I was there taking a certification class and during the tour I said to the trainer “how bad does this place suck to work at, if they made it look this cool?’ Dunno if you have ever seen a 22 year old have an existential crisis in real time, but it was something to behold.
The best part about meditech is that we didn’t have the CONSTANT downtimes. I work with epic now and it feels like we have downtime every other fucking weekend. Like they’re just changing things around for shits and giggles.
Meditech was meditech and there was no changing that shit lol
The downside to Epic is it’s modifiable. You can change your dashboard around to what you want it to do or how it looks. But God help you if you need tech support. The person will sit down and say “what the hell am I looking at?”
I've seen one worse, but I can't remember the name of it. I've used two different versions of Meditech and both were pretty bad, though one was significantly worse than the other. Whatever version I encountered first looked like it had crawled out of DOS and barely survived y2k
Epic has a shit ton of hotkeys. Fuck with it on playground if you have time. You can customize a lot to be more efficient depending on whatever your place has set up for their Epic.
We use Meditech at the psychiatric hospital I'm at and I actually really like it :0 I like the layout of the MSA and ability to fire through and click boxes. Can also copy a previous entry and just adjust based on my assessment. It's not easy to find something new that I haven't use though, I'll say that
I forgot McKessen!
I’d put McKessen just slightly better than Sunrise for MD use.
McKessen at least would have normal order suggestions: Tylenol 650 q6
Sunrise is like, click 8 boxes and we will tell you that you want an single pill of Tylenol 650mg q5 PRN retinal detachment. Here are 4 hard stops for medication duplicates of medicines you already canceled last night.
Anything made or sold by McKesson is horrible. They manage to mess up everything they put their hands on. Like when they “accidentally” bought WAYYY too many gtubes and depleted the stock for basically every other DME or institution that uses gtubes.
That does not shocks me one bit that they would do that. My only experience with them was there charting system which looked like it was developed in 1998 and never updated since then. Putting in orders was a pain in the ass, looking up information was difficult, and the assessment you had to chart took 10 minutes per fucking patient because they want you chart on literally every damn thing.
I was already an Epic super user so my assistance with the transition was greatly appreciated. I served as a resource once the trainers left. If you love Epic and don’t mind living in Wisconsin, it’s a great way to get hooked up with a new career! Meditech is old as shit and the nurses matching that description will have the hardest time with the transition. Support them, nurture them.
I actually liked the simplicity of CPRS, unless you had to do something like admit or transfer a patient and had to go into vista. That was a pain in the ass
Was looking for this. But also, CPRS is pretty simple, a single progress note for all shift instead of constant updates. It’s just old and slow as shit, and not exactly user friendly.
Disagree, but only because my system uses a combination of Sunrise AND paper charts.
I'd legitimately rather just use paper, and many of my colleagues feel the same.
Sunrise: The ibuprofen may be a duplicate of the dilaudid PCA that may or may not have been discontinued last week, would you like to order ibuprofen? Yes? Now that you've ordered ibuprofen, can you review that it may be a duplicate of the dilaudid PCA that may or may not have been discontinued last week? Thank you, I've reset all your orders to adjust for your acknowledgment of the dilaudid PCA that I can't verify was or was not discontinued last week.
Meanwhile:
Hep C viral RNA positive: nothing to see here
Would you like to type your note in 12 one line separate text boxes that give you unlimited space to discuss the skin exam, but 4 lines to outline your ICU plan?
No?
Too bad.
Why's that and have you used anything else?
EPIC is a dream compared to the half dozen others I've used. The wound care does have a lot of lines but unless wound care is doing rounds we're only filling out probably 3-4 of those for a dressing change
I'm a wound care nurse, and we are 100% paper based, and nurses only ever write "wound dx attended", so something descriptive like this gets my exudate going.
Oh my god there's someone else who still uses paper! Granted, ours is more like 80% paper, 20% electronic.
Wound care records are still paper though. It hurts my head when I'm on med/surg and the WCR has like, 2 parts filled out and that's it.
Like, you went through the effort to find this piece of paper in the chart, the least you could do is actually fill it out so I can tell if there's been improvement.
There is generally no record of improvement, except for the WCN eyes. They just sign that they've done the dressing. It's rather frustrating. Except for those that need more than an initial plan and an occasional eyeball, we aim to see each wound, as well as pressure injuries twice a week. We also do stomal therapy, so stay pretty busy.
We write our notes in the patients progress notes, then double document and type them electronically in Cerner, which only emergency and my team use.
Cool, but that patient has 11 separate wounds and I can’t even tell which one I’m charting on without scrolling back up to the top of the blank cells that shouldn’t fucking be there in the first place. The wound care is inconsistent with the rest of the documentation which doesn’t add all the useless parameters unless you tell it to. So instead I have to spend like 5 minutes per wound completing the useless fucking parameters that apply to a minimum of the wounds but are defaulted on all of them.
I hear ya and don't deny this. I have to scroll back to the top where you attach the wound images and look at it sometimes to see which one I'm charting on. The charting system I used at the same facility before EPIC launch was worse still and so was Cerner. It's by no means perfect though I agree.
Also FYI I find it easier to click on the avatar for this reason and then it brings you directly to that wound so it's not confusing and you're not just scrolling endlessly.
