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EPOWERdoc and Unique Features of ED EMR Software

Posted on October 11, 2011 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

As many of you know, when an EMR or EHR vendor wants to show me their system, instead of getting a full demo of their EMR I instead ask them to show me the unique features of their EMR. Basically, I’m interested in seeing the features, functions, approach, etc that makes an EMR or EHR vendor unique from the 300+ other EMR companies in the market today. This was my approach when EPOWERdoc approached me with a request to take a look at what they’ve created with their EMRDoc software.

Turns out that EPOWERdoc has been around for 12 years and is already in 250 hospitals in 40 states. That’s a pretty good footprint for an Emergency Department comnpany. In fact, I read that they’ve done 17 million Emergency Department visits in North America in their 12 year ED EHR history. Of course, these numbers come from EPOWERdoc and we know how good EMR install counts are from EMR vendors. However, even if that numbers bloated it’s a decent sized install base. Update from EPOWERdoc: The client numbers and ED visits are correct, we started out as a Paper Template system from software printing and that is where the large client base is predominantly. We are 36 months into the EDIS market with the product you looked at and have 18 live and another 9 by first qtr 2012.

During the short demo, EPOWERdoc showed me 3 or 4 interesting things about their Drummond Group modularly certified EHR. However, the feature that hit me most was the EMRDoc prose generator. In fact, this demo was one of the reasons that I’ve started predicting an EMR documentation revolution against hard to read, bulky, clinical notes.

I wish EPOWERdoc had a video of their EMR notes prose generator to demo it. If they create a video, I’ll post it to my EMR, EHR and Healthcare IT videos website. Until then, here are before and after screenshots of the EPOWERdoc interface which shows the granular data entry and the note that was created (click on the image to see the full image).

And now the image of the outputted documentation:

We could certainly debate the finer points of the user interface for inputting the data. Plus, a screenshot doesn’t show some of the other elements they’ve created to be able to quickly handle the input of the granular data elements. What hit me was how much the second image read like a clinical note. To be honest, as I read it I felt like I was hearing someone dictating a clinical note. Are their subtle differences where dictation is better, definitely. However, they seem to have done a good job of taking the granular data and turning it into clinical prose. I’ll be interested to hear some doctors thoughts on the above to see if they agree or disagree.

There were a few other interesting EMRDoc features that stood out to me in my short EMR demo.
-As an ED EMR, you have a different workflow than an ambulatory practice. As such, you need the ability to manage multiple open records at the same time. What I think EMRDoc does really well is switching between patients, but then also tracking your last documentation location for that patient.
-Related to seeing multiple patients, EMRDoc documentation feedback tool provides the user (doctor, nurse, etc) with a real time feedback as to the status of the level of documentation for medical coding as well as what has been completed in the note. In the ED where you’re regularly pulled away to deal with a pressing problem, the feedback statuses are a great little feature.
-EMRDoc has a feature that forwards clinical information and data from the Nursing Record to the Physician Record and from various sections of the Physician Record to other sections. Pretty slick implementation that reduces having to document that same thing multiple times.
-One of the big questions for an ED EHR like EPOWERdoc is how they deal with the hospitals large HIS system. EPOWERdoc’s answer was a partnership with Iatric who uses technology allowing data insertion into non accepting systems such as Epic, Cerner, McKesson or Meditech. I’d seen Iatric (They had the amazing trick shot pool table guy at HIMSS), but it sound like I should get to know them a little more. Maybe I can get Katherine Rourke to cover them over on Hospital EMR and EHR as well.

As I said, I didn’t do a full scale top to bottom demo of the EMRDoc ED EHR system, but I thought these were some interesting features of their EHR that were worth sharing. I’d love to hear some first hand experiences from any EPOWERdoc users. Let’s hear what you think in the comments.

A Trip to the ER: EMRs Aren’t Enough

Posted on March 17, 2011 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Guest Post: I got the following story that someone wanted to share about the challenges of EMR and workflow in a hospital. I love reading first hand experiences with EMR. Reminds me of a great experience that Neil Versel documented at an urgent care during HIMSS. I look forward to hearing your comments on the story.

Last month, my wife felt some discomfort in her chest. They weren’t pains, nor were they indigestion so much as a gurgling sensation. After two days and no change, she called our family physician. He told her she could come in for a blood enzyme test, but the lab result would take four days. Instead, he said to go to an ER where they could get the result in half an hour.

