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  • Re: Rep Retirement Lodge 199 - Dumb Poll of the Month

    Good Morning, MEUSA!


    Good Morning to the rest of tLodge!
    sigpic

    Let's Go 'Tute!

    Maxed out at 2,147,483,647 at 10:00 AM EDT 9/17/07.

    2012 Poser Of The Year

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    • Re: Rep Retirement Lodge 199 - Dumb Poll of the Month

      Good Morning, Lodge!

      Boring day at work so far. Phone has not rang once. Boss is off for the week. One of my co-workers called in today. I'm not even mad it as it is about time she kicked her boyfriend out of the house. So it is only 2 of us at the office today. I would not be surprised if my other co-worker goes home sick. Fun time of the year.
      Originally posted by Skeeterman
      Lady Wore Black is a hottie.
      "I love hockey, it is such a great sport. I love how the outfielders use their baseball bats to hit the ball across the ice field, pass the punter for nothing but net shot from downtown." - Unknown

      "No matter what happens in college hockey tournament, the Yankees will not win the World Series this year." - Mr. wore Black

      Comment


      • Re: Rep Retirement Lodge 199 - Dumb Poll of the Month

        Originally posted by leswp1 View Post
        EMR- one of the main reasons I left practice. Easily quadrupled the time it took me to do something and for many things worse than that. I used to dictate 26 patients in less than 30 minutes. I . The other one being a boss doc who was psychotic.

        I would rather stick a fork in my eye rather than deal with this for a living. Totally not functional for use as a medical person. Only function is to make insurance co. happy (and in the process make it impossible to function as a medical provider). If you think a small facility is hard... there are only so many moving parts there. Merge, go to a bigger system- more moving parts, more people screwed up, more people thinking they know what to do, more people telling the users what to do (and they all say something different ) .... 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!)

        Good Evening Lodge!
        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.
        I gotta little bit of smoke and a whole lotta wine...

        Comment


        • Re: Rep Retirement Lodge 199 - Dumb Poll of the Month

          Originally posted by Swansong View Post
          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.
          Last edited by leswp1; 12-27-2018, 03:46 PM.

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          • Re: Rep Retirement Lodge 199 - Dumb Poll of the Month

            I think you misread the tone of my post?

            As I said - I've no idea if Epic is the solution, but the fact remains we needed to get PHI digitized, and one of the truly positive things about Obamacare was that it kicked health care, kicking and screaming, into this century. Epic needs a massive UI overhaul (clearly it was designed by programmers, not UI experts) and to address the "eh, it's not worth fixing it so I'll let the nonsense stay" issue, which unfortunately are largely state or federally mandated in terms of types of data that must be collected. I'm glad that I don't work on the reporting/QA side - the few times I've had to jump in to help create required forms were awful. But this isn't necessarily on Epic (or any EMR). This is on our benevolent government that requires it.

            Digitization also satisfies many of the "portability" requirements in HIPAA, which old paper records don't really. Some of our private practices were still on 100% paper records as recently as August of 2016 and that's just completely insane to me.

            The buggy whip comment was largely, if not entirely, tongue in cheek.
            I gotta little bit of smoke and a whole lotta wine...

            Comment


            • Re: Rep Retirement Lodge 199 - Dumb Poll of the Month

              Originally posted by Swansong View Post
              I think you misread the tone of my post?

              As I said - I've no idea if Epic is the solution, but the fact remains we needed to get PHI digitized, and one of the truly positive things about Obamacare was that it kicked health care, kicking and screaming, into this century. Epic needs a massive UI overhaul (clearly it was designed by programmers, not UI experts) and to address the "eh, it's not worth fixing it so I'll let the nonsense stay" issue, which unfortunately are largely state or federally mandated in terms of types of data that must be collected. I'm glad that I don't work on the reporting/QA side - the few times I've had to jump in to help create required forms were awful. But this isn't necessarily on Epic (or any EMR). This is on our benevolent government that requires it.

              Digitization also satisfies many of the "portability" requirements in HIPAA, which old paper records don't really. Some of our private practices were still on 100% paper records as recently as August of 2016 and that's just completely insane to me.

              The buggy whip comment was largely, if not entirely, tongue in cheek.
              I am just a 'little' hot under the collar about EMRs. IMHO the mandate sent us into the dark ages. Less accessible information, more compartmentalized with no interconnectivity. I swear after the EMR seeing a new patient was like seeing someone in an ER- no info, rely on the pt to tell you info and hope you get it all.

