Tell me about your experience with EMR.. The good, the bad and the ugly!

canesdukegirl, BSN, RN · Sep 23, 2010

I am BEGGING my nurse manager to get touch screens for our e-charting. The system in place now requires one to go constantly from mouse to keyboard and it is terribly frustrating to have to chart for 20 minutes when the procedure I am charting on takes the surgeons 7 minutes to complete, skin to skin. I used to use Saturn (I am unsure if that is a program or an interface...can you tell I am talking out of the side of my neck here?!?) and I could chart a new pt in about 5 minutes. It was HEAVEN!

That is really my biggest issue with e-charting. We use GE now (I can't remember the name of the program...starts with a C) and it is sooooo outdated, but when I brought it to my NM's attention, she said that she wouldn't upgrade our charting until it got better. HUH?!? How about giving us a program that is not older than ME to chart with, and you will see less errors!

Since I work in the OR and some of our cases are very fast, my biggest concern regarding my chart is to get it completed before the patient rolls out of the OR. Our system is linked to every unit, so the PACU nurse is unable to get needed information until my chart is complete in the OR. I must take care of my pt first, and it burns me to no end that I feel chained to the blankety blank chart because of the inefficiency of the program.

I am so glad that you raised these questions, because I have been beating my head against the wall trying to find other e-charting systems to bring to her to consider. I can't find anything. Please help me?

dthfytr, ADN, LPN, RN, EMT-B, EMT-I · Sep 23, 2010

Seen 3 differant, it wasn't easy but I've managed to eliminate their names from my conscousness. The only good thing I can say about them, in common, is that they so restricted my ability to logically and accurately chart on patients that were I to get sued, it would be impossible to eke out an accurate evaluation of the patients condition or care. None were intuitive nor did they decrese work or improve efficiency. If just one software engineer would talk to a nurse they'd make a fortune. Sorry to be unhelpful, but I have to call them as I see them.

**canoehead, BSN, RN** · Sep 23, 2010

I work in the ER, and the way the patient tells their story, or the way things happen in the trauma room, the information I get doesn't happen in the same order every time. I need to be able to move forward and backward in the program without filling in mandatory fields.

I need to be able to save my work midsentence so I can attend to the patient, have the screen go blank for privacy, and then return to the computer later to finish.

Changing passwords frequently just means more calls to the helpdesk. And we need the same password for all the work. We write write passwords on the back of our badges, because there are 3 of them and they all change monthly.

We have to have a spot for free text on every page. Tick boxing is fill in the blank nursing, I personally hate them. Nobody fits into tick boxes, and some things are so bizarre...

I concur that going from keyboard to mouse frequently is frustrating and slows the process. I'd also prefer inobtrusive computers rather than desktops, or COWS. I want the patient to feel that they are my focus- not the machine.

Some information is best inputted immediately, like vitals, but reading/writing a history, or operative report needs to be done away from the distractions of the bedside.

I think it would be cool to have a password for the patient, and each professional could release notes or labs as appropriate, so they could find out what happened overnight, or when the last pain med was given. Patients control who gets access. They could also write their own questions and concerns in. Very helpful for a concerned family, and it could be a record of insanity for the folk that need it.

MedicLifelineRN · Sep 23, 2010

one word......"ICKY!"

Hate the EMR

HouTx, BSN, MSN, EdD · Sep 23, 2010

From an architectural standpoint, the point of interface needs to be situated so that the nurse is facing the patient when entering data. We need to be able to move the keyboard out of the way when it isn't being used, but it also needs to be quickly adjustable & very sturdy when it is used. We also need to be able to quickly 'slave in' a different monitor & keyboard to use during a crisis situation such as a code -- when using the bedside/room equipment isn't practical. Currently laptops and monitors/ keyboards are being jammed into every nook and cranny. I'm sure that I am not the only nurse who has concussed herself bonking into one of these things or fritzed it out by splashing water on the cpu because it was mounted beside the sink (!!!).

Wish List

= Nurses come in different sizes and shapes... equipment needs to accomodate this.

= All required supplies stored at the patient's bedside - auto inventory application integrated into EMR - triggers re-stock when supplies are used (e.g., dressing change, IV tubing change, etc)

= Touch screens for 'tick boxes'!

= Speech to text - manually triggered to replace endless keyboarding for narrative notes. Maybe a foot pedal so it is hands-free?

= Instant Messaging capability

- for critical values & urgent information (in a vivid highlight color) with an audible signal also...

- to send data or visuals (monitor tracings, VS graphs, etc) to physicians when needed

= Automatic Reminders (visual & audio) for medications, treatments, etc that are time sensitive

= We need camera/imaging capability - to record visual information about wounds, skin condition, etc. No need to have to rely on old fashioned paper descriptions in this electronic age; camera can also be set to visualize a patient that needs continuous monitoring when you are not in his/her room

= Robo-suit (like Sigorney Weaver wore in the original Alien movie) for moving heavy patients... or at the very least, built-in mechanical lifts for every bed

= Electronic performance support for all decisions/interventions

- How-to video immediately available for technical tasks (e.g., calibrating A lines)

- Algorithms to guide decisions (e.g., choice of wound care materials)

= On-demand patient education videos with touch screen interaction / post test - evaluates understanding & automatically documents

Can you tell I have been imagining this stuff for a while?

canesdukegirl, BSN, RN · Sep 23, 2010

I concur that going from keyboard to mouse frequently is frustrating and slows the process. I'd also prefer inobtrusive computers rather than desktops, or COWS. I want the patient to feel that they are my focus- not the machine.
.

