All the patients in my office who were inconvenienced yesterday deserve my thanks. They endured long processing times and our somewhat distracted visits with grace and good humor. They should be rewarded, as some of them waited over an hour to see me and all of them spent much longer in my presence than usual and without my utmost attention.

The morning began with a tweet from one of my twitter friends, based on my previous blog post:

It was rainy, dark and cold but on entering the office the bustle of extra people made it cheery. That seemed an auspicious start. Administration cut our patient schedules by half, much improved from our last implementation when lessened schedules were frowned upon and the physicians had to worry about their paychecks. This decision has created a learning environment.

My colleague was an incredibly good sport, despite the fact that she was given less than adequate support because, for some reason, there were no Epic personnel in the clinical area of our office. The trainers are as newly minted as we are. For geeky me, this was a puzzle to be solved and between our clinical superuser, my personal trainer (who is actually an administrator superuser) and myself, we could usually ferret out how to do something. Of course we were never entirely sure we’d made the right choice and there was the frustration that the same problem would have been solved in 30 seconds with an Epic specialist to show us. Toward the end of the day we had Meg from Medsys who shortened my learning time significantly and I was able to begin the personalization process which will make documentation faster and easier.

We had significant hardware/Citrix challenges including timeouts, frozen screens and difficulty signing in. The front desk personnel were registering patients in an impressive timely manner until they had a  motor vehicle insurance issue. Things slowed down to a crawl. However, the front staff was engaged and not overly stressed. They commented that their “on the job” training was many times improved over the classroom training.

The hardest thing for me is the flow of charting. Learning to document an encounter instead of a note makes sense in the electronic record but it’s been exasperating to tie the visit together because elements are in many places of the encounter–did I do all of the physical exam? Where is the physical exam? Did I renew the meds? Where are the meds? Did I order labs? Where are the labs? Which labs did I just order? How do I know I’m finished? It is no longer a linear process. The jury is out on that–there is no summary screen to review to ensure I’ve covered everything. I feel as if I’ve created a documentary mosaic.

The implementation staff responded quickly to our complaints and concerns, working hard to find answers to our questions and being honest with us. I applaud them.

My first impression after day one is that Epic is not as intuitive as it should be. It has many ways to accomplish the same thing which is a strength as well as a handicap. It will help me document faster than my previous EHR and it has the capacity to remind me of health maintenance such as mammograms and vaccines that are due on patients. It does not yet have clinical support tools embedded in the software and I look forward to that. I don’t love it, but I will probably like it some day and it’s already a huge improvement on my previous system.

It’s no circus but that’s probably a good thing. I really don’t like clowns.

Next week, next update.

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