Help With Cerner/FirstNet

[Backpack234]

Just got a new gig which has me switching to cerner. I used it back in residency but forgot all the tips and tricks. Specifically, right now I'm trying to create my own order sets because the pre-filled ones are incomplete.

For example, ED Chest Pain doesn't have a Dimer order to click. I can "add to phase" a dimer and it comes into the order set pre-selected as Dimer Blood Stat. But if I unclick it, the details go away and I'd have to re-select "blood" and "stat" details every time I order a dimer through this orderset. Is is possible to add and UNSELECTED order WITH details to an orderset? Then I could have my base orders pre-clicked and my patient specific orders available to select if needed.

I think I'm missing something here. Any cerner experts out there who can help?

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[RustedFox]

*Cries in Meditech*

 

[thegenius]

I use Cerner and in the past have asked questions about it, and I realize that hospitals use different Cerner builds. What works at one Cerner installation might not work at another.

For instance I want a .dot phrase to pull in radiology reads..some Cerner builds have that and others don't.

 

[thegenius]

*Cries in Meditech*

Meditech is the worst. Your notes would be easier to understand if you used a random word generator or offloaded your chart writing to a gang of orangutans.

 

[RustedFox]

Meditech is the worst. Your notes would be easier to understand if you used a random word generator or offloaded your chart writing to a gang of orangutans.

Our present build is far better than the Meditech I learned on my first job out, but the fact that HCA has adopted a "ride or die" attitude about sticking with it is very telling

 

[Fox800]

I've been painfully learning Cerner. Here's what I've found so far:

• Macros are your friends. Make macros for "basic information", family/social hx, PMH/PSH (I usually have it set to "reviewed in chart" then pull in history from the problem list in the chart). I have macros for multiple physical exams: trauma, pediatrics, cardiac arrest, abbreviated exam (MSE), etc. I also have multiple macros for the ROS: 10 point ROS negative, unable to obtain due to AMS, dementia, intubated, etc.
• You can save pre-completed notes for frequently used complaints. I have ones for AMS, chest pain, abdominal pain, medical clearance, peds URI, etc. My most efficient partners have an entire library of pre-completed notes for a wide variety of complaints.
• You can select (highlight) multiple radiology orders at the same time and type the same indication and it will be applied to all the orders. So if you are ordering a ton of trauma CTs this saves a ton of time. You can also select multiple labs and change them to "add-on", etc.
• You can do auto-texts like EPIC. I believe you have to look for the auto-text utility. I have it set up to do things like ..ama, ..physexam, whatever you want.
• Find out if your build it set up to pull in radiology reads or lab results. For my site, I can type ..rads and it will pull in every radiology read and I can paste it into the MDM in the radiology section.
• Make a favorites folder for your frequently used orders. I have an extensive favorites folder with all of my labs, medications, nursing orders (pulse ox, ambulate, road test, set up for pelvic exam), etc. When you are ordering something, you can right click and do "add to favorites".
• If you have PowerPlans, you can tweak the default checked and unchecked orders. Open a PowerPlan, then check and uncheck the default items you would like. Then you can click "save to favorites" or something similar at the bottom. This will save the PowerPlan under your favorites folder under "My PowerPlans".
• You can favorite your clinical impressions and follow up physicians/clinics as well. Learn and love this.

 

[RustedFox]

A word after the above post:

A lot of these features are entirely build dependent. My last site had few if any of those features.

 

[Fox800]

A word after the above post:

A lot of these features are entirely build dependent. My last site had few if any of those features.

Lame, broh.

 

[Siggy]

Just got a new gig which has me switching to cerner. I used it back in residency but forgot all the tips and tricks. Specifically, right now I'm trying to create my own order sets because the pre-filled ones are incomplete.

For example, ED Chest Pain doesn't have a Dimer order to click. I can "add to phase" a dimer and it comes into the order set pre-selected as Dimer Blood Stat. But if I unclick it, the details go away and I'd have to re-select "blood" and "stat" details every time I order a dimer through this orderset. Is is possible to add and UNSELECTED order WITH details to an orderset? Then I could have my base orders pre-clicked and my patient specific orders available to select if needed.

I think I'm missing something here. Any cerner experts out there who can help?

1. Get your order set up how you want it to look like.

2. Click "initialize"

3. Click "orders for signature."

4. Before you click sign, look on the top right of the order screen where the active and pending order sets are. Right click your order set and click on "Save as my favorite."

