Nurses Give EHR Usage a Usability Rating of F

[Natkat, BSN, MSN, RN]

This is not news as it is something we have all experienced for a long time. Dealing with EHR platforms that are complicated and not user friendly has made our jobs more difficult. 

 

https://www.healthcareitnews.com/news/nurses-give-ehr-usability-f-new-study

 

[CABGpatch_RN, BSN]

The #1 suckiest EHR is Meditech, without a doubt.  A system created by and for the for-profit HCA.

[Hannahbanana, BSN, MSN]

LNCs review EHRs all the time. They are dreadful. My colleagues just hate them too, for related reasons. For one thing, unless you’ve been involved in a litigated case I’ll be you didn’t know that the pile of records we get bear pretty much no resemblance to what you see. One of my (not at all) faves was 8743 unnumbered pp of stuff that included about forty pp each containing one thing, e.g., “7.41,” “WNL,” “Yes,” “896,” and the like. No clue as to what these referred to.
Then there were the raft of pp with systolic BPs, a couple of inches later (different dates) a pile of diastolics, and later still some means. No way to correlate with pressors, or any other data. These actually came from a case in a hospital where one of my high school classmates was a DON. I redacted (removed) identifying patient info and sent her some of it, saying, “Please tell me this isn’t what your nurses have to work with.” She was appalled.
I would tell my attorney to plunk down a pile like this in front of a nurse in deposition and ask her to show him where she charted something. Not possible.
I felt mean, bec it wasn’t her fault, but records derived for purposes of capturing billing are useless as a clinical communications tool, and can sink you at trial.
And don’t even get me started on the contortions necessary to find out underlying info on who accessed information, changed things, erased things, or saw things. RT might not be able to see things on their screen that pharmacy can see, nurses certainly can’t see other screens, physicians can’t see others, and more. I couldn’t just ask for “all records for John Doe for the admission of May 15-23, 2017” and actually, like, get the underlying metadata without specific requests. Throw in the data that gets automatically included from smart monitors, pumps, vents, or other gadgetry, and ... It’s crazy. 

[TriciaJ, RN]

On 4/23/2021 at 5:21 AM, Hannahbanana said:

 One of my (not at all) faves was 8743 unnumbered pp of stuff that included about forty pp each containing one thing, e.g., “7.41,” “WNL,” “Yes,” “896,” and the like. No clue as to what these referred to.
Then there were the raft of pp with systolic BPs, a couple of inches later (different dates) a pile of diastolics, and later still some means. No way to correlate with pressors, or any other data.
 

So we're decimating whole forests to print piles of uselessness?  In this day and age?  Unbefrickinglievable.

[Hannahbanana, BSN, MSN]

3 hours ago, TriciaJ said:

So we're decimating whole forests to print piles of uselessness?  In this day and age?  Unbefrickinglievable.

The old guys who didn’t even trust fax machines are mostly gone, LOL. Fortunately, most law firms nowadays deal with electronic  files, so I get my cases in PDF via Dropbox or other FTP (file transfer protocol) means. They are easier to deal c in some ways, not in others, but applying a little software to them I can at least sort and search in most of them. Still a ton of duplication and uselessness in there; I still need to take the time to place eyeballs on every goldern page. At least I don’t stub my toes on big boxes when walking into my office. 
Many of us wish for the days of written records. As in the AN of yore, you could scan a lot of pages for a particular color (lab was yellow, nursing notes had a blue border, etc.) or handwriting (who always used a blue-black ink fountain pen?). 
When you consider the nine uses of medical records, it’s clear that the EHR doesn’t go far enough to meet several of them. Sigh. 

[TriciaJ, RN]

I've never really missed paper charting - tomes of unreadable handwriting.  But you'd think EHR would be a little more advanced than it is.  I get that systems were built around billing but nursing informatics has been a thing for quite a while.  I thought we'd have useful records by now.

[Hannahbanana, BSN, MSN]

Nah, money is everything. If it weren’t we’d have adequate staffing and paychecks. 

[Natkat, BSN, MSN, RN]

On 4/23/2021 at 12:05 AM, CABGpatch_RN said:

The #1 suckiest EHR is Meditech, without a doubt.  A system created by and for the for-profit HCA.

Sad to say, I've used some that are way worse. And that's really saying something because Meditech is horrible.

 

[Natkat, BSN, MSN, RN]

On 4/23/2021 at 7:21 AM, Hannahbanana said:

And don’t even get me started on the contortions necessary to find out underlying info on who accessed information, changed things, erased things, or saw things. RT might not be able to see things on their screen that pharmacy can see, nurses certainly can’t see other screens, physicians can’t see others, and more. I couldn’t just ask for “all records for John Doe for the admission of May 15-23, 2017” and actually, like, get the underlying metadata without specific requests. Throw in the data that gets automatically included from smart monitors, pumps, vents, or other gadgetry, and ... It’s crazy. 

This is a similar problem to what I deal with constantly. I will get dinged by an auditor that says something like "you didn't complete the blah blah blah on page blah blah blah".  They will give me a printed copy of the document and it looks nothing like the data entry screen where I'm supposed to do this.  More often than not it'll be on page 16 of the data entry screen and go to that little icon in the lower left hand corner. I have to unclick the check box to get to the menu, then click on the radio button to open the data entry screen. But I can't just hit enter to get in there. No. I have to put my mouse pointer in there even though the cursor is already there and I should be able to type it.  Then I have to click final, then submit, then save.  Honestly. Who designs this stuff? If it's informatics nurses, you are letting us down. 

[Natkat, BSN, MSN, RN]

On 4/24/2021 at 5:44 PM, Hannahbanana said:

Many of us wish for the days of written records. As in the AN of yore, you could scan a lot of pages for a particular color (lab was yellow, nursing notes had a blue border, etc.) or handwriting (who always used a blue-black ink fountain pen?). 
When you consider the nine uses of medical records, it’s clear that the EHR doesn’t go far enough to meet several of them. Sigh. 

I started my career in medical records when everything was paper based. I took my first computer class right about the time things were starting to go electronic, so I was able to live in both worlds comfortably for a long time.  I am the rare person who does okay when the system goes down and we have to do paper charting.  I was a big advocate for digitized medical records. I thought it was a great idea.  What I didn't count on was how badly they could mangle the execution. EHRs are a disaster I could not have imagined. 

[Natkat, BSN, MSN, RN]

On 4/24/2021 at 6:59 PM, TriciaJ said:

I've never really missed paper charting - tomes of unreadable handwriting.  But you'd think EHR would be a little more advanced than it is.  I get that systems were built around billing but nursing informatics has been a thing for quite a while.  I thought we'd have useful records by now.

Oh man, I just said something like that. Why can't nurse informatics bridge this gap more effectively? 

I envision the development of EHRs goes something like this. 

Developer: Okay, so let's sit down and develop an EHR for nurses. So tell me what you nurses need to do your job.

Nurse: We need to chart our assessments and progress notes, look at test results and communicate with the doctor.

Developer: *develops something*  How's this?

Nurse: No, not like that. 

Developer: Okay what doesn't work for you? How can we make it work better?

Nurse: I have no idea. Just do whatever. 

Developer: Okay. I'll just come up with something. 

[Kitiger, RN]

One of the agencies that I work through started us using an electronic charting system. It's a pain, but - after a LOT of tweaking - it now works fairly well, except for the suction log!

Turns out, they are required to sent a hard copy of the suction log, but the software won't allow them to group the entries. They would have had to send in a separate page for every entry. So they have us chart on paper for the suction log.