12 June 2012
Our entire hospital booted up a new Electronic Medical Record (EMR), from top to bottom, we are now an Epic facility. Today was my first shift in the ER after go-live, which was Saturday. Holy smokes, what a project it was to get it up and running. This system now runs everything in the hospital, from the ER to the OR to the wards, to the business and billing function, stocking, housekeeping, nursing, RT/PT/OT, social work — EVERYTHING. And we went live with a "big bang," all at once.
The good news? It went, if not perfectly, very well, and certainly better than expected. There were no major issues, which was a huge relief since the programming team was frantically building critical elements until the day before go-live. It's really disconcerting to sit with tutors three days before the event, ask how to order labs, and be told, "well, this is how you'll do it, but you can't do it now since that module is still in development." But to their credit, they got it done and it works.
The bad news? Not too much, other than the fact that the system is massive and really, really complex. This makes the learning curve super steep, and the impact on operations during the first week has been substantial. We have lots of support, with tutors and specialists standing by our elbows guiding us through each workflow, but every simple little thing takes forever as you're learning it.
How complex is this system? Just my interface, and I am but one provider of many classes, has by my count at least 15 different screens I interact with, and each screen has dozens of widgets and elements I need to operate. Worse, the behavior of each widget isn't always consistent from one context to the next. There are multiple ways to get some common tasks done, which is nice, but it's so easy to get lost in all the menus, windows and panes. It's pretty overwhelming, and mistakes can be frustrating to undo.
And I'm an eager adopter, a computer savvy guy. For me to be completely on overload, I pity some of the less nerdy folks working in our hospital.
I don't want you to think I'm down on this system. I loved our old EMR, Picis, because it was super elegant and simple and easy to get stuff done. This is much more intricate, which is a big challenge to learn but — I think — will be more powerful once I get it mastered. I can see myself being much more efficient than I was before within a couple of months. I hope.
For those who are interested, we have the ASAP module with the Notewriter function, but my off-the-cuff reaction is that Notewriter is utter crap and I don't think I'll ever use it. I've constructed a H&P skeleton with a lot of datapoints auto-populated from the chart and I am using Dragon dictation. The current release of Dragon seems much more accurate than older ones I have used, and there were Dragon experts there giving us lots of tips & tricks to really take advantage of the shortcuts available.
For example, I can order meds & labs verbally, and even common lab panels, using the mic. I can also drop in a standard age/gender/complaint specific physical exam with three words. (IMPORTANT: proofread/edit the output to make sure it's appropriate for the actual patient!) Also, I've made a slew of medical decision making notes with links that pull in personal/clinical data from the chart for common situations.
So it's a powerful tool, and I may wonder how I ever got by without it in a year or two. But for now, my head is spinning and I've gotta go lie down.
[EDIT: The de-identified screenshot was provided by the nice folks at Epic.]
Posted by shadowfax at 6:41 PM