The Epic Circus Winds Down

For the last two weeks I’ve had my head down jumping through hoops, working hard to personalize Epic so my

 JEFF HEINZ/The Globe Gazette

JEFF HEINZ/The Globe Gazette

documentation is accurate, thoughtful and describes the patient’s story to the reader. We’ve had the usual glitches with hardware and software but the major problems have eased. I still don’t like the “dumb” thin clients which lock me out of the patient’s chart and have me walking up and down the hallway in order to close the software in one location so I can put orders in or finish my note in another. It is a terrific waste of time.

So what do I like about Epic?

  • -The interface is pleasant to the eye.
  • -The ability to make physician-specific templates of things I say to patients and staff repetitively on-the-fly, as I see patients.
  • -The big screen format.
  • -The ability to communicate with patients via the MyChart portal in a more robust manner.
  • -Releasing patient notes to them in the portal (although it sure would be nice to have a default button so I wouldn’t have to choose that option every time).
  • -Having an online community on the Epic site to discuss software “fixes”.
  • -In March, all of my system’s employed physicians, Immediate Care facilities, hospitals and ERs in my area will be onboard. Since the chart is patient centric, I’ll be able to see what’s going on in those facilities.
  • -Some true intraoperability–I can access patient information from any other Epic source in the country, including across town. This is huge and has already impacted patient care in a positive way.
  • -Having support in Verona, WI (home to EpicCare) with the expertise and desire to help you.

What I don’t like about Epic:

  • -Everything we do with patients is an “encounter”. I have to open one to write an order, document a telephone conversation, etc. If I open one and change my mind, I still have to sign the darn thing instead of just cancelling out of the encounter.
  • -It is too “clicky”. Things that should be accomplished in one click takes multiple. Thank goodness there are plenty of keyboard shortcuts but for individuals that aren’t used to using them, that is of little help.
  • -The lack of a Verona-based Epic expert in our office the first day of GoLive. We spent so much time figuring out simple things that someone with more training and experience could have told us in seconds.
  • -My work environment is not designed well. I have to strain my neck to keep eye contact with patients, or turn the computer away from them. I’ve got to work on this. There has to be a better way.
  • -The most annoying thing, and a big backward step for me, is the inability to get email notifications when a patient messages me on the MyChart Portal. Since 2013 my patients have had answers to their medical questions at odd hours of the night or on weekends. That is not possible with MyChart, although I guess I can get a one time notification in the evening if someone has sent me a message IF my system Leadership approves (and why would they not OK that?). This is definitely a step backwards, and in a time when patient engagement is considered so vital, it seems odd that the arguably “best in Klas” EHR doesn’t have that functionality.

Oh, and did I mention how much I dislike the thin clients?

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When the Narrative Isn’t

With the advent of the AHR I frequently get notes from referring physicians are ERs that look like this:

 

HISTORY
Chief Complaint
Patient presents with
• Dizziness
• Syncope
Patient states he passed out x3 prior to coming to the ED. Per patient, I fainted three times at home. The last time my wife called an ambulance and they brought me here
Patient is a 32 yo male presenting with: syncope
History provided by: Patient
Language interpreter: no
Syncope
Episode history: Multiple
Most recent episode: Today (Patient states he fainted x3 this morning)
Duration: 20 seconds
Timing: Intermittent
Progression: Worsening
Chronicity: exertion and standing up
Witnessed: yes
Relieved by: Lying down
Worsened by: Nothing tried
Associated symptoms: Difficulty breathing and Dizziness
Risk Factors: coronary artery disease

I find templated text difficult to read. Does the version above tell the patient’s story?  Since I’m not a computer, it’s easier for me to encompass the story when it’s written in a true narrative form:

     Patient presents to the emergency room following three distinct episodes of fainting. The first one occurred in bed while he was lying down. His wife noticed he had stopped talking, shook him and he seem to be back to normal. The next episode occurred when he was walking into the bathroom and his wife heard him fall. The final episode occurred on the stairs. Each episode was only a few seconds  in time and there was no loss of bowel or bladder function with them. He did not appear confused following the spells. All episodes occurred within the space of about 30 minutes. EMS was called and they did an EKG and were concerned that he might be having a heart attack (patient has a left bundle branch block that is not new). He was mildly short of breath and a little dizzy prior to the third episode. He denies chest pain. Nothing clearly made it better or worse. He has no prior history of fainting or passing out. He does have a prior history of heart stents for coronary artery disease.

Perhaps I’m old-fashioned. Maybe the templated writing is just as effective, or maybe more so when understanding what happened to the patient. I’d love to get your opinion. Please write in the comments below.

 

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Wear the White Coat-a leadership opportunity

The Greater Louisville Medical Society (GLMS) hosts an annual “Wear the White Coat” opportunity for leaders in the Louisville community to spend a day with a physician and get a first-hand look at what we do. When GLMS president Dr. James “Pat” Murphy put a direct plea into my inbox it seemed easy to volunteer.

The program began with a breakfast get-together to meet our shadows. Mine was London Roth, an enthusiastic Human Capital Consultant executive with Humana. It took me a while to understand what her job is but both of us are avid social media advocates so it was a match made in heaven. On a Monday morning London joined me for five hours during which most of my patients allowed her to accompany me in the exam room. She listened to their medical issues and participated, with the patient’s permission, when they had questions of her. She was observant, interested and insightful. She was indulgent as I ranted about issues with her company, as well as other payors. She asked lots of questions.

London and Kathy

Kathy & London Selfie

She commented on the awkwardness of our EHR system. She saw first-hand that, even if it is well-intentioned by the insurance company, sending over-worked clinicians patient information of who has not had colonoscopies, mammograms, pap smears, etc. are next to useless.  Who in the office has time to work the data, especially if it is not as accurate as the insurance company believes? London also listened to patient stories about how her company’s HR policies affect employees’ ability to care for themselves and their families.

We met again at a dinner organized for the group where each “shadow” related their experience. State politicians spoke about better understanding when legislature affects physicians’ ability to practice. Business leaders talked about how seeing the effects of poor health habits reenforced the need for encouraging their employees to have healthier lifestyles. Community leaders saw how patient support systems (or lack thereof) can determine the success of patient care plans.

Personally, London gave me two gifts: she ended her comments with how well I knew about the little things that were important to my patients, the human connection that makes for a better patient-doctor relationship. And she designed the best iPhone case ever, a gift to me illustrating one of my frequent questions to patients:IMG_5730

Programs like this give IRL* examples of how physicians and patients are affected by the decisions of community leaders and what they can do to impact change in their companies and legislative bodies. As Dr. Murphy said “when you wear the white coat, it becomes part of you forever”.

 

 

*IRL = In Real Life a frequent expression used in Social Media. http://www.urbandictionary.com/define.php?term=IRL (caution, this link contains foul language).

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