If only....

[TurtleDO2012]

---

Members do not see this ad.

http://www.armytimes.com/story/military/pentagon/2015/04/12/carter-social-media/25513773/

No wonder getting an assignment can be a crap shoot at times with so many antiquated systems.

http://www.politico.com/story/2015/...pentagon-ehr-emerges-from-shadows-116776.html

We might have epic by next year hopefully.

 

[Slevin]

Once the contract is awarded it'll take 5 years for them to implement the system and have it pull old records from AHLTA/Essentris/CHCS/HAIMS/SYNAPSE am I missing any

Remote systems based on ships will have to download the records of shipboard personnel before heading out and be able to merge them with the master database upon return to shore.

The radiologists at my local hospital recently told me that not only can't they view the images from other institutions (say based at El Paso and SM was from Camp Lejune but recently PCS'd) they claim they can't even see the reports in AHLTA.

Getting Epic or some other system off the ground will be a massive under taking but hopefully it'll allow me to stop checking 4-5 different systems Email/AHLTA/CHCS/Relay Health etc for messages/records from patients.

Also how's about the army fix their online training components... How come every time I am required to take online training I have 4-5 different locations to do it Swank Health/ALMS/Cyber Security/etc. waste of my time

 

[DrMetal]

spital recently told me that not only can't they view the images from other institutions (say based at El Paso and SM was from Camp Lejune but recently PCS'd) they claim they can't even see the reports in AHLTA.

Not sure what you're talking about here. In global AHLTA, you can pull up rads reports from anywhere (unless they weren't deposited correctly). I've pulled up MRIs from 10 years ago, done 3,000 miles away.

They should keep AHLTA . . . .work out the bugs. We've invested too much time/effort/money into it. It's actually a great repository of information, it sucks to chart in in real time. They need to work on that as well as a plethora of other IT/buttonology issues, but they can make it work (maybe they're choosing not to, I'm sure there's a lot of politics involved).

 

[Slevin]

Not sure what you're talking about here. In global AHLTA, you can pull up rads reports from anywhere (unless they weren't deposited correctly). I've pulled up MRIs from 10 years ago, done 3,000 miles away.

They should keep AHLTA . . . .work out the bugs. We've invested too much time/effort/money into it. It's actually a great repository of information, it sucks to chart in in real time. They need to work on that as well as a plethora of other IT/buttonology issues, but they can make it work (maybe they're choosing not to, I'm sure there's a lot of politics involved).

With Rads I can see the reports (not images) but one of the radiologists at my local MTF called me on the phone and said they can't view any rads reports in AHLTA. So basically when I reference prior studies that are in AHLTA in my imaging request saying patient has minor herniated disc at L4-L5 evidenced on MRI performed at Leavenworth 2 years ago and now wanting repeat imaging. The local rads guys don't look at the previous report

And like you said AHLTA is painful to document in real time, doesn't have access to Essentris reports, etc. I would like a new system that has all the info inpatient, out patient, relay health requests, etc. AHLTA isn't capable of that, it's been cobbled together over the past decade with a poor workflow, lack of any real consistency and is prone to crashing. It's a billion dollar system and I wish it could work better but it was probably designed by committee to the cheapest bidder

 

[Gastrapathy]

Your radiologists can't be bothered to have an AHLTA account. That's all there is to it. We had ER docs like that.

 

[Slevin]

They could also look in CHCS but they don't bother to do that

 

[Mad Jack]

Epic relies on custom builds. I'm sure that they will manage to **** up their build of Epic beyond usability even when it is deployed.

 

[DrMetal]

With Rads I can see the reports (not images) but one of the radiologists at my local MTF called me on the phone and said they can't view any rads reports in AHLTA.

Somethings not right there. I can tap into global ahlta from my ship even and pull up anything i want.

 

[idq1i]

Your radiologists can't be bothered to have an AHLTA account. That's all there is to it. We had ER docs like that.

1 - Outside-of-DoD imaging we rely on upload of reports, if anyone bothers to request them. This may be the problem here.

