Who uses paper charts still?

[toomuch]

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I hate paper charts, I could say it over and over, they are inefficient and time-consuming. I was very spoiled in medical school and practically exclusively used electronic medical records and now find my resdiency sometimes unbearable without them.

I loved having Cerner powerchart at most of the places I rotated during medical school.

So now, the hospital I'm at is trying to decide which electronic medical record company to choose, do any of you have experience with ge, epic, eclipsys, mckesson? what do you think of it?

Also, which academic hospitals do you know that have paper charts still? Can I get a list somewhere.
Does UPenn? John Hopkins? I've learned that sometimes even the bigger most known hospitals have had trouble converting.

 

[nonesuchgirl]

I hate paper charts, I could say it over and over, they are inefficient and time-consuming. I was very spoiled in medical school and practically exclusively used electronic medical records and now find my resdiency sometimes unbearable without them.

I loved having Cerner powerchart at most of the places I rotated during medical school.

So now, the hospital I'm at is trying to decide which electronic medical record company to choose, do any of you have experience with ge, epic, eclipsys, mckesson? what do you think of it?

Also, which academic hospitals do you know that have paper charts still? Can I get a list somewhere.
Does UPenn? John Hopkins? I've learned that sometimes even the bigger most known hospitals have had trouble converting.

Johns Hopkins still uses them. There aren't enough computers in JHOC to do otherwise. 🙄

We use EPIC/HIP, EPR, and something else- the OR schedulers have another program. POE is for order entry. There's another system for Peds, one for Nutrition/Dietary, one for oncology, another for entering lab values/path reports... Dentistry clinic has yet another system... Most suck. EPIC/HIP is still DOS, if you can believe that.

I'd love it if we'd switch over to EMR- yay no more filing!- but it's such an undertaking.

 

[ESU_MD]

is this the same as order entry?

Isnt a waste of time to have to enter orders in the computer, only to have the nurse just call you anyway to clarify it>?

plus- the nurses getting edgy about not taking verbals...

there is nothing that is more of a waste of time than to have to log in a computer just to enter an order.

 

[nonesuchgirl]

is this the same as order entry?

Isnt a waste of time to have to enter orders in the computer, only to have the nurse just call you anyway to clarify it>?

plus- the nurses getting edgy about not taking verbals...

there is nothing that is more of a waste of time than to have to log in a computer just to enter an order.

Some places have the actual record online too, like all the old clinic notes and OR reports and crap. We've got it, we just print everything out because you can't access it in clinic.

I am currently being forced to use paper charts again, and I hate them.

The worst part is this conversation:

Clinic Staff: "Do you have your chart with you today?"
Patient: "No, you have it."
Staff: "No we don't, you do."
Patient: "No, you have it."
Me: <breaking in> "Well, do you have any medical problems."
Patient: "Yeah, I have a problem with my liver, or maybe my eyes, I forget. I take three medicines."
Me: "What medicines?"
Patient: "They're white, and have writing on them."

Why would a patient have their chart with them??

Also, I'm of the opinion that clinic staff rank with child life on the useless list. There are a few gems, but most make me want to spork myself.

 

[nonesuchgirl]

They check it out when they go to see specialists.

Most places I would agree with you. In my case, circumstances are a little different, and they are totally indispensible.

Wow. Each clinic has to keep their own records at my place. And then we've got "central" records, which are never updated and is staffed by cranky old women who'd rather bitch than work. 😡

 

[Flopotomist]

For all of the negative things you can say about the VA, their computer system is amazing. I wish that program was used everywhere...

 

[HomerSD]

I love CPRS, but it's unlikely that many places will pick it up despite the government giving it away at low cost. Apparently, CPRS handles billing poorly, which is extremely important to everyone else.

 

[toomuch]

hmmm. i don't mind logging into a computer to eneter an order, it's better than verbals or faxing or figuring out what was already ordered or what someones labs or vitals signs or their past medical history is over the phone while you can just look yourself and click a button.

Of the places I have been to, the nurses understand practically all the order entries. The progress notes, consults, h and ps, inpatient, outpatient, er, or, radiology, procedure reports and etc, are all on the computer in the same place. Powerchart does remind me of the cprs system of the va.

 

[IndyXRT]

We're in the long transition period. We still have paper charts, but less and less is being done in them. Now we have the option of writing notes in the chart or in Cerner Powerchart. I'm sure that eventually, all notes will be in Cerner. Unfortunately, the clinics are still largely paper charts (with central electronic records for labs/path/radiology/dictation). Order entery is still on paper for now. I will be very glad when the transition is over. There is a daily hunt for charts in our clinic, since they could be at the treatment machine, with the nurses, with the dosimetrist, with the physicist, with the resident, or with the staff doctor (or at the front desk, the secretary, etc.).

 

[45408]

For all of the negative things you can say about the VA, their computer system is amazing. I wish that program was used everywhere...

Yeah, so I've heard. I've been on paper charts for the past two months 🙄 I don't mind the paper charts except that I can't read any attendings' handwriting - not that they wrote much anyways, and I type much much faster than I write. Besides, if a patient has 20 problems, and 19 of them are "continue with..." then I'd rather copy/paste than re-write.

 

[Faebinder]

I HATE papercharts.

1) Someone always thinks they are more important than the physician to have the chart. ARGH!!!

2) Many nurses are such slackers when it comes to executing the orders. The advantage of an electronic chart is that there would be no fudging of time of response to an order. If everyone takes 10 minutes to do an order but a certain nurse takes 1 hour... we know whose slacking.

