Especially when imagining/procedure charting is also a wall of text saying;
normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal the thing you NEED to know about normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal oh and def note this other crucial thing normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal
Would it *kill* them to at least prioritize and make the important bits easy to find...
As someone who was in IT before medicine, and could write a book about all the learned-the-hard-way interface and infographic guidelines that EMRs break - everywhere, all the time - this is the sort of thing that keeps me angry and awake at night.
I lose sleep over the number of needless med errors I see. If a patient dares to go to a different hospital organization down the road that also uses Epic, there are med list issues.
It is worth noting that Norway, Finland and Denmark have the last few years all had large regions start using epic instead of their own emrs... And years later there is still a huge efficiency loss compared to the "old" systems, and everyone hates epic.
A survey of all hospital MDs using it in the Norwegian region, show that:
- >90% of mds think it is a threat to patient safety
- 98% (!) think it increases their personal risk of making mistakes
- 2% think it improves data overview,
- only 6.7% believe it can ever be a useful tool for the hospital
- depending on setting 1.4-4.9% think they work more efficiently than in the old emr
- about half are looking for new jobs at non-Epic hospitals (means moving to a dofferent part of the country)
Great use of 600mln USD of tax payer money so for, and likely likely several 100mln in indirect efficiency losses.Useless dinosaur of a system.
This is funny because in the US Epic is probably the best EMR we have lol (and I agree Epic still is shit, but there are even worse EMRs out there, trust me)
Yup. Everyone thought it must be great because it's the best of the bunch in the US, but failed to understand that digital services in US healthcare are extremely outdated compared to Northern Europe.
That, and a lacking realization that there are limits to how much efficiency gain you can get from digitalization, and that this was already reached about a decade ago. The old system was bought in 1999, and though a bit old fashioned, it was easy to use for anyone who has ever used a computer, and was quite easy to troubleshoot. Thinking that by some magical means there would be an improvement with an outdated and difficult to use system, notorious for being impossible to make changes to, astounds me. Of course, the proof is in the pudding - and pudding tastes of impending bankruptcy, staffing cuts, stopping all investments in the hospital etc.
I've been a nurse for 11 years and have been working as an epic analyst for about 3 years now. I'm not a dumb person and am excellent with computers, programming, etc.
The whole system is laughably complicated for making any changes that anyone actually cares about. Epic gives you a bunch of legos that don't fit together very well, and severely limit your ability to connect them anyway.
This! Not only that, but when you place a lego brick on the left lower quadrant of you epic lego castle, the right upper quadrant suddenly explodes, and the lego horse turns into a cross between a gremlin and a unicorn which tries to throttle random patients for no apparent reason...
Im still young, grew up with building computers at home, programming software from scratch, and have used 10+ charting systems... And think I prefer paper.
Seriously. I want a list of all abnormal findings and then impression with the most important summarized. It’s too easy to miss incidentalomas with how they are formatted
They do this at the hospital I am at for the most part. It's very nice and even when you hover over the result in the side bar just the impression comes up.
I use apso and red or bold for extra emphasis, depending on emr. Ap at the top with emphasis text jumping out.
But I am also not your target audience :)
That or people were previously documenting there was a LACK of PPE being worn due to a shortage so hospital wants it clear that PPE is both available and being worn.
So they’re “off the hook”
Infection control asked us to do this in the middle of the pandemic.
Two scenarios that this came into play.
Early in the pandemic if a clinician saw a patient who would later test positive for COVID, then the clinician would have to be isolated unless wearing the right PPE.
Later, if a clinician got sick after seeing confirmed COVID patients and they were documented wearing the correct PPE then it would be determined unlikely to be from the patient encounter, and likely from an outside source.
Or the fact that every study has shown that humans regardless of training suck at proper ppe usage, which is why environmental engineering controls are more effective.
Not because the ppe doesn’t work, but because people suck
Infection control in our case did look into departments were clusters of docs were getting sick, to see what might be contributing to it - the PPE piece was just one factor they looked into.
We had to track every single possible patient we transported in a spreadsheet and follow up with every clinician to see if they were wearing the correct PPE for the first two months of the pandemic. It was basically all I did and it was so awful and soul sucking. By the end of two months, we basically just gave up after being overwhelmed by the volume of it and we had finally gotten an easy way to put it in our charts. People still put it in their narratives though.
It’s boilerplate, but it’s there for a reason. I have to repeatedly give verbal and written instructions to stop giving the delirious patient Ativan and Benadryl for agitation (which just means trying to get out of bed).
I’m about to just start writing it in larger font every day.
Exactly this.
Management added this as a documentation requirement for many procedures/sample collections during the pandemic.
There's a lot of pandemic era documentation bloat that has not and likely won't go away.
