Epic EMR

[tucker27705]

Has anyone had experience with the EPIC EMR? Specifically, the anesthesia epic emr? If so, what are your thoughts on it? I am not looking for general comments on emr's, I have extensive experience with them from residency. I am really looking for individuals who have used EPIC and their thoughts on whether it is any good.
Thanks

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[imfrankie]

Has anyone had experience with the EPIC EMR? Specifically, the anesthesia epic emr? If so, what are your thoughts on it? I am not looking for general comments on emr's, I have extensive experience with them from residency. I am really looking for individuals who have used EPIC and their thoughts on whether it is any good.
Thanks

I use it in the OR and like it.

 

[TrustMe]

I am curious as well. I have never used it but the place I got a job at uses it.

 

[kardioversion]

I'm a med student being paid by Epic to teach physicians how to use the system, I just made a few quick videos for the anesthesiologists as a quick over view. I'm also going to make one about customizing and smart text.

This video is the first, and includes an example of "smart text"

http://youtu.be/hrB7dzSHQ2I

 

[Impromptu]

We just started using it at our pediatric hospital. I took the training, but haven't used it intra-operatively. I will be there again in December, so will finally get to see how it works intraoperatively.

We have a great system at our adult hospital, CompuRecord (which is now great after lots of tweaking by our computer technician). The biggest problem is it isn't very integrated with the rest of the hospitals systems. We went electronic years ago in the OR, but the rest of the hospital went fully electronic just a couple months ago with Epic. (Prior was a half electronic half paper hospital record). We'll be switching the adult ORs to Epic within a year or two.

I guess it is good enough that our two main hospital systems are using it or will be using it.

 

[Gimlet]

We just rolled out the Epic Optime/AIMS recordkeeping system at our main hospital this week. I'm not in the OR this month, but I've gone through the training and did a bunch of shadow charting in the training environment during my cases last month. It sounds like the roll out hasn't gone perfectly (as expected), but so far no major problems. Most of the problems with the rollout have been on the administrative side with assignment of cases on the new status boards, which is a huge change for the support staff.

I think the intra-op record keeping will be popular once people get used to it.

My problem with Epic is that they sell the basic unimproved product every time they get a new contract. 90% of the problems we encountered during the testing/training phase and the roll out must have been encountered at multiple other institutions, but there was zero anticipation by Epic of the issues that came up with us that I'm sure could have been foreseen based on past experience with rolling out a new AIMS at multiple other hospitals.

Other little things bother me, too, like the lack of a dedicated space to document Train of Four. Every anesthesia record I've ever used had a dedicated line for ToF, but was told by multiple Epic trainers that in Epic you have to just write a "quick note" to document ToF, which to me is cumbersome compared to what could easily be programmed in as an assessment that would take two button clicks to document. I couldn't believe this hadn't been brought up by multiple hospitals before. Also, communication of airway management on the record leaves a lot to be desired. Very hard to tell exactly how the laryngoscopy and intubation went based on what is actually recorded when you enter your airway management information after induction. It's stuff like this that I wish Epic did a better job of improving from version to version and hospital to hospital...why do we have to reinvent the wheel on everything? (or be told that this wheel simply can't be invented on Epic and we just have to work around the issue).

 

[Planktonmd]

Has anyone had experience with the EPIC EMR? Specifically, the anesthesia epic emr? If so, what are your thoughts on it? I am not looking for general comments on emr's, I have extensive experience with them from residency. I am really looking for individuals who have used EPIC and their thoughts on whether it is any good.
Thanks

We use it and once tweaked to your specific practice it is good but the tweaking takes about a year.
Epic anesthesia is a new market for them since they only started the anesthesia application 3-4 years ago compared with someone like PICIS who has been in the anesthesia business for 15 years.
So, the application is evolving and still rough around the edges in some areas but it is elegant and highly customizable.

 

[cincincyreds]

My biggest concern about anesthesia computer keeping is the legal liability. What if someone accidently selects your name as the attending covering and the patient has a bad event. The lawyer will come after you. What if the patient has a postop MI, and you don't notice a computer error so that one of the recorded BPs is 30s systolic went it really wasn't because the BP cuff was malfunctioning at the time and you forgot to write a note saying how you alleviated the issue.

I really prefer pen and paper for my anesthesia documentation. I do understand there are less episodes of documented hypotension with pen and paper versus computer EMR.

 

[sevoflurane]

Used EMRs in the past. I currently am back to paper charting... and I like it.

