I have a big hate-on for Epic

[fiatslug]

and yes, I've used it before for 2 yrs in fellowship! We just implemented it at my job, and they are so unprepared for psychiatry (and particulary partial hospitalization, where I work). I know ultimately it will be better, but IME it is *so* inferior to the blessedly intuitive, just what you need and no extra bells & whistles CPRS at the VA.

/rant

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[Bartelby]

The VA system rocks, I have to give you that. Epic is pretty amazing too though. Once I learned how to use smart phrases to autopopulate labs and figured out how to make automatic note templates I really fell in love with it. I got to the point where in ten minutes or less I could come in and see all of the patients labs, overnight events, etc etc as I constructed the notes. I then went room to room to actually check in with them, returned to the computer to type in the few manual fields, and was able to round with my notes completely finished. I could make it through a 3 - 6 patient census in under an hour with notes completely done this way, although it wasn't psych. The feeling of having all my notes finished by morning rounds was amazing!

Still, what my hospital had before for each patient was a physical nursing chart, a physical physician/consults chart, an electronic labs system, and an electronic medical orders system. You actually had to go through all four sources and then handwrite a note every day on every patient, and people hoarded the physical charts so that you had to search for almost every one. Going from that to Epic is nearly enough to make you cry tears of joy...

 

[OldPsychDoc]

First-World problem...Annoying, but inevitable.

Still I wish I could get my billing done with fewer than 9 clicks per patient...

Of course, that's probably what all of us Borg are programmed to say by now.

 

[sunlioness]

I like Epic even though I haven't figured out all the bells and whistles. I have a smart set that I use for my visits and then I dictate the actual note. For a while there, I was forgetting to bill people, but I'm pretty good about remembering to do that now.

 

[whopper]

We've been using Lastword in University Hospital in Cincinnati and that system blows. We're switching to Epic.

Great. I finally got the crappy system down. While Epic is supposed to be better, another 2-3 weeks where I don't know WTF I'm doing and will spend 20 minutes just trying to get a guy his diet order changed.

 

[F0nzie]

I used to know the ins and outs of Epic 5 years ago. Now I have to relearn the new version. One thing I don't like about the update is how cluttered it is with BS requirements. Change my name to Dr. Click.

I don't care for CPRS because of all the paragraph + spacing glitches, idle crashing and 20 minute lockout, and awkward admission order sets + popup windows. The version of CPRS that doesn't suck has yet to be released.

It would be neat when all documentation can be done with ipad-like tablets and a stylus. But then that would be too easy and efficient. There is no incentive whatsoever to accomplish this because it would only save 1-2 hours per day of documentation time at most.

The problem with EMR these days is it costs a ton of money to create, maintain, adhere to HIPPA compliance, encrypt data backup, and provide 24/7 customer support. Small changes or glitches in the system can cause catastrophic rippling effects which is just another aspect that increases the overhead. I look forward to the day EMR is CHEAP and STREAMLINED. I won't hold my breath.

 

[F0nzie]

This is the official drink for this thread

 

[BobA]

I find that EPIC tries to be all things to all people and ends up being nothing to everyone.

Important information is hidden among piles of BS I don't care about.

It's got way too many buttons. It takes over 100 clicks to do an admission!!

 

[fiatslug]

I find that EPIC tries to be all things to all people and ends up being nothing to everyone.

Important information is hidden among piles of BS I don't care about.

It's got way too many buttons. It takes over 100 clicks to do an admission!!

Yes, yes, yes, 1000 times yes!!! That's my biggest Epic gripe. Things that were simple are now ridiculously complicated.

Sunlioness, you should see my smarttexted evaluation . It's ridiculously overdetailed. As is, I think, Epic.

BUT I am getting to do Dragon training next week, which I think will actually make documentation easier and faster than previously (we were all dictation before). I do think Epic makes documentation easier, BUT orders... entering meds... effing tedious.

