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What’s the latest on MHS Genesis rollout, user-friendliness, etc? Will it eventually replace or subsume Innovian (the stand-alone anesthesia charting system)?
MHS Genesis news?
- Thread starter Monty Python
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It's on hold per COVID, amen!
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It allegedly has an integrated anesthesia EMR, so I expect Innovian will go away. I've used the Cerner anesthesia EMR in the past, and it was pretty good, so I'm cautiously optimistic that this particular module won't suck.
Knowing how the government works, the last 15 years of case data in the Innovian database will be deleted and lost, or at least functionally impossible to access for any data mining, QA, or PI projects. I mean, it's always been functionally impossible to do any of that kind of work, but I fear the data itself will be just lost when the switch happens.
Knowing how the government works, the last 15 years of case data in the Innovian database will be deleted and lost, or at least functionally impossible to access for any data mining, QA, or PI projects. I mean, it's always been functionally impossible to do any of that kind of work, but I fear the data itself will be just lost when the switch happens.
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This software is not designed for the military, and specifically the operational world. It is designed for hospital systems and outpatient settings where these is continuity of care and you have single RNs or MAs or front desk staff doing the same job over and over.
The T-Con functionality is virtually gone. Before a TCon could do almost anything a regular encounter could, (put in labs, imaging, consults, meds, etc). THe subsitute now is to send yourself a message from within Genesis and save it to the patient's chart. The only order you can associate with it is a medication prescription.
Physicians don't have the ability to add people to our schedule in order to do an encounter to, say, order an xray. Example from today - one of my Marines broke his ankle at and was splinted at an outside hospital. I either have to tell him to see another provider in the clinic to coordinate ortho follow up, I need to have him schedule an appointment with me in the clinic on a day where I'm not with my unit, or I have to call one of my corpsmen that's at the clinic, get them to log in, and book me a walk-in appointment, then I can open that up remotely and order imaging and an ortho referral.
Every encounter generates multiple notes and there's no way to combine or get rid of them. The corpsmen intake with vitals and their quick little HPI generates a note that's separate from mine, that I can't take over.
The notes also aren't organized and saved by type of note. Each individual has to title their note uniquely, or just use the standard "outpatient clinic note" as what it's called. So, whereas in AHLTA you can scroll through and see the primary diagnosis, the provider, the clinic, the location, etc., all you can see here is the note title. Can't see what clinic it was from, and if the provider saved the note without giving it a title of "back pain" or something other than "outpatient clinic note," you can't change it (as far as I'm aware).
Shotexes at the unit spaces are a thing of the past. I suspect this, along with many other changes, are to decrease our concierge medicine we provide the line, and force them to come to clinic for everything. A shotex used to be able to be run by 2-3 corpsmen and they could knock out 2-3 immunizations for 200+ people in 2 hours, and then spend an additional 20-30 minutes logging it into MRRS. Now, it takes around 8-12 corpsmen to process 50-75 flu shots an hour. Good news is that it is logged into Genesis in realtime, and is probably safer and better.
Batch lab entry no longer exists. Let's say you're doing pre-deployment HIV blood draws, or now you're doing pre-deployment COVID nose swabs, you have to generate individual encounters for each person. Another unit did this recently and it took 9 corpsmen 2 hours to do it for 300 deployers. In CHCS you could do a macro that could've allowed 1 corpsman to complete it in 1 hour or less.
It does not sync with DEERS. So new check-ins to the command might not appear in Genesis, and that is a pain to figure out on the fly for sick call visits.
The current bridge between AHLTA and Genesis is JLV. So if someone goes from a command using Genesis back to a command using AHLTA (and vice versa), all their results will be uploaded into JLV. Going back to the fact that Genesis generates a lot of documents, this means JLV is going to be crowded with excess documentation that is poorly labelled and hard to sift through.
Notes are not easy to read. They're cluttered, full of junk, like like most EMR systems but way worse than AHLTA. Except for mental health notes written in AHLTA. Those are hard to make more unreadable than they already are.
