Positive or Negative... EMR - page 2

Hi, Our rural hospital is in the process of implementing the" EMR" system. In my previous position we had access via Sorian, but it was more for a doctors use than for us. All I have heard it... Read More

  1. by   psu_213
    Quote from kikididi
    All I have heard it negative, negative negatice things about going electronically!
    I think this is the 'silent majority' effect. I.e., most people will love it...most who worked with it before love it. However, there is a relatively small number of people who hate it (either they hated working with an earlier system or the just hate the idea) and they will yell and scream and kick and moan about it to the point that they will drown out the majority who like it.

    Another thing...one place where I did clinicals for school did primarily paper charting, but some limited information was on the computer like lab results, vitals, dictations...well, the system was 20 years old, difficult to navigate (you could not point and click, you could not use the arrow keys...the only way to navigate was with the function keys and the tab key). It was so far behind the computer programs of the 21st century that it was almost impossible to use. Some people may be so 'turned off' but the limited capabilities of an old program, that they decide to hate a new program before the even try it. Just a thought.

    P.S. I think EMRs are wonderful!
  2. by   nurseprnRN
    I am glad to hear that EMR is useful at the bedside. I want to say that often it totally sucks when I have to review a chart for other reasons. I get a huge pile of printouts which may or may not be organized in any cohesive manner, even if, when you look at the sequential page numbers (1 to 2467...oy). If I want to follow all the labs, there MIGHT be a series of labs sheets....or the day-to-day results might be printed on the pages with today's dietary note, PT note, nursing note, MD note, and whatnot. Or what.

    I might get a daily flow sheet with notes, VS, and such, or I MIGHT get a pile of a hundred papers with nothing more on each page than one number (not labeled-- 7.23, 300, 0.005...2... WTH?) or one word or abbreviation (red...transported.... BMT...) and no dates. I might get all the MD progress notes sequentially-- this is, mercifully, fairly common-- but they are printed as if they are all on one long page that got cut at 11" intervals, so it's impossible to sort the whole chart by dates. I might get a page of BPs that give me a two thirds of a page of numbers marked :systolic: with a date and time for each one, followed by one third of a page of numbers labeled :diastolic: with a date and time for each one of them, followed by a new page with the second half of all the diastolics, and then the rest of that page is the pulse rates. Try and follow THAT for trends. If you get something useful on a screen that shows trends over time with cause and effect (like from hemodynamic gtts) while the patient is still in care, thank god for that. But once it goes to hard copy, it's crap.

    Add another page that "documents" hemodynamic med drips q10 minutes -- maybe I'll find this near the VS, but maybe it will be in a totally different box, hundreds of page numbers away-- and another for vent settings, another half a page for ICP (only charted q 1hour, though the gtts and the CO2s and the temps and NG output and osmos and the sodiums are all....somewhere...) and it's really, really hard to get a cohesive sense of narrrative.

    As to handwriting, great. However, you don't have to look around AN too far to see that there's considerable illiteracy in nurses (and probably in other disciplines). Just because I can easily read, "reciveed pt from ed allot of bloody dranage in foley reported to dr halppporin no new rders given tylnol as order" doesn't make me feel as if I have been informed by someone who knows what to look for.

    As for "What does ObamaCare have to do with it?" the Affordable Care Act mandates medical records go to the electronic format to help with record tracking and access from all quarters-- medical office, all departments in the hospital, the all-important billing, research, communication between disciplines, teaching... I believe there are exceptions allowed for small shops (I haven't read it recently) but over time any facility that doesn't go to some sort of EMR can be fined hugely, or have their bills denied or delayed.
  3. by   mmg7
    EMR is an up-to-date, fast way of providing patient care. It is so useful for communicating with other nurses nd disciplines when trying to access or see a patients information without having to lug through a hefty chart. Once you get the hang of using the new system, I guarantee that the positives will outweigh the negatives! Great system, for those of you who are hesitant, just give it a shot. After all, the point of the system is to provide faster and more effective, quality patient care... which ultimately is what our job is all about! The patients!
  4. by   nurseprnRN
    Quote from mmg7
    EMR is an up-to-date, fast way of providing patient care. It is so useful for communicating with other nurses nd disciplines when trying to access or see a patients information without having to lug through a hefty chart. Once you get the hang of using the new system, I guarantee that the positives will outweigh the negatives! Great system, for those of you who are hesitant, just give it a shot. After all, the point of the system is to provide faster and more effective, quality patient care... which ultimately is what our job is all about! The patients!
    Actually, although I can understand that how you stand depends on where you sit, there are far more "points" to be appreciated and considered for any system of medical records. If you sit in a hospital patient care unit, it might be all about "faster and more effective quality patient care" (memo: everything has quality-- the word does NOT always mean "good quality" ). But that is a very limited view of the world.
    If you are in the billing department, it means a way to recover the costs for your institution, without which there will not be as much money to pay for staff and facilities.
    If you are in the risk management department, it's a way to follow trends and identify problems and how the solutions are working.
    If you're in the supply chain, it's a way to discover what supplies or gadgetry is used, how often, and where.
    If you're in the legal department, it's a way to demonstrate compliance with standard of care in the event of a suit that calls it into question.
    If you're from the associated educational institution or an internal audit or research team (like infection control), it's a source of data for research.
    If you're a clinician, it's a communication device between team members.
    If you're administration, it's a source of data to allow you to recertify as a provider or keep your facility license.

