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mydesygn

mydesygn

pediatrics
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mydesygn specializes in pediatrics.

mydesygn's Latest Activity

  1. There should be a downtime process available. I would contact the Info Systems or Education depts so they can get you the correct information if you are unsure what to do. Generally, each institute does something slightly different - typically orders are entered once the system comes up. This may be done by the ancillary depts such as lab, pharmacy etc... There may be a timeframe for documentation. For example, if the system was down less than 2 hrs - you would enter your documentation - if it was more than 2 hrs, you would have the paper documentation scanned in and enter a note in Epic stating the timeframe in which the paper documentation that was scanned covered.
  2. mydesygn

    LOINC mapping for lab results

    I was wondering the same thing- typically - mapping LOINC codes to lab tests is done by a LIS (Lab info systems) coordinator. Depending on your EHR, you should have a nomenclature vendor who would assist with that also
  3. mydesygn

    Gaining experience without hospital's support

    In general, our facilty has over 120 staff in the IS dept which is pretty good for a large metropolitan area. Of the staff - not one has a degree specifically in informatics. The two nurses hired with the title of informaticist both came from Education and have a BSN. As a pure informaticist, you actually don't do the high volume of technical work (ie server support, databases, interfaces etc..) this type of work is typically performed by the technical staff. I am not an informaticist nor are the 4 other nurses working with me - we are systems analysts . This is the distinction. As a systems analyst, you are not limited to purely clinical projects involving nursing and providers. I have worked on various software implementations for our dietary dept, bed management dept, ehr upgrades, rehab, respiratory, lab, meaningful use etc.. None of which utilized my nursing patient care background specifically; however my knowledge of the healthcare systems and the workflows is what is valued not so much my patient care experience. The informaticist tend to focus more on nursing and provider workflows (documentation, order entry etc..) My issue with focusing nursing informatics as opposed to healthcare information systems is eventually most facilities will have implemented documentation, barcoding, cpoe etc.. There is a pretty good market now. I have seen many institutions bring on consultant for 6 mos stints with these implementations but not necessarily hire for informaticists. They tend to hire for analysts with technical skills such as interfaces, report writing, sql, etc.. nice way to see what is available is to search the job postings of various hospitals filtering for information systems - there are very few postings specifically for informatics. Your informatics posting are usually posted in the Education dept as technical trainers. As far as other positions, it's tricky without demonstrated experience - some of the nurses I have worked with tended to work within hospitals, case management, research etc.. Research (in addition to Education) is also a good place to transition from if you can.
  4. mydesygn

    Gaining experience without hospital's support

    Most employers are looking for experience with the big EHR's. Having a degree in computer info systems and a RN will get you looked at but hospital based informatics tends to rely a lot on having worked with IS staff at the hospital in a super user role. My suggestion would be to try to gain experience with the EHR at your hospital - you are right, it is tough but you may be able to volunteer for doing chart audits but I'm sure your current manager wants you on the floor in staffing and so getting in the superuser role can be challenging. I wouldn't expect support in your dept - it is of no advantage to them to encourage your growth in another position. Like most positions, you want to network - joining local chapters of informatics groups might be helpful if you live in an area large enough to have an active chapter. I have a degree in info systems as well as nursing and happened to apply for an opening at my hospital at the right time when the IS dept was specifically looking for a nurse. I didn't have any EHR experience but a lot of nursing and management but I was quite fortunate. I would recommend getting a degree in information or computer systems and not informatics specifically. Like you said, a master in informatics is not particularly useful without experience however a general computer degree demonstrates that you have learned a wide variety of platforms and can demonstrate an understanding of information systems plus it is useful in other fields besides healthcare. I would suggest trying to get on with a consulting firm to gain experience with EHR - obviously that's travel and they want experience too but you may at the minimum get on somebody's radar.
  5. mydesygn

    Clinical systems analyst vs informatics

    For a systems analyst, you would not necessarily need a clinical degree/background. A systems analyst could support any part of the healthcare IT - anything from financial applications (such as Kronos) to administrative applications to medical records. As a systems analyst, you can work with any application or dept within the healthcare system. You may be expected to do development or programming, report writing etc. An informaticist is mainly dedicated to clinical applications - they tend to focus almost exclusively on clinical depts (nursing, respiratory, physicians, pharmacy). They tend to help develop training/ education and serve in a liaison role with clinical user. As an informaticist, you would be expected to have worked as a clinician (nurse, therapist, physician) whereas a systems analyst does not need or require a clinical background or clinical job experience - a technical background is sufficient
  6. mydesygn

