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Why is Epic better than Cerner?

So, I've been hearing about Epic a whole lot. What is the big deal when compared to Cerner? Is it really that much better for nursing documentation? What is your experience with these two systems? Which do you use and what do you absolutely love (or hate) about it? There's talk we're converting to Epic, so any details would be much appreciated :twocents:

rninformatics, BSN, RN

Specializes in Informatics, Oncology, IVT, Home Health.

Epic is currently considered the hotest Health Information System. Said to be the "Cadilac" of HISs. Some consider its integration and functionality better than other HIS vendor products .......such as Cerner,Meditech and McKesson.

Epic unlike many of the other HIS vendor products has a different methodoloy when it comes to implementation. Many other vendors will allow you (for additional fees/costs and time) to "customize" their products. Thus allowing an individual organization to alter the original functionality of the application(s) and how they/it works within the organization's idiosyncratic work flows and business processes. You know how Peds says they do things (documenting drsg changes or processing a specimen or even med reconciliation) differently on their unit than does the Med Surg unit or you know how Hospital A in New York processes and handles charging vs how its done by Hospital B in Chicago?

Some vendor's allow for these idiosyncrasies while Epic holds strongly to a more standarized implementation methodoloogy without customization.

Epic's thing is: "Customize it after we get it implemented". There is something to be said for avoiding customization, keeping to standardized functionality and processes and avoiding exspensive and time consuming retro fits and testing with each upgrade or enhancement.

I also want to say .......if memory serves me right..... that Epic was one of the first HIS vendor products to receive national certification.

I'm going to write an article (in the near future) comparing the top 4-5 vendor products..........so stay tuned.

So, I've been hearing about Epic a whole lot. What is the big deal when compared to Cerner? Is it really that much better for nursing documentation? What is your experience with these two systems? Which do you use and what do you absolutely love (or hate) about it? There's talk we're converting to Epic, so any details would be much appreciated :twocents:

RN Zeke

Specializes in Postpartum, Antepartum, Psych., SDS, OR.

Epic and Cerner user here (others also), Epic rocks. I would enjoy working during another Epic going live on the consulting end.

mydesygn

Specializes in pediatrics.

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

rninformatics, BSN, RN

Specializes in Informatics, Oncology, IVT, Home Health.

My Desygn and anyone else,

Can you give me additional specific and objective differences between Epic and Meditech, Epic and Cerner or Cerner and Epic or any other specific functionality limitations or restrictions in any other of the major HIS vendor products?

My Desygn, its SO nice to hear constructive criticism and objective short comings of useability, functionality, interoperability and or integration issues in specific applications! instead of non-specifc non productive crap such as "its not user friendly" its nice to hear how or exactly what the application can't do.

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

I am not sure, these days, that paper is not better than Cerner. I've gotten very tired at their lack of customer service and their lack of caring about updates that make things worse. Their QA department on the most recent service pack for 5.0 must have been having a really bad hair day (month?) when working on this.

It is impossible to fill out an OASIS correctly, reports necessary for state survey have not worked in over a year, and every time you install a new SP, printing 485's breaks.

Cerner will not even let you go to class to learn to customize their forms until you have been on the system for a period of time. Another annoyance is that they use Braden scale information that is 12 years out of date.

There effectively is no careplan for the other disciplines so not sure how you could get away without building your own without a risk for a conditional level survey. All in all, I would recommend against anyone considering it's purchase.

RN Zeke

Specializes in Postpartum, Antepartum, Psych., SDS, OR.

Not user friendly, no resource backup, manager not on board with training...could be good if made user friendly and hospital friendly> .....

rninformatics, BSN, RN

Specializes in Informatics, Oncology, IVT, Home Health.

Greetings Cay,

Can you be more specific that "not user friendly, not hospital friendly"?

What exactly does that mean related to functionality, what Cerner (which application(s) are we talking about?) can't do or doesnt do?

Not user friendly, no resource backup, manager not on board with training...could be good if made user friendly and hospital friendly> .....

RN Zeke

Specializes in Postpartum, Antepartum, Psych., SDS, OR.

Cerner charting/Example for discharge find PM Conversation on top of page with other information. Why not Discharge Conversation. There are multiple sites one must go to to do a D/C, not just one. Charting unit specific, one must hunt for various places to chart, hope one can figure out where they all are. Hope this makes some sense. I'm sure there are different packages hospitals may purchase, just like what ya want in a car? Classes needed to provide adequate training for nurses and others before going live is welcomed before going live with any program. Site navigation is difficult as there are so many ways to do one thing, this confuses me, don't know about the rest of the people.

Edited by RN Zeke
Adding more information.

mydesygn

Specializes in pediatrics.

It is pretty difficult to really understand the differences in the system without having actually worked in both. I think we put a little too much emphasis on user opinion. I realize that is a controversial statement so I am going to clarify it a bit.

We purchased a third party ambulatory record based on the preferences of our primary clinics. The users saw demos and the sales staff said that their system could do everything (integrate w Meditech, full support etc..)

Needless to say once the application was implemented - there were a lot of complaints from the users and the integration with Meditech didn't happen, the consideration of key departments were not even addressed in the decision making.

Users tend to focus on "looks" , the interface and not functionality. All they know of interface design is Ipod and Iphones. They think that the computer ought to think for them and don't understand the concept of "garbage in, garbage out". Anytime a doc tells me something is not "user - friendly" - I have to force myself not to ask them what other HCIS they have used and how they came to that conclusion.

