kinda disappointed with Epic. Any way to address some issues?

[end stage fibro]

I recently switched to a shop that uses a pretty wide open and upgraded version of Epic. I have used Cerner for 7 years prior to that and was excited to try the purported king of EMRs. To be honest, I am disappointed. I've spent 6 months customizing and would consider myself power user level (I didn't take that course though...what a waste of time to learn like 5 tips) and have read through several threads on SDN where i picked up a few tricks (user dictionary, various kb shortcuts). Anyways, was hoping someone could help me with some pain points. I've asked my analyst for some help too:

When i favorite an order, why do I have to go to the order search popup window for it to show? Some frequent orders magically popup in the search bar immediately in the side menu, then i can add it to the shopping cart directly. I have not found a way to add orders to the search bar directly
For the life of me, I can't find a shortcut for the order search window. I have tried "the claw" to try to find the activity reference name but cant even find that so even using EpicACT is out of the question. closest i can get is going to the sidebar order window with ctrl+o
In cerner, the more specific i typed an order the easier it was to select. E.g. typing lasix 40 iv would give me the exact order. In epic, the most specific i can get is lasix iv and then have to click a little more to get to the 40mg dose.
what the duck are these nursing plan of care notes and progress notes? is there a way to hide them
in cerner, i was able to make a note filter such that EKGs, echos, cath reports and a bunch of other stuff would show up in the notes window. is this possible in epic?
why are the notes limited to this encounter only? can i change that? in cerner, all notes would be available at all times. I know about chart review but am trying to minmize clicks
is there a way to change the order of tabs within the navigator sections? LIke defaulting to discharge instead of admit
can i access speed buttons from the notes tab? Opening a note from the rounding tab is garbage
is there a kb shortcut to switch the tab in the summary activity? like going from overview to labs
why the hell is it so laggy? i know for certain my hospital system is not the problem- each click is roughly 120 ms of lag. that wasnt acceptable in starcraft how is it acceptable now
is there an easy way to review all abx and cultures for a patient going back multiple encounters? this might be a physician builder issue but I belong to the Dr. Metal school of thought and dont want to get all these extra useless certs that are time intensive
i am a member of the user web. I've read galaxy and the userweb response time is glacial and usually not too helpful

thanks for any help

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[NotAProgDirector]

If you're talking about the claw and EpicACT links, you're well beyond a power user. You might seriously consider becoming a physician builder if you have that option.

There was a presentation at XGM this year of a site that set up EpicACT links and placed them in a disappearing text box in your note. So, while working on your note, you could click on links to open various parts of the chart. When you sign your note, all of the links are removed. Happy to try to find it on the UserWeb.

I'm not certain what you mean by orders showing up magically in the search bar. Much depends upon whether you're talking about inpatient or outpatient. The "Chart search" which should both be in the StoryBoard and also the magnifying glass in the upper right corner will search the chart for you, but you can't put orders in that way. For inpatients, you'll be using Manage Orders which should open in a sidebar on the right. That's what Ctrl-O opens. So I'm clearly not understanding what you mean by the search bar in the side menu.

Epic can have buttons on a patient list that jump you directly to order entry, if that would be helpful.

Regarding shortcuts for Lasix 40mg IV etc, you can definitely create those. Order lasix IV on a patient, and click the star. Set the dose to 40mg once. Then change the display name at the top of the window to Lasix 40 (or Lasix IV 40 or whatever you want). Accept that. Now click the star again, and choose to create a new preference list entry. Now edit it to be 80 mg, and change the name to be lasix 80. Now, when you order lasix 40 or 80, you should get your order. If you do this well, you'll discover that you can type Lasix 40, press enter twice, and get the order (the second enter will simply pick the order off your preference list). You can also edit your preference lists directly using the Tools option under the Epic menu.

In the Notes activity, you can't create filters to exclude classes of notes. However, I find it helpful to adjust the settings to the "short" setting (where each note is listed on one line), and to set the display by Service. Since our nurses use a Nursing service for their notes, it makes it very easy to know what types of notes there are, and how to find the most important ones. You can create all sorts of note filters on the Chart Review Activity / Notes tab, so that would be an option and you could definitely exclude anything you didn't want to see there.

You can't make those things show up in the Notes activity, but they will all be in Chart Review. We have a Cardiology tab there, and I've built filters to eclude all the crap that tends to collect there, and specifically to find the key studies such as Echoes / caths / etc.

One of the issues / tricks / problems with chart review filters is that you can only make filters for something that exists in that patient's chart. So you need to find some sick patient who has gotten lots of things done, make the filter there. Then, you can use the filter in anyone's chart.

