Another Rant (skip if you don't want to read my b****in' and moanin')

[QofQuimica]

Like the finance guy or gal, I feel like ranting on SDN tonight too. It has nothing specifically to do with nontrads in my case, but I just feel like ranting about it anyway.

I hate charting. Really, really hate it. It takes a long time; it's painful to navigate the EMR, and the more patients you see, the further behind you get on documentation. It doesn't take long for the backlog to reach critical when you're working several days in a row. Then I started getting little electronic notes through the EMR from the billing/coding specialists at the hospital about how I need to finish my charts. Tonight I logged on and there were a few dozen of these messages. As if I didn't already feel stressed out enough at the sight of there still being 57 unsigned charts in my queue! To make matters worse, I don't only have to sign my own charts; I also have to sign the charts of any midlevels I supervise.

I know this is part of the growing pains that go with starting a new job. New EMR, new hospital system, new adjustment. And I understand why charting is important. And on the bright side, I have a better system in place now for not getting as much behind. But that doesn't help me with all the charts from last week that I still have to finish, now does it???

OK, on that note, I will now go sign a few more, because otherwise I'll be even further behind tomorrow....

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[HinduHammer]

Like the finance guy or gal, I feel like ranting on SDN tonight too. It has nothing specifically to do with nontrads in my case, but I just feel like ranting about it anyway.

I hate charting. Really, really hate it. It takes a long time; it's painful to navigate the EMR, and the more patients you see, the further behind you get on documentation. It doesn't take long for the backlog to reach critical when you're working several days in a row. Then I started getting little electronic notes through the EMR from the billing/coding specialists at the hospital about how I need to finish my charts. Tonight I logged on and there were a few dozen of these messages. As if I didn't already feel stressed out enough at the sight of there still being 57 unsigned charts in my queue! To make matters worse, I don't only have to sign my own charts; I also have to sign the charts of any midlevels I supervise.

I know this is part of the growing pains that go with starting a new job. New EMR, new hospital system, new adjustment. And I understand why charting is important. And on the bright side, I have a better system in place now for not getting as much behind. But that doesn't help me with all the charts from last week that I still have to finish, now does it???

OK, on that note, I will now go sign a few more, because otherwise I'll be even further behind tomorrow....

I take it your hospital/department doesn't use scribes... As a former ED scribe and current clinic scribe, it seems that many physicians really like having us there both to document HPI, PEx, DDx, etc., but also to help keep the docs from falling too far behind. I was routinely told that the docs spent hours less per day on charting when they had scribes. Not sure if you can have your hospital or department look into a professional scribe company, or if you could independently look to find an eager pre-med and get them cleared to scribe for you... but it might help your documentation burden. I've also remember in the ED that seasoned attendings would make fun of physicians newly out of residency because they always have perfect looking charts that take a lot more time to do, while the more seasoned attendings just put in just enough work to do it right and no more.....

Edit: PS, sorry you're having a less than stellar night

 

[QofQuimica]

If I could pay a premed to follow me around and write my charts, I totally would. I'd even write them a great LOR for med school!

FWIW, I don't know whether to be amused or annoyed that some of you are liking my rant.

 

[mspeedwagon]

Out of curiosity, what EMR system are you using. Speaking as someone that monitors oncology trials for protocol compliance for a living (and thus is working with a new EMR system every few weeks), EPIC has been great (for me as and the oncologists I've worked with). Lots of functionality in there that I would assume would make charting easier. I/they also like Cerner (again to review records). I've seen AllScripts used a few places and some smaller vendors (iKnowMed is used by US Oncology).

I would love to see one universal EMR system so that I don't have to learn how to navigate a new system at each hospital, but that's not likely. I can imagine it's a real pain for docs too as they move from hospital to hospital.

 

[mspeedwagon]

Duplicate post (Oops!)

 

[lovelybones]

Eager pre med right here!
I wish I could find someone like you in my area who I could do that kind of work for. It would be meaningful as opposed to just volunteering in the ED and greeting patients -.-

 

[QofQuimica]

Out of curiosity, what EMR system are you using. Speaking as someone that monitors oncology trials for protocol compliance for a living (and thus is working with a new EMR system every few weeks), EPIC has been great (for me as and the oncologists I've worked with). Lots of functionality in there that I would assume would make charting easier. I/they also like Cerner (again to review records). I've seen AllScripts used a few places and some smaller vendors (iKnowMed is used by US Oncology).

I like Epic too; it's much better integrated than a lot of other hodgepodges of EMRs. AllScripts is not as user-friendly IMO. Glad to hear that you like Cerner, because apparently we're going to get it in the future.

I would love to see one universal EMR system so that I don't have to learn how to navigate a new system at each hospital, but that's not likely. I can imagine it's a real pain for docs too as they move from hospital to hospital.

Likewise.

Eager pre med right here!
I wish I could find someone like you in my area who I could do that kind of work for. It would be meaningful as opposed to just volunteering in the ED and greeting patients -.-

Come on down. FL is a much better home state to apply from than MA anyway.

Actually, I am not sure what the hospital policy is regarding whether premeds are allowed to shadow me. But I'd be happy to do it if the hospital would allow it. I like a captive audience.

 

[2Pints]

I like Epic too; it's much better integrated than a lot of other hodgepodges of EMRs. AllScripts is not as user-friendly IMO. Glad to hear that you like Cerner, because apparently we're going to get it in the future.

Likewise.

Come on down. FL is a much better home state to apply from than MA anyway.

Actually, I am not sure what the hospital policy is regarding whether premeds are allowed to shadow me. But I'd be happy to do it if the hospital would allow it. I like a captive audience.

