EMR Rant

[Tegridy]

Something to think about when choosing aa job, the EMR.

I am fairly young and have been using computers for >20 years. Having worked in several hospitals in many different roles, I have experienced variable EMRs. Something those hunting for a job (let us say in primary care, though I am going into a specialty), EMRs can really make or break you. We do, honestly, live in an information age where paper charts will not get people very far with the amounts of data we have to sort through. With that being said, your first job should consider which EMR you use for several reasons: learning to be a provider, giving good patient care, and learning your trade.

The first place I ever worked used raw dictation, a mix of paper charts, and computer record systems to dig through and add to a patient’s dataset. It actually was not that bad. I will not hound on this since these setups are rarely found anymore due to the req for purely digital EMRs.

I current work (residency), in a place where we use several EMRs. In short, the worst in all scripts basic (essentially garbage), the best is epic (best I have used yet). In the middle are Sorian (old cerner), and CPRS (the VA).

Epic is great for many reasons: you can find patient data (search function), notes are easy to write, and the screen is easy to read. Labs, rads, and most everything are set up where they are easily accessible. Personalization is easy, and the options are limitless, though NOT required to understand to provide good patient care. from what I have used, this is the best system to learn medicine on.

Sorian: It is OK. Outdated but not used anymore except by hospitals honestly waiting to transition to newer EMRs. Notes are easy to write, most things are easy to find, and actions are often auto-populated into progress notes. It is a middle of the road system.

CPRS: Honestly not great but sadly better than some EMR out there It does resemble a Windows 98 program, though seems to be set up fairly simply (probably varies at each VA). When in doubt, you can free text things into notes, and labs are not too hard to find. It seems to be hard to personalize, and many VAMC facilities have people make templates which are usually worse than free texting. The best part of this EMR is the front page, which reveals most important information without too many clicks.

Allscripts: I believe we have to basic version, which is basically garbage. Notes are difficult to read, scanned in docs are almost unreadable, and trying to find old information is probably worse than the paper EMR. Free-text boxes are small and hard to read (I am in my early 30s, it is not a vision problem). Any company that uses allscripts basic is almost certainly garbage. From what I have experienced, it is hard to deliver good patient care on this system.

/Point of the rant: What EMR your first job or two has matters. Pick one with a good one. If they have allscripts basic, run. I would quit but you cannot in residency. I would question the intelligence of any management that chooses allscripts basic as an EMR. It may be cheap, but the cost is that of rather poor patient care, and hours clicking stupid boxes that do not exist on other EMR.

There may be worse ones out there, but once you taste garbage, you know its scent, and should avoid it all costs.

[Nurse2It1000]

I completely understand your frustration, but you may be surprised to learn that it is not always the EHR program's fault. In many cases, it is the hospital's IT department that is responsible for issues related to the EHR.

All EHRs are able to support a range of clinical workflows, from basic to complex. However, It is important to remember that EHRs need to be regularly maintained to ensure they are up to date and support changing clinical workflows. EHR vendors release new content, updates, and optional add-ons, just as cars require regularly scheduled maintenance, updates, and sometimes new parts to run smoothly. It is important for hospitals to properly configure the system to meet user's needs, just as one would maintain oil, tires, and gas in a car. 

Hospitals' IT departments often fall short in enabling EHR workflows and maintaining EHRs as required. To address this issue, Clinicians need to hold IT accountable for ensuring EHRs contain the latest software capabilities. I would suggest for every issue you find, I would open a IT ticket, as well as an Incident Ticket. It's very common for multidisciplinary teams to review all incident tickets and require follow-up measures. This could be a great way for clinicians to voice their frustrations and keep IT accountable. 

 

 

[Tegridy]

2 hours ago, Nurse2It1000 said:

I completely understand your frustration, but you may be surprised to learn that it is not always the EHR program's fault. In many cases, it is the hospital's IT department that is responsible for issues related to the EHR.

All EHRs are able to support a range of clinical workflows, from basic to complex. However, It is important to remember that EHRs need to be regularly maintained to ensure they are up to date and support changing clinical workflows. EHR vendors release new content, updates, and optional add-ons, just as cars require regularly scheduled maintenance, updates, and sometimes new parts to run smoothly. It is important for hospitals to properly configure the system to meet user's needs, just as one would maintain oil, tires, and gas in a car. 