That evening, a Friday, we went to the nearest ER, at Large, Modern, Suburban DC hospital (LMSDC.) We walked right up to the triage nurse, a woman in her 60s who stood there and took down my wife’s info on paper: Name, Chief Complaint, Age, and Triage Class, a 3. We were handed the paper, the only copy, and sent to the first of what would be three exam rooms.

The room was for EKGs. It was equipped with a machine, bed, etc., and a desktop PC. After a few minutes, a tech came in and ran the test. I asked how the scan got into my wife’s record. She told us it was sent electronically to imaging where it would be reviewed and put in the record, but she didn’t know how it was entered, electronically or scanned in.

We had three more visitors, two nurses and an admissions clerk. Admissions came in with a COW, a computer on wheels. She started asking demographics, insurance, etc., but was called away. The first nurse came in went over why we were there, about meds, etc., took a blood sample and did something on the room PC and left.

The second nurse came in, went over symptoms, meds, etc., again, and scribbled the information on a scrap of paper in her hand. We never saw either nurse again. While waiting for the next step, I saw that the first nurse had logged into the PC, but not logged out.

We were then moved to a small exam area with five beds to wait for an attending and to wait for four hours until time for another blood sample. The area was run by a tech I’ll call Sam. Sam was a remarkable multitasker. Among other things, we saw him:
• Arrange patients and families in the cramped space
• Look for other staff
• Take blood
• Check orders
• Organize a stack of loose forms into their patient clipboards
• Change bed sheets
• Check the EMR for updates
• Check on patient moves

Sam did all this, and from what I could tell, was the only person who was actually followed the different aspects of his cases.

At first, the area was at capacity with crying children, their worried parents and others typical of a Friday night in an ER. While Sam directed traffic, the admissions clerk caught up with us and finished my wife’s record.

Around nine, an attending came in. He stopped midway in review for a half hour cell call and then returned. He recommended that she should go on a heart monitor and stay overnight. After the attending’s visit, we settled down to wait for a room. Sam checked every now and then to see where it stood, but it went nowhere.

About eleven, while making my second run to the ER vending machines, I saw the attending and mentioned that it was getting pretty boring waiting for a room and a monitor. Surprised, he said he’d ordered the monitor and that it should have been put on in the ER. With that, he checked with the charge nurse to get it done. The charge nurse came to see us and had us move to another area with a monitor, which a nurse started. Just after midnight, still waiting for a room, my wife sent me home. She called about one to say she’d been moved to a medical floor and was on a monitor.

I knew that LMSDC adopted an EMR three years ago and, indeed, it was clear that meds, complaints, orders, etc., were being entered into it. However, it was also clear that their system was a receptacle not a workflow tool. Apparently, LMSDC simply overlaid the EMR on its paper system, eliminating some parts, but keeping others. These other elements persist in their own parallel world. For someone such as Sam, who tries to keep his patients current it means more work not less. This explains why he had to deal with the EMR and constantly sort and organize paper forms into their proper patient clipboards.

Even that is not LMSDC’s major ER workflow problem. The heart monitor problem shows there is no shared task list. That is, once the attending entered the order, and I believe he did, the order is in the EMR. However, who is to carry it out and when should become a task that all others can see. Thus, the conversations among the attending, the charge nurse, Sam, my wife and me should have been unnecessary.

A couple of gratuitous points. LMSDC’s system is heavy on desktop machines. It cries for laptops or pads. Nurses, techs, attendings spend their time flying from one desktop to another, logging in and, sometimes, out. It’s a machine centric rather than a user centric system. Users never have their own workspace. They are always in hit and run mode. Even if they have a good system workflow and a good shared task list, they spend enormous time and energy logging in and out of room machines. It’s no wonder things get lost in the cracks.

LMSDC’s system runs both patients and staff ragged in another way. We moved three times, no record I expect. Nurses came and went. The attending should have been on skates. The only one with a dedicated space was Sam which explains why he could get so much done without exhaustion. How much easier their difficult lives and their patient’s lives would be if the patients came to the staff rather than endure the ER’s fast action minuet.

What’s so amazing is that despite their poor IT support and their constant motion, the staff was invariably professional, focused and friendly.

Best of all, after a night in the ER and a morning on a medical floor, my wife was discharged. She’s fine.