Anytime you open a patient to view their history, lab results, etc., it pops up you to the default screen as if you're going to start charting a note, but then it pops up a reminder or two that you're opening a discharged encounter and can't chart in it. As far as I know, there's no way to just open a patient's chart, you have to actually open a previous encounter to view their chart. Every patient has two encounters built in, a "Lifetime pharmacy" encounter, and a "History" encounter. It still does all that with a history encounter. And every time you open a chart, you have ot indiciate why you're opening the chart. Are you a physician, are you doing a peer review/QI project, are you doing it for billing, or are you "breaking the glass" (emergency access to everything in the chart).
Viewing results isn't as user friendly as AHLTA (or Epic).
There is no consult log, like in AHLTA, where you can follow up (and learn from) the consults you place to specialists.
Still haven't figured out how to do PHAs or PDHRAs with this system, as there's no TCON, and it'll be impossible to call my corpsman up to enter in walk-ins all the time for PHAs done at my unit office. Or do I just shoot myself a message (the new TCon) and save it to the patient's chart? Or just do it online and forget about billing for it because it's a stupid system that needs to go away?
On the plus side, I can create multiple patient lists for different purposes (AHLTA only allowed you to do one).
I had really high hopes for this, as I was expecting it to be like Epic. But it is most definitely no where near as good as Epic (while there are no good EMR systems, Epic probably is the best in my opinion).
To be fair, I haven't been using it very long and maybe once I learn more on how to use it, it'll make more sense. And I'm not like one of those people that's constantly complaining saying we need to switch back, I'm trying to learn how to use what we've got, but I'm just making you all aware that this is a BAD system. Whoever decided to pick this probably works in some ivory tower somewhere and hasn't been a junior medical officer in an operational setting, or even an outpatient clinic.
The T-Con functionality is virtually gone. Before a TCon could do almost anything a regular encounter could, (put in labs, imaging, consults, meds, etc). THe subsitute now is to send yourself a message from within Genesis and save it to the patient's chart. The only order you can associate with it is a medication prescription.
Physicians don't have the ability to add people to our schedule in order to do an encounter to, say, order an xray. Example from today - one of my Marines broke his ankle at and was splinted at an outside hospital. I either have to tell him to see another provider in the clinic to coordinate ortho follow up, I need to have him schedule an appointment with me in the clinic on a day where I'm not with my unit, or I have to call one of my corpsmen that's at the clinic, get them to log in, and book me a walk-in appointment, then I can open that up remotely and order imaging and an ortho referral.
Every encounter generates multiple notes and there's no way to combine or get rid of them. The corpsmen intake with vitals and their quick little HPI generates a note that's separate from mine, that I can't take over.
The notes also aren't organized and saved by type of note. Each individual has to title their note uniquely, or just use the standard "outpatient clinic note" as what it's called. So, whereas in AHLTA you can scroll through and see the primary diagnosis, the provider, the clinic, the location, etc., all you can see here is the note title. Can't see what clinic it was from, and if the provider saved the note without giving it a title of "back pain" or something other than "outpatient clinic note," you can't change it (as far as I'm aware).
Shotexes at the unit spaces are a thing of the past. I suspect this, along with many other changes, are to decrease our concierge medicine we provide the line, and force them to come to clinic for everything. A shotex used to be able to be run by 2-3 corpsmen and they could knock out 2-3 immunizations for 200+ people in 2 hours, and then spend an additional 20-30 minutes logging it into MRRS. Now, it takes around 8-12 corpsmen to process 50-75 flu shots an hour. Good news is that it is logged into Genesis in realtime, and is probably safer and better.
Batch lab entry no longer exists. Let's say you're doing pre-deployment HIV blood draws, or now you're doing pre-deployment COVID nose swabs, you have to generate individual encounters for each person. Another unit did this recently and it took 9 corpsmen 2 hours to do it for 300 deployers. In CHCS you could do a macro that could've allowed 1 corpsman to complete it in 1 hour or less.
It does not sync with DEERS. So new check-ins to the command might not appear in Genesis, and that is a pain to figure out on the fly for sick call visits.
The current bridge between AHLTA and Genesis is JLV. So if someone goes from a command using Genesis back to a command using AHLTA (and vice versa), all their results will be uploaded into JLV. Going back to the fact that Genesis generates a lot of documents, this means JLV is going to be crowded with excess documentation that is poorly labelled and hard to sift through.
