The New York Times has has an article about Epic’s EMR system titled Digitizing Health Records, Before It Was Cool. Epic is only one of many large EMR vendors who produce software to manage patient medical records and other data related to the overall business and function of healthcare organizations. A few others worth mentioning are Allscripts, Meditech, Cerner, I.B.M., McKesson, Siemens and GE Healthcare. They all have their benefits and drawbacks. Most of them have similar challenges when it comes to overall function and impact on patient care. But most of them are also diligently working to correct their shortcomings.
One of the biggest hurdles I’ve encountered is the difficulty in getting printed records out of the electronic system. Then again, getting something onto a page is not the primary focus of a digital EMR system to begin with, but tell that to the legal system who haven’t quite caught up with the same digital standards that the government is requesting of hospitals. Perhaps the government needs to get those standards in line before it starts making requirements of others.
Epic: The Cadillac of Electronic Medical Records
Epic is considered by many to be Cadillac of EMR systems. When I was searching for a role in nursing informatics there were many opportunities which involved the Epic software. Epic Certification is a hugely desirable resume builder that many in HIT would love to have, myself included. This is paid for my health organizations an individuals and is rumored to be over $10,000 for a 3 days training stent. I have been told that they are a great system, but just like all the other EMR vendors on the market, often they promise more than they are currently capable of delivering.
The one thing I do know that Epic offers that many fall short on is it’s functionality of healthcare systems. They have a system that works well in both the acute and ambulatory systems. And rather than having to finagle to make these pieces talk to each other, they are built to be integrated. So if you are a large health system, Epic’s design can reduce some of the headaches involved with sharing data and PHI across your health network.
EMR Vendors Rolling in the Dough
These HIT software vendors are booming right now. The description of the Epic facilities brings to mind images of the eBay and Google campuses which appear to be fun and almost whimsical places to work. I suppose that you can afford to 2 feet tall spiral slides for your employees when nearly every healthcare organization in the country is scrambling to buy products that you products because of government incentives and eventual requirements.
I share the same concern that many in the HIT world share in my skepticism that these software vendors are going to shake hands and play well together as we progress in the meaningful use initiative. Right now the requirement is that we have the data available in our own systems. Fairly soon the requirement is going to be the sharing of the data with other healthcare organizations and eventually leading to a national EMR. It’s a beautiful dream, but making it a reality will not be without it’s challenges.
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I'm Ready to ThriveThere is Big Money in EMR Interfaces
Since all these vendors write their own code, have their own language, and support their own bottom lines, they don’t always play well on one another’s playground. One of the biggest challenges we face in HIT is making products talk to one another. This often involves tedious labor, hoping, crossing fingers, and shelling out funds for ‘custom interfaces’ just to make the simplest processes work. Then it’s a matter of saying a prayer and hoping that everything just works, because fixing it if it breaks can be just as much of a challenge as it was to get it working to begin with.
Regulations Needed?
As much as I hate any additional regulations, I’m fearful that forcing these software vendors to make compatible code is going to be the only cost-effective method for meaningful use to actually be meaningful and not bankrupt healthcare facilities. HL7 and continuity of care documents are a start, but the EMR software vendors need to be in the business of patient care and not just in the business being profitable.
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I have to say that I have only briefly encountered EPIC in my short stints as an agency nurse at other hospitals, and I *HATED* it!!! Vehemently, adamanetly, despised it. I have worked with T-Systems in every ER that I have ever worked in as staff, and it has seriously made me consider NOT working at other hospitals simply because they use EPIC in ther ER. It may be a fine tool for inpatient, and I will be the first to admit that I recieved inadequate training on it, however T-systems is so user friendly and intuitive that it requires barely any instruction at all. In triage the triage nurse chooses the appropriate template, ABD Pain, or ENT. From that point forward you are presented with a relavant systems focused assessment tools, with one colum of normal findings, one colum of abnormal findings. A left click circles it, a right click lines through it. Everything can be expanded upon and free-texted if needed. Vitals can be entered in a snap, and through discharges are easy to enter with no need for these nurse to spend thier time coding because all of the charges are all captured. (This was something that I encountered at one hospital, they expcted the ER nurse to enter all of the coding and billing before closing out the chart after every discharge.) Another point in favor of T-Systems, is that it prints out beautifaly. Records are logiacly ordered and in actual text. Honselty in my opinion I think this is the best charting system for an ER.
Our hospital uses Meditech and I certainly don’t find it to be “user-friendly”.
We installed athenahealth system in our office and find it to be fairly easy to use. It is cloud based and that makes updates a breeze-they are just there.
I agree with you about systems talking to each other. It seems we are a long way from that.
It’s going to take some serious collaboration on the software vendors part.
A large part of my job is working with one of vendors to trouble shoot issues and make improvements in our workflow. I find they have difficulty communicating with each other withing their own company, so I can only imagine how it is for them to talk to another vendor who is a direct competitor.
I know that the patients and provider benefits are going to be awesome when we get there, though.
I’ve worked with nearly all of the computer systems you have listed above, and I have to say, Epic is called the Cadillac for a reason. And Meditech? Well using it is about as fun as driving a 15-yr old geo metro. Have you ever played around in Epic? Because you can do that with this system- it is so user-friendly and intuitively built that you can go in and just figure it out with little-if-any instruction. It has (gasp!) drop down menus! At the hospital where I learned this, training took all of a half a day, and we were proficient. When administrators are considering a new system, it seems they only consider the cost of the system, rather than how long it will take to train all existing and future staff on the system. There are huge long-term cost savings to be found in adopting a user-friendly system like Epic.
Heather,
I’ve user Cerner, Meditech, Allscripts, and VistaEMR.
I have not had the priveledge of working with Epic.
I guess it depends on what you’re wanting in an EMR.
The Cadalac will give you that smooth and luxiourious ride you are looking for, but is going to cost a pretty petty and guzzle the gas. The Geo Metro you can get for practically nothing, run for practically nothing, but occasionally will have to do some banging around and finagling with things to make it go.
So I guess it just depends on how frugal you want to be and how much effort you want to put in it.
Which is more cost effective?
I’ve heard epic comes in at 120 million for the initial investment for a small health system, then there is the monthly maintenance fee.
I don’t know the values on the others… but that’s a lot of cash.