2 - Reports may be helpful to primary care, but are quite useless to my field (particularly with the overall poor quality of rads services in the military and in the communities surrounding so many bases). The fact that I can't pull images on people imaged in the DoD is pathetic by 21st century standards. I now have to request a CD from a base less than 2 hours away from me if I want to compare.

t-14 months...

 

[j4pac]

CHCS looks like something produced by the creators of DOS...but it is INFINITELY more stable than AHLTA. AHLTA reminds me of Windows Vista. They pushed it out to look pretty...but it has to be the most unuser friendly EMR ever created. Explain to me why you can't seamlessly go back and forth between S/O and A/P. Is it that frickin hard? Or how about the standard orders? You know...you type in Afrin...the standard dose pops up (well done AHLTA)...but after you submit the med...it pops of a low duration error. What the f' is a low duration error!!!!!!

 

[BigNavyPedsGuy]

"Since taking over the Pentagon's top job in February, Carter has repeatedly cited the professional networking site LinkedIn as an example of what the military needs for better internal management"

Just imagine the stupid beauracratic requirements of the military combined with the serial spamming ability of Linked-In....glorious merging of evil superpowers.

 

[j4pac]

How about clicking ctrl+z on AHLTA? You know...the Microsoft shortcut for "undo"? Not in AHLTA world. In AHLTA world it means..."I'll kick your ass out of the program making you lose all the work that you have done up to this point."

Or...how about copy forwarding a note, editing or writing and addendum to the note but forgetting to click ENTER within the field. Another way of AHLTA telling you that you're f'ed.

I really could write a book about AHLTA. I would probably title it "How to not create an EMR." The funny thing is the med students are actively searching residency programs with an EMR...you better be careful what you wish for. AHLTA is essentially nothing more than a piece of crap designed to crush morale and allow administraters to effortlessly data mine to worsen morale even further.

 

[Slevin]

I'm so frustrated with AHLTA I'm contemplating just writing a regular note in word and then copy/paste it into the add nite field. I'm just so annoyed with the whole system

 

[Shikima]

How about clicking ctrl+z on AHLTA? You know...the Microsoft shortcut for "undo"? Not in AHLTA world. In AHLTA world it means..."I'll kick your ass out of the program making you lose all the work that you have done up to this point."

Or...how about copy forwarding a note, editing or writing and addendum to the note but forgetting to click ENTER within the field. Another way of AHLTA telling you that you're f'ed.

I really could write a book about AHLTA. I would probably title it "How to not create an EMR." The funny thing is the med students are actively searching residency programs with an EMR...you better be careful what you wish for. AHLTA is essentially nothing more than a piece of crap designed to crush morale and allow administraters to effortlessly data mine to worsen morale even further.

It's good preparation for Meaningful Use which is madated by the Gov't.

 

[TurtleDO2012]

HAIMS-The catch everything paper copy repository. If you ever see an AHLTA note with a paperclip symbol then it basically says go look in HAIMS for the medical record. Other another system!!!!

We should all just start doing handwritten super notes with a bunch of circles kind of like the ER T sheets, then scan them into HAIMS and in AHLTA say see HAIMS. It really would be full circle from paper to EMR to now just looking at scanned images of paper charts.


In terms of Epic it likely would be something they would just push out going forward starting a specific date maybe at specific sites with whatever capabilities that were selected and then trickle down to other sites. The real crapshoot is going to be likely having to deal with both AHLTA to view past garbage while at the same time starting to use Epic in the current encounter going forward.

 

[pgg]

AHLTA is an abomination and needs to be completely ****canned, with extreme prejudice, yesterday. We've been "fixing bugs" in that steaming pile of crap for years and years and years. And it still sucks.

Essentris is a cartoonish mess that any CS undergrad who wasn't painfully and confusedly coming down off a meth binge would be ashamed to turn in for credit. Wankers couldn't even be bothered to use antialiased fonts, something Windows does for you.


