Anyone using 100% EMR order entry?

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Specifically any hospitals requiring docs to do order entry directly into the computer with no paper backup?

If so, how do you like it? How has it been working? Drawbacks?

I am really interested to hear your stories!

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No, we don't have this in our hospital. But as an ex-IT guy, this is the best and the right thing to do. Basically, the software can be programmed to linked to various department. The MD's order will be forwarded real time and there will be a lot less error. There will be no guessing of the MD's handwriting. There will be no faxing or delivering meds order to pharmacy. Radiology orders entered will be showed up in their department's computer screen. As I work in hospital environment daily, the majority of the problems are caused by inefficient work flow. These kinds of problems can be eliminated by software that runs on computer networks. Hospitals are very old fashion, it takes them forever to realize the benefits of computer technologies.

If I were to design the system, I'd make it touch screen like most ER systems. This will make it very easy for the MDs, especially those from old schools to use the system. Then after they select everything they want, the screen will show the list of their order for review before they hit the "comfirm order" button.

We can also make it remote accessible to the MDs. Therefore, they can dial-in and connect to the hospital's system and give orders. After they put in an order remotely, the nurse's station's computer will have a pop up screen prompting the nurse/secretary to note the order etc... Oh, how wonderful !

Enough dreaming.....I'll still be dealing with pen and paper tomorrow....

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i work in a veterans hospital and we are totally computerized--all orders must go into the computer. only in real emergencies are we to take verbal orders--med orders go directly to pharmacy, same with labs, diets, xrays, consults etc. we have a back up papersystem in place when computers "go down"--we give irm time to solve problem then we start "downtime"orders after go ahead from admin-- we also have totally barcoded med admin using computers--we have one designated computer that will print out med sheets ( the old-fashioned kind)-even when main computers are down-- and they will also print out pts history,current meds and recent labs as ALL pt info is in computer---we really haven't had any long time down time-- the longest was i think less than 24 hours-- i totally love these systems

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No, we don't have this in our hospital. But as an ex-IT guy, this is the best and the right thing to do. Basically, the software can be programmed to linked to various department. The MD's order will be forwarded real time and there will be a lot less error. There will be no guessing of the MD's handwriting. There will be no faxing or delivering meds order to pharmacy. Radiology orders entered will be showed up in their department's computer screen. As I work in hospital environment daily, the majority of the problems are caused by inefficient work flow. These kinds of problems can be eliminated by software that runs on computer networks. Hospitals are very old fashion, it takes them forever to realize the benefits of computer technologies.

If I were to design the system, I'd make it touch screen like most ER systems. This will make it very easy for the MDs, especially those from old schools to use the system. Then after they select everything they want, the screen will show the list of their order for review before they hit the "comfirm order" button.

We can also make it remote accessible to the MDs. Therefore, they can dial-in and connect to the hospital's system and give orders. After they put in an order remotely, the nurse's station's computer will have a pop up screen prompting the nurse/secretary to note the order etc... Oh, how wonderful !

Enough dreaming.....I'll still be dealing with pen and paper tomorrow....

Totally agree! I've worked in IT as well, and also don't understand why so many hospitals need to be pulled kicking and screaming into the late 20th century, let alone the 21st.

Rather than jamming things like magnet status down our throats, what about improving efficiencies? I don't get this mentality. IMO this is one huge example of how nursing is kept as a scapegoat..."That nurse must have transcribed my order incorrectly."

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Totally agree! I've worked in IT as well, and also don't understand why so many hospitals need to be pulled kicking and screaming into the late 20th century, let alone the 21st.

Rather than jamming things like magnet status down our throats, what about improving efficiencies? I don't get this mentality. IMO this is one huge example of how nursing is kept as a scapegoat..."That nurse must have transcribed my order incorrectly."

A nurse is just a coordinator, nothing more than a coordinator. You take orders and carry them out. When you see things not pull together, you call MDs, pharm, radiology etc. When things not working right, we get the blame. If we replace this area of work with computers, then we will be only doing the *real* nursing care work, then we have less terriorities. Terriorites have higher priority over efficiency due to insecurity. I missed the mentality and openess of the IT geeks. Another example of inefficiency in nursing is chain of command (read: controlling and filtering of truth).

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i work in a veterans hospital and we are totally computerized--all orders must go into the computer. only in real emergencies are we to take verbal orders--med orders go directly to pharmacy, same with labs, diets, xrays, consults etc. we have a back up papersystem in place when computers "go down"--we give irm time to solve problem then we start "downtime"orders after go ahead from admin

It's the same as above for us. I LOVE it. As a student I had a chance to do clinicals at several facilities with different methods. The EMR was one of the reasons I work where I do. We will soon be going completly "paperless", for all charting etc. I can't wait. I hate writing. I'd rather type.

