Programs with good EMRs

[WhatUpDoc!]

Hey guys,

Awhile back, I posted this same question in the Med-Peds forum without much response, and since I had a revelation last week to just do peds (realized that adults really suck ), I figured I would post it here.

So I was wondering what programs offer complete and fully functional electronic medical records (i.e. NO WRITTEN NOTES, orders are computerized, etc...)? I have long been fed up with indecipherable consult notes and just sloppiness in general with written progress notes. At the hospital where I've been doing most of my rotations, ALL the charts disappear at 6:30am and slowly resurface throughout the morning (supposedly the nurses take them for check-out during this period, but there's always at least 2-3 charts/morning that vanish and nobody knows their whereabouts!) This is really a letdown because I would seriously consider this program if my productivity didn't go down the drain by hunting down charts every morning and using the Rosetta Stone to figure out what the ENT attending wrote about my retropharyngeal abscess kid.

So please guys, help me out and let me know what programs do a good job with utilizing EMRs so I won't have to worry my life with the aforementioned issues.

Thanks

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[PEA]

Geisinger Medical Center in Danville, PA is completely paperless.

 

[coldflare]

Emory was just implementing all of the EMR features of Cerner Powerchart when I graduated from med school there.

 

[rotatores]

Hey guys,

Awhile back, I posted this same question in the Med-Peds forum without much response, and since I had a revelation last week to just do peds (realized that adults really suck ), I figured I would post it here.

Don't forget...with every pediatric patient comes an attached adult

 

[elr1983]

NOT CHOP....paper notes, paper vital signs, a few different computer systems for various notes.

I think Boston and Children's National both are paperless but could be wrong...

 

[blanche]

just to put a plug....there are programs that are paperless and then there are programs with 'good EMRs'. not neccessarily the same thing.

good EMRs were developed after the millenium change, can be figured out by someone w/basic computer skills, and don't require memorization of non-standard keyboard keys (where i was a med student, the 'home' and 'f10' keys were key to entering orders...) also, they do not involve loading excessive amts of data on the screen that is junk and makes things slow. they simplify things instead of complicating things.

i worked at a hospital where they transitioned to a new expensive bells-and-whistles EMR. it sucked. sure, all there were all sorts of places that one could tuck away little nuggets of information and data, but you got lost in the damn thing and spent 20 minutes trying to compose a simple progress note. forget trying to free text. my best days of residency were when the system went down.

 

[WhatUpDoc!]

just to put a plug....there are programs that are paperless and then there are programs with 'good EMRs'. not neccessarily the same thing.

good EMRs were developed after the millenium change, can be figured out by someone w/basic computer skills, and don't require memorization of non-standard keyboard keys (where i was a med student, the 'home' and 'f10' keys were key to entering orders...) also, they do not involve loading excessive amts of data on the screen that is junk and makes things slow. they simplify things instead of complicating things.

You're right A program that is paperless, but has a cumbersome and non-user friendly EMR interface kind of defeats the purpose.

Thanks for the responses guys. I'll be narrowing down my program roster as I get more info. about successfully implemented EMRs around the country.

 

[WhatUpDoc!]

Don't forget...with every pediatric patient comes an attached adult

So very true! And I'm totally fine with that as long as they don't ask me to treat their CAD, CHF, OSA, COPD, OA, HTN, and whatever other alphabet soup past medical history that everyone over 50 has!

 

[PEA]

I have used to 2 EMRs. One called Mysis (I think) and the other one Epic. Epic was by far much easier to use and I really, really liked it. That being said, Epic was already well-established in the one hospital and all departments were using it so the whole hospital was truly paperless... even x-rays were viewable within it. No need to go to a different computer to view your x-rays. The hospital with Mysis was just instituting their EMR and not all departments were 'live' so it probably isn't a fair judgement when it was going thru 'growing pains'.

 

[jonb12997]

EPIC at Geisinger is great. If I wasn't a mac person, I technically could check on my charts and write notes from home (not that I would)... the only trick is finding a computer, but at least the children's hospital has enough laptops on wheels that that usually isn't a problem.

the one problem I have with it is the fact that we have to do what seems to be a lot of clicking around in the NICU in order to find all the different stuff we need. Vitals, IV fluids, PO fluids, A/B's... etc. I spend a good 2 to 2 1/2 hours in the morning before I even go look at my babies. That's probably the one downfall. still WAY easier than going and tracking down charts though!

 

[generic]

ERIC sure is great. (or generic).

But unfortunately, my program is using EPIC, but not totally implemented yet--still have to try to decipher consultant and attending scrawl. Only labs and radiology is on there, and a few notes from outlying clinics.

One day, one day...

But yeah, I totally hear you that it seems weird to spend so much time at the computer instead of the bedside. That's how I felt at the VA--just sitting in my little doctor "office" for 4 hours a day and we'd come out occasionally to eyeball the patient, then go back to sitting at our computers and printing TPS reports.

 

[DrThom]

Cincinnati is going live to EPIC on 1/10/10... (at least all the inpatient services are...my continuity clinic remains tied down to logician)

 

[zoondel]

My program (SUNY Downstate) has two hospitals - the County side has Quadramed/Misys, which is fully-functional but has a bit of a learning curve, and hasn't been streamlined to meet the individual needs of every department (especially NICU!) The Downstate side is still partially on paper, but they've "promised" to be transitioning to Eclipsys this year. We'll see.

But it's MUCH better than paper charts any day of the week!

 

[peppy]

I just wanted to say I absolutely think that you are wise to consider this a factor in choosing your residency.
I did most of my med school rotations in a hospital that had a very good EMR system (including a completely electronic order system) and I didn't appreciate how much easier an EMR makes life for residents until I foudn myself wasting time looking for charts, trying to decipher handwriting, and having to go all over the hospital on call nights just to sign orders.

 

[J-Rad]

If I wasn't a mac person, I technically could check on my charts and write notes from home (not that I would)...

Epic works fine from home on my Mac (I take home call as a fellow).
All the Epic love here is interesting. Our hospital implemented it and most people hate it (though it has nice features). However this is related to how it was implemented institutionally and the way our facility decided to set it up (the program is customized for each vendee).

 

[WhatUpDoc!]

Programs with verified EMRs
- University of Michigan
- University of Cincinnati (Epic in Jan.)
- Geisinger Medical Center (Epic)
- Emory (Cerner)
- SUNY Downstate (Misys)

Feel free to add more

 

[bjackrian]

Denver Children's - U of Colorado has EPIC for everything at the main hospital (inpatient and outpatient) and it works pretty well. We do rotate at the county hospital which had computerized order entry, but notes are hand written.

Also Children's National in Washington DC has Cerner for all inpatient and most outpatient experiences.