Tell me about your experience with EMR.. The good the bad and the ugly!

Hi everyone,

I am a healthcare architect, doing some research on electronic medical records use on inpatient hospital units (med/surg units, specialty inpatient units, or any type of critical care or intermediate care unit). Since I come to this site all the time to read what nurses and other healthcare professionals really think (not always the same as what our clients/hospital administration tell us!), I thought I might ask for some help with my research project.

Please leave your comments about EMR experiences, and fill out the quick, anonymous survey linked below. I am interested in everything about EMR charting... Where do you chart? When? How often? Is it better or worse than paper records? Does it take longer? Is it more efficient? Do you wish your hospital would arrange things differently or better to make charting easier? Do you think they made a mistake when they put together the current system?

The informaton helps us improve design of patient rooms, nurse stations, and overall unit design.

Thanks for your help...

Here is the link to the survey: http://www.zoomerang.com/Survey/WEB22B8GYXJ7FJ
I am BEGGING my nurse manager to get touch screens for our e-charting. The system in place now requires one to go constantly from mouse to keyboard and it is terribly frustrating to have to chart for 20 minutes when the procedure I am charting on takes the surgeons 7 minutes to complete, skin to skin. I used to use Saturn (I am unsure if that is a program or an interface...can you tell I am talking out of the side of my neck here?!?) and I could chart a new pt in about 5 minutes. It was HEAVEN! That is really my biggest issue with e-charting. We use GE now (I can't remember the name of the program...starts with a C) and it is sooooo outdated, but when I brought it to my NM's attention, she said that she wouldn't upgrade our charting until it got better. HUH?!? How about giving us a program that is not older than ME to chart with, and you will see less errors!Since I work in the OR and some of our cases are very fast, my biggest concern regarding my chart is to get it completed before the patient rolls out of the OR. Our system is linked to every unit, so the PACU nurse is unable to get needed information until my chart is complete in the OR. I must take care of my pt first, and it burns me to no end that I feel chained to the blankety blank chart because of the inefficiency of the program. I am so glad that you raised these questions, because I have been beating my head against the wall trying to find other e-charting systems to bring to her to consider. I can't find anything. Please help me?

Seen 3 differant, it wasn't easy but I've managed to eliminate their names from my conscousness. The only good thing I can say about them, in common, is that they so restricted my ability to logically and accurately chart on patients that were I to get sued, it would be impossible to eke out an accurate evaluation of the patients condition or care. None were intuitive nor did they decrese work or improve efficiency. If just one software engineer would talk to a nurse they'd make a fortune. Sorry to be unhelpful, but I have to call them as I see them.

I work in the ER, and the way the patient tells their story, or the way things happen in the trauma room, the information I get doesn't happen in the same order every time. I need to be able to move forward and backward in the program without filling in mandatory fields.I need to be able to save my work midsentence so I can attend to the patient, have the screen go blank for privacy, and then return to the computer later to finish. Changing passwords frequently just means more calls to the helpdesk. And we need the same password for all the work. We write write passwords on the back of our badges, because there are 3 of them and they all change monthly.We have to have a spot for free text on every page. Tick boxing is fill in the blank nursing, I personally hate them. Nobody fits into tick boxes, and some things are so bizarre...I concur that going from keyboard to mouse frequently is frustrating and slows the process. I'd also prefer inobtrusive computers rather than desktops, or COWS. I want the patient to feel that they are my focus- not the machine.Some information is best inputted immediately, like vitals, but reading/writing a history, or operative report needs to be done away from the distractions of the bedside. I think it would be cool to have a password for the patient, and each professional could release notes or labs as appropriate, so they could find out what happened overnight, or when the last pain med was given. Patients control who gets access. They could also write their own questions and concerns in. Very helpful for a concerned family, and it could be a record of insanity for the folk that need it.

one word......"ICKY!"Hate the EMR

From an architectural standpoint, the point of interface needs to be situated so that the nurse is facing the patient when entering data. We need to be able to move the keyboard out of the way when it isn't being used, but it also needs to be quickly adjustable & very sturdy when it is used. We also need to be able to quickly 'slave in' a different monitor & keyboard to use during a crisis situation such as a code -- when using the bedside/room equipment isn't practical. Currently laptops and monitors/ keyboards are being jammed into every nook and cranny. I'm sure that I am not the only nurse who has concussed herself bonking into one of these things or fritzed it out by splashing water on the cpu because it was mounted beside the sink (!!!). Wish List= Nurses come in different sizes and shapes... equipment needs to accomodate this. = All required supplies stored at the patient's bedside - auto inventory application integrated into EMR - triggers re-stock when supplies are used (e.g., dressing change, IV tubing change, etc)= Touch screens for 'tick boxes'! = Speech to text - manually triggered to replace endless keyboarding for narrative notes. Maybe a foot pedal so it is hands-free?= Instant Messaging capability - for critical values & urgent information (in a vivid highlight color) with an audible signal also... - to send data or visuals (monitor tracings, VS graphs, etc) to physicians when needed= Automatic Reminders (visual & audio) for medications, treatments, etc that are time sensitive= We need camera/imaging capability - to record visual information about wounds, skin condition, etc. No need to have to rely on old fashioned paper descriptions in this electronic age; camera can also be set to visualize a patient that needs continuous monitoring when you are not in his/her room = Robo-suit (like Sigorney Weaver wore in the original Alien movie) for moving heavy patients... or at the very least, built-in mechanical lifts for every bed= Electronic performance support for all decisions/interventions- How-to video immediately available for technical tasks (e.g., calibrating A lines)- Algorithms to guide decisions (e.g., choice of wound care materials)= On-demand patient education videos with touch screen interaction / post test - evaluates understanding & automatically documentsCan you tell I have been imagining this stuff for a while?