5. Set the name you want... this will be the name displayed in the order screen for that order set.

6. It will now appear under "my favorite plans" folder when you go to submit new orders.

I have a bunch of these that I routinely use. My vent favorite plan comes with preloaded CXR, ABG, artifical tears, propofol drip, fentanyl drip, and a templated vent order (AC/VC rate 14, volume 500, FiO2 100%, PEEP 5). Similarly my insulin drip includes the qhour accucheck and BMP and Mg levels q6 hours. At my fellowship hospital we'd get 2-3 hypertriglyceride pancreatitis per year, so there's a separate order for that set (since it's a hard, non-titratable drip).

 

[maxxor]

Our present build is far better than the Meditech I learned on my first job out, but the fact that HCA has adopted a "ride or die" attitude about sticking with it is very telling

I wonder if they are the only place still adding new meditech installs.

As an intern in 2014, I had the distinct pleasure of using a meditech magic install that dated to the 1970s.

It was like working in a museum.

 

[RustedFox]

I wonder if they are the only place still adding new meditech installs.

As an intern in 2014, I had the distinct pleasure of using a meditech magic install that dated to the 1970s.

It was like working in a museum.

Yeah, that HCA refuses to admit that they made a big mistake and throw good money after bad absolutely amazes me.

 

[Angry Birds]

*Cries in Meditech*

I have Meditech Expanse. It's the absolute worst EMR I have ever used. Hands down.

 

[RustedFox]

I have Meditech Expanse. It's the absolute worst EMR I have ever used. Hands down.

Screenshot, please!

I don't even recognize this "Expanse" qualifier.

This is new joke fodder.

 

[Fox800]

I have Meditech Expanse. It's the absolute worst EMR I have ever used. Hands down.

T-Sheets Evolve might be worse. I heard so many good things about paper T-Sheets, but the EMR itself is absolute garbage.

 

[Angry Birds]

Screenshot, please!

I don't even recognize this "Expanse" qualifier.

This is new joke fodder.

Hmmm ok I’ll try to. Don’t want to get fired here though

 

[RustedFox]

Hmmm ok I’ll try to. Don’t want to get fired here though

Just edit out any PHI and such.
MS paint does that just fine.

 

[maxxor]

Hmmm ok I’ll try to. Don’t want to get fired here though

Or Google a screen shot.

 

[RustedFox]

Or Google a screen shot.

JESUS CHRIST.

I just did that.

I wish I hadn't.

If I had to work a 12 hour shift with those faces of patients staring back at me all gapmouthed and vacant-eyed, I would commit a crime or three.

Just kidding about the crimes, but you get the idea.

 

[maxxor]

JESUS CHRIST.

I just did that.

I wish I hadn't.

If I had to work a 12 hour shift with those faces of patients staring back at me all gapmouthed and vacant-eyed, I would commit a crime or three.

Just kidding about the crimes, but you get the idea.

Expanse or magic? Expanse cosmetically looks like lipsticked magic pig.

Magic legit was awful.


Edit: I don’t understand these rankings. Epic barely beat Meditech? Not that I love epic, but Meditech is so bad that it’s not even in the same planet.

Epic Systems, athenahealth, MEDITECH Top 2021 Best in KLAS Awards | TechTarget

Although Epic Systems was presented 11 Best in KLAS awards, athenahealth, MEDITECH, and Cerner excelled.

ehrintelligence.com

 

[rokshana]

I have Meditech Expanse. It's the absolute worst EMR I have ever used. Hands down.

Then you have not used allscripts…

 

[bravotwozero]

I have meditech expanse at my shop. We, paradoxically, switched from cerner to expanse.

It definitely sucks, especially for someone who was working with EPIC at his last gig.

Between the HCA version and this one, i guess it depends how you look at it.

The HCA version looks much more pre historic, but dirt simple, and allows you to auto populate generic statements that save you time, like a discharge note, CC note, hand off note, etc. Plus at the HCA prn gig where I work, it's coupled with dragon dictation, which is by far the best dictation software.

Expanse doesn't have that, but has a more user friendly interface. Here, it's paired with M Modal, which has useful features like voice commands, but the transcription quality is just not as good as Dragon.

 

[maxxor]

I have meditech expanse at my shop. We, paradoxically, switched from cerner to expanse.

Wow a new deployment!

I legit thought Meditech got a ton of initial installs in the 1970s (most of you know their core 1970s product as PCI-patient care inquiry) and rode the switching cost inertia as long as possible by being cheaper yet still checking all the HITECH / ONCHIT / MU boxes despite being so bad.