As for a 5 year project ... this is actually going to get done pretty fast. 1st rollout to the lucky Pacific Northwest is supposed to be 2016 I think. DoD is throwing money, time, and people at this project like nothing I've ever seen before. Well, not counting Halliburton/KBR. One of my collaterals is as a subject matter expert, alongside dozens, if not 100+ others, split over a number of areas/domains. Unbelievable how many people are part of this, clinicians and not. There was just a huge conference in VA a few weeks ago. Commands are being ordered from up in high by the prince of darkness himself to free people from other duties to travel to these events from, well, everywhere, all funded. The amount of travel money spent 2 weeks ago for just one of these shindigs could probably have funded 90s-era CME travel for every DoD physician for a couple years.

It's going to happen, and soon. It remains to be seen how well it'll be done, but even if we wind up with crayons, tin cans, and string it'll be better than AHLTA and Essentris.

 

[DrMetal]

It's going to happen, and soon. It remains to be seen how well it'll be done, but even if we wind up with crayons, tin cans, and string it'll be better than AHLTA and Essentris.

I love your prose btw, were you an English major or do you have a surrogate writer?

I'd beg to differ a little bit. If they would screw us up with another EMR (Epic, or whatever else) rendering us with just "crayons, tin cans", then I'd rather have no change at all. Just keep AHTLA/Essentris, improve on it. These systems have been employed for > 11 years now. Again, they're a great repository of information. If you're a clinician of any sort, you rely on that fact to pull up all sorts of information (labs/rads/previous encounters) that you then employ in your own decision making process. You know how important that is when you work in a system that lacks such a repository.

Again, they're terrible to chart in in real time . . .to the extent that I've created my own templates in Word, that I fill out and paste into AHTLA (a trick I copies from my Ophtho friends and several other clinics). Why should I have to stoop to such measures??? A valid question . . .sometimes when you work for the gov't, you just have to find a work-around to get the job done.

One things for sure: no matter the EHR, all providers seem to turn against them very quickly. Where I moonlight, they employ a http-IE based EHR that's lightning fast, way easy to use . . . .No sooner than 6 months after it's implementations, providers were complaining about having to click too many bubbles, having to use Ctl+Alt+Del to log in, etc etc . . .

 

[Pannu86]

The thing about EHRs is which one is the lesser of the evils. I having worked on Epic, Sun systems/Sunrise, CPRS (the VA health system), All Scripts, Quadramed and a few others, personally feel Epic is my favorite to work with. CPRS (the VA system) comes close second, working on these two is a breeze 🙂
Oh and btw, if Epic does come to any health system they are usually able to integrate the previous information the beast that they are!

 

[j4pac]

HAIMS-The catch everything paper copy repository. If you ever see an AHLTA note with a paperclip symbol then it basically says go look in HAIMS for the medical record. Other another system!!!!

We should all just start doing handwritten super notes with a bunch of circles kind of like the ER T sheets, then scan them into HAIMS and in AHLTA say see HAIMS. It really would be full circle from paper to EMR to now just looking at scanned images of paper charts.


In terms of Epic it likely would be something they would just push out going forward starting a specific date maybe at specific sites with whatever capabilities that were selected and then trickle down to other sites. The real crapshoot is going to be likely having to deal with both AHLTA to view past garbage while at the same time starting to use Epic in the current encounter going forward.

LOL. My clinic looks forward to the days that AHLTA is down so that we can do paper notes. We have actually tried to do SF600s and either scan into AHLTA or HAIMS and we have been bitched at. The reason...the coders have a more difficult time data mining. Without EMR, HEDIS goes away. Without EMR, Medical Home goes away. Without EMR...live improves significantly.

 

[TurtleDO2012]

A major reason why we need to transition to a mass produced EMR over improving Ahlta or essentris is because pretty much all other devices are more compatible with the major EMRs and those companies invest more effort in maintaining and updating their systems. I only hope that if we do go with epic that more of their support staff handles any problems and the current level of AHLTA IT support employed by the military can be sent packing.

For example my clinic just purchased new overly priced blood pressure machines because we are great at misusing funds. These machines are great because with a compatible EMR it auto inputs all of the collected vitals. Presto every screener could be fired now and I can see my patients actually on time at their appointment and not 10-20 minutes later after they collected simple vitals and asked a few superficial questions about depression.