    See? Much, much more than what you see in action. Which, come to think about it, highlights the problems those other departments have when your bedside/unit-based documentation is bad.
  5. by   ItsANurseLife
    We have Meditech, and I love it. I love the electronic medication record, it's so easy to scan pt's arm band, scan meds, pull up side effects right there to educate pt, and make sure correct dose is being given. I also love that when I'm administering BP meds, the pt's last set of vital signs pop up, or when I'm giving Lasix or potassium supplements the pt's last lab level pops up. Labs, test results, pt's history, etc is all at my fingertips.
  6. by   BrandonLPN
    My question is: Is it true there is a federal mandate that all medical records have to be EMR by 2014? I keep hearing this, but I suspect it's a rumor. I can't imagine my facility implementing EMR within a year....
  7. by   NRSKarenRN
    Moved to our Nursing Informatics forum.

    EMR Spending In Healthcare Makes a Big Impact On Finance and IT Hiring

    ...Driving this undercurrent of rising demand is The American Recovery and Reinvestment Act (ARRA). This act includes a health IT program that has been allocated more than $17 billion. This subsidy money is being provided to healthcare organizations in the form of grants or reimbursements for implementing Electronic Medical Record (EMR) packages. Some of the popular EMR systems are Epic, McKesson, Cerner and MediTech.

    In addition to the subsidy dollars, there is a very aggressive implementation timeline requirement. Originally planned with a 2014 deadline, the timeline will likely be extended to 2017 or beyond. This translates into a demand for talent for a minimum of 6 years, but the demand will likely not decline precipitously after that. It's creating an industry-specific Y2K-type bottleneck.

    There is such high demand because healthcare organizations are rushing to be compliant. The Patient Protection and Affordable Care Act is forcing hospitals to become compliant with "meaningful use" of the EMR system. This means many things, but the focus is on automating records and allowing all providers to share the same patient record amongst each other.

    Our home care agency implemented an EMR in 2002 -would never want to go back paper referrals and pens ever. Three months ago, my Central Intake Department was granted access to our health systems hospital Meditech EMR. It has been a huge help in care transitions: no more smeared fax demographic sheets, or lines running through phone numbers, can pull up Case management last note to see client sudenly decided to go to nursing home ...or to cousin Sally's home. I can copy hospital discharge summary directly into homecare database as >50% patients have no clue where theirs went. When the PCP office sends me a RX for " Needs Home care. DX Ambulatory dysfunction" -no demographic sheet nor insurance sent, I can review what is in EMR to complete referral.

    Patients who are admitted to any hospital outside our system, I can printout last visit note and med list and fax to ER upon request. Medical equipment companies can send record release to get wound care notes released to them so they inturn can bill insurance companies with proof needed for wound dressings as now have wound care measurements.

    For those nurses without computer experience, there will be a learning curve of 6 months or more. 3 RN's quite to work for another agency with paper records --surprise 1 1/2 yrs later when agency was bought out, new owners had same EMR as one they fled.
    Having the attitude "I will learn this", will be more successful than those who relish life in the good ole days.
  8. by   BrandonLPN
    Thanks for posting that, I guess it's more than a rumor.
  9. by   hveltre
    EMR's are wonderful if they are integrated and adaptable. Obstacles are the inability to tailor the system to your organizations workflow. At times it feels like putting a round peg into a square hole. Although I could not imagine going back to paper, depending on the system you work with, electronic documentation can be very challenging. At least in the acute care setting. Not have hard stops for critical information, multiple screens and clicks for documentation and lack of integration resulting in repetition are a few of the issues. Chart review can also be very challenging in some systems, my current system actually has a nice view of the record but a prior system I worked with was very difficult. Another issue is the affect it has on your patient contact. Instead to being face to face your face is in a computer and the patient is on the sidelines. We work hard to look up from our screens and make that eye contact and not seem impersonal when conducting an assessment. Good Luck!