Confused

How Many Different EHRs Do You Use?

One of the challenges that physicians face in their adoption of EHRs is the need to use multiple clinical systems based upon their location(s) of practice. For example, a physician may use one EHR system in their private practice, a different EHR in the hospital(s) in which they consult, and potentially a different version of hospital EHR if they also work in a hospital-based ambulatory clinic. EHRs are complex applications that require training and a great deal of practice in order to use the system well. Developing proficiency with a single EHR is difficult and is significantly compounded when having to learn multiple systems. Last week, we received an email from a physician who stated, “When my work involved using 4 different EHRs, I QUIT!!!” This is not the type of feedback that anyone is seeking; however, it is the reality of working in a healthcare system in which there is limited standardization between EHR systems in terms of user interface design and commonly used workflows.

EHRs differ depending on their location of use:

  • Hospital inpatient EHRs (such as Cerner, EPIC systems, GE Centricity) are highly structured and are designed for sharing of clinical notes and diagnostic tests between different departments and wards. These systems are optimized for computerized provider order entry, sharing of procedural and operative reports, and collating all information related to a patient’s management in the form of a discharge summary. Inpatient EHRs are optimized for episodic care.
  • Community-based EHR systems function quite differently. They are focused on capturing information that is configured to reflect the needs of individual physicians or groups of physicians who are directly caring for a patient. These are provider centric tools that capture detailed information about a specific patient over a length of time.
  • There is another category of EHRs that are used in hospital ambulatory clinic settings, i.e. outpatient clinics. These EHRs may be a module of the hospital inpatient system, optimized for outpatient management, or could be a completely different product. Outpatient EHRs are designed for clinical documentation, ordering of investigations through hospital diagnostic facilities, booking procedures or surgery in the hospital, or prescribing medications to external pharmacies. These systems are a hybrid of the community-based ambulatory EHR and the hospital inpatient EHR.

Working in multiple locations using paper charts has inefficiencies; however, there is no need to learn different navigation or documentation processes. A paper chart is a paper chart. The same cannot be said for EHRs.

Remembering a unique login and password for each system adds complexity for users. Add in upgrades and training on new features and it becomes quickly evident that keeping up with EHR systems and processes is a major task.

How many EHRs do you have to use in your clinical practice? Share your experiences.

Comments:

3 responses to "How Many Different EHRs Do You Use?"
  • December 8, 2012
    John
    said:

    EHR in general is dangerous for patients and doctors. It is cumbersome, inaccurate, and consumes valuable time otherwise spent with patients. “Cut and paste” is the natural extension of physicians’ attempts to free themselves from the burden of ridiculous “meaning(less) use” requirements. Guess what? The rest of the note is mumbo-jumbo too.

  • December 8, 2012
    Allen
    said:

    Obviously, you do not know what a good EMR is. Mumbo-jumbo may be what you get from your program, but not from mine.

  • December 29, 2012
    Irwin Abraham
    said:

    What would be a good EMR?
    I want one: easy to write the note, flexible for large or small notes, where notes are placed end to end in a complete narrative, where I can put an addendum, and which I can search quickly for any set of words( among other needs).

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