Notes are not easy to read. They're cluttered, full of junk, like like most EMR systems but way worse than AHLTA. Except for mental health notes written in AHLTA. Those are hard to make more unreadable than they already are.
Anytime you open a patient to view their history, lab results, etc., it pops up you to the default screen as if you're going to start charting a note, but then it pops up a reminder or two that you're opening a discharged encounter and can't chart in it. As far as I know, there's no way to just open a patient's chart, you have to actually open a previous encounter to view their chart. Every patient has two encounters built in, a "Lifetime pharmacy" encounter, and a "History" encounter. It still does all that with a history encounter. And every time you open a chart, you have ot indiciate why you're opening the chart. Are you a physician, are you doing a peer review/QI project, are you doing it for billing, or are you "breaking the glass" (emergency access to everything in the chart).
Viewing results isn't as user friendly as AHLTA (or Epic).
There is no consult log, like in AHLTA, where you can follow up (and learn from) the consults you place to specialists.
Still haven't figured out how to do PHAs or PDHRAs with this system, as there's no TCON, and it'll be impossible to call my corpsman up to enter in walk-ins all the time for PHAs done at my unit office. Or do I just shoot myself a message (the new TCon) and save it to the patient's chart? Or just do it online and forget about billing for it because it's a stupid system that needs to go away?
On the plus side, I can create multiple patient lists for different purposes (AHLTA only allowed you to do one).
I had really high hopes for this, as I was expecting it to be like Epic. But it is most definitely no where near as good as Epic (while there are no good EMR systems, Epic probably is the best in my opinion).
To be fair, I haven't been using it very long and maybe once I learn more on how to use it, it'll make more sense. And I'm not like one of those people that's constantly complaining saying we need to switch back, I'm trying to learn how to use what we've got, but I'm just making you all aware that this is a BAD system. Whoever decided to pick this probably works in some ivory tower somewhere and hasn't been a junior medical officer in an operational setting, or even an outpatient clinic.
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Close, probably JLV.$50 says they put it all in HAIMS
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I hope we can keep CHCS. That DOS shell is awesome, fast, and efficient. Plus it reminds me of the 80s, a simpler time, when Van Halen was king, and movies were great:
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We have to do MHS Genesis training in January before we go to clerkships in San Diego. Is it being used there now? When I was enlisted there it was still Essentris, etc.
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Nope. No command prompt system. There is not way to put in orders without some sort of documentation. And any order, other than medications, requires an actual encounter created by a corpsman/nurse. For anyone that enjoys efficiency and getting things done, be prepared for your workflow to be hindered.
Balboa transitions in January. Hope you aren't there during the transition, it's pretty brutal. I think they'll benefit from learning from Pendleton's transition, but still, it's tough.
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I get there mid Feb. Hope they’re done by then.
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Good luck with that...
Don’t crush my dreams.
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I’ve been saying it for years - people are going to miss AHLTA. People are also going to miss the vista at the VA. If you know how to use it it is powerful and has a ton of information available for chart review. It’s easy to find specialty consults, labs, and old data. Also incredibly easy to copy forward notes for clinic productivity, you can basically put any information you want in each note.
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Hit me up when you get to San Diego. My wife just went through super user training at Balboa so she can probably assist if needed.
She can get you up to speed over an outdoor, social distanced home cooked meal at our place if you want.
I'm enjoying Epic during my one year "as a civilian"....then I'll be welcomed back to MilMed with Genesis in full swing. That being said, I have been using Epic for 4 months now and still feel slightly less efficient than I was with AHLTA/Essentris but only because I spent 8+ years mastering efficiency with the latter. I'm sure by the end of this year I'll be 2x faster than I was with AHLTA/Essentris and then hit a wall trying to figure out Genesis back in MilMed land. Oh well, such is life.
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There is no doubt that Epic is superior to anything we use in the military, as far as an EMR goes.
But, I understand why the DoD didn't select epic, and it has nothing to do with cost. Epic is fraught with IT vulnerabilities; a 13-yo Russian hacker would have a field day with it. So how do other hospital networks deter the hackers? They do so with very tight security measures that are easy to maintain on a small, local network (very unlike the DoD network, which is global, and gets pinged by said hackers 100 times per minute). Epic, like most civilian software (Zoom, etc, etc) can't meet the DoDs standards for security.