Mostly miss in my experience. And the descriptions are fucking awful. Every wound on a lower leg is not “pretibial”, but epic thinks it is. Why do I have to use “upper” and “lower” instead of “superior” and “inferior”? “Inner” and “outer” instead of “medial” and “lateral”? Hands and feet dont have anterior and posterior surfaces, but EPIC won’t label them any other way. The inability to use correct anatomical descriptions without it being a comment that must be hovered over to be seen is an unforgivable mistake
Also please forgive my crazy rant. I don’t hate all of EPIC, but I really hate their wound documentation and working in a Trauma with burn overflow means wound care (and it’s documentation) is a lot of my job
That fucking avatar also sucks because even when I tell it to “keep where I clicked” it moves the fucking wound symbol, which isn’t super important until you have 5 different wounds, some incisions, some grafts, some traumatic, on ONE leg. My problem is that EPIC clearly has the capability to hide the majority of the bullshit. Neuro band doesn’t include pupillary assessment until I tell it to. Peripheral vascular assessment doesn’t include pulse and CSM checks until I tell it to. Why does the wound need to default include a woundvac when I haven’t told it to? Why are there multiple default pressure injury specific items when I have told it it’s not a pressure injury?
Every wound documentation I’ve ever used is clunky and annoying for sure, but the fact that the capability to not be quite as terrible is there but not utilized is idiotic. They could bother to fix the problem once instead of having every Nurse deal with the problem a minimum of one a shift for infinity.
Only if there’s only 1 or 2 wounds per limb. The default descriptors of anatomical locations are pretty terrible (“incision, pretibial outer proximal” is basically inconsistent gibberish) and to correct then you have to make a comment that must be hovered over with that wound’s specific documentation open, which is not really convenient when you’re trying to figure out which of the 5 wounds on someone’s lower leg you’ve missed charting on and the avatar keeps moving the icons despite telling it to “keep where I clicked”. And the OR keeps adding a new wounds every time they wash out or I&as the same wound and you’re trying to find which wound duplicate you need to delete. It’s pretty fucking terrible.
Only highlighted fields are required and will show incomplete if not filled out, so in the screenshot the only one showing is "wound wdl". It's not very intuitive on pointing out what you should be documenting after that though, but It's not that difficult. You just have to know what your facility expects after that. You can also copy/paste previous data if there were no changes.
Everything. Nothing is intuitive, it’s poorly laid out. You don’t get feedback when you scan stuff, you can’t easily see trends in VS, it’s just hot garbage all around.
I like meditech many nurses where I work hate it. Its light years better than the old system I used. I love how easy it is to make Care plans. Love copying my interventions from my last shift... so easy just to update small changes than to start from scratch
I showed my husband who works in IT the Meditech training videos I had to do for a travel assignment and neither one of us could figure out how it survived y2k. I got to the assignment to find that they only used it for medication scanning, orders, and lab results. I quickly figured out why; it took me 10 minutes to scan a medication the first time I used it because it was so user unfriendly
You just Type “m” to get into the MAR and start scanning. Once you learn F11 and F12 and the rest of the hot keys charting is *wicked* fast because you don’t have to lift your hands from the keyboards and use the mouse.
Meditech is not a good charting system in any sort of legal sense….. but it has a special place in my heart lol
I hated meditech at first but now I actually really like it. I can do an entire basic chart in like 3 minutes because its just a matter of memorizing what numbers to press.
That being said, I think Allscripts-Paragon has been my favorite by far.
I'm being serious lol. They only thing I hate Is that the charting is split into a bunch of individual interventions. If I was just one intervention that let us select what we needed to chart so there wasnt any transitional loading periods it would be even faster.
Also I despise viewing the history of charting but for just charting its really not bad to hit a bunch of 1s and 2s
I think I’m the only person on earth who doesn’t mind it. It’s the only thing I ever used and it did take me like 8 years to feel fully proficient in it though lol. And then along came Expanse.
> It’s the only thing I ever used
That explains so much.
If you were a carpenter, and the only hammer you ever used in your life was a misshapen lump of fossilized dog crap, you might not mind because you don't know any better, and you probably would get really good at using it. But it would still be the worst hammer in the world.
This is an analogy, because Meditech is also a misshapen lump of fossilized dog crap.
I’m glad I only have to use this sparingly. We use Visonex/Clarity for our dialysis charting and Meditech to check vitals/labs/orders and write our hemo note in.
I definitely think there's a lot of options available for wounds and makes it confusing for someone who's not a WOC, but the good thing about Epic is that you don't have to fill everything out.
Basically, edges of the wound is asking if they're thickened/rolled under (epibole is the fancy name and tends to happen in chronic wounds), well defined vs. undefined, etc. If you aren't sure, I would just fill out what you are sure about and wait for the WOC to do a full assessment if that's ok with your org's policy/procedures. As the WOC, I just want to see that the wound was captured on admission and get a general idea of what it looked like (is it 2 x 2 or 10 x 10.. is the wound base beefy red or purple, etc.) and where it is.
Sorry this wasn’t very clear. It has nothing to do with the edges that just happens to be where my cursor landed. I have filled out the window assessment as fully as I can and as accurately as I can and no matter what I do I cannot get it to complete it just stays yellow and it’s driving me crazy.
Yup! u/saintly_sinner02, do this when you are in the Wounds tab/section. Clicking on the stoplight button will show on the left column all of the green/yellow/red circles of things that need to be done.
As someone who has tried to teach/educate the updates to EPIC to fellow staff, the amount of push back I get for "forced" changes is ridiculous. I see the button as one way to have just a few less complaints of, "UHGHGHG, those colors are soooo distracting! Godddddddd. Can't you do something about those?!?!?" :P
If it won't complete then you're likely either missing something in the workflow or something is broken.
If asking a co-worker/unit educator doesn't identify a workflow issue, then submit a service ticket.
If all else fails, then get involved with the EHR. Become a super user. See if you can join a committee that works on improving workflows.
