Hospitals with efficient EMR/Digital imaging

[drfunktacular]

Some of the issues raised in the 56-hour week thread (http://forums.studentdoctor.net/showthread.php?t=524809) have got me wondering:

Which hospitals/residencies have the most l33t EMR/digital imaging systems? I mean, I'm all for a productive work day, but if I have to get to work an hour early to copy down a bunch of numbers that I already have access to in an EMR system, I will really not be a happy camper. I would really love to spend the majority of my pre-rounding time talking to/examining patients to see how they're doing, and be able to print off a concise report detailing their overnight vitals, labs, radiology reports, etc. in a few minutes rather than spend an hour every day trolling multiple systems to track down all this information.

Does anyone work at (or has anyone interviewed at) programs that are really aces as far as their digital efficiency goes? I myself will most likely be looking for IM programs in/around Texas, but I am curious to hear about good implementation anywhere...

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[chrisisinnocent]

The VA system is pretty decent. I have heard some people complain about it but out of the different EMR systems I have used in the past it's my favorite.

 

[Blade28]

Yeah, the VA's CPRS system may be a little old, but it's consistent across the ENTIRE COUNTRY and it works well (even allows orders!).

 

[Winged Scapula]

And for those of us who type fast, you can type your notes (although I must say the tendency of some to cut and paste the same note day after day is not only tedious but fraught with treachery).

How does having an efficient computer system relieve you of having to write the vitals down, though? Seems to me that people are still going to want to see them in print or for you to have them available at all times...hence the need for the ol list in the pocket. What needs to change is not the EMR but the system.

BTW, a place that was bad when I did my fellowship was Robert Wood Johnson...different systems for VS, for labs, PACS, etc. NOTHING was integrated (although they kept promising it would be)...any updates frm anyone there?

 

[Blade28]

How does having an efficient computer system relieve you of having to write the vitals down, though? Seems to me that people are still going to want to see them in print or for you to have them available at all times...hence the need for the ol list in the pocket. What needs to change is not the EMR but the system.

BTW, a place that was bad when I did my fellowship was Robert Wood Johnson...different systems for VS, for labs, PACS, etc. NOTHING was integrated (although they kept promising it would be)...any updates frm anyone there?

(1) Agreed - the attendings are always going to want recent vitals and labs handy.

(2) Our county hospital here has a similar problem. Vitals are on flowsheets, labs, radiology dictations, x-rays, CT scans, etc. are all on different systems.

 

[drfunktacular]

And for those of us who type fast, you can type your notes (although I must say the tendency of some to cut and paste the same note day after day is not only tedious but fraught with treachery).

This is one of my biggest problems with EMR; seeing residents do this drives me nuts (although I'll probably get sucked into the same trap when I'm a resident). Time demands placed on residents are too great for them to sit and compose a thoughtful complete note if they can get by half-a$$ing it. Especially when this is implicitly condoned and no one except those "cranky old attendings" force them to compose new consult notes, accept notes, d/c summaries, etc.

How does having an efficient computer system relieve you of having to write the vitals down, though? Seems to me that people are still going to want to see them in print or for you to have them available at all times...hence the need for the ol list in the pocket. What needs to change is not the EMR but the system.

This is 110% easy to fix. At my hospital, PCT's and nurses have wireless glucometers that automatically transmit the daily POCT FSBG into the EMR system. Then they roll around their little vitals machine that is inexplicably not wireless or plugged into the EMR system, and write down all the little numbers it spits out on a piece of paper that sits on a table in the nursing station for every med student and resident to copy onto a piece of paper. Why on earth they haven't rolled out vitals machines that talk to the EMR when they have glucometers that do is beyond me.

Once they had those, the daily vitals range would print out onto your rounding report along with their meds, lab results, rads results, etc. Easy!

 

[AwesomO]

How does having an efficient computer system relieve you of having to write the vitals down, though? Seems to me that people are still going to want to see them in print or for you to have them available at all times...hence the need for the ol list in the pocket. What needs to change is not the EMR but the system.

You could do a couple things. First you could have a wireless network making it available on your PDA or tablet PC. Or for the less technically inclined a good emr should let you click on your patient list and print out all new labs for the day.

 

[Blade28]

This is one of my biggest problems with EMR; seeing residents do this drives me nuts (although I'll probably get sucked into the same trap when I'm a resident).

On my last rotation at the VA (Vascular) I was covering one weekend for the General Surgery service as well, and was in charge of that service's med students. I totally busted one of the med studs for copying and pasting from my note.

(1) He was writing his note after mine anyway, which kind of defeats the purpose of prerounding.
(2) He copied the EXACT format of my A/P, which tends to be a little unique, since I list my plan after the assessment with arrows as follows:

A/P: 57 yo M s/p lap VHR (POD #2)
Guarded
--> D/C NGT, start clear sips
--> OOB as tol, encourage IS
--> D/C PCA, start oral pain meds

Etc.

 

[gutonc]

On my last rotation at the VA (Vascular) I was covering one weekend for the General Surgery service as well, and was in charge of that service's med students. I totally busted one of the med studs for copying and pasting from my note.

(1) He was writing his note after mine anyway, which kind of defeats the purpose of prerounding.
(2) He copied the EXACT format of my A/P, which tends to be a little unique, since I list my plan after the assessment with arrows as follows:

As an intern on a VA Gen Med service, I had a med student who actually wrote, "Agree with excellent attending note. See intern note for complete details of HPI and ROS. See resident note for details of assessment and plan." That was her entire admit note. Awesome.

 

[NotAProgDirector]

You will need a subscription to see this, but the JAMA editorial on cut&paste is worth a read.

 

[orientedtoself]

going back to the op's question, michigan has an excellent emr, careweb. i miss it. i like cprs as well. but the one time a year that cprs goes down unexpectedly, you are completely f*ed.