 

[fiatslug]

Also, we're just launching, with all the predictable HAs and screw ups you can imagine. Whopper--schedule vacation during the launch . If they let you. It's much smoother coming in to an Epic that has been working well for a few months/years than starting afresh.

 

[Apollyon]

Also, we're just launching, with all the predictable HAs and screw ups you can imagine. Whopper--schedule vacation during the launch . If they let you. It's much smoother coming in to an Epic that has been working well for a few months/years than starting afresh.

That's not a vacation - that's a sabbatical!

(That some consider sabbattical to BE a long vacation, that's neither here nor there.)

 

[OldPsychDoc]

Also, we're just launching, with all the predictable HAs and screw ups you can imagine. Whopper--schedule vacation during the launch . If they let you. It's much smoother coming in to an Epic that has been working well for a few months/years than starting afresh.

I naively asked for the week off that we were "going live".
Haven't been shot down that fast since I asked the prom queen to dance with me...

I find that EPIC tries to be all things to all people and ends up being nothing to everyone.

Important information is hidden among piles of BS I don't care about.

It's got way too many buttons. It takes over 100 clicks to do an admission!!

Yes, yes, yes, 1000 times yes!!! That's my biggest Epic gripe. Things that were simple are now ridiculously complicated.

Sunlioness, you should see my smarttexted evaluation . It's ridiculously overdetailed. As is, I think, Epic.

BUT I am getting to do Dragon training next week, which I think will actually make documentation easier and faster than previously (we were all dictation before). I do think Epic makes documentation easier, BUT orders... entering meds... effing tedious.

I'll see you your thousand yesses and raise you a million.
But wait unit you start adding silly Dragon transcription errors into the mix!

 

[Doctor Bagel]

I guess you like what you use the most because I like Epic more than CPRS. Of course, maybe my hatred of CPRS is attached to my hatred of all the administrative crap at the VA and all the extraneous forms I need to fill out. I do agree, though, that it's harder to find the specific information you're looking for in Epic. Creating notes, though, and putting in orders are easier, imo. I also like that I can actually edit a note instead of doing the whole erroneous note thing.

New EMR anywhere has to suck, though. Hope they get everything tweaked soon.

 

[whopper]

I haven't used Epic yet other than just to read notes for patients for court hearings, not putting in orders, but I have it in that regard to be far better than the other programs out there such as Lastword and Avatar.

I don't disagree with the statements above bashing Epic, but if you've used other systems, Epic tends to be accepted as better from people who've used the rest.

Of course, in a few weeks, when our hospital switches to Epic, the shoe will be on the other foot and I'll likely be joining all of you in bashing Epic!

 

[Apollyon]

I don't disagree with the statements above bashing Epic, but if you've used other systems, Epic tends to be accepted as better from people who've used the rest.

Of course, in a few weeks, when our hospital switches to Epic, the shoe will be on the other foot and I'll likely be joining all of you in bashing Epic!

My experience comes from EM, but I suspect it can be extrapolated across other fields - as I've said, "It's not so much how good an EMR is, but which one sucks the least".

 

[fiatslug]

My experience comes from EM, but I suspect it can be extrapolated across other fields - as I've said, "It's not so much how good an EMR is, but which one sucks the least".

What I don't get is why didn't they make Epic more like a physical chart? So that you nurses and therapist and SW notes and Tx planning notes are in their own sections and more easily found? I seriously don't need to click through 20 different "pt appeared to be sleeping" nursing notes. Physicians aren't able to differentiate our group notes from our H&P or follow up notes or admit criterion notes... *why* would that be so hard to do? And "scanned documents" is a black hole of mostly useless information that obscures the one thing of value you are trying to find... Argh.

Dragon training tomorrow.

 

[Fifty 3rds]

What I don't get is why didn't they make Epic more like a physical chart? So that you nurses and therapist and SW notes and Tx planning notes are in their own sections and more easily found? I seriously don't need to click through 20 different "pt appeared to be sleeping" nursing notes. Physicians aren't able to differentiate our group notes from our H&P or follow up notes or admit criterion notes... *why* would that be so hard to do? And "scanned documents" is a black hole of mostly useless information that obscures the one thing of value you are trying to find... Argh.

