Epic EMR what are your thoughts medical students?

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PieOHmy

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I know what I had to deal with to learn epic for the first time and still going through six months later.
What are your thoughts medical students? I bet you spend 1/2 rotations just battling epic and not even talk about medicine. Instead of talking about different kinds ofcongestive heart failure you spend similar time on how to navigate epic...

I think it is an utter piece of garbage software and its implementation is a cruel joke on anyone who has to use it.

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It’s better than the crap that Cerner and Nexgen put out there
 
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I’ll take it any day over the EMR we had at the VA. Epic has its kinks but it imo it’s very very fast compared to other EMR and the use of the mobile Haiku app allows for more real time updates.
 
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I personally enjoy messing up a presentation because the info I needed was in a nebulous spot in epic I didn’t know existed.
 
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Mark Zuckerberg needs to make a healthcare EMR minus the privacy issues
 
EPIC is 1000x better than pretty much any other EMR I've touched. I've had meditech, cerner, allscripts, whatever the trash was at the VA, and athena. On interviews now, and programs will mention if they have EPIC because incoming students like it better pretty much across the board.

Sure, in the beginning there are some nooks and crannies (lots of bells and whistles as someone else put it) that can swallow up some data if you don't know where to look, but its still so much cleaner and easier to understand at first glance and has tons of customization options so you can change lots of these things to make it easier on yourself. When on 4-5 week rotations, it will take days, if not an entire week, to get used to an EMR even at a fairly basic level. I can only say that I was "proficient" at using EPIC and allscripts (inpatient version - the outpatient form is even more of a dumpster fire) by the end of my rotations with them - and allscripts was mainly bc that was on a SUBI where I was doing a ton of stuff by myself (new interns for half of it) and had to learn it for that "H".

I'm finishing a rotation now with combined athena/meditech and the latter feels like it hasn't been updated in years, to the point where it looks and feels like trash. Athena looks nice and new, but it is unresponsive and feels like its just trying too hard to look nice without actually working well. The structure is better in EPIC, its easier to do dot phrases and the like, easier to write notes, easier to place orders, easier to get records from OSH. And as someone mentioned, the apps on phone and iPad are a godsend (Haiku and Canto I think. If you're complaining about EPIC, its likely just cause you knew your previous system well enough to counteract how bad it truly was.
 
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Literally spend 1 hour just customizing your schedule, patient list columns (for prerounding), dot phrases and note templates. Also epic haiku for your phone.
 
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Go use McKesson if you want to see garbage. Epic is great. I don’t see why anyone born in the 80s or 90s would have any problems with it. It’s very intuitive.
 
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Go use McKesson if you want to see garbage. Epic is great. I don’t see why anyone born in the 80s or 90s would have any problems with it. It’s very intuitive.
clicking buttons 1000x per day is not my idea of fun. its busy work...

MOreover the bloated notes generated by the residents are complete and utter garbage.

I dont need to look at sodium levels on your note if all im interested in is the potasium. I dont need to know how many review of systems you went over and dont put in your note the time it took you to write the note.. give me just the pertinent facts .. 2-3 lines max so i can go about my day
 
Lol. I hope you're not IM. Unless you're surgery or something notes should be a lot longer than 2-3 lines. Clicking in an EMR isn't anyone's idea of fun, its work, which is why you get paid, regardless, EPIC is better and once you get to know it better, it will save you clicks. And bloated notes are just as big of a problem in every institution with every EMR, just as is copy/paste.

Also, Idk why theyre doing the time thing, but a lot of places require similar things for documenting hours these days.
 
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I dont need to look at sodium levels on your note if all im interested in is the potasium.
You literally don't. If you're interested in potassium look at the results tab not someone's note.
 
You literally don't. If you're interested in potassium look at the results tab not someone's note.
My point was if the sodium is not important in the problem we are dealing with why put it in the note. Just put relevant things so i can figure out what you re thought process is and allow me to follow it.. You re not allowed to do that because of regulatory things..
It takes cognitive load to look at the number you wrote and figure out that is not important, but this is.. multiple that by 100, 1000 notes per month..

Wears heavy!1
 
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clicking buttons 1000x per day is not my idea of fun. its busy work...

MOreover the bloated notes generated by the residents are complete and utter garbage.

I dont need to look at sodium levels on your note if all im interested in is the potasium. I dont need to know how many review of systems you went over and dont put in your note the time it took you to write the note.. give me just the pertinent facts .. 2-3 lines max so i can go about my day
Being a physician has always been busy work. Paper charts, dictations, EMR. I’ve done them all. They all suck. Work is work and work sucks. That’s life. Least we get paid well.
 