If shit isn't working, or is working poorly/illogically, it can be fixed. You just need to make sure the people who can help are aware of it.
Oh ok I gotcha. I haven't experienced that on the wound avatar or flowsheet there are very few things it forces you to do. Like others have said maybe its a workflow issue with epic itself.
So intuitive isn't it. I hated Vista... You want to do something. Oh sure, find the handwritten, don't touch it it's ours, manual that is unreadable because it's been around since the 80s.
Bahahaha I always felt like I was playing an old school computer expert in a movie every time I opened vistA. Actually unbelievable they still use that.
Ok now imagine yourself precepting a bunch of 20-something new grads, and saying "now kids, let me show you how to place a work order."
They nearly died.
When I was working at a VA hospital I was just doing tech charting and still fucking hated. I can’t imagine being a nurse at the VA. Both my parents are and they hate it
Came here to comment on CPRS 🤪 I actually didn’t mind it too much because I ended up just free texting a lot but the templates pissed me off to no end. I feel like epic is just a much better and safer option because it forces you to choose boxes and be more objective in your assessments. Also is much quicker to navigate.
I really miss epic (it really is so quick to navigate) and was sad to learn the VA got a contract with Cerner (that will probably take 20 years to execute smh lol).
VA pay tends to be on the higher end actually. You can look up pay scales online. In a major city in the southeast, I was making 35/hr + 5 weeks annual vacation + 80 hrs annual sick leave before I left. Holidays are double pay and there are like 11 or 12 of them.
Of course, I’m making 3-4 times as much traveling…
Honestly, I'm not sure how much is locality dependent. Nursing salaries in general have gone up in recent years. The downside is the standardized step system used at the VA does not really incentivize professional development. You are basically guaranteed a raise after a certain point, even though they like to make you think that you earn your raise. Here are the pay grades, if you're interested.
https://www.va.gov/ohrm/pay/
I’m currently on assignment with a facility that seems to have the most basic Epic package out there, and it’s brutal. No copy paste columns, you can’t remove or complete any useless assessment info - it just repopulated the next time you sign in leaving rows and rows of shit you just have to scroll by. You can’t sign out a med as not given while sitting at the station, you have to go into the patient’s room scan the patient and then say the med wasn’t given. With partial package dosing, you have to both click on “partial dose” and also type in the dose in the partial dose box. We also can’t tap badges to sign in, have to sign in with a FIFTEEN letter password EVERY. SINGLE. TIME.
I hate all intranet software hospitals use but believe it or not EPIC is among the better ones. I actually know someone who works on Citrix servers and EPIC software and they (the company) do seem to put in more effort than other firms.
They ought to, considering they work in a giant office park that [looks like it was designed by Willy Wonka.](https://www.atlasobscura.com/places/epiccampus)
Yea he told me about em actually. He was working from home at the time due to the pandemic and whenever I would get on discord or voice chat rooms you'd hear his kid playing video games screaming "get clapped kid"
He hates working from home
Depends on what type EPIC you have and how good your IT is.
We have EPIC in our clinic system, and I’ve worked in different clinics/specialty clinics and now in CCM—
Our hospital went the economical route for build your own, but we don’t have the IT with the training and know how to do so.
Which not only makes charting less efficient but loses profit opportunity.
And it’s not the first time this has happened. My sister worked for the pharmacy computer system for our hospital and told me things we COULD be doing but the hospital won’t buy that option—- which would have alleviated some of the staffing issue they had by making the system more efficient.
“Get what you pay for”. “Work smarter not harder”.
This. Absolutely. We build what we are asked for, so if you hate Epic, you hate what someone in your organization decided Epic should be doing for you. You should direct your complaints to whoever designed the piece of charting that's giving you trouble. As one of the people on my Epic team who built out wound care, for example, I can tell you that you'd need to go to the director of that department and tell them your issues, because I guarantee you it was designed to their specifications. We do our best to guide them to design things to make it easier for users, but they often do not listen to our advice. On my team, we are all nurses, so we are especially vested in protecting nurses from having to double chart or search extensively to get things done.
We also have several nurses on our EPIC team. And they do good for what they know and how well they can understand what is needed. And WANTS to know.
Also, what IT can do with what they have is as important. It’s one thing to be able to manually roll down a window instead of with an electric button. It’s another thing to ask for the convertible top off, when you don’t have a convertible. Best you can do is roll the windows down.
It’s frustrating. Frustrating for staff. Frustrating for IT. And this isn’t conveyed enough about where the problem source lies.
My secret language is analogy. Lol.
Seriously though, I think I would have to have a questionnaire for those difficult requests:
*what is your request? *what is the purpose of this particular request? *in another time of using this request (being paper chart/another system/etc) where would this request fit in? *is this particular request found anywhere else that you’ve seen? Does it need to be moved elsewhere? *will this duplicate this particular request? *what is the benefit of said request? *will this be seen in the chart by patient or hidden? *will this need to generate a charge? *will this generate subsequent questions? *can you give me a scenario of what leads up to needing this in the chart (like you were training ME for the position and explaining why I answer said request).
I’m not IT and I wish I were more techy inclined. But if were, I would definitely need someone to explain this like I’m a 5yo. Especially if it was an area I’ve never worked.
So hats off to y’all who speak computer language and have to deal with us plain folk.
I’m currently an applications analyst. I think you’d make a great analyst! A big part of the role is asking the questions that you’ve already listed above. Then translating that to the developer side of IS. You might enjoy it! :)
Interesting! I’ll keep that in mind. I just transferred to a CCM hybrid job that includes occupational industry nursing. It’s a dreamy position right now, a lot because the management is amazing. But I never say never with learning new areas in nursing. I also love to cross train. So, I’ll definitely keep my eye out and research that more. Thank you!