 

[pike1]

Other little things bother me, too, like the lack of a dedicated space to document Train of Four. Every anesthesia record I've ever used had a dedicated line for ToF, but was told by multiple Epic trainers that in Epic you have to just write a "quick note" to document ToF, which to me is cumbersome compared to what could easily be programmed in as an assessment that would take two button clicks to document. I couldn't believe this hadn't been brought up by multiple hospitals before. Also, communication of airway management on the record leaves a lot to be desired. Very hard to tell exactly how the laryngoscopy and intubation went based on what is actually recorded when you enter your airway management information after induction. It's stuff like this that I wish Epic did a better job of improving from version to version and hospital to hospital...why do we have to reinvent the wheel on everything? (or be told that this wheel simply can't be invented on Epic and we just have to work around the issue).

I'm a resident at UW and from what I understand we were supposed to be the first center to use EPIC anesthesia EMR. Gimlet, the system you describe definitely sounds like a basic unpolished version of epic. For example, our version has easy TOF documentation built right into the record and appears as it would on a paper chart. All you have to do for TOF is point and click. In fact you can even easily point and click other options like DBS, or sustained tetanus. Also, the airway documentation could not be easier. We have a point and click version under a Lines/Drains/Airways tab that lets use easily click on buttons corresponding to ease of BMV (grades 1-4 based on that Michigan paper), view on DL, blade used, alternative device used (i.e. FO scope, glidescope, etc), tube size & type, even cuff pressure. The LDA tab is accessible to other hospital users, so they can easily see this info as well. The record still allows you to use smartphrase/ free text to document airway stuff in the event you get an unusual case. Our workstations in the OR are touch screen so you can document very quickly (though I have clumsy fingers, so I just use the mouse). Let me know if you guys have any other questions about this system, I am happy to answer questions about it. I really feel that this system frees you up to do what matters, which is of course provide care to the patient.

 

[BDanes]

how do you document stuff in the major traumas? We just got trained on EPIC and it looks like a nightmare for level 1 trauma cases. You have to put an order in for blood and can only do 4 units. They didn't have an answer for us regarding mass transfusion protocols.

 

[IlDestriero]

how do you document stuff in the major traumas? We just got trained on EPIC and it looks like a nightmare for level 1 trauma cases. You have to put an order in for blood and can only do 4 units. They didn't have an answer for us regarding mass transfusion protocols.

Our massive transfusion protocol takes a phone call. Attending to blood bank. Done. Orders later. You don't even have to sign the massive transfusion blood release form. The call gets the ball rolling. Some things can't go through epic. Like verbal orders in true emergencies.

 

[pike1]

how do you document stuff in the major traumas? We just got trained on EPIC and it looks like a nightmare for level 1 trauma cases. You have to put an order in for blood and can only do 4 units. They didn't have an answer for us regarding mass transfusion protocols.

We also have a massive transfusion protocol that just takes a phone call to the blood bank to activate. For other orders, epic utilizes computer based order sets that we have customized by our own anesthesia department. For example, we have a PACU order set with all the pertinent PACU orders we might need. Ours even allows you to pick in which order you want anti-emetics given. These are very easy to use and take less than 1 minute to put in all PACU orders you might need. We also have an easy to use intra-op lab order set.

I personally think that the best thing is that this system charts all the vitals for you. Epic can even distinguish aline pressures vs NIBP pressures automatically, and it appears just as it would in a typical paper chart. This makes it very easy to document things accurately even when your dealing with a busy case like a major trauma or a sick cardiac case.

 

[Mman]

My biggest concern about anesthesia computer keeping is the legal liability. What if someone accidently selects your name as the attending covering and the patient has a bad event. The lawyer will come after you. What if the patient has a postop MI, and you don't notice a computer error so that one of the recorded BPs is 30s systolic went it really wasn't because the BP cuff was malfunctioning at the time and you forgot to write a note saying how you alleviated the issue.

I really prefer pen and paper for my anesthesia documentation. I do understand there are less episodes of documented hypotension with pen and paper versus computer EMR.

In every anesthesia EMR I've ever seen, nobody can accidentally say it's your case. You have to type a password to verify it's you and "sign" the chart.

And paper charting is great for fudging vitals so the train tracks can run on every case, but everybody understands on an electronic record that it is far more accurate. And if the cuff is truly misreading systolics in the 30s, you remember to type a note about how it's malfunctioning.

 

[IlDestriero]

In every anesthesia EMR I've ever seen, nobody can accidentally say it's your case. You have to type a password to verify it's you and "sign" the chart.

And paper charting is great for fudging vitals so the train tracks can run on every case, but everybody understands on an electronic record that it is far more accurate. And if the cuff is truly misreading systolics in the 30s, you remember to type a note about how it's malfunctioning.