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I've used Epic, CPRS, Cerner, Sunrise and AllScripts.

While they all have their issues, Epic is the best of the "modern" EMRs that I've tried. Other than that, CPRS seems to underrated. Sure, it doesn't have the fanciest GUI, but to me, it's the kind of minimalism I look for.
 
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My point was if the sodium is not important in the problem we are dealing with why put it in the note. Just put relevant things so i can figure out what you re thought process is and allow me to follow it.. You re not allowed to do that because of regulatory things..
It takes cognitive load to look at the number you wrote and figure out that is not important, but this is.. multiple that by 100, 1000 notes per month..

Wears heavy!1

Residents often write “K at 2.6” or something in their assessment anyway. I often skip the objective section unless I really don’t know anything about a patient.

Looking through the EMR is a PITA but often really helpful, especially with all the altered mental status and “poor historians” out there. Taking the time to review has saved my butt multiple times.
 
Being a physician has always been busy work. Paper charts, dictations, EMR. I’ve done them all. They all suck. Work is work and work sucks. That’s life. Least we get paid well.
When i was doing paper charting especially in the OR my life was a LOT simpler.
 
When i was doing paper charting especially in the OR my life was a LOT simpler.

Paper charting is great in the sense that you can scribble nonsense that no one can read and get away with it. I've seen some truly awful, awful paper charting that was best served to a HIPAA bin. As someone who dealt with both paper charts and EMR through medical school and residency, EMR has been vastly superior in communicating a SOAP note. Where it falters significantly is when people copy+paste their notes yet neglect to update them ,or fill it with autopopulated garbage.

Still, I'll take EMR over paper charts any day (especially in radiology where getting the clinical information is a few clicks away).
 
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Paper charting is great in the sense that you can scribble nonsense that no one can read and get away with it. I've seen some truly awful, awful paper charting that was best served to a HIPAA bin. As someone who dealt with both paper charts and EMR through medical school and residency, EMR has been vastly superior in communicating a SOAP note. Where it falters significantly is when people copy+paste their notes yet neglect to update them ,or fill it with autopopulated garbage.

Still, I'll take EMR over paper charts any day (especially in radiology where getting the clinical information is a few clicks away).
Results were always resulted on a computer system.
You would always review the labs, images biopsy results on the computer.

FOr some reason i have a difficult time following the flow of things on an epic chart.
 
EMR has been a boon for anesthesia.

I can read the chart of my next patient and put in orders while I’m in the OR taking care of someone else. Prior to EPIC, I couldn’t see their chart until I meet the patient in preop 10min before their surgery starts so there were more last minute surprises and delays when we had paper charts. I’ve also been able to instantly access records from other hospitals. A couple months ago I had a patient who had a pericardiectomy in Minnesota. I could see her op report, anesthesia record, and echo as if they were done at my own hospital in California.
 
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I've used Epic, CPRS, Cerner, Sunrise and AllScripts.

While they all have their issues, Epic is the best of the "modern" EMRs that I've tried. Other than that, CPRS seems to underrated. Sure, it doesn't have the fanciest GUI, but to me, it's the kind of minimalism I look for.
I've used CPRS and EPIC both quite a bit. While EPIC is really quite intuitive and dot phrases/templates are really helpful with saving time, CPRS is also quite efficient once you get to know it. VA has a pretty new massive contract with Cerner though last I heard, and will be transferring over to it at some point :(
 
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Results were always resulted on a computer system.
You would always review the labs, images biopsy results on the computer.

FOr some reason i have a difficult time following the flow of things on an epic chart.

I'm speaking more about the chart notes rather than the results. While I would prefer speaking directly to a clinician, sometimes they're hard to get a hold of as they're busy themselves. In those cases, I would peruse through an H&P and see if I could narrow down a differential diagnosis for my imaging findings or check if my findings are concordant with the history and physical.

If I had to suffer through paper charts, I would leave my impressions only as precise as can with whatever clinical info I get from the order requisition.

I do agree that all EMRs, Epic included, need a revamping to be more clinician-friendly rather than a first-and-foremost billing tool.

Btw, relevant article on Denmark's healthcare system after Epic was rolled out and the frustration that ensued: Lost in translation: Epic goes to Denmark
 
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You're a attending physician complaining about EPIC? You could be a a place that uses some allscripts product, or Meditech, or Sorian or Invision. Be grateful.
 