Notes is specifically designed for this encounter only. Chart review is where you go to look for older notes. But, you could use chart review all the time if you wanted, since everything will be there.

No, you can't rearrange the sub-tabs on an activity. However, if you ask your build team these sub tabs can be created as an activity themselves -- then you'd be able to favorite it and just click it up at the top. But many build teams won't be thrilled about this idea, since then if they want to update content they need to do it in two places.

Not sure what you mean by speed buttons for notes. What are you trying to do? Create a note from a template?

There's no kb shortcut that I know to skip along the reports in the Summary tab. What you might want to consider is getting the Navigator rebuilt. Anything on the summary tab can be put on a Navigator, and then you can just scroll through.

There are zillions of reasons it could be laggy. Network issues for sure. A slow report to load -- in our last upgrade Epic "improved" the MAR report with these icons (not really an improvement IMHO). But it made the report very slow to load, especially for patients in the hospital for more than a few weeks. We adjusted the report to only pull 10 days worth of data, made that much better. You can see report load times in the Session Information Report (also when you use the claw, which I think is the same thing). Could be a citrix problem -- if not enough citrix servers, that can be the bottleneck. You need someone on the back end to look and sort it out (except for the report load times, you can see that easily).

I too want a good way to see cultures and Abx. You can do this with a Synopsis report -- needs to be built (i.e. you can't do it). There was also a presentation about this at ClinAC at XGM. Something I want to work on.

Userweb doesn't tend to respond to end users asking "how do I do XYZ". EpicEarth is theoretically for that purpose, and is horrible. UserWeb is mainly for builders.

 

[DrMetal]

If you're talking about the claw and

There's something in Epic called the claw ? As in, Dr. Claw?

 

[tantacles]

The clawwwww

 

[end stage fibro]

thank you for the great reply, as always!

If you're talking about the claw and EpicACT links, you're well beyond a power user. You might seriously consider becoming a physician builder if you have that option.

There was a presentation at XGM this year of a site that set up EpicACT links and placed them in a disappearing text box in your note. So, while working on your note, you could click on links to open various parts of the chart. When you sign your note, all of the links are removed. Happy to try to find it on the UserWeb.

thanks for the tip...I think I will have to reconsider becoming a builder.

I'm not certain what you mean by orders showing up magically in the search bar. Much depends upon whether you're talking about inpatient or outpatient. The "Chart search" which should both be in the StoryBoard and also the magnifying glass in the upper right corner will search the chart for you, but you can't put orders in that way. For inpatients, you'll be using Manage Orders which should open in a sidebar on the right. That's what Ctrl-O opens. So I'm clearly not understanding what you mean by the search bar in the side menu.

sorry...I meant the Manage Orders. not sure why i was bringing up the search bar. Currently in epic, some frequently used orders will populate. In the Manage Orders search field. So if I type "La," Lasix 20 IV automatically comes up just under the orders search field.. I cannot figure out a way to add more orders to that popup/tooltip.

Regarding shortcuts for Lasix 40mg IV etc, you can definitely create those. Order lasix IV on a patient, and click the star. Set the dose to 40mg once. Then change the display name at the top of the window to Lasix 40 (or Lasix IV 40 or whatever you want). Accept that. Now click the star again, and choose to create a new preference list entry. Now edit it to be 80 mg, and change the name to be lasix 80. Now, when you order lasix 40 or 80, you should get your order. If you do this well, you'll discover that you can type Lasix 40, press enter twice, and get the order (the second enter will simply pick the order off your preference list). You can also edit your preference lists directly using the Tools option under the Epic menu.

so this is the workflow I have been using. The nice part about Cerner is that I could type any med at any dose, hit enter, and have it add to the orders right away. didnt have to rely on making a ton of different favorites

No, you can't rearrange the sub-tabs on an activity. However, if you ask your build team these sub tabs can be created as an activity themselves -- then you'd be able to favorite it and just click it up at the top. But many build teams won't be thrilled about this idea, since then if they want to update content they need to do it in two places.

Did not realize that. Doesn't hurt to ask them and see what happens

Not sure what you mean by speed buttons for notes. What are you trying to do? Create a note from a template?

I saw on galaxy that you can open a note and on the very top of the note there a are few buttons, which they refer to as speed buttons. For example, button 1 is titled progress note and would load your progress note template, button 2 is H&P and would load a default H&P template, etc. Currently, I am using my dictation software to make a macro that loads the type of note and automatically inserts the template, which works OK but is kinda kludgy. I can make speed buttons but they can only be accessed (that I know of) through some rounding navigator. Takes me longer to get through the navigator than write the note.