              Serious question- Curious how this solves portablility. None of the EMRs we had communicated with anyone else so we had to print out stuff to send (or we got printed stuff). Complete drek. We used to call the previous practice and ask specific questions and the other practice could look it up and give us answers which we would then manually enter. Dealing with the pts in the NH the students just throw up their hands. Inches high records, no way to make any sense out of them except sifting thru manually hoping to find what you want. Not linear, frequently disjointed. I know what I am doing and it is close to impossible to find stuff. Honestly the paper is 100% easier to deal with than trying to make sense out of a pt record. Exceptions- if you ask it to print out immunizations.

              Comment


              • Re: Rep Retirement Lodge 199 - Dumb Poll of the Month

                IIRC, Epic wasn't the EMR that les had to use.

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                • Re: Rep Retirement Lodge 199 - Dumb Poll of the Month

                  Good morning to tLodge!
                  Quinnipiac Bobcats
                  2023 National Champions
                  ECAC Regular Season Champions: 2012-13, 2014-15, 2015-16, 2018-19, 2020-21, 2021-22, 2022-23, 2023-24
                  ECAC Tournament Champions: 2016
                  East Regional: 2013 (Champions), 2014, 2016 (Champions), 2023 (Champions)
                  Northeast Regional:

                  West Regional: 2015, 2021
                  Midwest Regional: 2019, 2022
                  Frozen Four: 2013, 2016, 2023 (Champions)

                  Pass complete. Lipkin has a man in front! Shot... SCORE!!!

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                  • Re: Rep Retirement Lodge 199 - Dumb Poll of the Month

                    s’upp y’all

                    One night down in Amsterdam
                    Took girl out for a walkabout
                    She said it stinks! Won’t be able to wash the sweet smell out of her coat
                    a legend and an out of work bum look a lot alike, daddy.

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                    • Re: Rep Retirement Lodge 199 - Dumb Poll of the Month

                      Good Morning, MEUSA!
                      Good Morning, Mookie!


                      Good Morning to the rest of tLodge!
                      sigpic

                      Let's Go 'Tute!

                      Maxed out at 2,147,483,647 at 10:00 AM EDT 9/17/07.

                      2012 Poser Of The Year

                      Comment


                      • Re: Rep Retirement Lodge 199 - Dumb Poll of the Month

                        Originally posted by The Rube View Post
                        Afternoon, Lodge. Business was DEAD today, I was next in line to take Voluntary Time Off, so I did. Would rather lounge around at home watching movies than be bored out of my skull at work, especially since I think the rest of the week will be the same as today.
                        I would bet you move some ice melt today.

                        Minnesota's Pride On Ice: 1974, 1976, 1979, 2002 & 2003 NCAA National Champions


                        And the preacher said, you know you always have the Lord by your side
                        And I was so pleased to be informed of this that I ran
                        Twenty red lights in his honor
                        Thank you Jesus, thank you Lord

                        ~Mick Jagger/Keith Richards

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                        • Re: Rep Retirement Lodge 199 - Dumb Poll of the Month

                          So on Wednesday I came down with the HOLY-MOTHER-OF-GOD crud that was going around here the past few days. I left the office after I was sitting at my desk shivering while wearing my flannel shirt, hoodie, and winter hat, and then I was nowhere near able to make it into the office yesterday. The only reason I'm in today is I can't afford to miss another day due to running out of PTO.
                          "The party told you to reject the evidence of your eyes and ears. It was their final, most essential command." George Orwell, 1984

                          "One does not simply walk into Mordor. Its Black Gates are guarded by more than just Orcs. There is evil there that does not sleep, and the Great Eye is ever watchful. It is a barren wasteland, riddled with fire and ash and dust, the very air you breathe is a poisonous fume." Boromir

                          "Good news! We have a delivery." Professor Farnsworth

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                          • Re: Rep Retirement Lodge 199 - Dumb Poll of the Month

                            Good Morning, Lodge!

                            2 co-workers out sick, boss on vacation, and leaving me here at work to run the show even though I am not feeling that well. I am able to function. Fun times. At least it is D-E-D dead.
                            Originally posted by Skeeterman
                            Lady Wore Black is a hottie.
                            "I love hockey, it is such a great sport. I love how the outfielders use their baseball bats to hit the ball across the ice field, pass the punter for nothing but net shot from downtown." - Unknown

                            "No matter what happens in college hockey tournament, the Yankees will not win the World Series this year." - Mr. wore Black

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                            • Re: Rep Retirement Lodge 199 - Dumb Poll of the Month

                              Happy Birthday FadeToBlack&Gold!!

                              Good afternoon Lodge!
                              it is supposed to be 50F here. Hasn't made it out of the mid thirties

                              My fitbit band bit the dust. I need another one. And I need to go pick up something I ordered. I will need a crash helmet.

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                              • Re: Rep Retirement Lodge 199 - Dumb Poll of the Month

                                Soooooooo many bikes here.
                                a legend and an out of work bum look a lot alike, daddy.

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