"Paperless" ED's?

[cipher]

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As someone who has indecipherable handwriting, I'd love to do my residency somewhere that minimizes pen-and-paper charting as much as possible. Are there any residency programs that rely primarily on a computer-based system?

 

[JackBauERfan]

As someone who has indecipherable handwriting, I'd love to do my residency somewhere that minimizes pen-and-paper charting as much as possible. Are there any residency programs that rely primarily on a computer-based system?

East Carolina University seemed to have mostly paperless.

 

[southerndoc]

Be careful what you wish for. A recent study highlighted the fact that electronic documentation often consumes more time and distracts from patient care.

Personally, I'm a big fan of template-based charting. It's easy to circle and cross out things as opposed to writing. Just don't get in the habit of circling WNL (we never looked) on everything, especially if something is listed in the category but you didn't check (i.e., circling WNL for neuro when you checked everything except walking the patient; normal gait is listed on the neuro checklist, so if you circle WNL, it means you're documenting you tested for it even though you didn't).

 

[Seaglass]

We have paperless charting with dictation here at Wake. No complaints.

 

[bartleby]

Templates are great for billing, and crappy for the next doc trying to figure out what the hell you actually saw. The advantage of the electronic charting systems is that all of them, in one form or another, assemble some sort of narrative which is far more comprehensible.

The electronic charts are extremely helpful for repeat customers, as you have access to the full ED record without having to wait for a paper chart. Chance favors the prepared mind.

Personally, I'm a big fan of template-based charting. .

 

[Siggy]

While this won't help for residency, the ED at the hospital I volunteer at has taken it to the next level. They have a contract with Scribe USA so that all the ED docs basically have their own little assistant that follows them around and fills out the forms for them.

 

[southerndoc]

Templates are great for billing, and crappy for the next doc trying to figure out what the hell you actually saw. The advantage of the electronic charting systems is that all of them, in one form or another, assemble some sort of narrative which is far more comprehensible.

The electronic charts are extremely helpful for repeat customers, as you have access to the full ED record without having to wait for a paper chart. Chance favors the prepared mind.

Our template charts are scanned into the computer. You can access ED records from any computer in the hospital or clinics.

 

[kbrown]

hennepin is paperless

 

[Seaglass]

Our template charts are scanned into the computer. You can access ED records from any computer in the hospital or clinics.

I think the point was that a paper template t-system chart is about worthless for actually telling someone else what was going on with the patient. At least that's been my experience.

 

[southerndoc]

I think the point was that a paper template t-system chart is about worthless for actually telling someone else what was going on with the patient. At least that's been my experience.

They're worthless until you get accustomed to looking at them.

Of course if people only document 2 words for the chief complaint and then circle "WNL" for everything, then yes, it's worthless. We are discouraged from doing that. We have to cross out (with backslashes) any pertinent negatives for the history and also physical exam findings.

The best type of care summary is probably a dictated summary, but these can be both time consuming (until you get dictations down pat) and expensive.

 

[Apollyon]

I think the point was that a paper template t-system chart is about worthless for actually telling someone else what was going on with the patient. At least that's been my experience.

Additionally, an attending was telling me that they are virtually indefensible in court.

 

[margaritaboy]

I'm a fan of dictation, as I haven't found anything else that can encompass the sheer amount of information and changes in the clinical course of complicated patients. For simple chief complaints though, I think it is more time consuming that written documentation.

 

[southerndoc]

I'm a fan of dictation, as I haven't found anything else that can encompass the sheer amount of information and changes in the clinical course of complicated patients. For simple chief complaints though, I think it is more time consuming that written documentation.

Once you get the dictating style down, it can be a lot quicker than writing out the entire chart.

 

[Apollyon]

Once you get the dictating style down, it can be a lot quicker than writing out the entire chart.

You know, there's a down side to each one - you're right on the dictation, but the transcription costs can be prohibitive. A template-driven system (like Wellsoft, Emergisoft, and IBEX) adds 25% to the time needed to document, but gives more detail. The T-sheet is fast, but, as alluded to above, doesn't tell someone else much about what is going on (as for being indefensible in court, I didn't ask the guy if he had been sued!).

 

[colforbinMD]

Be careful what you wish for. A recent study highlighted the fact that electronic documentation often consumes more time and distracts from patient care.

I wonder who this study was done with. I would suppose that older clinicians who are less use to computer use and more established in their ways of documentation would be slowed significantly compared to a residency program.
More then likely it's not a matter of IF things are going paperless at your ED but rather WHEN.

 

[Jeff698]

We use IBEX at Scott & White. I'm very torn about whether I like it or not.

I hate using it for my dictations because, as someone pointed out, it is worthless for furture docs trying to figure out what happened. I'm pretty used to reading the things and, when I'm off service, I have no clue what happened. Worthless from that standpoint. Actually, worse that worthless becase we seem like idiots when the only representation of what we did is that note.

I do like the ability to sign up for patients and get an instant feel for what is going on in the department at a glance. I also like the ability to do a chart in real time. I use dictation for the vast majority of my patients but I have to wait until after the dispo to do the dictation, i.e. everything has to be done. With IBEX, I can't document as I go and don't have to wait for stuff to get done. This is really nice for those patients I'm going to have to hand off at the end of the shift. I can just do the hand-off and I'm done. When I'm dictating them, I hand-off and then still have a bunch of dictations to do.

The good news is that at our hospital we have the option of doing either dictation, IBEX or a combination.

Take care,
Jeff

 

[Apollyon]

The good news is that at our hospital we have the option of doing either dictation, IBEX or a combination.

Heh - by CONTRACT, I have to use IBEX at my next job.

 

[margaritaboy]

One advantage of written documentation is that you can do it while you are taking the history from the patient. It gives you more face time with the patient and when you leave the room, you are 90% done. Of course, it back fires if the patient is complicated or has a prolonged ED course with studies, and reassesment.

I haven't used any purely paperless systems, though I look forward to trying them out.

 

[docflanny]

Grand Rapids has a combination of check boxes (form ROS and PE normals)and dictation. ie. defer to supplemental sheet for normals and common PMH.