Epic EHR, anyone using?

[Mastodynia]

We are about to "go live" with epic ehr. Anyone have recent experience regarding the rollout and what it did to productivity? Suggestions of what you did to mitigate this would be helpful.

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[Kubed]

One of the hospitals I'm at uses Epic. The first few shifts were pretty rough, but everyone seemed to recover quickly. I found I was much more efficient when I freetexted the HPI rather than using the epic template. I also tried to put in the HPI right away when I entered orders. That way if I was getting slammed with patients, I could quickly dispo and then have something to go off of later on to complete the chart.

 

[deleted6669]

epic is a pile of crap.
electronic t-system is much better.
when we switched to epic we had to double our staff to see the same # of pts...

 

[xaelia]

I found I was much more efficient when I freetexted the HPI rather than using the epic template.

Our coders require us to complete the click-box HPI and ROS for billing purposes.

If you want to see the same # of patients per hour, expect to spend a lot of time at the end of your shift doing documentation.

 

[SolidGold]

EPIC sucks, its slows me down terribly at the childrens hospital. I've seen the electronic t-system and was impressed by it. I'd prefer dictation any day though.

 

[Tiger26]

To put things in perspective based on our new EMR, I long for the days of the 'efficiency' and 'ease of use' of EPIC . . .

 

[Mastodynia]

As a resident I was at a hospital that rolled out Epic and it was rough. I'm not sure if they recovered to the productivity level as before Epic.

All the naysayers (I'm with you), is this based on first interaction or long-term speed issues that persisted?

Thanks for the freetext on HPI. Regarding the coders telling you to use checkboxes, screw 'em and get new coders. They just don't want to do any work unless they are getting paid less for coding off an EHR.

 

[deleted6669]

All the naysayers (I'm with you), is this based on first interaction or long-term speed issues that persisted?

.

long term issues that persisted...we never got back to our pre-epic productivity....originally the added staff was "just for a few months" until we were up to speed....that was years ago....T- system is the bomb. best emed ehr by far.

 

[xaelia]

Regarding the coders telling you to use checkboxes, screw 'em and get new coders. They just don't want to do any work unless they are getting paid less for coding off an EHR.

EPIC is in use both at my residency and my moonlighting hospital; coders at both use the clickboxes for billing.

Using the freetext HPI risks losing RVUs from missing HPI and ROS elements required for level 4 and 5 charts. Since I get incentive pay based on RVUs, I cross my is and dot my ts. The internal site shows how many coworkers lose RVUs based on downcodes for missing elements, so it's clear that people are losing money from sloppy charting.

 

[deleted109597]

I can chart 3 pts per hour using Epic, but it isn't easy. Macros and dot phrases are the way to go.
It is a handy system for looking up old charts.

 

[squad41]

I actually taught EPIC for all the hospital staff post-grad school before med school for a year at a 900 bed facility. It has a few pros (multiple ways to sort through old encounters), checks for drug-drug interactions with every order, good if you are suspicious of a frequent fliers/drug seekers in the ED in terms of sorting past visits by CC, etc....however, I've never been able to be convinced it improves efficiency.

 

[gro2001]

One of the hospitals I train at does paper charting, so when I first saw EPIC I was very impressed. But there is nothing like a templated EMR. Saves SO much time in the ED!

 

[DrQuinn]

went from paper charts in residency, to semi-electronic but no POE at my first job, and now some dictations at rural and EPIC at most of our FFS sites. I prefer EPIC. I type fast, and the dot phrases will save you tons of time (thinks like fever workup in kids, belly pain workups, chest pain MDM). Our production never really changed,a nd its probably easier to document things you might forget like pulse ox or cardiac monitoring. Its great from a chart review standpoint, and you can see all the outpatient clinic notes which is fan-f'ing-tastic.
Q

 

[Blake300m]

I think you can actually chart quite a bit quicker with Epic than any other computer documentation system I've seen, and even faster than T-sheets (and certainly better documentation overall) once you get used to the system.
As someone above mentioned, dot or smart phrases are the way to go. With regards to sloppy charting and losing RVUs, this really should never happen with Epic. Just click on the last tab that says "Note." - from there you can type into the H&P exactly as you would if it was all a blank template. You can have a dot phrase for review of systems that says "All systems reviewed and otherwise negative except as noted in HPI" and everytime you type ".ros" this will pop up - that is billable for Level 5 and takes about 1/2 sec to do.
As far as a physical, just have a dot phrase for a normal physical that encompasses eight different areas that you would normally chart. Use that dot phrase (".normalphysical") for all but the most abnormal physicals, then just delete or bold the items that are pertinent to the pt's presentation. Again, for a noncomplicated exam takes <30 sec.
Your discharges will be incredibly quicker, as Epic typically has frequent chief complaint discharge instructions built in that you can attach. You can also make a dot phrase for basic discharge instructions that will pretty much cover everything for a generic pt.

For the most part, the people I've seen that hate Epic hate it bc they have not taken the time to figure out how to use it to their advantage.

 

[Blake300m]

And briefly, with regards to the better documentation, again use the dot phrases.
Something like PERC, which takes a while to type out the 8 criteria each time - you can simply make a dot phrase that will take you a second to type (.perc) and will autopopulate with all the criteria.
You can do this with so many things and really can make a note fly by. especially peds notes - you can have a mild asthma, mod asthma, severe asthma physical that you use each time, and then just tailor it to each individual pt (or in most cases doesn't need tailoring at all). epic will also autopopulate the most recent vital signs if you type ".vs"

 

[bigred08046]

We are about to "go live" with epic ehr. Anyone have recent experience regarding the rollout and what it did to productivity? Suggestions of what you did to mitigate this would be helpful.

AWFUL!! This army of Stepford robots do not communicate well with humans. Judy Faulkner's army are brainwashed geeks that frankly are a bit scary. Our go live was disastrous with yelling patients, screaming doctors and confused administrators running around with their heads cut off.

 

[airball]

And briefly, with regards to the better documentation, again use the dot phrases.
Something like PERC, which takes a while to type out the 8 criteria each time - you can simply make a dot phrase that will take you a second to type (.perc) and will autopopulate with all the criteria.
You can do this with so many things and really can make a note fly by. especially peds notes - you can have a mild asthma, mod asthma, severe asthma physical that you use each time, and then just tailor it to each individual pt (or in most cases doesn't need tailoring at all). epic will also autopopulate the most recent vital signs if you type ".vs"

How do you make a smart phrase that will auto populate criteria such as age, med usage (OCP), etc?

 

[deleted109597]

You can put age in, but not outpatient meds unless you want all of them.
But you don't need to. Just put the 8 questions, and * the end of them. Go through, hit F2, and type yes or no to each question.

 

[TooMuchResearch]

How do you make a smart phrase that will auto populate criteria such as age, med usage (OCP), etc?

Your chart already shows the patient's age. Having it a second time doesn't do anything. If the chart overall contains all elements of PERC, your MDM can just say low risk for PE (by Wells or whatever you use...Again rest of chart should reflect that), PERC negative.

 

[TooMuchResearch]

Also everyone should know this thread is 6 years old.

To answer OP: Yes, I use Epic.

 

[deleted109597]

Also everyone should know this thread is 6 years old.

Well it's not like EPIC has changed any over that time. Except maybe more unscheduled downtimes.