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You're a attending physician complaining about EPIC? You could be a a place that uses some allscripts product, or Meditech, or Sorian or Invision. Be grateful.
or CPRS where you have to enter 20 passwords to get to the actual meat and potato.
 
The wasteful garbage that is EPIC, is a cruel, cruel joke
 
The wasteful garbage that is EPIC, is a cruel, cruel joke
Are you trolling? If not, better hope you don’t work at a place that uses meditech or the like. Your eyes might fall out
 
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Epic is superior to every other EMR I have encountered.
 
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Epic is the best EMR I have ever worked on. It is still a terrible product, terrible customer service, and they should really have medical personnel instead of just IT and Admin consulting on its design for ease of use and better user experience. But still better than other EMRs...
 
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Epic is the best EMR I have ever worked on. It is still a terrible product, terrible customer service, and they should really have medical personnel instead of just IT and Admin consulting on its design for ease of use and better user experience. But still better than other EMRs...

I worked at Epic, and I take offense to the customer service dig (not really)... I felt like I did a pretty good job, and most people there start out making more than a PGY-4, which is insane IMO.

There are some physician consultants that work there, but the major focus is not on medicine, but on insurance. Judy, the CEO, would always make a big deal about how we had the patient at heart and how important the patients were, but I literally just fixed people’s systems so that Medicare and Medicaid wouldn’t deny their claims for stupid things like having CPT codes in the wrong order.
 
Epic is the best EMR I have ever worked on. It is still a terrible product, terrible customer service, and they should really have medical personnel instead of just IT and Admin consulting on its design for ease of use and better user experience. But still better than other EMRs...

There are medical consultants involved in the design and these medical consultants continue to be involved. The problem isn't Epic (which is also the best EMR I've worked with). The problem is that insurance companies run and rule the medical field. The problem is the number of things we have to document to get paid for doing our jobs. The problem is people who've never set foot in a hospital dictating how patient encounters should be documented and what you must and must not say to a patient. Those are the issues. Not Epic.
 
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It’s akin to asking which STD we would prefer to have, but in my experience (as a hospital employee, not physician yet) it goes EPIC>Cerner>Meditech>everything else

Could be a LOT better.
We have built these systems from the ground up for billing instead of patient care/making healthcare professional’s lives easier, and sometimes it shows.
 
There are medical consultants involved in the design and these medical consultants continue to be involved. The problem isn't Epic (which is also the best EMR I've worked with). The problem is that insurance companies run and rule the medical field. The problem is the number of things we have to document to get paid for doing our jobs. The problem is people who've never set foot in a hospital dictating how patient encounters should be documented and what you must and must not say to a patient. Those are the issues. Not Epic.
epic is garbage. It is epic. there are many other better ones
 
I have used anesthesia record keepers a LOT better than epic. When you pull up an old anesthesia record from epic, you have no idea what the **** youre looking at. It's pure garbage.
Phillips compurecord was A LOT better. A LOT.
EKO systems was pretty good.. It was a knob and you scrolled through what you were looking for then clicked when you found it.
Phillips compurecord was great . Used it at a few places. it was good. Ive never used cerner but it seems it's anesthesia platform is sort of like compurecord.

The point is, if clinicians are struggling with these and quitting by the droves, its time to make a change.
If you have to pay 8-10 people on site and a 24/7 support line manned just for people to document their findings, there is something wrong.
When you look at this, perhaps we should not be complaining about how much money I make.
 
I have used anesthesia record keepers a LOT better than epic. When you pull up an old anesthesia record from epic, you have no idea what the **** youre looking at. It's pure garbage.
Phillips compurecord was A LOT better. A LOT.
EKO systems was pretty good.. It was a knob and you scrolled through what you were looking for then clicked when you found it.
Phillips compurecord was great . Used it at a few places. it was good. Ive never used cerner but it seems it's anesthesia platform is sort of like compurecord.

The point is, if clinicians are struggling with these and quitting by the droves, its time to make a change.
If you have to pay 8-10 people on site and a 24/7 support line manned just for people to document their findings, there is something wrong.
When you look at this, perhaps we should not be complaining about how much money I make.
OK so your original post should have been
"Epic sucks for anesthesia".

I don't know enough to say on the score, but for clinical non-surgical medicine, Epic is pretty good.
 
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I have used anesthesia record keepers a LOT better than epic. When you pull up an old anesthesia record from epic, you have no idea what the **** youre looking at. It's pure garbage.
Phillips compurecord was A LOT better. A LOT.
EKO systems was pretty good.. It was a knob and you scrolled through what you were looking for then clicked when you found it.
Phillips compurecord was great . Used it at a few places. it was good. Ive never used cerner but it seems it's anesthesia platform is sort of like compurecord.