Quote from canoeheadI concur that going from keyboard to mouse frequently is frustrating and slows the process. I'd also prefer inobtrusive computers rather than desktops, or COWS. I want the patient to feel that they are my focus- not the machine..

HouTx-I think I just shed a tear of joy...and I felt chills at the possibility of this kind of charting. I think I need a cigarette...

Quote from HouTxFrom an architectural standpoint, the point of interface needs to be situated so that the nurse is facing the patient when entering data. We need to be able to move the keyboard out of the way when it isn't being used, but it also needs to be quickly adjustable & very sturdy when it is used. We also need to be able to quickly 'slave in' a different monitor & keyboard to use during a crisis situation such as a code -- when using the bedside/room equipment isn't practical. Currently laptops and monitors/ keyboards are being jammed into every nook and cranny. I'm sure that I am not the only nurse who has concussed herself bonking into one of these things or fritzed it out by splashing water on the cpu because it was mounted beside the sink (!!!). Wish List= Nurses come in different sizes and shapes... equipment needs to accomodate this. = All required supplies stored at the patient's bedside - auto inventory application integrated into EMR - triggers re-stock when supplies are used (e.g., dressing change, IV tubing change, etc)= Touch screens for 'tick boxes'! = Speech to text - manually triggered to replace endless keyboarding for narrative notes. Maybe a foot pedal so it is hands-free?= Instant Messaging capability - for critical values & urgent information (in a vivid highlight color) with an audible signal also... - to send data or visuals (monitor tracings, VS graphs, etc) to physicians when needed= Automatic Reminders (visual & audio) for medications, treatments, etc that are time sensitive= We need camera/imaging capability - to record visual information about wounds, skin condition, etc. No need to have to rely on old fashioned paper descriptions in this electronic age; camera can also be set to visualize a patient that needs continuous monitoring when you are not in his/her room = Robo-suit (like Sigorney Weaver wore in the original Alien movie) for moving heavy patients... or at the very least, built-in mechanical lifts for every bed= Electronic performance support for all decisions/interventions- How-to video immediately available for technical tasks (e.g., calibrating A lines)- Algorithms to guide decisions (e.g., choice of wound care materials)= On-demand patient education videos with touch screen interaction / post test - evaluates understanding & automatically documentsCan you tell I have been imagining this stuff for a while?

For multi partner practices, having all the pts' history, meds, labs etc in one place is great. The gynecologist can see exactly what the dermatologist ordered, and the internist knows the gyn hx, and each can see all the labs which prevents unecessay repeats. An ER having access to a complete record would be so much better than Aunt Susie trying to remember all her meds, or when she had a surgical procedure. We all know that pts (innocently or intentionally) forget to tell us stuff.No more trying to decipher penmanship. Even nurses can be sloppy writers.

Our system is designed for gathering info for audits, not for improving patient care. Plus, it is so inefficient that people create work arounds or just don't do so-called required charting. Examples: the screens that used to serve as a "Kardex" to inform staff about diet, activity, labs draws, treatments can have several conflicting orders like npo, general diet, ADA, low Na, fluid restrict 2 L, fluid restrict 1.5 L, that people will ignore it or just pass on verbally what they believe is the last order. It is difficult for nurses to retrieve data quickly like when did patient last eat, when was their last dose of beta blocker, is their Hct trending down?Multiple programs used within the hospital don't interface, or don't interface well. So paper copies are printed from OR, ED, cath lab for meds, procedures, I&Os given there. So if I need to know how much fluids a patient got I must wrestle the paper chart away from the UC, doc, therapist or wait for it to come back from imaging with the patient to get this info.I would love to be able to sign on with my badge or thumbprint or voice recognition, instead of having to log on my user number and ever changing password everytime I need to enter something or check data.And charting on 12 different screens minimum for each patient is ridiculous. And the care plans had to be moved to paper because the program couldn't accommodate them. Arrrgh, that is basic nursing process but isn't important enough to be part of the EMR.

I haven't used EMR since 2009, when I was a clinical instructor, but I assume there is still the problem of what to do when the system is "down". Big, big problem, especially when it happens at shift change.Another big problem for me as an instructor is that the hospital insisted that all my students enter data and give meds under my password. The State Board said it was okay, so I dealt with it.

Great ideas! I love the idea of camera/imaging capability. It's so obvious - staff should be able to put photos into the EMR, the same way doctors and techs can use PACS to save all the diagnostic imaging stuff.Regarding the robo-suit: we're not there yet, but more and more new architecture is accommodating to bariatric patients. For the first time in 2010, the healthcare architecture guidelines have suggestions for bariatric design. Lately, we are doing floors, where 10%-50% of rooms include built-in lifts. With other clients, we include space for storing portable lifts. Of course, that takes more space, which means more $$ for the client!As for the software/UI issues with EMR, sometimes I wish Steve Jobs would step in and partner with some of the larger EMR software companies, and whip them into shape. I have an ipod, and iphone and an ipad, and I've never read the manual for any of them. They are 100% intuitve, simple and easy to operate. The stuff I hear about EMR software is the opposite. I mean, fooling with a mouse? Really? Steve Jobs, are you reading this?