I too want a good way to see cultures and Abx. You can do this with a Synopsis report -- needs to be built (i.e. you can't do it). There was also a presentation about this at ClinAC at XGM. Something I want to work on.

Guess I already have a builder project

thanks again for your reply

 

[CopaceticOne]

In all seriousness - what is "the claw" and how does one access it?

 

[end stage fibro]

In all seriousness - what is "the claw" and how does one access it?

It's a keyboard gesture that brings up a bunch of technical info and under the hood stuff for activities /notes, etc. Useful only for nerdy types

Officially, just press ctrl+alt+shift+f10+f12 to toggle it on or off. For me, it's a little more finicky. I have to be in the notes activity, press and hold ctrl alt shift, press and hold f12, then press f10

 

[CopaceticOne]

It's a keyboard gesture that brings up a bunch of technical info and under the hood stuff for activities /notes, etc. Useful only for nerdy types

Officially, just press ctrl+alt+shift+f10+f12 to toggle it on or off. For me, it's a little more finicky. I have to be in the notes activity, press and hold ctrl alt shift, press and hold f12, then press f10

Since I'm one of those nerdy types - Thanks!

 

[NotAProgDirector]

sorry...I meant the Manage Orders. not sure why i was bringing up the search bar. Currently in epic, some frequently used orders will populate. In the Manage Orders search field. So if I type "La," Lasix 20 IV automatically comes up just under the orders search field.. I cannot figure out a way to add more orders to that popup/tooltip.

I was just looking at this. It appears to be something built into Epic -- things you order frequently tend to pop up like that. I see no way to "force" it, it just learns over time. Probably has a limited number of default options. It's not on any preference list that I can see.

so this is the workflow I have been using. The nice part about Cerner is that I could type any med at any dose, hit enter, and have it add to the orders right away. didnt have to rely on making a ton of different favorites

On the outpatient side, you can just order Lasix 80 and it should give it to you. That's because on the outpatient side there are separate orders for Lasix 20, 40, and 80 since there are pills in all those sizes. On the inpatient side, you just order Lasix 40mg, and the pharmacy will deliver it -- either as a whole 40, two 20's, or a half of an 80.

You can just press enter in Manage Orders (or click the Add button), you'll get a list of all of your favorites and you can check off as many as you want. Not exactly what you were looking for, though.

I saw on galaxy that you can open a note and on the very top of the note there a are few buttons, which they refer to as speed buttons. For example, button 1 is titled progress note and would load your progress note template, button 2 is H&P and would load a default H&P template, etc. Currently, I am using my dictation software to make a macro that loads the type of note and automatically inserts the template, which works OK but is kinda kludgy. I can make speed buttons but they can only be accessed (that I know of) through some rounding navigator. Takes me longer to get through the navigator than write the note.

Sadly, speed buttons can be defined by department, or even by patient factors (i.e. chief complaint), but you can't make them yourself. You'll need to dot phrase in your templates

 

[Aheadbyacentury]

Is cerner better in your opinion? I think EPIC is a pile of garbage. Just make life so much harder.

 

[end stage fibro]

Is cerner better in your opinion? I think EPIC is a pile of garbage. Just make life so much harder.

Depends...Would you rather have a kick in the teeth or baseball bat to the ribs? Not sure i fancy either.

The mystique surrounding epic definitely made my expectations too high though

 

[gutonc]

Sadly, speed buttons can be defined by department, or even by patient factors (i.e. chief complaint), but you can't make them yourself. You'll need to dot phrase in your templates

I just want to say that, like most things Epic..."it depends".

Our IT dept locks down a ton in Epic for the plebes (and even our physicians who are certified Builders have less access than Epic assumes), but we can build all the speed buttons we want. I have 12 that I use in the outpatient setting.

 

[FutureInternist]

Is cerner better in your opinion? I think EPIC is a pile of garbage. Just make life so much harder.

For me, the only people who complain about Epic are those that haven’t used Cerner.

 

[rokshana]

For me, the only people who complain about Epic are those that haven’t used Cerner.

Or allscripts…*shutter*

 

[chessknt]

Or allscripts…*shutter*

Yea Allscripts is like trying to run a race after having both your kneecaps shot out at the start.

 

[FutureInternist]

Or allscripts…*shutter*

I have not had the displeasure but have heard about it..

 

[AussieAg]

Or allscripts…*shutter*

Amen. Allscripts was terrible. I'd take longer opening the damn note than writing it.