check is pretty routine and can be fairly similar pt to pt but may em encounters require a lot of free texting outside of the templates if you want a third party to be able to understand your note. at the end of every single epic note I do I put an ed summary free texted with presentation, pertinent exam, labs, ddx and plan so the next day if the pt comes back someone else will know what I was thinking. really that summary could be the stand alone note but the coders would code it as a level 1 and we all know emrs are about generating money so that just wouldn't do....

[Gopherfan23]

EMEDPA,

 

I do agree with you on some topics.  EPIC isn't the best EMR out there, but it is becoming the most popular and it's what the majority of providers have. 

 

The beauty of the system is the "extra crap"!  I never have to type in problem lists or medications.  You get your 4 points on your HPI, let EPIC templates do their magic, and then use a smart phrase in the HPI and fill in the basics.  2-3 minutes per chart with >90% of my charts are level 5 billing (that are eligible).  Again, I am hesitent to do this because my business partner got banned from paforum, but there are a number of helpful videos on my site (epic-smart-phrases.com) that show you just how easy it is to get through a note.  There should be no reason you should have to free text a note at the end because it should be all documented in your note.

[UGoLong]

We deal with several different EMRs, which is a cause for confusion for us. In general, I feel that our productivity has gone up in the office and rounding in the hospital because (1) notes are easy, (2) records are at your fingertips, (3) reconciling scripts etc is easier in the office, (4) figuring out if someone is cleared for surgery based on test results is easier.

 

The big deal is tailoring your EMR for what you do. The Cerner progress note was unwieldy for us, until we carved it back. You also need to weigh between typing a few words when you need to, versus trying to make a template do everything. The point of diminishing returns is something that I think each of us needs to find for our own practices.

 

P.S. Not sure why you guys like Cerner over Epic.  

[EMEDPA]

U- cerner is a lot more streamlined than epic for em at least. you can do a 1 sentance procedure note in their template, not so in epic. you can also see the entire encounter on 1 screen.

the other issue with epic is it takes longer for providers to get in to see a pt because now the in room nursing assessment takes 20 min. all I really want is c/c, vitals, med list and allergies. everything else is fluff for billing purposes. They are inputing a lot of stuff that used to be the purview of providers. sure, if someone is crashing you don't worry about it but for a run of the mill pt the nurses are very territorial about it being "their turn" with the pt so they can ask all the required stuff, most of which I could care less about like social hx stuff. if its relevant I will ask. I don't care if they live alone or with their 5 cousins if the complaint is ankle sprain and they are 22 yrs old. I don't need to know if the 240 lb football player feels safe in his home if I am seeing him for a runny nose and cough.

[FSUnoles]

We use epic in here at Univ of Miami. its not bad once you set up templates