None the less, every system has short comings. Most excel at certain aspects (Epic has good inpatient clinical but lacks key components, Meditech has an integrated platform but when you try to be a jack of all trades - you end up the master of none)

When I was a nurse, I remember thinking how "antiquated" a system was and having to remember keystrokes. However, I never noticed that the system never went down and don't remember ever having to call IS with a frozen screen or slow processing. As an IS analyst, I recognize the user frustration yet I recognize the larger considerations.

disenchanted RN, ADN

Specializes in CCRN, CMC, CPAN, CAPA.

I don't think a user friendly computer charting exists ; It is cumbersome, time consuming, takes away from the bedside time, we are practically chained to these rolling computers ; I agree that site navigation is very difficult (to say it very kindly).

Whoever designed these programs are likely not nurses, or if they are, they are out of touch with what nursing is actually like anymore. The opinions of Nurses who currently work at the bedside are never consulted or asked anything when the hospitals purchases these programs. They are simply shoved down our throat. Oh well. I guess we don't have any choice but to keep on taking it.

I understand computer charting is necessary and the way of the future and all that ; but at least create a program that flows and is practical. The one we have is called Horizon Clinicals. I'm pretty much used to it now, but I still hate it.

stephenfnielsen

Specializes in ICU, Informatics.

Epic is most definitely customizable, and most definitely has an ambulatory module (it was actually their bread and butter in the early days). In fact... I really don't know how Epic could be more customizable, they are known to build custom code for customers when their model system doesn't fit the bill. The reason why they encourage so strongly to stay close to their model is because if a system strays to far it can't use all their amazing training materiel out of the box. It's also true if you monkey around too much, future upgrades won't play nicely.

Two features that I haven't heard of outside of the VA that Epic provides is their "Care Everywhere" and "Lucy" modules. Care Everywhere allows completely unaffiliated facilities to share patient information. Lucy gives a patient a repository for all their health information from any different Epic shop. Since so many level I trauma centers are going live with Epic, Care Everywhere becomes especially useful. We see a lot of patients going to OHSU for their specialty care, and return home for the rest, no more faxing/Fed Ex'ing records back and forth.

Aside from the price tag I really can't see why anyone would be implementing anything but Epic right now.

I've used both Epic and Cerner. Epic was a lot easier to learn and a lot easier to navigate through in my opinion. With Cerner I loved the task list though, everything you needed to chart on would be on one list so you wouldn't miss documenting something.

rninformatics, BSN, RN

Specializes in Informatics, Oncology, IVT, Home Health.

Just a few suggestions for those of you still struggling with the user experience and your organization's current HIS (whether using it for documentation, results reporting, bar code medication administration, etc) perhaps some of the issue is your competency with the application? Consider contacting the staff development, education or IT/IS department and requesting additional training on the applications that you are having trouble with.

If the issues are system/network responsiveness/related, have you followed the appropriate channels and consistently reported the issues? No one knows there is a problem if you dont report it. And dont tell me you reported it once and expect it to be fixed. If you give up then the problem will never be fixed. And yes I know you are busy. I know you are clinically being asked to do more with less. Who said nursing was an easy gig? When I originally started practicing nursing we on the oncology unit were expected to adminster all personal care, empty the garbage in our patients' rooms, change linen, make beds, round with the doctors, assist with all bedside procedures, draw all labs, start are own IVs, mix our own chemo (that's right!) and piggy backs, and more so dont tell me about how busy you are - I know and that is the nature of the beast!

Does the hardware you are using (laptop, notebook, scanners, etc) need to be replaced? Are you caring for the hardward properly, plugging the WOWs (workstations on wheels) in when needed? Just as there is more than knowing anatomy & physiciology to successfully start and maintain a patent IV site and safely administer chemotherapyy without exstravisation there is more to using clinical information systems technologies.

Additionally who of you has volunteered to be involved in the implementation, training, testing, evaluation and or redesign groups formed or forming at your organizations to address these issues? Who of you tossing out so casually the "it's not user friendly" statement without actually being super-users who volunteer to proactively help improve the problems?

I've been a practicing RN for 25 years and working in HIS/HIT for 15 and there is no perfect system but my hat is off to all those clinicians (CNAs, USs, nurses, lab techs, MDs, pharmacisits, rad techs, therapists, dieticians, etc) who also work in HIS/HIT or volunteer as super users, systems testers; or work in research and development, as educators, specialists and trainers) to improve these systems, the users' experiences and make this specialty better.

Getting off my soap box now.........

Edited by rninformatics
cause

mydesygn

Specializes in pediatrics.

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.

seanynjboy

Specializes in Medical-Surgical, Supervisory, HEDIS, IT.

EPIC rules and Cerner drools! Epic is way more user friendly in my opinion than Cerner but each HIS has their own merits. I am doing IT support for Cerner right now for the Barcode Admin go-live and I came from an EPIC hospital (as did a lot of these nurses I am working - 3 hospitals here are on EPIC) and a lot of them say "I miss EPIC" or "EPIC does it this way". Most of them are not Cerner fans...

emtb2rn, BSN, RN, EMT-B

Specializes in Emergency.

No experience with epic (yet). Cerner (powerchart, firstnet & iview) is a clunky product that is not intuitive for charting. I notice a significant number of nurses who simply type out a narrative note rather because they get frustrated trying "to find a box to click". While this might be a training or personal issue, it remains an issue for reviewing.

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