Re: Rep Retirement Lodge 199 - Dumb Poll of the Month
Funny you say this - I have a couple friends who are young doctors who love it. One used some version of Meditech when she started and said that the new system made her job a zillion times easier. Funny how perspective varies so much.
I'll guess your practice didn't add Dragon into your system? Some of our family medicine practices love it, especially those that love to write voluminous notes.
Ultimately, Epic ushers in what is a needed perspective change in medicine, in my opinion. Health Care is the caboose of the IT train and it absolutely shouldn't be. I'm not sure if Epic is the most ideal setup, but the health care industry needed to be dragged into the internet age. I feel for those that are left behind - truly I do. But something about buggy whip manufacturers.........
The bulk of my job is fixing things that shouldn't need to be fixed: printing. It's a paperless records system. No, you don't need to print every **** thing. I know that's how you've done it for 6541857574 years. But stop wasting paper and my time.
Wellll, since you responded sounding like this is because people are resistant to technology- let me disabuse you of this notion.
-it takes 4 times as long to do any task when using technology that is currently available. This means that instead of doing a note in 2 minutes it can take upwards of 30 minutes if you have a complex patient, even if you are fast (which I was).
-Patients universally HATE the computer in the exam room. They want you to look at them not at the computer. I touch type. You cannot do a note without also spending way too much time looking at the screen to click into each little box. If you wait and look thepatient in the face then you spend hours after you finish seeing the patient to enter the info. Of course you can have a scribe which ignores the fact the patient may want privacy or at least the impression of privacy (and hey, how efficient is something that used to take one person a minimal amount of time and now requires 2 people to do and still is way too time consuming? that shows how completely effed up it is!)....
- new docs have no flipping clue what they are missing in the notes where you click little boxes. I am sure they love it. They use templates that fulfill the measures for the insurance company but impart no useful info. My 1st yr nursing students can tell you how useless they are- blanket templates that give misinformation because to correct the template is too much effort or they never really read what was written because it is the same for the last 5 notes. Same misinformation is routinely repopulated in every note. But... the note is done, looks beautiful from the insurance company's perspective so they get paid.
-Ask just about anyone who has had experience with both and we will all tell you the nuance in notes is gone. There is no place to communicate the subtle things one could use when dealing with a patient. I did a lot of things that had psych overtones. No place to convey the finer points of that in the 3 systems I dealt with so free text was the way to go except you can do the ---
-volumous dictated notes. Unfortunately these are discouraged because they do not go over when transferring to a new system- in fact when we switched we found most of that doesn't transfer which necessitated toggling between systems. In fact volumous dictated notes are also not searchable either. so the insurance co will not give you credit for what you did unless you also click all the little boxes that may or may not actually convey what is true but meet the measures required.
-There is no way to access info in a linear fashion by flicking to sequential info. You need to click open every single note to look at the various parts. You can't skim like in a paper chart to find something. This is time consuming and downright dangerous if you need to find something very quickly. Theoretically everyone should enter the info in the same place but in Family practice, where you see huge variety this is a massive problem.
-it is possible people entered info without it being connected to a note so you need to search different little sections that are not actually connected to the note to find them. This is also problematic and dangerous. Info without background info or supporting evidence is just entered. Sometimes in multiple places. Example- I had a GYN call me about something a patient refused to get treated. She warned me that this problem might masquerade as a simpler problem. In the old chart we would have put something right in the front of the chart so it was visible when it was picked up. I had to enter this warning in 7 different areas of the EMR and it was highly likely someone could enter that person's chart and still miss the warning.
Ask anyone in a field that isn't cut and dried and who 'used a buggy whip' if they feel the EMR system is efficient and they will tell you no. We literally have providers in this community that lost so much money due to the inefficiency they took the penalty and went back to straight dictation. EMR is not built for the providers to impart or find information unless it is simple data. It is built to support the insurance companies being able to monitor measures.
If you can find a way that allows the info to present in the paper chart/linear format while maintaining the stupid little stroke the insurance company boxes then great stuff. Pre EMR I saw >20 pts a day, dictated notes that I got complimented on all the time and still finished before 8p most nights. When I left it was 16-18 pts and I was up until 1A every night. EMR I charted regularly for hours and produced notes that absolutely sucked because there was no way to do it right. THere are no templates for people with multiple complexities and psych issues.
I could do my refills in about 10 minutes if I was slow and messages were usually done in less than 30 minutes. Before the receptionist took the message and while she was speaking tot he patient could have the chart open in 2 places and the schedule open. In about a minute she could jot when the pt was due and could see from the chart when the patient had been in last, what I said and if anything had happened since. TO do this same task in the EMR-Messages meant multiple steps.- open the schedule, open each note and message separately to see what they say, then find the med and populate. If it was OK I could click my 26 clicks and refill. If not I had to look thru stuff- open a bunch of different windows, then send a note to the nurse who also needed to click thru a bunch of boxes. No one in their right mind thought this was efficient. The insurance companies loved they could track all the stuff tho.
All sorts of research showing the negative impact this is having on providers, outcomes, patient and provider satisfaction. Recently went to a conference where they were quoting a study that showed no benefit to patient outcome, compliance, satisfaction, improved documentation or tracking with an EMR but increased time and effort to have the same or less of a result. Finally. They used to try to tell us it was more efficient. Now at least they don't try to cover the cow poo with perfume. They just admit they are using it to make things more trackable for the insurance co.
Well. I guess I have some strong feelings about that.
) .... My personal opinion is who ever invented EMR should be staked out in a desert over a fire ant nest with their eyelids stitched open and a little bit of honey poured on strategic spots so they can chew little holes in ... (no strong feelings here!)
