Home Forums Discussions General Discussion Happy New Year and EHR thoughts

Happy Holidays from the Northern Mariana Islands. I have been working with the RPMS EHR for some months, now, and have a few thoughts on comparison with AC.

Points for AC: AC is simple (at least when you ignore all the meaningful use bloating), and pretty intuitive. I liked the simplicity and stability of electronic prescribing the way it was done. I really liked the ease with which the PH, FH, SH, and problem list were maintained and brought into each encounter. It is easy to store both labs and PDF imports. I miss UpDox for a feeling of patient intimacy and involvement.

Points for RPMS: AC has a pitifully few placeholders, like %AGE, %LName, etc. RPMS has hundreds. For a hospitalist note, these are great; I can have things like today's labs, outpatient med list, inpatient med list, vital signs, active problems and inactive problems, vaccination history, etc. auto populate anywhere into a note that I want or that makes the note clearer. Custom templates for different encounter types are easy; that is, the types of data presented, presentation order, look, feel, presentation... everything about the note is customizable, so that for example a daily SOAP note is totally different from an admission H&P or discharge summary, or consult note. It is absolutely, totally stable. No weirdness or instability, ever.

If I were King, I'd take parts of each of these programs and mold them into something else. Also, the job of hospitalist in a place that is kind of a "Second World" environment makes everything different. AC would not really work as well with what I am doing, now, but might work as well as what I have. With each, I have had to "Innovate, modify, adapt and overcome." And, really, therein lies the joy.

So, anyway, I hope all is well for you in the new year. Laissez les bon temps roulez.

Merry Christmas and Happy New Year to you Dave. Nice to hear from you and to hear your thoughts on RPMS v.s. AC. Are you working as part of the Indian Health Service, Dave? RPMS is the system the IHS uses.

You are now using templates since no longer using voice dictation? You weren't in favor of templates in the past.

Our hospital bought RPMS from the Indian Health Service since it was cheap for a quasi-government facility like the Commonwealth Health Service. It is actually an early version as the residents coming through who are used to the VA version tell me.

John, the templates are just that; templates into which data is to be entered, not the "right click and select 'low back pain' "thing that is meant in AC. The static data or information that already exists in another part of the chart can be brought in in many different ways. The custom template may include (or not) the things like family history, social history, etc. that are always there in an AC note but not really relevant to every kind of encounter. The problem list can be brought in, but it is neither expected or allowed to have a template to throw in actual decision making data or what you plan to do for each problem. Actually, however, since we see many of the same things repeatedly it is sort of fun to imagine:

Problem 1. Sepsis. (right click here). (select) Blood pressure dropping, art line and central line in place. Will give 2 liters ringer's lactate bolus, start meropenum and vancomycin after blood cultures, urine cultures, sputum cultures obtained, start norepinephine drip to maintain MAP above 90.......

Problem 2. Fibrillatory arrest. (right click). Begin amiodarone drip at..........

I'm sure CMS won't mind......