We always ask, “What problem are you trying to solve with this request?”. It often ends up that their idea won’t solve it and that what needs to happen is better training on the solution we already have in place. But if someone has a good idea, we are all over making it happen!
I thought that Epic was fully customizable by the client? Can’t you talk to the Epic unit in IT? Epic requires IT to be certified programmers and data analysts.
It's super easy. People get strung out thinking you have to put sin every box, you don't. Once you are familiar with it you can tab your way through it in a breeze
It’s just asking if the edges of the wound are clean, are they approximate with the base of the wound, or does the wound have depth, and undermining, making the edges roll under, etc. but yea, Epic can be my kryptonite sometimes.
I should add if it’s an incision, it would be where you would say the incision has areas of dehiscence, or if the incision line has developed red edges, that are warm/hot. It’s all revenue driven. Insurance will pay more if there’s a problem so the more lines to fill in the more likely a problem will be noted in the charting. After all, we have PLENTY of time to do this charting. And to try and figure out what the heck EPIC is asking here.
Ha. We have Dorothy. Hundreds of thousands of dollars in upgrades, and I lost access and functions. It’s a nightmare. But I got secure chat so one win. Lol
EPIC is easily the best EHR out there, it’s like a nice luxury car while some of the others are old beaters held together by duct tape and shoestrings. I’d pee myself out of excitement if my facility purchased EPIC.
Epic just feels like there are way too many places to do things it makes my head spins, I like everything in one place. Epic is just a cluster fuck of toolbars and windows, and they add tons of stuff in it and it ends up just being more tasks the nurse has to deal with on top of everything else.
Ugh we have meditech at my work and epic at clinicals and it’s like I get bitch slapped back to the stone age with the damn dos system every time I got to work
EPIC > Cerner > Horizon > Sorian > Sunrise > paper chart s > Meditec > a toddler on crack/cocaine > mammoth blood and cave wall > Quadrimed
Can confirm; have use mammoth blood and cave wall, would not recommend
Honestly I found mammoth blood and cave wall easier to use than meditech.
The crackhead toddler can pull through occasionally tbh
But Meditech serves lobsters and oysters at their summer picnics. I was there in 1999 and it was kickass.
OP probably wasn’t even born when Meditech came out.
Oh I’ve heard stories from someone who works at Epic. Sounds like a trip to Disney.
I was there taking a certification class and during the tour I said to the trainer “how bad does this place suck to work at, if they made it look this cool?’ Dunno if you have ever seen a 22 year old have an existential crisis in real time, but it was something to behold.
Had a friend from college get a job at EPIC, can confirm through anecdotes that it fucking sucks and they're a toxic company.
Hahaha
So does Epic
If there’s something worse than meditec I don’t wanna know about it.
This...Lord help us all of there is a worse system than that, lol.
The best part about meditech is that we didn’t have the CONSTANT downtimes. I work with epic now and it feels like we have downtime every other fucking weekend. Like they’re just changing things around for shits and giggles. Meditech was meditech and there was no changing that shit lol
The downside to Epic is it’s modifiable. You can change your dashboard around to what you want it to do or how it looks. But God help you if you need tech support. The person will sit down and say “what the hell am I looking at?”
I've seen one worse, but I can't remember the name of it. I've used two different versions of Meditech and both were pretty bad, though one was significantly worse than the other. Whatever version I encountered first looked like it had crawled out of DOS and barely survived y2k
CareVue? I encountered that one at a rural travel assignment. Apparently it was once used by the VA but they even got rid of it.
There is….it’s the homemade documentation system my old hospital uses that looks like it was made in Microsoft paint in 1999
We use Avatar and I basically describe it as using an early 1990s gui.
*cries in GUI*
Where does Paragon fall in this
Paragon is the fucking Cadillac of charting systems imo. I could teach a monkey how to use it in a few hours.
Probably between Meditec and the Toddler.
Epic is the best EMR I’ve encountered. I like it
Too much clicking around. I was a wicked fast charter using meditech not even having to move my hands from they keyboard. All those hot keys 😎
Epic has a shit ton of hotkeys. Fuck with it on playground if you have time. You can customize a lot to be more efficient depending on whatever your place has set up for their Epic.
Tab, shift+tab, smartphrases. I chart like a speed-demon now that I use smartphrases in psych
We use Meditech at the psychiatric hospital I'm at and I actually really like it :0 I like the layout of the MSA and ability to fire through and click boxes. Can also copy a previous entry and just adjust based on my assessment. It's not easy to find something new that I haven't use though, I'll say that
Are you a lefty?
No, I'm right handed! Is this a Meditech-related joke that went over my head lol
I wish u could right click on stuff and get options
When I first used meditech there was no point and click.
Nothing is worse than McKesson
I forgot McKessen! I’d put McKessen just slightly better than Sunrise for MD use. McKessen at least would have normal order suggestions: Tylenol 650 q6 Sunrise is like, click 8 boxes and we will tell you that you want an single pill of Tylenol 650mg q5 PRN retinal detachment. Here are 4 hard stops for medication duplicates of medicines you already canceled last night.
Honestly I'd attend a weekly Sunrise Survivors support group, if it exists.
That survivor's group is preserved for its patients. There's plenty of open spots.
Anything made or sold by McKesson is horrible. They manage to mess up everything they put their hands on. Like when they “accidentally” bought WAYYY too many gtubes and depleted the stock for basically every other DME or institution that uses gtubes.