    Call Schedule

    In our dept, we rotate call daily for the clinical team and then we rotate night/weekend call each week. You are on call for all the clinical apps not just the apps that you are a specialist for. Initally, they tried the specialist route but some staff would end up never getting a calls and other staff were constantly resolving issues. In general, if we are up at night late with a call, we can take off a half day but generally it's really not worth it. I may sleep a bit later the next day. Having been a nurse, I understand a hospital is a 24 hour organization. We have had quite a few analysts from outside healthcare who left because of night/weekend call. No sympathy from me - it was well explained at hire that hospitals are not 9 to 5 and you may get called even when you are not on call
  7. mydesygn

    Why is Epic better than Cerner?

    Very well said. I will add my other two favorites: "Nobody helped us learn how to use this or asked us about it" - to which I reply, the staff assigned to be superusers never showed up for training or if they did it was inconsistent. In addition, your manager either devoted no resources to help in training and building or she provided individuals who had no interest or desire to do what was being asked. And before you say nursing was not consulted - maybe you need to speak with your managers / directors - Nursing is always consulted. Your managers / directors are your voices. "This is not user-friendly" - really - this is not an Apple Iphone. All your telephone has to do is text, make calls and email. This is designed for professionals to capture and compile specific vast and complex information, it must bill, meet federal requirements, etc.. You did not learn how to become a nurse in a day. You had classroom training, orientation and mentors. You devoted your time to learning. I agree that items could be streamlined or changed however you will still need to make the time and work together with your educators to develop appropriate training. Be part of the process.
  8. mydesygn

    EPIC Computer Program

    I have read quite a few comments about hospitals not having competent IT staff. As both a nurse and IT, I am and have been on both sides. Most hospitals do not have enough IT staff. Hospitals are notoriously bad about hiring IT. I Often hear stories of one person responsible for building and maintaining multiple clinical modules - there is no way you can begin to do the level of support and troubleshooting. So, before being judgmental - consider that many hospitals barely staff enough nurses to care for patients - I can assure you they put even less resources into IT.
  9. mydesygn

    Physician Ordering and Documentation

    We are C/S 5.6 facility and are CPOE for our inpatient areas (will be implementing in ER) soon. My advice is to really consider how to phase the project. You really need to spend the first year rebuilding orders before you even begin the order entry for docs. Our orders were built w/o physicians in mind (ie medications were entered by pharmacists, imaging was entered by techs, most other orders entered by clerks) Orders have to be streamlined, simplified. Medication order strings have to be built. Orders should be generic instructions. A doctor should not have to try to figure out which of 3 Dopplers to order. Just one and let the techs figure out which to charge for
  10. mydesygn

    Medi Tech...Who slept with Who? Vent.

    Most hospitals have to look at the bottom line. Meditech has been around since the early 80's which in the computer world is a really long time so realistically a complex application such as Meditech will be built on older technology. Newer versions have more of a gui interface so I suspect your hospital probably has not upgraded and is on a older, Magic version. Our facility recently considered switching to Epic quoted at a cost of 90 million dollars and it was still missing ambulatory and blood bank. Even after purchasing Epic, we still would have to keep Meditech for the missing components. You might hate how it looks but speaking from the backend - intergration, support and price definitely come into play. I'm not saying that Meditech is the best but every system has it flaws. Applications are like cars - doesn't matter how pretty they look; if they can't get you where you need to go.
  11. mydesygn

    Why is Epic better than Cerner?