 

[CajunMedic]

I'm going from a fairly decent FirstNet build with MModal, back to ancient Meditech w/Dragon at my full-time with Medhost/Dragon at my per diem site. I'm just hoping to carry all my Voice commands and dot phrases with me somehow

 

[turkeyjerky]

Then you have not used allscripts…

Truth.

I'm going from a fairly decent FirstNet build with MModal, back to ancient Meditech w/Dragon at my full-time with Medhost/Dragon at my per diem site. I'm just hoping to carry all my Voice commands and dot phrases with me somehow

I've not found an efficient way to do this yet. I always copy/paste everything into a word or google drive docuement and transfer manually. Only catch is that many hospitals block gmail and external hard drives...(yet I've never found one that blocked facebook, reddit or sdn)

 

[rokshana]

Truth.

I've not found an efficient way to do this yet. I always copy/paste everything into a word or google drive docuement and transfer manually. Only catch is that many hospitals block gmail and external hard drives...(yet I've never found one that blocked facebook, reddit or sdn)

Allscripts is the 7th circle of hell...i legit would turn down an assignment at a place that has allscripts.

 

[BoardingDoc]

Truth.

I've not found an efficient way to do this yet. I always copy/paste everything into a word or google drive docuement and transfer manually. Only catch is that many hospitals block gmail and external hard drives...(yet I've never found one that blocked facebook, reddit or sdn)

Use a 3rd party dot phrase program. There are several out there. I've been running a program called phraseexpress since I was a resident. It runs off of a thumb drive. No matter where I'm working or what EMR I'm using, I just plug in the drive, run the app and now I have all of my dot phrases available.

 

[RustedFox]

Use a 3rd party dot phrase program. There are several out there. I've been running a program called phraseexpress since I was a resident. It runs off of a thumb drive. No matter where I'm working or what EMR I'm using, I just plug in the drive, run the app and now I have all of my dot phrases available.

I have phraseexpress and use it for one of my side-gigs. It's pretty good. The UI isn't the most intuitive, but it gets the job done.

The whole "plug in your thumb drive" step may cause a problem, though.

 

[RustedFox]

Expanse or magic? Expanse cosmetically looks like lipsticked magic pig.

Magic legit was awful.


Edit: I don’t understand these rankings. Epic barely beat Meditech? Not that I love epic, but Meditech is so bad that it’s not even in the same planet.

Epic Systems, athenahealth, MEDITECH Top 2021 Best in KLAS Awards | TechTarget

Although Epic Systems was presented 11 Best in KLAS awards, athenahealth, MEDITECH, and Cerner excelled.

ehrintelligence.com

Whichever one of those monstrosities had mugshots of the patients all left-justified, with various looks on their faces, as if they were trying to say things like: "HURR", "DURR", "HURR-DURRRR", and "DERRP".


EDIT: Parade of DERPS screenshot attached below.


ADDITIONAL EDIT: I ... can't..... I just can't.... stop laughing.

 

[bravotwozero]

Yeah that’s definitely not expanse. Thank heavens for that.

 

[BoardingDoc]

Yeah that’s definitely not expanse. Thank heavens for that.

Not your version maybe. I'm using meditech expanse and it looks basically identical to what @RustedFox posted. Derpy photos and all.

 

[BoardingDoc]

I have phraseexpress and use it for one of my side-gigs. It's pretty good. The UI isn't the most intuitive, but it gets the job done.

The whole "plug in your thumb drive" step may cause a problem, though.

I had an issue at one hospital where their computer system had a way of detecting and reporting when a thumbdrive was inserted. I just encrypted the drive and told IT about that and what I was using it for and they left me alone. Every other place I've worked, I haven't bothered to run it by anyone nor have I ran into any issues.

You could also email the program and your phrases file to yourself and simply download it to whatever machine you're working on if the physical drive is likely to be a problem.

 

[Angry Birds]

Not your version maybe. I'm using meditech expanse and it looks basically identical to what @RustedFox posted. Derpy photos and all.

Ours doesn’t have the photos but yes that’s expanse. Each hospital can customize it a bit…

But yeah it’s literally the absolute worst EMR I’ve ever used

 

[RustedFox]

Ours doesn’t have the photos but yes that’s expanse. Each hospital can customize it a bit…

But yeah it’s literally the absolute worst EMR I’ve ever used

Elaborate.
How is it worse than the Children's Television Workshop version of Meditech that we all know and hate?

 

[souL0]

Anyone have any idea how to combine a macro with a smart template instead of a dot phrase using Cerner? Like if I wanted to pull in rads, I could simply right click and the macro would run the smart template and insert the information into the chart?