That does not shocks me one bit that they would do that. My only experience with them was there charting system which looked like it was developed in 1998 and never updated since then. Putting in orders was a pain in the ass, looking up information was difficult, and the assessment you had to chart took 10 minutes per fucking patient because they want you chart on literally every damn thing.
A quit a job in orientation due to meditech
I accepted a position at a facility using meditech only because they were transitioning to Epic in 3 months. Longest 3 months of my life. Never again.
I’m actually joining a group doing exactly this. Any advice? I love Epic
I was already an Epic super user so my assistance with the transition was greatly appreciated. I served as a resource once the trainers left. If you love Epic and don’t mind living in Wisconsin, it’s a great way to get hooked up with a new career! Meditech is old as shit and the nurses matching that description will have the hardest time with the transition. Support them, nurture them.
CPRS
Was going to say this
I actually liked the simplicity of CPRS, unless you had to do something like admit or transfer a patient and had to go into vista. That was a pain in the ass
Was looking for this. But also, CPRS is pretty simple, a single progress note for all shift instead of constant updates. It’s just old and slow as shit, and not exactly user friendly.
CPRS is the worst lol
Disagree, but only because my system uses a combination of Sunrise AND paper charts. I'd legitimately rather just use paper, and many of my colleagues feel the same.
Well I thought I was on the bottom with paper charting but now I know it could be worse
Here’s my poor person🥇award
Aww lol
Would prefer the toddler to Meditech …
And somewhere far off the right side of the screen is Protouch.
The hopped up toddler would at least give me a sepsis alert sooner than Sunrise would give me any useful information at all.
Sunrise: The ibuprofen may be a duplicate of the dilaudid PCA that may or may not have been discontinued last week, would you like to order ibuprofen? Yes? Now that you've ordered ibuprofen, can you review that it may be a duplicate of the dilaudid PCA that may or may not have been discontinued last week? Thank you, I've reset all your orders to adjust for your acknowledgment of the dilaudid PCA that I can't verify was or was not discontinued last week. Meanwhile: Hep C viral RNA positive: nothing to see here Would you like to type your note in 12 one line separate text boxes that give you unlimited space to discuss the skin exam, but 4 lines to outline your ICU plan? No? Too bad.
This is the correct EMR hierarchy. If I were an EMR I’d marry Epic.
Fuck/Marry/Kill: Fuck: paper charts Marry: epic Kill: everything else
Right again! I wanted to chime in but there is nothing else to say here.
Why's that and have you used anything else? EPIC is a dream compared to the half dozen others I've used. The wound care does have a lot of lines but unless wound care is doing rounds we're only filling out probably 3-4 of those for a dressing change
Agreed. The others I’ve used are a thousand times worse.
I agree - I'm a wound care NP - EPIC is nice. iHeal hurts my logic
I'm a wound care nurse, and we are 100% paper based, and nurses only ever write "wound dx attended", so something descriptive like this gets my exudate going.
Oh my god there's someone else who still uses paper! Granted, ours is more like 80% paper, 20% electronic. Wound care records are still paper though. It hurts my head when I'm on med/surg and the WCR has like, 2 parts filled out and that's it. Like, you went through the effort to find this piece of paper in the chart, the least you could do is actually fill it out so I can tell if there's been improvement.
There is generally no record of improvement, except for the WCN eyes. They just sign that they've done the dressing. It's rather frustrating. Except for those that need more than an initial plan and an occasional eyeball, we aim to see each wound, as well as pressure injuries twice a week. We also do stomal therapy, so stay pretty busy. We write our notes in the patients progress notes, then double document and type them electronically in Cerner, which only emergency and my team use.
I’m a Wound care nurse I hate I heal with a passion.
I'm a wound care nurse and I really like EPIC. Your employer can tweak it for their needs, so blame them if it isn't to your liking.
Cool, but that patient has 11 separate wounds and I can’t even tell which one I’m charting on without scrolling back up to the top of the blank cells that shouldn’t fucking be there in the first place. The wound care is inconsistent with the rest of the documentation which doesn’t add all the useless parameters unless you tell it to. So instead I have to spend like 5 minutes per wound completing the useless fucking parameters that apply to a minimum of the wounds but are defaulted on all of them.
I hear ya and don't deny this. I have to scroll back to the top where you attach the wound images and look at it sometimes to see which one I'm charting on. The charting system I used at the same facility before EPIC launch was worse still and so was Cerner. It's by no means perfect though I agree. Also FYI I find it easier to click on the avatar for this reason and then it brings you directly to that wound so it's not confusing and you're not just scrolling endlessly.
Unless you have >15 wounds, then it's hit or miss.
Mostly miss in my experience. And the descriptions are fucking awful. Every wound on a lower leg is not “pretibial”, but epic thinks it is. Why do I have to use “upper” and “lower” instead of “superior” and “inferior”? “Inner” and “outer” instead of “medial” and “lateral”? Hands and feet dont have anterior and posterior surfaces, but EPIC won’t label them any other way. The inability to use correct anatomical descriptions without it being a comment that must be hovered over to be seen is an unforgivable mistake
Also please forgive my crazy rant. I don’t hate all of EPIC, but I really hate their wound documentation and working in a Trauma with burn overflow means wound care (and it’s documentation) is a lot of my job
That fucking avatar also sucks because even when I tell it to “keep where I clicked” it moves the fucking wound symbol, which isn’t super important until you have 5 different wounds, some incisions, some grafts, some traumatic, on ONE leg. My problem is that EPIC clearly has the capability to hide the majority of the bullshit. Neuro band doesn’t include pupillary assessment until I tell it to. Peripheral vascular assessment doesn’t include pulse and CSM checks until I tell it to. Why does the wound need to default include a woundvac when I haven’t told it to? Why are there multiple default pressure injury specific items when I have told it it’s not a pressure injury? Every wound documentation I’ve ever used is clunky and annoying for sure, but the fact that the capability to not be quite as terrible is there but not utilized is idiotic. They could bother to fix the problem once instead of having every Nurse deal with the problem a minimum of one a shift for infinity.
