Home Forums Discussions General Discussion Hospital EMR

OUR CRITICAL ACCESS HOSPITAL IS LOOKING AT EMRS. DOES ANYONE HAVE A GOOD EXPERIENCE WITH THEIR HOSPITAL EMR?

CPSI - No......

ok

I do not.
However the AFP article from June 2011 broke down the 30 most commonly used EMR's by primary care docs and I recall several of the "beefier" EMR's were being used by hospitals and the VA and most were not terribly user friendly except one, but the one our hospital recently chose and is implementing is nextgen, and I recall one question in the survey of the article about next gen which impressed me, and only about 17% of the users of nextgen answered they would purchase it again, if i recall correctly.

Here is the link and it was 23% of nextgen users would buy again and vista was rated fairly high (one of the beefier emr's)
http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=32&ved=0CG0QFjABOB4&url=http%3A%2F%2Fwww.nxtbook.com%2Fnxtbooks%2Faafp%2Ffpm_20110708%2Findex.php%3Fstartid%3D30&ei=7tMXUPvRKpCp0AHRiIDABw&usg=AFQjCNFOUm4__1oRJGOAwJhiwOxyttDxTA

Centricity. No.

Cerner Powerchart. Ugh.

Part of the problem is that hospitals have much different priorities for their EMRs and physician usability isn't one of them.

Vista -- the EMR that the VA uses? The output I have seen(from copies given to patients) looks like unformatted chicken scratches.

At our hospital they have been using Allscripts. Do they like it? The latest rumor is a switch to Epic.

John,

Only the messenger, the only EHR I personally recommend is AC
I have not seen the chicken scratches. But if I read the survey right I think Epic and Vista were the two top rated of the larger sized EHR's in the survey.

I need to correct earlier remark 23/30 mark, and 1 is the best mark and 30 the worst, was the rating for buying again of next gen--still not stellar numbers.

Our local hospital uses CPSI. A real cumbersome, costly and redundant system. The local doc's strongly dislike this system. I have heard some favorable things about epic.
CPSI charges a great deal of money to interface with AC.

Epic is being used at the Cleveland CLinic as well as at Philadelphia Childrens hospital - where I saw it in action and I have seen the referral data back at my office...it sends out alot of gook....but not to bad for doctor/patient usability...but a 1 hour visit with A VERY NICE GENETICIST at CHOP she took 5 min to examin the child and about 40 to do the new patient note...didnt help that my daughter was easily crashing the system with errant key strokes...good luck getting any hospital administrator to listen..with the new government regulations, RAC audits, etc...the last people they consult are the ones who work there everyday. I am soon to give up all hospital based medicine and never thought that I would....

Re: Dr. Leslie

I gave up hospital medicine about a year ago, and couldn't be happier. The hospital used to be the focal point of my life; I thought it was necessary to a satisfying medical career.

CPSI and "hospitalists" did me in -- but after the initial grieving my loss, I have adjusted, and now feel liberated.

To expound on my comment - we use CPSI which I believe markets to Critical Access Hospitals - it is clunky, buggy, bombs intermittently, at 2 am it shuts down for 15-45 min for updates (have had this happen when doing dictation - lost 2-3 page dictation). Has no reasonable usefulness in ER - horrible for entering scrips (turned off e scrips after 1 week - interaction and formulary checking was taking 1-5 minutes per med to do and we complained bitterly) - they are turning back on this week and I believe it will be no better. That being said I was able to learn how to use it and I can use it as effectively as I believe its design allows - works for low volume (I only have 2 or 3 inpatients per day) - we still use a transcriptionist who types our dictation - if you use the templates and dragon it is painfully slow and difficult to use.

Yes, and to dilate on my comment, CPSI was one of the main reasons I didn't fight too hard when the hospital proposed to replace the private docs with hospitalists.

I could see the handwriting on the wall -- every "upgrade" made it worse! Taking care of more than 2-3 inpatients was phenomenally time-consuming and I was always late to the office.

