EPIC Medical Charting Software...a journey

[mtnjam]

Anyone else using EPIC?

Kind of nice features, but definitely a major shitshow with the rollout at our hospital which just switched off Cerner and now everyone's scrambling to figure out what to do now that EPIC has been turned on. Lot's of "I don't know"s and deflection to other departments decisions and responsibilities of the correct flow in charting and what needs to be ordered.

IMHO, a lot of missing pieces in training and rollout, but what do I know...I'm just a medical imaging technologist

[Buzzworthy]

I’ve integrated bar code scanners for BCMA to all the major health information systems over the years. Epic by far was the worst to work on. Most integrations need 2-5 configurations to get proper output. Epic needs 30-35 configurations.

I wish you a lot of luck.

[adrenalated]

My wife used to use it at her previous job and my MIL helps admin an Epic system.

From what I understand, Epic works best when highly customized to the specific hospital system. It worked great for my wife at her major hospital system. When she used more stock versions at smaller clinics, it was a nightmare.

Sounds like your admin/IT folks bungled it. Good luck.

[fastfred]

been on hold with my insurance company for a half hour trying to figure out why I got a bill 2 years later a week ago hitting me up for payment of services that should have been covered
fucking idiats don't have an explanation neither does the anesthesiologist who blew up my phone for weeks with an automated texts and calls to hit me up for a good review on line

fuck insurance companies and fuck health care for profit

[mtnjam]

fuck insurance companies and fuck health care for profit

...but how about not for profit health care (joking of course)?

Yes, adrenalated, it does seem currently that is the case with the Epic software package our HCM (Trinity) purchased, probably on a discount.
Lots of parts of the software were not purchased and we have all sorts of outside shell companies that work with our hospital, but not directly so those outside companies haven't switched to Epic and now we're relying on software patches or workarounds to compensate for those which has created even more work for clinical staff. I'm currently seeing lots of, "we don't know how that is supposed to be integrated, talk to your managers" Too much cart before the horse going on....

I'm just glad I'm not an administrator

[::: :::]

i preferred when providers would actually look at you, even touch you occasionally to see your responses - now they just ask questions from behind a wall hung monitor & type into the database

[CTR]

All my ophthalmology colleagues that are forced to use it hate it for eye records. Seems like my pals that use it are sortof forced to use it because of hospital affiliations.....seems to be more hospital based/designed than outpatient/office records....I wouldn't touch it with a ten foot pole but that is only from rumor and innuendo second hand reports......Chet

[Garbowski]

They rolled out EPIC at my hospital system in the past year. I'm more of a researcher/allied type in Radiology, but got some training. I hear some bitching but overall not more than I would expect from any new software rollout. It was a HUGE operation with the switch- I tried to ignore most of it but they had a ton of boots on the ground and seemed like overkill to me. Definitely growing pains and customization needed, but most seem fine with it.

I remember when I first started out of school in like 2005 and was completely shocked at the lack of electronic medical records- I had assumed it was all figured out by then. Huge downside to not having a standardized national system.

[irul&ublo]

Ahhh….EPIC…makes me think of the good old days.

[old goat]

Our hospital was the first Kaiser and one of the first hospitals in the country to use EPIC. I think Kaiser spent $3B to build it with EPIC. We had meetings to design orders for various specialties--I did vascular surgery. When it came time to implement we had 5 or 6 evening training sessions several hours long, with excellent Chinese food. Still some of the docs struggled and a few retired early. Meanwhile, the residents, who didn't have an EMR at the university hospital back then, got one afternoon to learn it and had no trouble.

For me, from a doc's standpoint, the biggest problems with EPIC are in how docs use it, not in the software itself. It's too easy for hospital docs to auto-populate their daily progress notes with diagnoses, labs, and vital signs. Discarded diagnoses keep showing up in the daily notes long after they've been ruled out. Dangerous lab values and vital signs can find their way into the note without the doctor noticing them. And the accumulation of results mean that the daily note gets longer and longer every day, filled mostly with stuff from all the days before, while somewhere in there you might find a doctor's actual thoughts about what is happening with the patient.

The other thing I didn't like--the nurses charting was in a separate section and was mainly a lot of check boxes. I really missed seeing nurses' notes, on the same page as the doctors' progress notes, telling in a few sentences how the patient did on each nurse's shift--did they have a lot of pain? Did they throw up? Did they get out of bed? With EPIC that kind of information requires a lot of time and effort to find, and most docs don't bother.

At Kaiser, we can see everything that has happened to a patient, inpatient and outpatient, at every Kaiser facility in the region, since the day EPIC was instituted. With a little effort we can get the records from other Kaiser regions. Absolutely priceless. A big multispecialty, multifacility inpatient/outpatient health care system is where an EMR really shows its value. For a single hospital or medical office it's mainly a cure for bad handwriting.

[skinipenem]

IME Epic works great for some specialities and not so great for others.

Builds are proprietary to each facility/ system. Thus the build itself is critical to success.

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[old goat]

The medical record should first and foremost be a means for providers to understand and communicate what's happening with a patient. Administrators forget that--they want it to be a billing tool and a legal document first and second. Providers must resist.