Instead of Genesis, I just wish they had fixed the glitches in AHLTA and made is more use friendly. It's already coded in visual basic, would have been very easy to do.
But, I understand why the DoD didn't select epic, and it has nothing to do with cost. Epic is fraught with IT vulnerabilities; a 13-yo Russian hacker would have a field day with it. So how do other hospital networks deter the hackers? They do so with very tight security measures that are easy to maintain on a small, local network (very unlike the DoD network, which is global, and gets pinged by said hackers 100 times per minute). Epic, like most civilian software (Zoom, etc, etc) can't meet the DoDs standards for security.
Instead of Genesis, I just wish they had fixed the glitches in AHLTA and made is more use friendly. It's already coded in visual basic, would have been very easy to do.
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Sounds great!
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I feel bad for your wife. All our super users are hating their lives right now. But I think a lot of my complaints are more problematic with the operational side - specifically a Marine Centered Medical Home that doesn't have the resources or training to actually be a MCMH.
I think you'll be surprised at how much is missing from Genesis compared with Epic. I remember Epic as a med student, and on outside rotations as an intern, and it took some getting used to, but it was pretty intuitive. I think Genesis will end up working better for inpatient care than outpatient care, at least in our operational settings.
Makes sense. I'm just surprised at how little customization was done for the DoD (at least from my limited perspective). I'm sure a lot was done behind the scenes to get it to communicate immunizations to MRRS and things like that, but the workflow things just don't make sense. The ability for a corpsman to sit down and crank through mass orders with CHCS was great. We recently had 9 corpsmen take 2 hours to input 300 COVID swabs for a deploying unit. That could've been done by two corpsman in less than 2 hours, or one corpsman if they knew how to use macros.
And the requirement that any orders, or any substantiative documentation, must be associated with an encounter is ridiculous. I don't know if the MTFs are trying to force us to capture RVUs, or what, but it doesn't work well for operational providers that aren't in the clinic 5 days a week with a consistent front desk staff to screen requests.
And what's going to happen with T-AHTLA? Is there going to be a T-Genesis? Something tells me not, but who knows.
I agree: A modern, polished, and faster AHLTA/CHCS, with adoption by the VA and a link between Vista and the new system, would have been a better investment,
Edit: Example (see attached image) of the number of documents that are generated from a single ER encounter. You can't retitle the bolded, but you can rename whatever is under it, not bolded. It's actually a potentially nice feature if people utilize it and there's a standard naming convention. For example, someone comes in for back pain and headaches, in AHLTA, only the first diagnosis is displayed.. Here you can say "headaches and backpain" as the note title.
In Genesis you can filter by physician notes, which is also nice. However, until Genesis is adopted DOD wide, anyone reviewing these notes in JLV will be stuck sorting through all those documents you can see there. It's going to be a very cluttered chart dive.
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Dang, I wish I wasn’t on my phone so I could address some of the items you listed in your post. I’m not a huge fan of genesis, but I’ve been using it for almost three years and our team RN is a superuser. Believe it or not, there are solutions to many of the issues you mentioned. Much trial and error, and many fu€ks were given to figure them out. Ordering labs, xrays, meds, etc. can easily be done outside of an encounter and there’s also a tcon function that works decently and none of it involves sending yourself a message. Frustrating? Oh hell yes. Somewhat manageable so you don’t go completely insane? Close to yes.
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Please hook me up with the knowledge when you get the chance.
I'm sure things will get better with time, and trial and error like you said, and it has already gotten better over the past 2 weeks, but it is a painful process.
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Launching at balboa this Saturday.
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GAO wants the VA to stop the rollout
GAO Calls for Stop to VA's Electronic Medical Record Rollout Until Early Problems Get Fixed
Last fall, the Government Accountability Office identified issues with the system before it was introduced in October.
Nothing else I'm aware of. I will say that things are getting better. There are some things I still miss from AHLTA and CHCS, but overall I'd say Genesis will be an improvement.