AMEN! I absolutely HATE having to go to the computer to chart. Some of the scrub techs that I work with think that the nurses in the OR are PLAYING on the computer. One of them actually said this to me, "When you are done checking your email and stuff, could you please pull a 4-0 Vicryl for me?" I won't even repeat my reply.

canesdukegirl, BSN, RN · Sep 23, 2010

HouTx-I think I just shed a tear of joy...and I felt chills at the possibility of this kind of charting. I think I need a cigarette...

TDCHIM · Sep 23, 2010

From an architectural standpoint, the point of interface needs to be situated so that the nurse is facing the patient when entering data. We need to be able to move the keyboard out of the way when it isn't being used, but it also needs to be quickly adjustable & very sturdy when it is used. We also need to be able to quickly 'slave in' a different monitor & keyboard to use during a crisis situation such as a code -- when using the bedside/room equipment isn't practical. Currently laptops and monitors/ keyboards are being jammed into every nook and cranny. I'm sure that I am not the only nurse who has concussed herself bonking into one of these things or fritzed it out by splashing water on the cpu because it was mounted beside the sink (!!!).
Wish List
= Nurses come in different sizes and shapes... equipment needs to accomodate this.
= All required supplies stored at the patient's bedside - auto inventory application integrated into EMR - triggers re-stock when supplies are used (e.g., dressing change, IV tubing change, etc)
= Touch screens for 'tick boxes'!
= Speech to text - manually triggered to replace endless keyboarding for narrative notes. Maybe a foot pedal so it is hands-free?
= Instant Messaging capability
- for critical values & urgent information (in a vivid highlight color) with an audible signal also...
- to send data or visuals (monitor tracings, VS graphs, etc) to physicians when needed
= Automatic Reminders (visual & audio) for medications, treatments, etc that are time sensitive
= We need camera/imaging capability - to record visual information about wounds, skin condition, etc. No need to have to rely on old fashioned paper descriptions in this electronic age; camera can also be set to visualize a patient that needs continuous monitoring when you are not in his/her room
= Robo-suit (like Sigorney Weaver wore in the original Alien movie) for moving heavy patients... or at the very least, built-in mechanical lifts for every bed
= Electronic performance support for all decisions/interventions
- How-to video immediately available for technical tasks (e.g., calibrating A lines)
- Algorithms to guide decisions (e.g., choice of wound care materials)
= On-demand patient education videos with touch screen interaction / post test - evaluates understanding & automatically documents
Can you tell I have been imagining this stuff for a while?

I'm curious about something, HouTx...would you prefer a device the size of, say, a Droid or iPhone, or something larger, like the size of an iPad or Kindle?

kesr · Sep 24, 2010

For multi partner practices, having all the pts' history, meds, labs etc in one place is great. The gynecologist can see exactly what the dermatologist ordered, and the internist knows the gyn hx, and each can see all the labs which prevents unecessay repeats. An ER having access to a complete record would be so much better than Aunt Susie trying to remember all her meds, or when she had a surgical procedure. We all know that pts (innocently or intentionally) forget to tell us stuff.

No more trying to decipher penmanship. Even nurses can be sloppy writers.

nursej22, MSN, RN · Sep 24, 2010

Our system is designed for gathering info for audits, not for improving patient care. Plus, it is so inefficient that people create work arounds or just don't do so-called required charting.

Examples: the screens that used to serve as a "Kardex" to inform staff about diet, activity, labs draws, treatments can have several conflicting orders like npo, general diet, ADA, low Na, fluid restrict 2 L, fluid restrict 1.5 L, that people will ignore it or just pass on verbally what they believe is the last order.

It is difficult for nurses to retrieve data quickly like when did patient last eat, when was their last dose of beta blocker, is their Hct trending down?

Multiple programs used within the hospital don't interface, or don't interface well. So paper copies are printed from OR, ED, cath lab for meds, procedures, I&Os given there. So if I need to know how much fluids a patient got I must wrestle the paper chart away from the UC, doc, therapist or wait for it to come back from imaging with the patient to get this info.

I would love to be able to sign on with my badge or thumbprint or voice recognition, instead of having to log on my user number and ever changing password everytime I need to enter something or check data.

And charting on 12 different screens minimum for each patient is ridiculous. And the care plans had to be moved to paper because the program couldn't accommodate them. Arrrgh, that is basic nursing process but isn't important enough to be part of the EMR.

bookwormom · Sep 24, 2010

I haven't used EMR since 2009, when I was a clinical instructor, but I assume there is still the problem of what to do when the system is "down". Big, big problem, especially when it happens at shift change.

Another big problem for me as an instructor is that the hospital insisted that all my students enter data and give meds under my password. The State Board said it was okay, so I dealt with it.