EMR in the ED

LilgirlRN, ADN, RN · Nov 19, 2009

We use FirstNet!!! LOVE it!!!!!!!!!

crb613, BSN, RN · Nov 22, 2009

We had Ibex.....loved it! and upgraded ( what a joke) to Meditech....its horrible!

EmergencyNrse · Nov 22, 2009

T-System! The Ferrari of EMR systems.

The rest like CERNER and Wellsoft are like Yugo's by comparison.

Tonjia · Dec 3, 2009

we used EDM from Meditech. I love it, as long as you incorporate all of the modules with it (PDOC, PCI etc) then it is a very high functioning system.

Emergency RN · Dec 3, 2009

When it's working, it's great. When it's not, it's horrible. We use HMED and it has a tremendous learning curve, and the problems that crop up are eye opening.

If you're going to be the one to authorize the system, don't sign on the money line until they fix all the potential problems first. This can be with computer communications of one their programs to any pre-existing but essential program that you may already have. If they (meaning the computer world) can port Windows programs to a Mac through emulation, then there isn't anything that cannot be made to communicate with another program (and don't let them tell you it's impossible, what they're really saying is, they don't want to have to pay someone to do it). If this is the case, let them know in no uncertain terms that the contract rests on those sorts of details; that if they cannot solve something simple like that, then you'll look elsewhere. Further, like someone else alluded to support will be a lifelong issue. Ask to see a list of their customers so that you can call them and solicit opinions. If they don't want to give it to you, then forget them. If they do, ask the nurse managers there (not the IT people) what the issues with the computers have been and how quick is support resolution, and whether or not they would purchase the system if they had the choice again.

Before spending millions of your institutional dollars on something that is going to stay with you for years to come, make the vendor earn every penny. Test run the thing in say, only one or two pilot units for a year. See what problems crop up, and see that the vendor solves them first, before buying. This way, you can be sure to get a system that quickly dovetails into your hospital and community needs. After all, we're there to take care of patients, not to fix computer problems.

Good luck.

MassED, BSN, RN · Dec 3, 2009

EMR through Meditech. Hate it. It is way too complicated and doesn't allow for easy maneuvering when you're searching for labs, xrays, H&P's, etc. I think it would be great for the floor, but not in the ED. I had used MedHost in the past, which then communicated to Meditech for the floor, so they were able to access the information. That was wonderful. Sure wish the North East would catch up and implement the touch and click system of charting in the ER. Life was sooooo much easier with that system.

MassED, BSN, RN · Dec 3, 2009

Obviously I can be of no help because I have never heard of EMR or IBEX. I have been a traveling ER nurse for 5 years and have not come into contact with anything with those initials. Maybe you could enlighten those of us in the dark.

I'm surprised you have never encountered an EMR in 5 years. I have never worked at an institution that does not have it. I've worked in 3 states and know nurses in many others, and all have EMR. Do you work in a hospital?

MassED, BSN, RN · Dec 3, 2009

We use codonix currently in our ED. The hospital uses Meditech. These 2 do not work together. The docs bought Codonix to help with their billing-fair program- We will be switching to Meditech in the summer--hope it's a good system for ED charting
Anne

no, Meditech is not an ER specific charting system. This is what I am currently using also, and there are many features to it that are not ER specific. It is ridiculous. You have to click in and out of a screen on a patient to find items - when you call report, you don't have all you need in front of you and you have to go into the EMR to find what you need. It doesn't flow well.

MassED, BSN, RN · Dec 3, 2009

By the way, I started working with Meditech 15 years ago and it hasn't changed one bit. There are upgrades, but for some reason, the powers that be must be resistant to change. After all these years for Meditech to be the same animal is ridiculous. For instance, Meditech MUST have the capability to capture ER charges, but we're still doing paper charges for IV's and fluids, even though you chart IV info into Meditech. Also, you have to enter history with each visit, as opposed to the history being pulled from each previous visit automatically. This is something that is possible, but not done in the ER. This would make our lives easier - we could verify the information and move on. If a patient comes in with SOB and we enter their info and see their meds that are there from a previous visit and could see their history, we would know a lot before even asking the patient. If more IT people were nurses, it would make our lives more stream lined.

MassED, BSN, RN · Dec 3, 2009

we use ibex. we were the first ed in nj to go paperless, but not without heartache. the quality of our documetation is suffering, not to mention the ease of finger swipe errors. people just arent documenting things they would have had it been right in front of them. i have the unlucky pleasure of doing hundreds of chart audits a month and i read some charts and cringe.
for example, we had a brain dead pt (huge bleed) who wound up being an organ donor very quickly.
after being declared brain dead twice and the procurement, the me read the chart and noticed the pt was a&ox3 on arrival. this was no where near the truth, but was entered into the mr by habit. now this a big problem.
it also time stamps when you do your charting. if you dont enter the actual time you did something, it looks like it was done at the time you charted it. this was a big problem with another pt expiration.
the recall of pt visits and legibility is invaluable. rx writer should be great, too, once we get it.
it also takes a while to get software changes made through programming.
it also cant interface with our hospital's main charting system, which are jcaho problems w/ medication reconcilation and ed holds.
these problems might be inherent with any emr system, who knows? shop around and good luck!
uote=ernursie172]we are currently looking at different vendors for emr in our emergency department. if your ed is using emr i would love to hear your comments, pitfalls and all please!!! we will be doing a site visit at houston medical center in georgia to check out ibex next week.
thanks for your input....:)

oh my god, without the option to time edit, i'd be in trouble with my computer charting, as would probably 99.9% of er nurses.

Tonjia · Dec 4, 2009

no, Meditech is not an ER specific charting system. This is what I am currently using also, and there are many features to it that are not ER specific. It is ridiculous. You have to click in and out of a screen on a patient to find items - when you call report, you don't have all you need in front of you and you have to go into the EMR to find what you need. It doesn't flow well.

Meditech is the corporate name for the company who makes the system. The ER specific module is the "EDM".

I have been on 2 implementation teams for EDM. Your module is performing exactly as your implementation team built it. Each EDM module is fully customizable and can be built to specifics of your ED.

Overall, it is a very functional system, we have developed a "summary" option that allows us to click and read when giving report. All aspects of the patients visit including lab results are included in the summary. You might ask your IT representative if they would build one for yours too.

We also use a point and click assessment. we use IBM thinkpads and the touch tip pens that come with them. Do any of you guys work in an ED that has implemented PDOC?

we go live with PDOC in March and our docs are loving the chance to be involved in customizing the module.

As is consistent with any computer program, EDM is only as good as those who build it.

It also helps if you have an IT dept that is proactive in maintaining the module, ours are very helpful.

MassED, BSN, RN · Dec 4, 2009

we do have a "summary" option, but it is not comprehensive, and it is cumbersome when reading it - the information doesn't flow well. It is not a good fit for an ED. I believe they think it works well, possibly because they haven't worked in another ED with a fantastic charting system. I'm moving soon from this place, so we'll see how another place works with their charting. My luck, it'll be paper charting. Eeeeeekkkkk!!!!