I'm Cerner "super user" in FL if you need some quality training for CPOE and PowerNote Cerner has it's pros and cons like all systems but hopefully your hospital won't design their own system using Cerner like my hospital did. When I went on some contract training trips to help other hospitals go live with Cerner, I was increasingly frustrated when I discovered the functions my hospital decided not to use.

Not sure how EPIC is with templates but I've seen some doctors embrace templates for their order sets and notes just tailoring the specifics to each patient that seems to cut down on their charting.

One of our intensivists does a great job with putting order sets in a planned state so that we can initiate when a patient finally transfers out of the ED. This way we can have everything set up before the patient arrives to start treatment as soon as possible. So not looking forward to documenting as a physician in the future...it's a beast even as a nurse. Good luck with finding an efficient system for you.

 

[type12]

My experience with EMR is it's a cash grab, or maybe the requirements are so strict and difficult that it leaves no space to work on UX. Most of these have poor navigational control, and require a mouse, which slows you down. There's a great deal of stuff that can be done to improve it, but I'm wondering if, considering that it's been so long and no one has done it, if the cost of being compliant will always prevent a good interface.

Some software is like porn to use: you just enjoy using it. Ulysses III comes to mind, as does chrome, and a bunch of others. If they had this for EMRs, man, that'd be awesome.

I think scribes actually factor to prevent this from happening, as the user experience of a low-level worker is not important. I think scribing is a great way to get experience, mind you, but just looking from an administrative angel.

 

[QofQuimica]

Haha, "administrative angel" has to be one of the better oxymorons I've seen.

I don't give a flying rip about how fun any software is to use. I'd just as soon not use it at all. That's not to say that I want to go back to the days of handwritten notes, because those are a PITA too. If I had the option to pay a scribe to write charts for me, I totally would do it.

 

[type12]

Haha, "administrative angel" has to be one of the better oxymorons I've seen.

I don't give a flying rip about how fun any software is to use. I'd just as soon not use it at all. That's not to say that I want to go back to the days of handwritten notes, because those are a PITA too. If I had the option to pay a scribe to write charts for me, I totally would do it.

Ha, I was wondering who said that, and it was me!

I didn't mean fun in the sense of "whee," but basically what you said: typing on a full-sized keyboard is more "fun" than typing on a smartphone.

There's no way this would ever happen (or should), but basically, think vim/emacs for charting.

 

[milski]

Ha, I was wondering who said that, and it was me!

I didn't mean fun in the sense of "whee," but basically what you said: typing on a full-sized keyboard is more "fun" than typing on a smartphone.

There's no way this would ever happen (or should), but basically, think vim/emacs for charting.

Hm, are you really sure that emacs does not have some commands for charting?

 

[Straw Hat]

I hate charting too and I'm sure as a nurse I'm not charting half as much as a physician. Although a few nurses who have worked at other places have said our floor charts more than they've ever had to. It just seems so useless to me and I feel like all I'm being used for is to bill patients saying I did this and I did that. And I doubt any physician looks at what I've written for info except for the vital signs and they'll just ask whatever info they want in person or on the phone. I've used Cerner before and that didn't seem too bad but my exposure to it is very limited. I believe our hospital uses its own developed EMR and it's actually not too bad. But I still hate charting.

 

[Gauss44]

Thanks for being real. I like it when people say things how they are, as oppose to, butt kissing, sugar coating, or acting as if everything is just always perfect for other unspecified reasons.

 

[Ailleurs]

If I could pay a premed to follow me around and write my charts, I totally would. I'd even write them a great LOR for med school!

FWIW, I don't know whether to be amused or annoyed that some of you are liking my rant.

I totally would do this for the experience! It's hard getting volunteering hours where you get a direct look into what physicians have to do without knowing someone in the field. You have to go through a lot of people...

 

[ridethecliche]

Can you dictate your notes?

 

[QofQuimica]

I totally would do this for the experience! It's hard getting volunteering hours where you get a direct look into what physicians have to do without knowing someone in the field. You have to go through a lot of people...

Where in the country are you?

Can you dictate your notes?

No. I never liked dictating anyway. Had to do it on some services as a resident.

 

[Serenitysweety]

Ooh! Florida resident here! It would be hoping too much that you're part of he gator nation right?

Actually, I am not sure what the hospital policy is regarding whether premeds are allowed to shadow me. But I'd be happy to do it if the hospital would allow it. I like a captive audience. [/QUOTE]

 

[ridethecliche]

No. I never liked dictating anyway. Had to do it on some services as a resident.

Really? All the docs I work with do it that way. They dictate right after seeing a patient and they just have to approve the transcripts once they're in. They're done during their day essentially.

 

[Ailleurs]

Where in the country are you?

I'm in NYC.

 

[jl lin]

Superfluous and redundant are two words that comes to mind when looking at documentation in healthcare.

 

[wholeheartedly]

Superfluous and redundant are two words that comes to mind when looking at documentation in healthcare.

And inaccurate often.


My institution is making the switch from an institution designed EMR to either EPIC or Cerner. I'm not sure I have a preference with how little I've used them, but I have a sneaking suspicion whichever one they choose won't play as nice with our laboratory system software as they think it will...

Funny aside, when my friend's hospital was making the switch to EPIC they had boxes for backup order forms and stuff in a box at the nurses station. The box had a sign that said:

"Backup forms in case of EPIC failure"

 

[QofQuimica]

Heh.

I've never used Cerner, but I Epic. It does have a steep learning curve initially, but once you get your macros set up and you get used to it, the integration aspect of it is awesome.