Now they propose to replace this beast (after spending $millions on it) with Cerner -- which doesn't look a whole lot better, but now I have no dog in the fight.

In any case, it allowed me better access to hospital records from outside the hospital, which is good. But that could be achieved in a far less cumbersome manner, it that were the purpose of the program.

CPSI doesn't solve any problem that doctors have -- I doubt they ever actually listen to doctors at all. And it creates a whole host of new ones.

Cerner PowerChart is a real beast, steep learning curve, multiple cascading and overstuffed windows all over the screen. My local hospital implemented it last summer and has monthly unplanned crashes, hours at a time, and one major almost week long failure during which several physicians claim that patient data was lost.

I don't claim to follow the software industry closely, but wouldn't this be news if Microsoft or Oracle had these issues? Why is healthcare software engaged in a race to the bottom?

Cerner has been around for a long time. Lots of big institutions use it and it has a long track record. Horrible program to use but it checks all the boxes they are looking for at the cost of usability. "We employ you so we are responsible for your efficiency and this is the one we picked." seems to be the motto. I used it at the hospital for about 10 years and it has not improved significantly.

Our hospital uses McKesson's Paragon. It's been a disaster so far. I get emails all the time from the medical staff coordinator with subject lines like, "How to find a urine culture", etc. They couldn't find my preoperative dictation the morning of a surgery, and my case was delayed for over an hour. I was not pleased.

Our hospital use Medsphere/CareVue. It has been a great product.

John, every piece of medical software I have seen (and I don't exclude AC) has the hallmark of being rushed into production. Look how long MS Word has been around, and all updates have been relatively minor tweaks for some time. With the EHR, there are external rules like MU stuff, and they keep changing. No one has time to sit back and say "let's see if we can design the most user friendly, attractive, and stable software possible." The only rule Word had was to provide a powerful and fairly intuitive word processor.

Agreed, David. And Microsoft has the resources to do it right. But at some not-so-distant time in the past they were also young and hungry, like AC.

I still think it's time for some developer to step up and do it right. Listening to veteran users is an important step (as long as this means fixing problems promptly ). Fixing the daily annoyances that still plague our favorite EMR has been glacially slow.

This is why AC is the leader in most surveys. It was designed for physicians by physicians. While there are other EMRs that have been designed by Docs, they have been more affected by the software side.
A tradeoff of affordability is that it often takes longer to get changes accomplished. On the other side, they are careful to make sure that any change does not create it's own set of issues (or at least most of the time )

Yes, John, the folders must stay closed!!!!
Such a simple thing, such a big annoyance.

I think HIT (health care IT) has 3 major reasons it seems to stink at times, to paraphrase.
1. It is a highly complex (Data Wise) environment. (even aviation obeys the rules of physics, sometime patients not so much).
2. At least as far as physicians are concerned, the end users are highly sophisticated and intelligent as well as fiercely independent customers who usually came from somewhere else and are used to having of their own way, or at least the way they used to do it they were first trained.
3. This is a highly regulated industry, as far as the output or input goes (I.e. what we have to do), much less regulation for the actual appearance or function (lack of any standards at all go UI).

in addition we have very high expectations of technology to assist us: for instance digital radiography. I can hardly imagine practicing without immediate access to images. Yet a short ten years ago I had to walk from the fourth floor down to the radiology suite on the first floor and wait in line to have a film pulled for me.

While Word is complex, the average user barely scratches the functions list, and uses only what is a relatively simple program, with no content. IN an EMR, with CPOE and CDS, you have enourmous complexity and content requirements.

Back to the original question, our hospital uses Siemens soarian product, and the experience has been spotty although access to the information is clearly better than with the paper chart. I don't love it but I can use it to take care of patients.

I also agree with your discussion on complexity, Roger. I can understand the challenges of interfacing with different users and complex information systems. And I for one am not questioning why it's taking longer for more advanced functions, such as practice management . But I don't think that product complexity fully explains why the Letter Writer can't change formats, the spell checker can't remember mixed case words, or the search functions quirky.

Now, Donna, folders not staying closed in Imported Items, that's simply madness.