Dragon training tomorrow.

Technically, this is possible but then you'd have many tabs at the top and it becomes crowded. The problem right now is Epic must make everything available that has ever been available. In the coming years, I think we will see the software begin to thin itself down as it gets a handle on streamlining workflows, grouping information according to user/job title and cleaning up a few artifacts from it's earlier development stages.

Compared to the other programs, I'd take Epic any day of the week but I'm biased.

 

[fiatslug]

Familiarity with the system is not breeding contentment

Does anyone have a favorite smartphrase for labs or meds to pull into a note? Everything I've found is horribly clunky or requires ill-defined parameters. Where's the stabby-guy smilie?

 

[OldPsychDoc]

Familiarity with the system is not breeding contentment

Does anyone have a favorite smartphrase for labs or meds to pull into a note? Everything I've found is horribly clunky or requires ill-defined parameters. Where's the stabby-guy smilie?

Don't know how standardized they are across institutions but at our place .cmed brings up current meds, .cmedip current inpatient meds (with dosing schedule), and .last24 (or 48 or 72) brings up lab results for that # hours.

 

[notdeadyet]

It's not so much that Epic is so bad as that there are a lot of bad Epic installations out there.

The ones that work best are those that were driven by software specialists that relied on subject matter experts representing their fields. The worst are the ones driven my clinicians that weren't willing to cede power to "outsiders," resulting in a hodge-podge of stuff that doesn't play well together and is an interface that really represents departmental politics.

 

[Fifty 3rds]

It's not so much that Epic is so bad as that there are a lot of bad Epic installations out there.

The ones that work best are those that were driven by software specialists that relied on subject matter experts representing their fields. The worst are the ones driven my clinicians that weren't willing to cede power to "outsiders," resulting in a hodge-podge of stuff that doesn't play well together and is an interface that really represents departmental politics.

This x 100

 

[sunlioness]

And "scanned documents" is a black hole of mostly useless information that obscures the one thing of value you are trying to find... Argh..

My problem with scanned documents is that oftentimes I don't think they get scanned. I mean I will know that I saw someone's medical records that I requested, but then when I go to look for them in Epic, I can't find them. I don't know if I'm looking in the wrong place or if the scanning bin I am sticking them in is actually a conduit to the same planet where all the mismatched socks go.

 

[ZigPig]

I used to work at Epic before I went to med school... and despite my familiarity with EMRs, I get lost in all of them - Epic, Cerner, and whichever other ones I have used. They all are incredibly unintuitive.

I worked with a Family physician who used his Dragon to streamline his workflow. He created very complex macros-- I was amazed that he taught himself programming to do this --but he said in the long run it saved him a lot of time. I thought that it would be useful to share with other physicians using the system-- but apparently IT thought it was too complex to support, they did not understand what he was doing, and they even prevented him from doing some of the things he was doing. He said that every time system changed to a different version, he had to reprogram many of his macros.

I think the EMRs are developed to do some powerful things, but the basic workflows are hidden by complexity. I think that the software developers should spend more time on understanding, and then increasing the efficiency of workflows, rather than packing in more features. I plan to go back to work with EMRs part time to increase their simplicity, intuitiveness, and efficiency... after I graduate from med school... and then get through residency... and after getting my practice started...

 

[whopper]

I remember my last year of residency, when EMRs were first being implemented, the hospital had a meeting with a psychiatrist they chose from the hospital to offer feedback on how to make the EMR work well with the psychiatrists, and I was there as a chief resident.

There was a heck of a lot of good free food. The attending just sat there and ate the food and didn't seem to give a damn about anything. I kept mentioning that the EMR needed to be very user-friendly and mentioned concerns I had while he basically tried to shut me up so we could get out of there faster.

And then when the EMR was started, it blew. The attending didn't do squat to fix the system.

The guy was promoted a few weeks later.