I am a healthcare architect, doing some research on electronic medical records use on inpatient hospital units (med/surg units, specialty inpatient units, or any type of critical care or intermediate care unit). Since I come to this site all the time to read what nurses and other healthcare professionals really think (not always the same as what our clients/hospital administration tell us!), I thought I might ask for some help with my research project.
Please leave your comments about EMR experiences, and fill out the quick, anonymous survey linked below. I am interested in everything about EMR charting... Where do you chart? When? How often? Is it better or worse than paper records? Does it take longer? Is it more efficient? Do you wish your hospital would arrange things differently or better to make charting easier? Do you think they made a mistake when they put together the current system?
The informaton helps us improve design of patient rooms, nurse stations, and overall unit design.
Great ideas! I love the idea of camera/imaging capability. It's so obvious - staff should be able to put photos into the EMR, the same way doctors and techs can use PACS to save all the diagnostic imaging stuff.
Regarding the robo-suit: we're not there yet, but more and more new architecture is accommodating to bariatric patients. For the first time in 2010, the healthcare architecture guidelines have suggestions for bariatric design. Lately, we are doing floors, where 10%-50% of rooms include built-in lifts. With other clients, we include space for storing portable lifts. Of course, that takes more space, which means more $$ for the client!
As for the software/UI issues with EMR, sometimes I wish Steve Jobs would step in and partner with some of the larger EMR software companies, and whip them into shape. I have an ipod, and iphone and an ipad, and I've never read the manual for any of them. They are 100% intuitve, simple and easy to operate. The stuff I hear about EMR software is the opposite. I mean, fooling with a mouse? Really? Steve Jobs, are you reading this?
Specializes in Management, Emergency, Psych, Med Surg.
PLEASE... what ever you set up, make sure that there is a terminal in every room plus a rolling terminal to use in addition. Have every other system interface with your documentation system... Labs, Xray etc. A very excellent system is in place at Swedish Hospital in Seattle. You might want to take a look at it. My husband was a patient there at the main campus and it was the most efficient system I have ever seen. And the staff love it. Doctors put in their own orders which decreases errors and the system interfaces with pharmacy so the minute they put in their orders they go to pharmacy. Very little delay in getting patients the medications they need. The system does so many things I can't describe them here.
Here are my complaints, though, in hopes that better systems will be developed in the future. We use Cerner, by the way.
*Log in time is too long. In a perfect world, I would scan my badge and my password screen would pop up in less than 3 seconds. In reality, I have to click on the "powerchart" icon, wait 15+ seconds for it to open, then type in my user name and password, then wait several seconds for it to open, and *then* I can access my patients' charts. I want instant access, pretty much.
*The bedside charting devices we use are fine, but I need to be able to chart more things on them. First of all, the devices are a scanner and charting device all in one. Which is fine, except that it is large and cumbersome. I want something that looks like a phone. And I want to chart as if I am texting on a qwerty keyboard. I want to be able to chart my complete assessment on the handheld device. I don't want to just chart i/o, meds, vitals, the little things there. I want to be able to chart it all.
It's heavy, about 10 inches long and 5 inches wide at the top, and can't fit in a pocket. You have to just carry it around (which means you're always setting it down and losing it, or having to find a place to set it down, which can end up being an infection control issue. If I could put it in my pocket, it wouldn't ever touch a patient's bedside table, their bed, a chair, etc).
I would like them to look more like a blackberry. Something that can fit in a larger pocket, something that I can type on with my thumbs...as texting becomes the norm, many of us (even us old ladies) are used to texting fairly long texts with our thumbs. I could certainly chart by exception on a handheld device like that.
Those are my main complaints. Overall, our cerner package looks similar to a website, each chart has a main page, and then tabs off to the side to link you to a screen of the patient's orders, lab results, etc. I like that. A chart should be like an easily navigated webpage.
Is it better to have a terminal in every room, or, let's say, a tablet for every nurse? Or both?
Swedish Hospital is, I think, a leader in a lot of innovative healthcare concepts. They seem to put a lot of thought and planning into their new facilities and avoid some of the pitfalls that happen to unluckier (or less forward-thinking) institutions.
I am not an IT specialist, but the interoperability issue is, I think, essential. In the design and building trades, we went through the computerization process 20-30 years ago, and, at that time, there was a fair amount of competition, at first, among proprietary software systems. The winner turned out to be a program called AutoCAD. From that point, the vast majority of architecture, engineering and contracting firms adopted AutoCAD as their software, and those that didn't, had to adopt AutoCAD-compatible systems. I feel like hospitals haven't adopted EMR to the tipping point, yet, where a "winner" is declared, but when it is, every software system on the market for every service line will have to be compatible with that system. They have to be able to "talk" to each other, easily and fluently, or what's the point?
nycarchitect
3 Posts
Great ideas! I love the idea of camera/imaging capability. It's so obvious - staff should be able to put photos into the EMR, the same way doctors and techs can use PACS to save all the diagnostic imaging stuff.
Regarding the robo-suit: we're not there yet, but more and more new architecture is accommodating to bariatric patients. For the first time in 2010, the healthcare architecture guidelines have suggestions for bariatric design. Lately, we are doing floors, where 10%-50% of rooms include built-in lifts. With other clients, we include space for storing portable lifts. Of course, that takes more space, which means more $$ for the client!
As for the software/UI issues with EMR, sometimes I wish Steve Jobs would step in and partner with some of the larger EMR software companies, and whip them into shape. I have an ipod, and iphone and an ipad, and I've never read the manual for any of them. They are 100% intuitve, simple and easy to operate. The stuff I hear about EMR software is the opposite. I mean, fooling with a mouse? Really? Steve Jobs, are you reading this?