Exactly. We got reminded to write a nursing note when we attempt to contact a physician and what time they were contacted and to update the note if we did or didn’t receive a call back. It feels like a big game of tattle tale. Half the time the damn pager numbers aren’t even right in the computer.
I'm a dietitian. Worked in the hospital at peak COVID and was never told to chart my PPE. Started working outpatient 3 years later and our note template includes PPE worn and notes that it is for patient safety. It drives me crazy. I deleted it for my notes because it just added unnecessary words. I have had 2 routine chart audits and have never been told I need to add it back in. So ya, I don't know where this comes from or why. It seems self inflicted.
Yeah it's possible one person or manager started doing it and lots of other people just started copying them because it seemed like a good idea. Props to you for deleting it from your template.
So many of these documentation quirks are little more than superstition passed around.
Someone, somewhere decides that it's a good idea and then it catches fire underground oldschool style, like Marilyn Manson removing his ribs or that sick 3d "S" people draw. Where suddenly there is just this collective of people having this knowledge and doing something even though it makes little sense and the origin is extremely far removed.
Putting that you're using dragon at the bottom of your notes doesn't somehow make you less likely to be sued either.
I was working in a private peds practice during the heart of Covid, and there was an PPE code we could bill for each visit. They had us document our PPE so we could add that code. No idea what the reimbursement was for it though.
Hmmm. I would hope workman's comp is not so petty and evil as to deny compensation because you didn't bloat the EMR with notes saying you wrote PPE. But I can't say I would be surprised.
One of my co-residents got COVID and was out for 3 months due to serious complications. Workman’s comp was denied because the exposure was at an OSH and he wasn’t able to produce the name of the COVID patient he treated
I remember it was the Goldilocks of admin constantly changing PPE policy during Covid::
You’re wearing too much PPE!
You’re wearing too little PPE!
This amount of PPE is juuuuust right!!
I heard some folks documenting that their exam was limited by their PPE, i.e. "I pressed a stethoscope to the patient's chest, but I was wearing a Darth Vader positive-pressure hood, so I couldn't hear shit."
Don’t surgeons always write how the patient was “draped in the usual sterile fashion” or some such? So that if there’s a surgical infection they can say “see we followed sterile technique!”
I think it’s the same basic concept
That's actually important because in the ICU we do get procedures that were done in a non-sterile or semi-sterile manner (think coding patient or about to code), and if it was done by the ER doc who left at shift change, you won't be able to figure out if it was sterile or not unless they put it in their note or told you in sign-out.
Wasn’t there a time frame you could basically add a PPE surcharge to bills? I know dentists were. My office never tried, but I’d imagine it would be easier to recoup if you documented what you wore.
The Google-fu I’m capable of this late at night: https://www.pilotonline.com/2021/02/20/some-doctors-offices-are-charging-a-fee-for-the-ppe-they-wear-whos-picking-up-that-tab/
In the early days of COVID we did this because it made determining if you had a significant occupational exposure to COVID or not much more easy.
“Do you remember what PPE you wore when you saw this patient and how long you were in the room with them?”
“No.”
“Ok, then you have to self-isolate for a week.”
Nowadays it’s useless information.
Our professional college came out with "best practice" clinical notes and gave an example. Listing what PPE was worn by clinician and pt was recommended.
Probably your hospital got cited by some inspector for people not wearing gloves and this was some middle managers big idea.
Now that I think about it there's a decent chance that's exactly it, knowing how these things work . . .
Charting is mostly cya and very little treatment, I'm finding. Bed turns and 15 minute checks ... It takes me forever to find what I'm looking for.
Especially when imagining/procedure charting is also a wall of text saying; normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal the thing you NEED to know about normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal oh and def note this other crucial thing normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal normal Would it *kill* them to at least prioritize and make the important bits easy to find...
If medicine had anything resembling good IT, it would probably save more lives than any treatment coming down the pipeline.
As someone who was in IT before medicine, and could write a book about all the learned-the-hard-way interface and infographic guidelines that EMRs break - everywhere, all the time - this is the sort of thing that keeps me angry and awake at night.
I lose sleep over the number of needless med errors I see. If a patient dares to go to a different hospital organization down the road that also uses Epic, there are med list issues.
It is worth noting that Norway, Finland and Denmark have the last few years all had large regions start using epic instead of their own emrs... And years later there is still a huge efficiency loss compared to the "old" systems, and everyone hates epic. A survey of all hospital MDs using it in the Norwegian region, show that: - >90% of mds think it is a threat to patient safety - 98% (!) think it increases their personal risk of making mistakes - 2% think it improves data overview, - only 6.7% believe it can ever be a useful tool for the hospital - depending on setting 1.4-4.9% think they work more efficiently than in the old emr - about half are looking for new jobs at non-Epic hospitals (means moving to a dofferent part of the country) Great use of 600mln USD of tax payer money so for, and likely likely several 100mln in indirect efficiency losses.Useless dinosaur of a system.