The point is, if clinicians are struggling with these and quitting by the droves, its time to make a change.
If you have to pay 8-10 people on site and a 24/7 support line manned just for people to document their findings, there is something wrong.
When you look at this, perhaps we should not be complaining about how much money I make.

The problem is that everything Epic does (and every EMR does for that matter) is to ensure maximum reimbursement from insurance. As insurance requirements have become more complex, EMRs have followed suit. Also, many of the EMRs use very outdated programming languages that are very cumbersome and make even small changes quite difficult. That’s why huge teams of people are required to keep it running.
 
OK so your original post should have been
"Epic sucks for anesthesia".

I don't know enough to say on the score, but for clinical non-surgical medicine, Epic is pretty good.
No you make a great point. Except the fact that I peruse the entire chart and I read notes written by all sorts of folks. From medical students to consultants.

The main problem is that folks (non clinical) believe more information documented is better when in fact the opposite is true.

There is a tremendous amount of noise in the chart around the actual meat that is giving you valuable information so you have to spend cognitive load to read nonsense to get to something that is telling you something.

And, I dont know when this started but why are people putting in their assessment and plan at the beginning of a soap note.

It is just so terrible.

epic for anesthesia DOES SUCK.
but so does EPIC IN GENERAL..
 
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Epic is okay. Integration of smart phrases makes things easy. However, some of the forced smart fields and clickbox-style positives and negatives just bloats the note.

I am also not a fan of how the labs are displayed in epic.

Best out right now? maybe. As good as it gets? Far, far from it. I'd say EMRs are about 30% of the way to where they should be. Epic also has an unparalleled "physician nudge" burden which is tedious and leads to ignoring potentially important info.
 
No you make a great point. Except the fact that I peruse the entire chart and I read notes written by all sorts of folks. From medical students to consultants.

The main problem is that folks (non clinical) believe more information documented is better when in fact the opposite is true.

There is a tremendous amount of noise in the chart around the actual meat that is giving you valuable information so you have to spend cognitive load to read nonsense to get to something that is telling you something.

And, I dont know when this started but why are people putting in their assessment and plan at the beginning of a soap note.

It is just so terrible.

epic for anesthesia DOES SUCK.
but so does EPIC IN GENERAL..
That's the fault of the person doing the charting.

Our coding department has been trying (mostly in vain) to explain to doctors that you don't have to actually list the entire PMH/med list/SH in the note to get billing credit.

For example, here's a patient note of mine from Friday:

Family Medicine Progress Note

Urinary Frequency
This is a new problem. The current episode started 1 to 4 weeks ago. The problem occurs every urination. The problem has been gradually worsening. The patient is experiencing no pain. There has been no fever. Associated symptoms include frequency. Pertinent negatives include no chills, discharge, flank pain, hematuria or hesitancy.



Review of Systems
Constitutional: Negative for chills.
Genitourinary: Positive for frequency. Negative for flank pain, hematuria and hesitancy.


Social History reviewed and updated as needed at this visit.

Vitals
Vitals:
10/18/19 1344
BP: (!) 138/87
BP Location: Left arm
Patient Position: Sitting
Pulse: 73
SpO2: 95%
Weight: 109 kg (240 lb)
Height: 5' 6" (1.676 m)




Physical Exam:
Physical Exam
Constitutional:
General: She is not in acute distress.
Appearance: Normal appearance.
HENT:
Head: Normocephalic and atraumatic.
Neurological:
Mental Status: She is alert.
Gait: Gait normal.
Psychiatric:
Mood and Affect: Mood normal.
Behavior: Behavior normal.
Vitals signs reviewed.