[::: :::]

The big four in our area are all on epic

My old office helped roll out the changeover (from the infrastructure/facility update side of things). I was not in the medical group, but I remember it took a long time from office chatter

[adrenalated]

For me, from a doc's standpoint, the biggest problems with EPIC are in how docs use it, not in the software itself. It's too easy for hospital docs to auto-populate their daily progress notes with diagnoses, labs, and vital signs. Discarded diagnoses keep showing up in the daily notes long after they've been ruled out. Dangerous lab values and vital signs can find their way into the note without the doctor noticing them. And the accumulation of results mean that the daily note gets longer and longer every day, filled mostly with stuff from all the days before, while somewhere in there you might find a doctor's actual thoughts about what is happening with the patient.

Related to this, from a patient's standpoint -

In the same large hospital system that my wife used to work for that used EPIC, some MA at some point made a mistake in my chart. They entered that I had asthma. I've never been diagnosed with asthma, never had symptoms of asthma, never had asthma. From that point forward every MA, RN, PA, and MD that I saw asked me "so you have asthma?" NO I don't have asthma! But apparently the way that they had EPIC set up, it was impossible for anyone but the MD listed as my primary provider to remove the incorrect diagnosis.

[mtnjam]

Related to this, from a patient's standpoint -

In the same large hospital system that my wife used to work for that used EPIC, some MA at some point made a mistake in my chart. They entered that I had asthma. I've never been diagnosed with asthma, never had symptoms of asthma, never had asthma. From that point forward every MA, RN, PA, and MD that I saw asked me "so you have asthma?" NO I don't have asthma! But apparently the way that they had EPIC set up, it was impossible for anyone but the MD listed as my primary provider to remove the incorrect diagnosis.

Using EPIC a little more now and I can completely see how that can happen. We are finding that the indications for medical imaging exams aren't using the information we as technologists are entering for the indication. It seems like these diagnosis codes follow the patient and if they are not entered correctly by the physician then it's just about impossible to get it fixed and removed.

This seems like it is currently very hard to fix, but we also didn't purchase the EPIC PACS software so we are using another software that supposedly "talks" to EPIC, but again finding that it really doesn't.

[AK47bp]

Tech Talk! Jongos


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[fastfred]

i was unaware that there was so many lawyers posting on here

[mtnjam]

i was unaware that there was so many lawyers posting on here

Lots of dentists too.

[old goat]

Related to this, from a patient's standpoint -

In the same large hospital system that my wife used to work for that used EPIC, some MA at some point made a mistake in my chart. They entered that I had asthma. I've never been diagnosed with asthma, never had symptoms of asthma, never had asthma. From that point forward every MA, RN, PA, and MD that I saw asked me "so you have asthma?" NO I don't have asthma! But apparently the way that they had EPIC set up, it was impossible for anyone but the MD listed as my primary provider to remove the incorrect diagnosis.

According to my medical record I'm still taking oxycodone (and Narcan) even though I keep telling people I haven't used it in 3 years. I should just stop telling people that, get it refilled, and sell it.

[bigdude2468]

I have no idea what works or doesn't work on the provider side of MyChart but my experience as a patient has been excellent. Living in WI for eight months of the year and SLC the other four I have multiple providers using EPIC / MyChart. I like being able to see lab results, radiologist reports etc on line, don't have to wait for someone to call. Messaging feature works well also.

In December of 2020 while skiing I developed chest pain. Ended up at Lone Peak Hospital in Draper UT which is part of the MountainStar Healthcare. I had never seen anyone in that system before but in 60 seconds the ER Dr knew that I had bypass surgery in 2005 along with mitral valve repair. Knew every medication I was on, knew I was allergic to clopidogrel (Plavix) which is a blood thinner. Most importantly he saw that from my records that after the bypass surgery my EKG shows an abnormal T wave which in my case turns out to be benign. Lacking that information my diagnosis could have been very different. Other than that my EGK was normal, I ended up at St Marks in SLC headed to the cath lab. The next day I contacted my cardiologist back in WI and he already knew I had been admitted and was able to see my test results, imaging, etc. Turned out the culprit was a blood clot that the ER Dr (god bless his intuition) blasted with heparin. My primary care Dr also knew what had happened. From this perspective it works pretty well.

[detrusor]

Our head IT guy was the first “outsider” given access to epics code. He completely changed how the anesthesia portion of epic works. Went from a total goat fuck to pretty damn functional. Skinepenem, you’d be very impressed now.

I imagine it has rolled out to other hospitals.

I guess the owner of Epic has more money than Oprah so…..


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[Flyoverland Captive]

I know one of Epic’s coders. When I told her my medical friends all seemed to hate it, she just laughed and said “they’re using it wrong.”

[MagnificentUnicorn]

I know one of Epic’s coders. When I told her my medical friends all seemed to hate it, she just laughed and said “they’re using it wrong.”

That’s what IT people always say


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[skinipenem]

I know one of Epic’s coders. When I told her my medical friends all seemed to hate it, she just laughed and said “they’re using it wrong.”

Peed my pants a little laughing

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[couloirman]

My hospital has Epic. At first I was excited to stop using Cerner but the way it shows labs is abysmal. It's so easy to miss a lab result the way the lab view works and the way you have to expend each herringbone to get it to show for instance the diff of the CBC. I love the search fxn, and I like my dot phrases, but Jesus Hercules Christ I hate charting so much in it