EMR and anesthesia

[roundabout1]

My hospital has purchased a less than stellar EMR system which did not take into anesthesia flows and documentation needs. We are expected to enter our preops, PACU orders, antibiotic times, and postops in the system. (There is no automated intraop record and no access to this system from the OR). Of course the administration does not understand why we have a problem with it. Avoiding details of everything that does not work with this system, I'll just summarize that it causes me concern about patient care and medicolegal issues.

Talking to friends and colleagues at other hospitals in my state and elsewhere, I learned that their departments use paper for everything- preop, OR record, postop- AND there are no plans in the works to convert to computer. Researching more I found the ASA blurb about EMR (https://www.asahq.org/For-Members/A...ory-Activities/Electronic-Health-Records.aspx).

Am I correct in my understanding that we are exempt from the penalties of not using an EMR but are eligible for the incentives (which I figure can be obtained only through using electronic records both in and outside the OR)?

I want to prove to the hospital administration that we don't have to be using this ridiculous EMR system yet we can still be compliant on paper.

Anybody know of any sites which can back this up (besides asahq)? Many thanks!

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[deleted682700]

I don't know, but if ever your hospital is forced to buy make sure they get EPIC, much better than medi techmedi tech

 

[Impromptu]

The big incentives for meaningful use of electronic medical records have been phased out and replaced with meaningful use penalties. To make it even tougher we are now required to electronically input those meaningful use data the very same day, which would have added an extra 10 minutes to each case during turnover time. No longer were we able to overnight ship them to our billing company to input for us. However, we learned that anesthesiologists can now be exempt from meaningful use requirements. We miss out on a now much small financial incentive, but we save about 10 minutes per case.

 

[sevoflurane]

A day of 15 T&As with anesthesia electronic medical records....

...should be fun.

 

[deleted171991]

A day of 15 T&As with anesthesia electronic medical records....

...should be fun.

Done in residency (~10-12/day). Left hand on the mask, right hand on the mouse. Crazy. Tonsils were easier, because they took longer and the left hand was free.

I also love EPIC, but that's like saying I love Rolls-Royce. Not everybody can afford one.

 

[deleted682700]

Done in residency (~10-12/day). Left hand on the mask, right hand on the mouse. Crazy. Tonsils were easier, because they took longer and the left hand was free.

I also love EPIC, but that's like saying I love Rolls-Royce. Not everybody can afford one.

Or ask the admin to provide a scribe , so you can concentrate on patient and repeat this buzz word patient safety 5-6 times.

 

[deleted171991]

My attending was the scribe occasionally.

 

[BuzzPhreed]

I want to prove to the hospital administration that we don't have to be using this ridiculous EMR system yet we can still be compliant on paper.

They may be conflating the "Meaningful Use" requirements outlined in the ACA with intra-op record requirements, which are not specifically mentioned in Meaningful Use.

 

[IlDestriero]

Integrated EPIC kicks ass. Now it is all there and easy to see. What fluids and meds in the ED or PICU, they see what we gave in the Or and when. Seamless.

 

[sleepallday]

Once you go EMR, you can't go back to paper anything. It makes my job so much easier. I've used both epic and cerner. Both pretty good, but epic is a little more intuitive.

 

[deleted126335]

The EMR is a major time sink. I spend a huge amount of my day in front of the computer that I never had to before. Their benefits are grossly overstated in my opinion.

 

[pjl]

We actually are faster for preops and have more available information using the computer records. Intraop there is no chance that you are not getting accurate vitals on the record either. It is good for supervising and ensuring your employees arent nudging numbers closer to normal, plus you can watch a little easier from your tablet wherever you happen to be. You can enhance your care with reminders for whatever you want at whatever frequency you want too so a little popup shows up when it is time to redose antibiotics or switch from crosswords to sudoko or whatever.

For ENT and other fast cases, there are macros that chart most things (you need to be ABSOLUTELY SURE that everything in the macro was done in every case though). Very similar to the time I used to spend scribbling a few comments on paper chart and slapping some vitals down, and honestly it is probably more accurate.

I am a big fan of EMR for anesthesia, it frees your hands from the paper charting of vitals and going back to chart vitals on hearts etc and allows you to pay more attention to the patient at hand. That said, we have EPIC, and a dedicated EPIC anesthesia IT person who caters to our whims on what will make it easier so I probably have an advantage over most.

 

[ranvier]

Proposed study: increased utilization of ephedrine with implementation of EMR in the OR.

 

[caligas]

Proposed study: EMR dramatically increases intraoperative hemodynamic variability.

 

[pjl]

Im sure Blade can find it, but I read a study regarding 3 groups:
Paper charting, not aware they were being observed
Paper charting, aware someone was observing
Electronic charting

Surprisingly, the second group fudged numbers almost as much as the first group.

 

[Sublimazing]

We learned on paper then switched to EPIC. Can't imagine a better way to do it. I know the dental anesthesia providers have been looking into indepedent programs that use ipads/tablets...im not sure how well those would work in a hospital

Anesthesia charting is so unique even on EPIC the anesthesia charting is its own component