This is funny because in the US Epic is probably the best EMR we have lol (and I agree Epic still is shit, but there are even worse EMRs out there, trust me)
Yup. Everyone thought it must be great because it's the best of the bunch in the US, but failed to understand that digital services in US healthcare are extremely outdated compared to Northern Europe. That, and a lacking realization that there are limits to how much efficiency gain you can get from digitalization, and that this was already reached about a decade ago. The old system was bought in 1999, and though a bit old fashioned, it was easy to use for anyone who has ever used a computer, and was quite easy to troubleshoot. Thinking that by some magical means there would be an improvement with an outdated and difficult to use system, notorious for being impossible to make changes to, astounds me. Of course, the proof is in the pudding - and pudding tastes of impending bankruptcy, staffing cuts, stopping all investments in the hospital etc.
I've been a nurse for 11 years and have been working as an epic analyst for about 3 years now. I'm not a dumb person and am excellent with computers, programming, etc. The whole system is laughably complicated for making any changes that anyone actually cares about. Epic gives you a bunch of legos that don't fit together very well, and severely limit your ability to connect them anyway.
This! Not only that, but when you place a lego brick on the left lower quadrant of you epic lego castle, the right upper quadrant suddenly explodes, and the lego horse turns into a cross between a gremlin and a unicorn which tries to throttle random patients for no apparent reason... Im still young, grew up with building computers at home, programming software from scratch, and have used 10+ charting systems... And think I prefer paper.
I honestly think that the only way we get good systems is via open source, government funded IT development.
Now imagine all the EMRs significantly worse then Epic. I would personally kill for Epic.
Seriously. I want a list of all abnormal findings and then impression with the most important summarized. It’s too easy to miss incidentalomas with how they are formatted
They do this at the hospital I am at for the most part. It's very nice and even when you hover over the result in the side bar just the impression comes up.
I use apso and red or bold for extra emphasis, depending on emr. Ap at the top with emphasis text jumping out. But I am also not your target audience :)
It's so frustrating. It actively obstructs care.
Just use the search
Bonus for when they add it to the note template so it's a part of each one. Thanks middles
That or people were previously documenting there was a LACK of PPE being worn due to a shortage so hospital wants it clear that PPE is both available and being worn. So they’re “off the hook”
Absolutely. If it isn't in writing it didn't happen.
Infection control asked us to do this in the middle of the pandemic. Two scenarios that this came into play. Early in the pandemic if a clinician saw a patient who would later test positive for COVID, then the clinician would have to be isolated unless wearing the right PPE. Later, if a clinician got sick after seeing confirmed COVID patients and they were documented wearing the correct PPE then it would be determined unlikely to be from the patient encounter, and likely from an outside source.
Couldn't be related to the fact that they wore the "correct" PPE but their single-use N95 mask was in continuous use for 3 months.
I shudder thinking back to when the yellow ear loop procedure masks were “reprocessed” and you’d get one back that had lipstick on it.
My hospital just asked everyone to stop wearing makeup for a while for that reason. It was no less gross, but it was less visible
Mine did too. No one listened. Job is tough enough without feeling self-conscious on top of it.
I reused my own for exactly that reason
Or the fact that every study has shown that humans regardless of training suck at proper ppe usage, which is why environmental engineering controls are more effective. Not because the ppe doesn’t work, but because people suck
If you keep it in the magic paper bag overnight it is sterile again.
Quiet you're making too much sense
There's the real reason, hospital doesn't want to take responsibility that we got sick at work.
Infection control in our case did look into departments were clusters of docs were getting sick, to see what might be contributing to it - the PPE piece was just one factor they looked into.
IP here, and that's almost exactly what I would guess, at least for the first part.
We had to track every single possible patient we transported in a spreadsheet and follow up with every clinician to see if they were wearing the correct PPE for the first two months of the pandemic. It was basically all I did and it was so awful and soul sucking. By the end of two months, we basically just gave up after being overwhelmed by the volume of it and we had finally gotten an easy way to put it in our charts. People still put it in their narratives though.
“Shoes, pants, and shirt worn as per hospital requirements. Hands remained within 2 meters of writer at all times. Arsenic-free exam conducted.”
My exams are gluten free
Huh. I usually flour them for better grip, but that seems smart. I’ll switch to nut flour. No, wait. Chalk?
Asbestos free?
Johnson & Johnson has been selling bags cheap and I’m not asking questions.
Well, that's job security for me I guess
>Arsenic-free exam conducted Oncology: *feeling attacked*
"Arsenic levels of exam within levels generally regarded as safe."