1. Polydipsia

- Hemoglobin A1c; Future
- Hemoglobin A1c

2. Type 2 diabetes mellitus without complication, without long-term current use of insulin (CMS/HCC)
New. A1c of 13. Started on insulin today. RTC in 1 week for f/u.
- insulin aspart, niacinamide, (FIASP FLEXTOUCH U-100 INSULIN) 100 unit/mL (3 mL) insulin pen; Inject 15 Units under the skin 3 (three) times a day before meals Dispense: 2 pen; Refill: 0
- pen needle, diabetic (NOVOFINE 30) 30 gauge x 1/3" needle; Use 4 times daily to inject insulin Dispense: 100 each; Refill: 11
- insulin degludec (TRESIBA FLEXTOUCH U-100) 100 unit/mL (3 mL) insulin pen injection pen; Inject 45 Units under the skin nightly Dispense: 1 pen; Refill: 0
- blood-glucose meter (ACCU-CHEK AVIVA PLUS METER) misc; Use to check blood glucose 4 times daily Dispense: 1 each; Refill: 0
- blood glucose test strips (ACCU-CHEK AVIVA PLUS TEST STRP) strip; Use to check blood glucose 4 times daily Dispense: 200 strip; Refill: 11
- lancets (ACCU-CHEK MULTICLIX LANCET) misc; Use to check blood glucose 4 times daily Dispense: 200 each; Refill: 11
- Comprehensive metabolic panel; Future
- Lipid panel; Future
- TSH; Future
 
The main problem is that folks (non clinical) believe more information documented is better when in fact the opposite is true.

There is a tremendous amount of noise in the chart around the actual meat that is giving you valuable information so you have to spend cognitive load to read nonsense to get to something that is telling you something.

And, I dont know when this started but why are people putting in their assessment and plan at the beginning of a soap note.
These aren't issues with Epic. I have Epic at my organization and see these issues in other peoples' notes but not my own. Sure, the organization chose to make default note templates/smartphrases which encourage bloat and put the Assessment and Plan first (they claim it's the part of the note others want to read so they put it at the top, but it messes with the flow of the note), but I chose to modify my own smartphrases to fix this. Epic gives me the capability to fix this. With other EMRs, the organization can choose these same options but I might not be able to just as easily fix them.

Epic is the best EMR I have used (and there are 5 others I remember using).
 
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I've used quite a few different EMR systems from having rotated at different locations with different EMRs and while I used to hate Epic because it was so complicated, I've come to the realization that I prefer having so many layers of redundancy rather than having no redundancy and only being able to find a button or piece of data in one place.

Although there are always ways to make Epic better, it's the best we've got so far.
 
When you pull up an old anesthesia record from epic, you have no idea what the **** youre looking at. It's pure garbage.

I am somewhat amazed by this statement. I have no idea how much work / pain is involved in putting in the OR Anesthesia course for a patient in Epic, but as a hospitalist reviewing it in our Epic is pretty amazing. I can see the entire run-sheet for the case, quickly scan for hypotension or other problems, easily see pressors and Abx given in the OR. And I can do all of this while the case is progressing, updated live. And at the end there's a summary of I/O's and all of the meds given. Perhaps you're looking for something else, but I think it's actually pretty good.

The main problem is that folks (non clinical) believe more information documented is better when in fact the opposite is true.

And, I dont know when this started but why are people putting in their assessment and plan at the beginning of a soap note.

I think your first point is a problem with many EMR's -- it's so easy to just stick stuff in your note, you easily get note bloat.

As already mentioned, the second point is some people trying to deal with the first point --- put the important stuff at the top so you don't have to scroll to find it.

In Epic you can also put collapsible sections in your note, collapsed by default, so that the "bloat" part is hidden.

I agree that we should make notes shorter and more relevant, and if done correctly won't affect billing.
 
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I am somewhat amazed by this statement. I have no idea how much work / pain is involved in putting in the OR Anesthesia course for a patient in Epic, but as a hospitalist reviewing it in our Epic is pretty amazing. I can see the entire run-sheet for the case, quickly scan for hypotension or other problems, easily see pressors and Abx given in the OR. And I can do all of this while the case is progressing, updated live. And at the end there's a summary of I/O's and all of the meds given. Perhaps you're looking for something else, but I think it's actually pretty good.
how do you do this? i can only see the pre and post op notes
 
In our implementation you just click the procedure of interest in the anesthesia tab.
oh i've never seen that before. i always just click on "notes"
 
oh i've never seen that before. i always just click on "notes"


Anesthesia record is not in the “notes” section. With regard to anesthesia, only the preop note, postop note, and any procedure notes (airway, lines, blocks) will populate in the notes section. The anesthesia record is not considered a note and gets its own tab.
 
In our system, the "Anesthesia event" is it's own encounter, so we look on the encounter tab. The encounter report includes the entire run sheet.

But each implementation of Epic can be different.
 
Repeat after me!

EPIC IS GARBAGE!
EPIC IS GARBAGE
EPIC IS GARBAGE

Perhaps if you have a ton of time on your hands when youre reviewing a chart epic is great but for me, when im looking at a chart there are like 5 other things i have to do at the same time and I just dont have time for epics Bull****. I need info NOW and i dont have time to wait for epic to load
 
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