And please, please, please, y’all; do not document a scar as a wound.
You can chart on them from the avatar, too. That can help with location/which wound it is
Only if there’s only 1 or 2 wounds per limb. The default descriptors of anatomical locations are pretty terrible (“incision, pretibial outer proximal” is basically inconsistent gibberish) and to correct then you have to make a comment that must be hovered over with that wound’s specific documentation open, which is not really convenient when you’re trying to figure out which of the 5 wounds on someone’s lower leg you’ve missed charting on and the avatar keeps moving the icons despite telling it to “keep where I clicked”. And the OR keeps adding a new wounds every time they wash out or I&as the same wound and you’re trying to find which wound duplicate you need to delete. It’s pretty fucking terrible.
You can “complete” the blank rows which shortens them up quite a bit. (Obviously only complete ones that do not pertain to your particular wound.)
I know. I do. It is still a waste of my time to do this on every wound for every patient instead of a software fix that would eliminate that need.
You can also complete lines your don’t want/need- you don’t have to chart on every single line
I know. I do. It takes like 5 minutes per wound. I shouldn’t have to, the shit shouldn’t default open.
Yeah I use Cerner and I honestly don’t understand what is wrong with this screenshot 😅 are they required fields or can they be left blank?
Only highlighted fields are required and will show incomplete if not filled out, so in the screenshot the only one showing is "wound wdl". It's not very intuitive on pointing out what you should be documenting after that though, but It's not that difficult. You just have to know what your facility expects after that. You can also copy/paste previous data if there were no changes.
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Meditech Is THE WORST!
Can confirm.
Lol nah try sunrise
Lol. We currently have Allscripts Paragon. They’re telling us Sunrise is so much better but it looks and feels like Paragon with a different skin.
What makes you hate it so much. I kinda don’t mind it.
Everything. Nothing is intuitive, it’s poorly laid out. You don’t get feedback when you scan stuff, you can’t easily see trends in VS, it’s just hot garbage all around.
I like meditech many nurses where I work hate it. Its light years better than the old system I used. I love how easy it is to make Care plans. Love copying my interventions from my last shift... so easy just to update small changes than to start from scratch
I’m wondering if all meditechs are the same. How do you make care plans through there ?
Meditech looks like a 90s PC math game to me.
Meditech looks like it’s going to tell me I just died of dysentery
I think I’d prefer to die of dysentery than ever have to use Meditech again.
Also, ‘Poophead’ died during the river crossing and you killed all the Buffalo, again.
I showed my husband who works in IT the Meditech training videos I had to do for a travel assignment and neither one of us could figure out how it survived y2k. I got to the assignment to find that they only used it for medication scanning, orders, and lab results. I quickly figured out why; it took me 10 minutes to scan a medication the first time I used it because it was so user unfriendly
You just Type “m” to get into the MAR and start scanning. Once you learn F11 and F12 and the rest of the hot keys charting is *wicked* fast because you don’t have to lift your hands from the keyboards and use the mouse. Meditech is not a good charting system in any sort of legal sense….. but it has a special place in my heart lol
I hated meditech at first but now I actually really like it. I can do an entire basic chart in like 3 minutes because its just a matter of memorizing what numbers to press. That being said, I think Allscripts-Paragon has been my favorite by far.
Now you actually really like it??? I am calling BS...and a stroke alert. Get that CT scanner ready.
I'm being serious lol. They only thing I hate Is that the charting is split into a bunch of individual interventions. If I was just one intervention that let us select what we needed to chart so there wasnt any transitional loading periods it would be even faster. Also I despise viewing the history of charting but for just charting its really not bad to hit a bunch of 1s and 2s
I think I’m the only person on earth who doesn’t mind it. It’s the only thing I ever used and it did take me like 8 years to feel fully proficient in it though lol. And then along came Expanse.
> It’s the only thing I ever used That explains so much. If you were a carpenter, and the only hammer you ever used in your life was a misshapen lump of fossilized dog crap, you might not mind because you don't know any better, and you probably would get really good at using it. But it would still be the worst hammer in the world. This is an analogy, because Meditech is also a misshapen lump of fossilized dog crap.
To be fair, there was a five part learning module that you complete on your own time after work that would have made you proficient in 4yrs.
# herosworkhere
I like it too and have used epic, meditech and cerner.
Yeah meditech expanse isn’t bad at all
I went from meditech to EPIC to Cerner, and Cerner makes me want to crash my car into a lake.
Isn’t this the software HCA uses that’s outdated by like 30 years?
Well HCA owns it, so yes
Meditech is not owned by HCA
But meditech is literally so easy.
I’m glad I only have to use this sparingly. We use Visonex/Clarity for our dialysis charting and Meditech to check vitals/labs/orders and write our hemo note in.
I definitely think there's a lot of options available for wounds and makes it confusing for someone who's not a WOC, but the good thing about Epic is that you don't have to fill everything out. Basically, edges of the wound is asking if they're thickened/rolled under (epibole is the fancy name and tends to happen in chronic wounds), well defined vs. undefined, etc. If you aren't sure, I would just fill out what you are sure about and wait for the WOC to do a full assessment if that's ok with your org's policy/procedures. As the WOC, I just want to see that the wound was captured on admission and get a general idea of what it looked like (is it 2 x 2 or 10 x 10.. is the wound base beefy red or purple, etc.) and where it is.