3) No more hunting who has order what.

4) No more unclear consults and bulls**t H&Ps.

 

[MilesMayhem]

I have never used anything but paper charts. Have I understood this correctly, that this powerchart is a program suite that is installed on a central mainframe + on all devices connecting to it like tablet pcs and pdas to read the data on the mainframe, and editing it?

 

[MilesMayhem]

And what happens if the system administrator decides that the hospital isn't treating him good, so he changes the password, copies all the medical data to his own drive, and sells the information to every insurance company in the us, before he heads across the border to mexico? That would be a little harder to do with paper charts.

 

[Acherona]

I HATE papercharts.

1) Someone always thinks they are more important than the physician to have the chart. ARGH!!!

2) Many nurses are such slackers when it comes to executing the orders. The advantage of an electronic chart is that there would be no fudging of time of response to an order. If everyone takes 10 minutes to do an order but a certain nurse takes 1 hour... we know whose slacking.

3) No more hunting who has order what.

4) No more unclear consults and bulls**t H&Ps.

So true!! There is always so much fighting over charts. The treating team needs it to round or write notes, the nurses need it to document, the consult teams need to look through it, sometimes multiple consult teams arrive at the same time. Then it goes by hierarchy. If an attending needs it the nurses come running with it batting their eyelashes. Oh and if the pt is going for a test, the chart has to go with him. E-charting is so much better! The only thing I don't like is the overuse of copy-paste and the pre-fab forms which make it easy to mistakenly keep pasting outdated info.

 

[OldPsychDoc]

We've been running fully electronic (EPIC) for about 2.5-3 years now.
It was a pain at first, with lots of complaining, especially from entrenched neo-Luddite nurses and attendings.
Now, especially reading the above posts, I wonder how we ever managed without it.
There are a lot of inconveniences with it--I hate spending 60-90 minutes a day typing my notes; often keyboard shortcuts are counter-intuitive; every now and then a set of orders goes missing (bringing new meaning to the term "EPIC FAIL" 🙄); and it can be a horrendous pain to try to do a complicated chart review that spans more than one admission (though at least all the info is THERE, it's just that sometimes you can't find it easily, or flip easily from one "page" to the next).
Bottom line--it's change for the better in the long run. Gladly trading my paper cuts for carpal tunnel!

 

[buckley]

Okay...this may be just because I'm a newbie but I hate epic! Igh. It is such a hassle to log-on just to request accuchecks and to figure out why you can't order "duplex scanning"...but "doppler" is good. I miss papercharts beause feel you're freer to express your thoughts in them. Plus, I feel that since using the computer, I am being dependent on it, like I don't know the dosages, nor feel the need to know the dosages

 

[DrJosephKim]

Unfortunately, many institutions still use paper charts. This is especially true for private practice offices. However, expect more integration with EHRs over the next decade, since Medicare will drive agenda.

 

[Hurricane]

Our main hospital still has paper charts, but they're in the process of converting to EPIC. The ER is supposed to be completely converted in Oct or November. In the meantime, I buck the system when I can by typing my notes in a Word template formatted to look like our progress note forms.

One of the private hospitals where we rotate had already gone completely to EPIC, and it's awesome. Only thing was, when I was there, they were at this awkward stage where they had both paper charts and EPIC. So sometimes you'd get an exchange like this:

Some doc: I ordered a consult on this patient on this patient, why haven't you seen them?
Me: I did see them, my full consult is in EPIC.
Some doc: Oh, well, I don't use the computer.

Like this is my issue. 🙄

Also, there are lazy docs who have made these progress note templates that autofill so much data it results in a note full of useless junk that you have to wade through to find the relevant info. Same goes for CPRS at the VA. But I have a feeling these people would probably write crappy notes in the paper chart too.

 

[deleted6669]

I LOVE paper charts.
2 of the 4 places I work use paper, 2 use an emr.
the places that converted from paper to emr had to double the # of providers/shift in the ED to stop the dept from bogging down.
much faster to just check a few boxes to order things then type each individual order and figure out that "preg eval u/s" isn't the correct format but "u/s, pregnant, first trimester" is .
the places that I work that use emr's I just dictate and put"see dictated note" in the emr as much as possible although I still have to order labs/meds on them.
one of the main reasons hospitals favor an emr is that they can then lay off secretarial staff and make providers do all the menial scutwork of ordering, following up labs, etc. it's part of the "secretarialization of medicine" in which some bean counter decided to have folks with more than a decade of post high school education doing data entry to avoid hiring extra staff to do it. it's like having providers do their own coding, makes no sense-there are people who do that for a living and do it well. places where I have to code I just use a gestalt 3/4/5 and if someone complains I change it.
it makes no sense to pay seasoned medical professionals big bucks to spend time doing the work that a high school grad could do for $10/hr.
when I work without an emr I sometimes see up to 6 pts/hr. with the emr my max is around 3/hr because you spend 5 min with the computer for every min with the pt.
the systems I am forced at 2 jobs to use are epic based. I have used the electronic T-system before and find it much better than epic but still inferior to a written or dictated note.

 

[cali-ob]

we use epic and I love it. during med school I used epic at my program. When I left for a year to do ob/gyn at another program I was constantly in medical records signing papers because mine was the only legible signiture on the chart and they decided they should just contact me to fill out all the missing info and dictate the surgeries.
Now, I am only responsible for that which is done while I am logged in, and you can read everyone's consults.
For the poster who said it slows you down...seems like maybe a typing course could help with that. The computer is WAAAAAY faster than writing (IMHO)