All the GI docs I have seen use the same type of documenting system for their colonoscopies and EGDs but it doesn't work well with essentris from what I have been told. So they have to paste the file in as a image or pdf file. Same thing for the OR with their drager systems and other specialties. The Pyxis med system doesn't work with essentris or AHLTA. Better EMRs work with these systems. I don't foresee anything but the major off the shelf EMRs being able to send me alerts to my iPhone or my iWatch at some point. Also the newer systems hopefully will incorporate better with the lab as well as labcorp since I think they have the DOD contract. Factoring in the VA the DOD is the largest healthcare system in the U.S. but we also the largest silo since we can't talk with any other system and even our own systems can barely talk to each other.

 

[dr zaius]

I'm so frustrated with AHLTA I'm contemplating just writing a regular note in word and then copy/paste it into the add nite field. I'm just so annoyed with the whole system

I do this. Especially for pre-op H&Ps. I timed it one day and found that I spend on average close to 4.5 minutes PER PATIENT waiting on AHLTA to load when I switch tabs. I have never hated anything more than I hate AHLTA. Sure, it's a repository of information, but good luck finding anything in there with the 33,000 case manager notes obstructing your view.

 

[DrMetal]

That's a shame. Our's is not nearly so slow.

The problem with scanning your own notes in is that the auto-RVU counter won't kick in, and depending on how strict your coding department is, they may or may not accept your manual coding (assuming you actually do this).

Can I ask: who really cares? Has anyone (in the milmed) really ever been disciplined, or not promoted, for not generating their greatest RVU potential? This copy and paste job is done by several clinics (ive seen it in ophtho, audiology, psych, ortho), no one seems to mind it nor has anyone prohibited the practice.

 

[Gastrapathy]

It was prohibited initially at my place but people gradually began to do it anyway. Pendulum was swinging that way when I separated.

 

[deuist]

I can personally attest that civilian residents in some programs get training in the basics of coding.

When I was in (a civilian) residency, someone from billing and coding would come to conference every six months to give us a refresher on charting so that we could maximize RVUs.

 

[Homunculus]

i use "add note" exclusively. during my several years as a generalist, templates, dragonspeak and the add note function was a lifesaver. now in subspecialty i don't use dragon so much, but the add note is still much easier-- and 10x easier at followup (copy/paste, edit/add what you need, done). RVU's are an interesting animal. they are definitely looked at for productivity and allocation of resources, which would make you think the command would do everything they could to help you maximize them. unfortunately coders are not viewed as important enough to keep around or hire. i would venture to guess that the vast majority of "underperforming" departments don't have a work problem but a work "extraction" problem. we've been begging for training from the coders for months and are still waiting. the coders i've contacted personally have even told me that they "only to audits, not training" which makes about zero sense as well.

luckily most of my initial visits i just self code to -05, with followups -13 to -14. seems to work ok.

RVUs are also used along with your FTE (which itself is a convoluted calculation full of gray areas and fuzzy math) to determine your "productivity" compared to other providers, clinics, hospitals, etc. so while you won't be fired or counseled for a bad number, if only to stay off the radar it's good to maximize what you can.

--your friendly neighborhood cntrl-c/cntrl-x caveman

 

[Gastrapathy]

Leave a little room for improvement in your coding. Then when some do nothing bean-counter complains, up code until they leave and then slide back down.

 

[HighPriest]

Can I ask: who really cares? Has anyone (in the milmed) really ever been disciplined, or not promoted, for not generating their greatest RVU potential? This copy and paste job is done by several clinics (ive seen it in ophtho, audiology, psych, ortho), no one seems to mind it nor has anyone prohibited the practice.

I can comment on this:

It definitely depends upon where you're stationed. At some smaller MTFs (like the one I'm at) the choppnig block is ever-present, and so RVU/FTE generation is absolutely watched. In times of feast, I would bet money that they never payed attention, but we're no longer feasting.