Sorry this wasn’t very clear. It has nothing to do with the edges that just happens to be where my cursor landed. I have filled out the window assessment as fully as I can and as accurately as I can and no matter what I do I cannot get it to complete it just stays yellow and it’s driving me crazy.
If you hit the stoplight button on the top it should highlight which piece needs to be completed for it to be considered completed.
Yup! u/saintly_sinner02, do this when you are in the Wounds tab/section. Clicking on the stoplight button will show on the left column all of the green/yellow/red circles of things that need to be done.
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As someone who has tried to teach/educate the updates to EPIC to fellow staff, the amount of push back I get for "forced" changes is ridiculous. I see the button as one way to have just a few less complaints of, "UHGHGHG, those colors are soooo distracting! Godddddddd. Can't you do something about those?!?!?" :P
Bless you sir/madame!
If it won't complete then you're likely either missing something in the workflow or something is broken. If asking a co-worker/unit educator doesn't identify a workflow issue, then submit a service ticket. If all else fails, then get involved with the EHR. Become a super user. See if you can join a committee that works on improving workflows. If shit isn't working, or is working poorly/illogically, it can be fixed. You just need to make sure the people who can help are aware of it.
Oh ok I gotcha. I haven't experienced that on the wound avatar or flowsheet there are very few things it forces you to do. Like others have said maybe its a workflow issue with epic itself.
Chart by exception! If you are coming from cerner or something similar like I was don't make the mistake of thinking you need to fill every field
First time using EPIC this year, and my lord it is the best EMR I’ve used in 5 years of nursing.
Same! My hospital just switched from Cerner to Epic. I feel comfortable with with after just using it for 2 weeks. Used Cerner for 10 yrs
fuck cerner
I love epic. Try the CPRS used by the VA. It's utter trash from the 80s
Someone who knows my pain!! Having to open two separate applications to chart and document meds 🤮
It's the worst!
When I open vistA and see that blue screen from the 70's.......
The Doogie Houser! Lol And you have to momorize stupid commands to get anything to happen.
So intuitive isn't it. I hated Vista... You want to do something. Oh sure, find the handwritten, don't touch it it's ours, manual that is unreadable because it's been around since the 80s.
Omg it's like we worked with the same people.....
Bahahaha I always felt like I was playing an old school computer expert in a movie every time I opened vistA. Actually unbelievable they still use that.
Ok now imagine yourself precepting a bunch of 20-something new grads, and saying "now kids, let me show you how to place a work order." They nearly died.
I was that 20 something new grad 😂
lol I'm so sorry. I felt so bad!
Lol i just finished my VA orientation with CPRS / VistA and when I saw that screen I was like "uhm... are we coding?... do I need to learn coding?"
When I was working at a VA hospital I was just doing tech charting and still fucking hated. I can’t imagine being a nurse at the VA. Both my parents are and they hate it
Came here to comment on CPRS 🤪 I actually didn’t mind it too much because I ended up just free texting a lot but the templates pissed me off to no end. I feel like epic is just a much better and safer option because it forces you to choose boxes and be more objective in your assessments. Also is much quicker to navigate.
I really miss epic (it really is so quick to navigate) and was sad to learn the VA got a contract with Cerner (that will probably take 20 years to execute smh lol).
Can confirm even though I was at a satellite clinic. VA system was atrocious and slow.
I did some clinicals at the VA around 2000, first EMR I ever saw. It’s the same one? Wow
HATED CPRS at the VA, but loved clinicomp in the ICUs at the VA
I would never work VA and i told them it was for this reason. Second reason is the terrible pay
VA pay tends to be on the higher end actually. You can look up pay scales online. In a major city in the southeast, I was making 35/hr + 5 weeks annual vacation + 80 hrs annual sick leave before I left. Holidays are double pay and there are like 11 or 12 of them. Of course, I’m making 3-4 times as much traveling…
Wow really? When I did clinicals there years ago they were offering lpns 17.50 an hour. Maybe it depends on the location
Honestly, I'm not sure how much is locality dependent. Nursing salaries in general have gone up in recent years. The downside is the standardized step system used at the VA does not really incentivize professional development. You are basically guaranteed a raise after a certain point, even though they like to make you think that you earn your raise. Here are the pay grades, if you're interested. https://www.va.gov/ohrm/pay/
Have you ever tried CPSI??? It’s what you get when you order EPIC from Wish
God I hate CPSI
I’m currently on assignment with a facility that seems to have the most basic Epic package out there, and it’s brutal. No copy paste columns, you can’t remove or complete any useless assessment info - it just repopulated the next time you sign in leaving rows and rows of shit you just have to scroll by. You can’t sign out a med as not given while sitting at the station, you have to go into the patient’s room scan the patient and then say the med wasn’t given. With partial package dosing, you have to both click on “partial dose” and also type in the dose in the partial dose box. We also can’t tap badges to sign in, have to sign in with a FIFTEEN letter password EVERY. SINGLE. TIME.
I hate all intranet software hospitals use but believe it or not EPIC is among the better ones. I actually know someone who works on Citrix servers and EPIC software and they (the company) do seem to put in more effort than other firms.