Yes, it only takes a few seconds to invalidate an artifact or erroneous reading, or write a sentence that the SPO2 was not accurate during IV placement.
It is easy to accidentally click on the wrong staff for a case, but you have to sign it yourself. If it's wrong, you can delete your name and send it back. If you don't sign a record in 24 hours you start getting daily emails to sign it. It's impossible to be put on a case you weren't involved with without knowing.

 

[Frank Rizzo]

Yes, it only takes a few seconds to invalidate an artifact or erroneous reading, or write a sentence that the SPO2 was not accurate during IV placement.
It is easy to accidentally click on the wrong staff for a case, but you have to sign it yourself. If it's wrong, you can delete your name and send it back. If you don't sign a record in 24 hours you start getting daily emails to sign it. It's impossible to be put on a case you weren't involved with without knowing.

Wish this was true, but I can tell you first hand that in the version of epic we use (been live for less than 6 months), staff can be changed in Epic without swiping your badge or typing a password. Attestations (present for emergence, present for induction etc) , on the other hand require it, but simply assigning staff does not. So in theory, you could be assigned to a case erroneously, and never attest. Then you just look like a lazy absentee MD that never stepped foot in the room.

The email about incomplete records part is true. However, epic generates a ton of email a day for everything, so it is not too difficult to see this being missed.

You would swear that the epic people haven't done this before when you're building your system. Its like reinventing the fukn wheel at times. And we were VERY PROACTIVE in building things. The EPIC folk told us that our group was one of, if not the most involved group they had worked with, so my general dislike for the system is not for a lack of effort. We are still changing things in the system.

All in all I would grade the system somewhere between a D+ and a C-.

I cherish the days that i go to one of our ASCs that still use paper.

 

[pike1]

Wish this was true, but I can tell you first hand that in the version of epic we use (been live for less than 6 months), staff can be changed in Epic without swiping your badge or typing a password. Attestations (present for emergence, present for induction etc) , on the other hand require it, but simply assigning staff does not. So in theory, you could be assigned to a case erroneously, and never attest. Then you just look like a lazy absentee MD that never stepped foot in the room.

The email about incomplete records part is true. However, epic generates a ton of email a day for everything, so it is not too difficult to see this being missed.

You would swear that the epic people haven't done this before when you're building your system. Its like reinventing the fukn wheel at times. And we were VERY PROACTIVE in building things. The EPIC folk told us that our group was one of, if not the most involved group they had worked with, so my general dislike for the system is not for a lack of effort. We are still changing things in the system.

All in all I would grade the system somewhere between a D+ and a C-.

I cherish the days that i go to one of our ASCs that still use paper.

Our version of epic is the same way in that their is no pass-code required to change the staff assigned to that case. However, we have not really had issues with staff being erroneously assigned to cases (we have been live for just over 2yrs). I think that the main reason for this is because when we log into the anesthesia application, the first screen you see is a personal status board. This status board is color coded and shows you your patients who are in pre-op, intra-op, or in the PACU. So anytime you log in (which would presumably be often when your working) you would easily see if you were assigned to a case that you are not involved with. The staff/resident assignment stuff can be easily edited. I also notice that some of my attendings have their Ipad linked right to epic. The Ipad allows them to quickly check on how all of their cases are going. I would think this capability would be a huge advantage, especially if you have 4 rooms going.

 

[Frank Rizzo]

Our version of epic is the same way in that their is no pass-code required to change the staff assigned to that case. However, we have not really had issues with staff being erroneously assigned to cases.

We haven't had any issues either... just saying its possible.

As for the ipad thing, I agree... the ability to briefly glance at the live intraop records from any computer is nice. Thats is one of the strengths of the system.

 

[Arch Guillotti]

My biggest concern about anesthesia computer keeping is the legal liability. What if someone accidently selects your name as the attending covering and the patient has a bad event.

I think this is a very far fetched scenario. In my experience it is possible to electronically put anyones name on the chart but if you didn't attend the case you will never sign it electronically.

 

[pike1]

We haven't had any issues either... just saying its possible.

As for the ipad thing, I agree... the ability to briefly glance at the live intraop records from any computer is nice. Thats is one of the strengths of the system.

I would say the more common mistake that can be made with the epic system is documenting on the wrong patient. Because of how the system is set-up, you could have 3 patient charts open at once. Maybe you are looking ahead to case number #3 of the day and forget to switch back to patient #1. As soon as you hit the start anesthesia time followed by the start data icons, epic will begin importing the vitals into the patients chart as if they are in the OR. I have not made this mistake yet, however I have heard of it happening. The best way to prevent this in my opinion is by looking at the chart ID info that you have open when the time-out is performed. Usually, the circulating RN or surgeon looks at the wrist band while myself or my attending looks at the screen we have open to confirm a match.