Hospitals' IT departments often fall short in enabling EHR workflows and maintaining EHRs as required. To address this issue, Clinicians need to hold IT accountable for ensuring EHRs contain the latest software capabilities. I would suggest for every issue you find, I would open a IT ticket, as well as an Incident Ticket. It's very common for multidisciplinary teams to review all incident tickets and require follow-up measures. This could be a great way for clinicians to voice their frustrations and keep IT accountable. 

 

 

I agree. At least part of the allscripts issue is our university pays for the cheapest version of an already bad emr and I doubt they keep it updated at all. Most of the issues sadly aren’t ticketable probably. It works, it just works poorly all the time and is so much worse than every other emr I’ve used. But I’m done in six months at least ?. I may just send I. Daily tickets saying it’s slow and terrible though to see if they can pull out the ole boot. 

[djmatte, ADN, MSN, RN, NP]

EHRs can be a double edged sword. They’re really only as good as the information they collect and grant access to. Unfortunately that data can be vast and can even hit a point of negative gains. Many of these newer systems could be exceptionally intuitional where it could take a range of data points and help guide care. Except so few people utilize our input the right data into those options that we still find ourselves accessing a range of external resources just to keep our work flow going. 

I’ve also found these things are only as good as the clinician willing to put in the back work to improve their own use. When I used epic, I took the time both on my own and as I charted to create smart phrases for a range of plans and assessment options for standard diagnoses. I had over 80 after three years of working with it. When my military unit added genesis, I did the same thing which infinitely improved my workflow. Few clinicians I know are willing to put in this time and struggle as a result.  Many complain about that system but it’s way better than ahlta and I’d argue is better than epic with the customization we have access to. 
 

 

[Nurse2It1000]

djmatte said:

EHRs can be a double edged sword. They’re really only as good as the information they collect and grant access to. Unfortunately that data can be vast and can even hit a point of negative gains. Many of these newer systems could be exceptionally intuitional where it could take a range of data points and help guide care. Except so few people utilize our input the right data into those options that we still find ourselves accessing a range of external resources just to keep our work flow going. 

I’ve also found these things are only as good as the clinician willing to put in the back work to improve their own use. When I used epic, I took the time both on my own and as I charted to create smart phrases for a range of plans and assessment options for standard diagnoses. I had over 80 after three years of working with it. When my military unit added genesis, I did the same thing which infinitely improved my workflow. Few clinicians I know are willing to put in this time and struggle as a result.  Many complain about that system but it’s way better than ahlta and I’d argue is better than epic with the customization we have access to. 
 

 

Excellent Point! 
 

I once was asked by a physician, if Epic is the Cadillac of EHR systems, why am I sitting here creating my smart “things” and making favorites? I responded, with these questions - “when you bought your last car, did the radio already have you favorite stations? Was the seat positioned in the right place? What about the mirrors?” 

[Tegridy]

djmatte said:

EHRs can be a double edged sword. They’re really only as good as the information they collect and grant access to. Unfortunately that data can be vast and can even hit a point of negative gains. Many of these newer systems could be exceptionally intuitional where it could take a range of data points and help guide care. Except so few people utilize our input the right data into those options that we still find ourselves accessing a range of external resources just to keep our work flow going. 

I’ve also found these things are only as good as the clinician willing to put in the back work to improve their own use. When I used epic, I took the time both on my own and as I charted to create smart phrases for a range of plans and assessment options for standard diagnoses. I had over 80 after three years of working with it. When my military unit added genesis, I did the same thing which infinitely improved my workflow. Few clinicians I know are willing to put in this time and struggle as a result.  Many complain about that system but it’s way better than ahlta and I’d argue is better than epic with the customization we have access to. 
 

 

Some are definitely superior to others. I’ve not heard of Genesis. Or the EMR platform that it is used on. CPRS has a few workarounds for making notes and other things fairly easy, but putting in orders is very tenuous as it does not have a global search function for most things besides medication. The basic version of all scripts has dot phrases but unfortunately not phrases or not something that  can improve the worst aspects of the EMR. I have used a few other ones, but I forgot the name to them. Dot phrases def make epic very manageable. 

[djmatte, ADN, MSN, RN, NP]

Genesis is essentially a different version of powerchart. I actually find it superior to epic because they take smart phrases to a different level. Where epic relegated them to dot phrases, Genesis allows any combination of letters or punctuation to create them. 

[Tegridy]

oh that does sound nice. 

The VA has some sort of "booster" program which helps with some things, but its one of the only systems without global search functions. We don't work there often, which is great but makes ordering things difficult since it has so many menus, not many of which are intuitive. ?