I hope it isn't as painful as you two describe.
Frankly, it's painful for the first few patients, then gets easier. What makes it most painful is when things are not set up for you or your group. We have had an extensive infrastructure for helping our groups and independent groups working within our hospital system migrate to EPIC, but some attendings frankly hated EPIC and have been resistant every step of the way. That makes it painful because they refuse any attempt to help set up EPIC for them before rollout or to customize it to optimize their workflow. Then after the EPIC roll out, things start to break because the training was blown off and the practice did not do what they needed to do. Then attending temper tantrums start to happen. It's my job to clean those messes up. But, as long as you get things organized during training with your support structure and don't blow off the training, this should not be that painful.
My office has an EMR (always have). Its mostly templated, so I dictate very little anymore. For other hospital notes, I rarely dictate because I have prefabbed notes and I type fast, thus requiring little changes - more of a pain really to dictate, and then log back in the next day, make changes and sign off.
Good. Make sure these same notes are created in EPIC for you. Or maybe that's part of your training to work on building them with help. See my next paragraph about whether you'll actually need to have these notes or not depending on your practice arrangement with that hospital. I recommend having an H&P/consult note, post-op note, daily progress note, and discharge note made for you. You may not need customized notes if you are happy with the generic notes. You may not need them on every patient, but it's good to know which notes you'll need when the situations come up.
The hospital which is transitioning to EPIC is paper based right now. My office FAXes over my H & P and they have pre-printed orders for my post-op patients. Scripts are done electronically through my office (except for Scheduled drugs which need to be printed out).
After all, the vast vast majority of my surgical patients stay less than 48 hours, more like 24 hours. Right now (at other hospitals with EMRs), I simply sign a pre-fab note which stays "no changes to H & P".
You can still fax over the H&P. As part of the pre-op navigator, you will just have to do a "interval note" with the no changes bit. That is as simple as typing out the equivalent of "Patient seen and examined. No changes since history and physical performed in my office which has been sent for scanning into EPIC." You can make a dotphrase for it so you just type ".nochanges" or something like that.
As for the orders, someone will have to enter these orders electronically. This might be you, it might be your PA/NP if you have one, or it might be a supporting RN. What needs to happen is that your pre-printed orders can be created as an "order set". You need a pre-op order set that can be created based on your paper orders. Unlike the notes which you can build yourself, you will likely need someone from your EPIC roll out team to build this for you. Also, you will want a at least one post-op order set built for you as well (I imagine you have paper orders for this as well?), and you may want more than one depending on your preferences and depending on how different your orders are for post-op to home, post-op to floor, and post-op to ICU (though to ICU may not apply to your practice). You will also have post-op instructions that you can build for yourself into a dotphrase so you stick it in for the patient quickly.
I know this sounds like a lot, but it really isn't once it's set up and once you get used to it. The EPIC screens (navigators) are set up to make this flow logically. You will have to reconcile the patient's medications on admission and discharge as a part of the navigators (I understand this to be a JCAHO requirement), but this is quick once you're used to doing it. Post-op it is also a JCAHO requirement to either immediately do a brief post-op note and then dictate or do the full post-op note later. Or you can do the full post-op note immediately. I mention this because I'm not sure everyone understands this point. Regardless, what many high volume proceduralists hate about EPIC is that it forces them or their support staff to satisfy JCAHO requirements that they often weren't fulfilling. Hospital administration loves this, physicians don't.
As for scripts, you don't *need* to use EPIC to generate them for you, but be warned that other physicians in that hospital system may look in EPIC to see what prescriptions that patient is on if they return to that hospital. They may not be aware of what prescriptions you have given them unless they look closely into your notes. There is a way to enter them yourself or have support staff enter them into EPIC without a new script being generated, but it's an extra step.
I have no idea if they'll have support staff to enter in the data; after all, these are community hospitals without employed physicians (i.e., they aren't my staff and they aren't requiring my office staff to do the training). But I'll be damned if I'm going to spend an hour (or anything more than 5 minutes) entering in another H & P for admission when I have a lengthy one from my office EMR.
You won't need to write another H&P in the case you're describing. The only case where you will need to do another H&P is if you are admitting a patient to that hospital for which you do not have a H&P from your clinic. You could still conceivably do the note in your office's EMR and fax it over, but this is rather clumsy. I don't know if you have to admit patients to that hospital outside of elective surgeries. If you ever do, I'd be ready with a standard admission note within EPIC and an admission order set that you're familiar with.