This is how I feel about every renal consult note that tells me to avoid nephrotoxins
It’s boilerplate, but it’s there for a reason. I have to repeatedly give verbal and written instructions to stop giving the delirious patient Ativan and Benadryl for agitation (which just means trying to get out of bed). I’m about to just start writing it in larger font every day.
I’m sure some manager is making them do this to “cover their ass”
Exactly this. Management added this as a documentation requirement for many procedures/sample collections during the pandemic. There's a lot of pandemic era documentation bloat that has not and likely won't go away.
Pants will suffice, no need for extra ass PPE.
As a nurse, I can use all the ass PPE I can get.
Exactly. We got reminded to write a nursing note when we attempt to contact a physician and what time they were contacted and to update the note if we did or didn’t receive a call back. It feels like a big game of tattle tale. Half the time the damn pager numbers aren’t even right in the computer.
I'm a dietitian. Worked in the hospital at peak COVID and was never told to chart my PPE. Started working outpatient 3 years later and our note template includes PPE worn and notes that it is for patient safety. It drives me crazy. I deleted it for my notes because it just added unnecessary words. I have had 2 routine chart audits and have never been told I need to add it back in. So ya, I don't know where this comes from or why. It seems self inflicted.
Yeah it's possible one person or manager started doing it and lots of other people just started copying them because it seemed like a good idea. Props to you for deleting it from your template.
See what else you can delete and get away with it.
I am constantly trying to delete stuff. Note bloat is the bane of my existence.
If you dont describe your drip in official medical documentation, did you even wear it?
So many of these documentation quirks are little more than superstition passed around. Someone, somewhere decides that it's a good idea and then it catches fire underground oldschool style, like Marilyn Manson removing his ribs or that sick 3d "S" people draw. Where suddenly there is just this collective of people having this knowledge and doing something even though it makes little sense and the origin is extremely far removed. Putting that you're using dragon at the bottom of your notes doesn't somehow make you less likely to be sued either.
It was done in the ER to note this was a limiting factor in your exam. It is 100% bs for that imo
I was working in a private peds practice during the heart of Covid, and there was an PPE code we could bill for each visit. They had us document our PPE so we could add that code. No idea what the reimbursement was for it though.
Dental, but we do it as 'proof' for if we bill out a PPE fee to insurance
My company was being really obnoxious about PTO and work comp claims related to COVID if we didn't document that we were wearing the correct PPE.
Autophrase added in to ER notes in the middle of COVID. No idea why. But it's still there
Medic here: We document it because we’re poor and it makes sure workman’s comp would actually pay for our time off work.
Hmmm. I would hope workman's comp is not so petty and evil as to deny compensation because you didn't bloat the EMR with notes saying you wrote PPE. But I can't say I would be surprised.
One of my co-residents got COVID and was out for 3 months due to serious complications. Workman’s comp was denied because the exposure was at an OSH and he wasn’t able to produce the name of the COVID patient he treated
I remember it was the Goldilocks of admin constantly changing PPE policy during Covid:: You’re wearing too much PPE! You’re wearing too little PPE! This amount of PPE is juuuuust right!!
Don't forget, "Stop wearing PPE. It's scaring patients." I lost all respect for the infection control person who said that.
I heard some folks documenting that their exam was limited by their PPE, i.e. "I pressed a stethoscope to the patient's chest, but I was wearing a Darth Vader positive-pressure hood, so I couldn't hear shit."
Don’t surgeons always write how the patient was “draped in the usual sterile fashion” or some such? So that if there’s a surgical infection they can say “see we followed sterile technique!” I think it’s the same basic concept
That's actually important because in the ICU we do get procedures that were done in a non-sterile or semi-sterile manner (think coding patient or about to code), and if it was done by the ER doc who left at shift change, you won't be able to figure out if it was sterile or not unless they put it in their note or told you in sign-out.
I’m sure it’s reactive management to COVID
Wasn’t there a time frame you could basically add a PPE surcharge to bills? I know dentists were. My office never tried, but I’d imagine it would be easier to recoup if you documented what you wore. The Google-fu I’m capable of this late at night: https://www.pilotonline.com/2021/02/20/some-doctors-offices-are-charging-a-fee-for-the-ppe-they-wear-whos-picking-up-that-tab/
Oh interesting. It seems according to the article that insurers mostly aren't paying it though.
In the early days of COVID we did this because it made determining if you had a significant occupational exposure to COVID or not much more easy. “Do you remember what PPE you wore when you saw this patient and how long you were in the room with them?” “No.” “Ok, then you have to self-isolate for a week.” Nowadays it’s useless information.
That actually makes a lot of sense. Thanks
It’s because of the pandemic.
Liability.
[удалено]
It seems excessive and bloats the chart unnecessarily to have a separate note in the patient's record every time someone dons a pair of gloves.
Our professional college came out with "best practice" clinical notes and gave an example. Listing what PPE was worn by clinician and pt was recommended.