~Jen

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A nurse is just a coordinator, nothing more than a coordinator. You take orders and carry them out. When you see things not pull together, you call MDs, pharm, radiology etc. When things not working right, we get the blame. If we replace this area of work with computers, then we will be only doing the *real* nursing care work, then we have less terriorities. Terriorites have higher priority over efficiency due to insecurity. I missed the mentality and openess of the IT geeks. Another example of inefficiency in nursing is chain of command (read: controlling and filtering of truth).

Hmm...I had a knee jerk response here but perhaps I am misunderstanding. You are stating that computers are taking "territory" away from nurses? Please explain.

Good EMR systems do nothing of the sort, which is why I am asking. If giving up "territory" means that I don't get blamed for a crappy order, then I'm all for it!

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Hmm...I had a knee jerk response here but perhaps I am misunderstanding. You are stating that computers are taking "territory" away from nurses? Please explain.

Good EMR systems do nothing of the sort, which is why I am asking. If giving up "territory" means that I don't get blamed for a crappy order, then I'm all for it!

Maybe I need to elaborate more here. When I was in IT, I saw the maturation of computer technologies. Actually, I designed systems to automate as much workflow as possible. Therefore, things used to require many people and lots of intervention can be automated hence reduce head count. Workers then started to loose their territories due to the replacement of workflow by computers and led to many layoffs. Also, when one was doing things all manually would empower his/her work. Technologies reduce the empowerment and autonomy of workers. An example in IT is to use networking management systems to automate software upgrade. I can package a service pack to push to all the workstations in the network during off hours, therefore, my technicians will be loosing their territory (installing service packs manually) and eventually many of them will be eliminated. The existence of the remaining techs will be a lot less significant because the company can do automation now. I have observed a huge difference between interfacing with IT geeks and with nursing staffs. While IT always stresses on efficiency, nursing stresses on introducing more and more unnecessary policies (work). I believe the mentality plays a big part in it and the most obvious one is "fear". Maybe more work means more secure?

I hope I have not offended anyone here.

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Maybe I need to elaborate more here. When I was in IT, I saw the maturation of computer technologies. Actually, I designed systems to automate as much workflow as possible. Therefore, things used to require many people and lots of intervention can be automated hence reduce head count. Workers then started to loose their territories due to the replacement of workflow by computers and led to many layoffs. Also, when one was doing things all manually would empower his/her work. Technologies reduce the empowerment and autonomy of workers. An example in IT is to use networking management systems to automate software upgrade. I can package a service pack to push to all the workstations in the network during off hours, therefore, my technicians will be loosing their territory (installing service packs manually) and eventually many of them will be eliminated. The existence of the remaining techs will be a lot less significant because the company can do automation now. I have observed a huge difference between interfacing with IT geeks and with nursing staffs. While IT always stresses on efficiency, nursing stresses on introducing more and more unnecessary policies (work). I believe the mentality plays a big part in it and the most obvious one is "fear". Maybe more work means more secure?

I hope I have not offended anyone here.

I see where you are coming from. And I agree that there is a huge difference between 'general IT' technologies and RN (hopefully) oriented EMR systems. We are talking about highly customized systems in HIM, often customized from facility to facility. And, of course, nurses are still ultimately responsible for giving a medication from an EMR order, which is much different than having the newest Windows Update pushed to 2 thousand PC's on a network. The end user really has no ownership of the Windows update, which is not true for HIM operations.

So it seems we do agree, to a point. :wink2:

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I see where you are coming from. And I agree that there is a huge difference between 'general IT' technologies and RN (hopefully) oriented EMR systems. We are talking about highly customized systems in HIM, often customized from facility to facility. And, of course, nurses are still ultimately responsible for giving a medication from an EMR order, which is much different than having the newest Windows Update pushed to 2 thousand PC's on a network. The end user really has no ownership of the Windows update, which is not true for HIM operations.

So it seems we do agree, to a point. :wink2:

I don't think I ever disagree with you ;) . What I have been trying to say is my speculation for the reasons that hospitals are slow or reluctant to use technologies for work flow. Hospitals do use technologies for diagnostics dept (such as PET scan equipment). However, work flow is ancient. IMHO, the systems to improve workflow is not considered investment for generating income. Here's another speculation, if there is such a computerized system to improve the workflow, our pt ratio is going to get much higher. They'll say: "Now, you guys don't need to do this or that so everyone has 12 patients." In fact, I have news from insiders of a local hospital that use computer systems like this has very high pt ratio (to 12 pts). Their ICU has a 1 to 5 ratio too. So, one way or another, we can't win.

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