    Course you do have to consider other items as well. Recently our hospital considered changing from Meditech to Epic. 90 million pricetag to purchase both Epic and Lawson. Would the docs / nurse love it - sure but here is what we would lose. 1) No integrated Blood Bank module - would have had to keep Meditech 2) No Human resource /payroll - would have had to purchase Lawson as part of the switch 3) No Ambulatory Documentation Meditech is by no means the "best" - hard to integrate, requires extensive testing with each update, reporting (you have to be a programmer to write a report out of Meditech - whole companies make a living from the lack of reporting options available) akward workflow for cpoe, documentation etc.. but you do get an integrated system at a relatively cheap price I would guess that there are some pluses in Cerner that are absent in Epic. and vice versa
  12. mydesygn

    Generating Downtime Forms for Meditech

    The 6 hour parameter has existed prior to my employment. So I am not sure of the logic but what I think is .. Our monthly scheduled downtimes start at 11pm with the expectation that we would have the system available by 4am. On average, it takes about 6hrs considering that we are not just taking Meditech code but also server patches and other system changes as well. In addition shift change, occurs at 6:30 am, if we run past 4am and do not have Meditech is available. Beyond that time would not give clinical staff enough time to document before shift change. 4 am is a bit of hard time to allow the clinicians significant enough time to document. We are in the process of implementing BMV however we have been on the EMAR for several years. Prior to each downtime, we print the current MAR for each patient. The nurses will typically document administrations in Meditech was the system is available however the documentation can remain on paper if downtime is more than 6 hrs.
  13. mydesygn

    Any Hospital Doing Full CPOE

    We are 5.54 with a planned update to CS 5.64 next year so in the meantime we work around the fact that continuous labs are not clearly identifiable from the PCS status board, the text of nursing interventions do not display when viewing orders in the orderset view. Fortunately, we have a fairly large IS department. Up until last year, we had one analyst to one module. I supported EDM, however now we have split our department between application support and project teams. My project team consists of 4 analysts and CPOE is our only project. We are fortunate that our inpatient nursing has be fully documenting in PCS and EMAR for the last 7 years so they are already actively using the PCS status board. Our physicians dictate in ITS as well as document H&P on paper. The challenge is been helping the docs understand that you can't simply convert paper orders to electronic - they are slowly realizing how much time the nursing and performing dept spent clarifying/looking for information because the paper order was not sufficient. For instance, our docs never realized that our GI Lab would go search the patient's chart to find a reason for performing the ph probe because the doc only wrote ph probe on the paper order and had never written a reason - we are now asking the physician to enter a reason when entering the electronic ph probe order.
  14. mydesygn

    Any Hospital Doing Full CPOE

    One of our issues, for instance is that physicians don't want to answer the Collected By Nurse query when entering labs - whether a lab is collected by the nurse or the lab phlebotomist can only reliably determined by the unit. At this point, we will likely have the doc enter an instruction to a clerk who actually enters the lab order. Our ultimate goal is to have orders entered by the physician go directly to the performing department and not print to a clerk who then enters the order for the performing dept. When I hear that all the physician orders print to the nursing unit - it usually means that someone on the nursing unit is then entering the order for the performing dept and thus you lose the efficency gained from the xray order going directly to xray and not having to wait for a clerk to enter order. The main benefit that the physicians have noticed is how much faster their xrays and labs are done after they enter the order. When the physicians ask what other hospitals, they are looking for a creative solution that avoids the obvius workaround of simply having an order print to the unit and then have someone on the unit enter the order for the performing dept. In addition, many areas are printing the nursing orders to the nursing unit thus avoiding having the nursing staff not rely on the PCS status board for notification of orders.
  15. mydesygn

    Any Hospital Doing Full CPOE

    I guess I find it really discouraging, we are doing full CPOE. Our hospitalists are entering all orders electronically - labs going to lab dept, nursing orders, xrays, meds.. As we ran into issues, our hospitalists ask "what are other hospitals doing" and I have to reply - nothing - they resolved the issue by printing the order or having a clerk enter the order electronically. We are using Meditech and many of our current issues will be resolved when we update to the next version but in the meantime, we are working around issues. I find that many of the many hospital systems vendors define CPOE by the Leapfrog standard of physicians entering medication orders electronically which is really misleading-once you define full CPOE as all orders suddenly the number of CPOE implementations that they advertise drop dramatically.
  16. mydesygn

    Any Hospital Doing Full CPOE

    We are in the process of implementing CPOE - what I have noticed is that most facilities are doing some sort of partial implementation 1) The physicians enter orders into the computer but they print to the floor OR 2) The physicians only enter medication orders but not all orders OR 3) The physician writes the order but a pharmacist or clerk enters the order into the computer Is anyone at a facility where the physician enters all orders into the computer and nursing verifies / performs care based on the computer order only - no printout.