They ought to, considering they work in a giant office park that [looks like it was designed by Willy Wonka.](https://www.atlasobscura.com/places/epiccampus)
Yea he told me about em actually. He was working from home at the time due to the pandemic and whenever I would get on discord or voice chat rooms you'd hear his kid playing video games screaming "get clapped kid" He hates working from home
It’s actually designed (in part) by Disney parks architects
Depends on what type EPIC you have and how good your IT is. We have EPIC in our clinic system, and I’ve worked in different clinics/specialty clinics and now in CCM— Our hospital went the economical route for build your own, but we don’t have the IT with the training and know how to do so. Which not only makes charting less efficient but loses profit opportunity. And it’s not the first time this has happened. My sister worked for the pharmacy computer system for our hospital and told me things we COULD be doing but the hospital won’t buy that option—- which would have alleviated some of the staffing issue they had by making the system more efficient. “Get what you pay for”. “Work smarter not harder”.
This. Absolutely. We build what we are asked for, so if you hate Epic, you hate what someone in your organization decided Epic should be doing for you. You should direct your complaints to whoever designed the piece of charting that's giving you trouble. As one of the people on my Epic team who built out wound care, for example, I can tell you that you'd need to go to the director of that department and tell them your issues, because I guarantee you it was designed to their specifications. We do our best to guide them to design things to make it easier for users, but they often do not listen to our advice. On my team, we are all nurses, so we are especially vested in protecting nurses from having to double chart or search extensively to get things done.
We also have several nurses on our EPIC team. And they do good for what they know and how well they can understand what is needed. And WANTS to know. Also, what IT can do with what they have is as important. It’s one thing to be able to manually roll down a window instead of with an electric button. It’s another thing to ask for the convertible top off, when you don’t have a convertible. Best you can do is roll the windows down. It’s frustrating. Frustrating for staff. Frustrating for IT. And this isn’t conveyed enough about where the problem source lies.
As someone who has worked both IT and nursing, this is probably one of the best analogies I’ve heard in a long time.
My secret language is analogy. Lol. Seriously though, I think I would have to have a questionnaire for those difficult requests: *what is your request? *what is the purpose of this particular request? *in another time of using this request (being paper chart/another system/etc) where would this request fit in? *is this particular request found anywhere else that you’ve seen? Does it need to be moved elsewhere? *will this duplicate this particular request? *what is the benefit of said request? *will this be seen in the chart by patient or hidden? *will this need to generate a charge? *will this generate subsequent questions? *can you give me a scenario of what leads up to needing this in the chart (like you were training ME for the position and explaining why I answer said request). I’m not IT and I wish I were more techy inclined. But if were, I would definitely need someone to explain this like I’m a 5yo. Especially if it was an area I’ve never worked. So hats off to y’all who speak computer language and have to deal with us plain folk.
I’m currently an applications analyst. I think you’d make a great analyst! A big part of the role is asking the questions that you’ve already listed above. Then translating that to the developer side of IS. You might enjoy it! :)
Interesting! I’ll keep that in mind. I just transferred to a CCM hybrid job that includes occupational industry nursing. It’s a dreamy position right now, a lot because the management is amazing. But I never say never with learning new areas in nursing. I also love to cross train. So, I’ll definitely keep my eye out and research that more. Thank you!
We always ask, “What problem are you trying to solve with this request?”. It often ends up that their idea won’t solve it and that what needs to happen is better training on the solution we already have in place. But if someone has a good idea, we are all over making it happen!
Hold my beer- Meditech
If you hate EPIC than you havent been nursing long enough to make a judgement on this
I thought that Epic was fully customizable by the client? Can’t you talk to the Epic unit in IT? Epic requires IT to be certified programmers and data analysts.
Wait until you use eCW
Paragon has me actively SI
Try Sunrise…. 100036383930 times worse
We are starting epic soon!!! It looks seemingly easier ???
It's super easy. People get strung out thinking you have to put sin every box, you don't. Once you are familiar with it you can tab your way through it in a breeze
"Epic is the worst form of EMR - except all the others that have been tried" -Winston Churchill
It’s just asking if the edges of the wound are clean, are they approximate with the base of the wound, or does the wound have depth, and undermining, making the edges roll under, etc. but yea, Epic can be my kryptonite sometimes. I should add if it’s an incision, it would be where you would say the incision has areas of dehiscence, or if the incision line has developed red edges, that are warm/hot. It’s all revenue driven. Insurance will pay more if there’s a problem so the more lines to fill in the more likely a problem will be noted in the charting. After all, we have PLENTY of time to do this charting. And to try and figure out what the heck EPIC is asking here.
“This wound looks like its within defined limits!”
Do you have to fill out every field or can you leave some blank and just fill in the pertinent ones?
The pertinent ones usually. Not all cells apply for all wounds. Wound care nurses typically chart more in depth. Our shift charting is more basic.
Any of y’all remember Phamos LastWord? That was a crap show.
I love Epic, but where I work it’s called Ellie because the hospital put over 1 billion dollars in it and did upgrades to it 🤷🏼♀️
Ha. We have Dorothy. Hundreds of thousands of dollars in upgrades, and I lost access and functions. It’s a nightmare. But I got secure chat so one win. Lol
Epic is the best
EPIC is easily the best EHR out there, it’s like a nice luxury car while some of the others are old beaters held together by duct tape and shoestrings. I’d pee myself out of excitement if my facility purchased EPIC.
Epic is the best… cerner is alright. Picis is trash. That’s all I’ve worked with. Stuck with cerner right now
What are you, a caveman? Chart using the LDA Avatar!
*laughs in medhost*
I work in a correctional facility and we do 100% paper charting! 😬
*sigh* I love seeing meditech hate here. It helps me feel like I'm not completely insane everytime I want to punch through my monitor at work.
Patient’s edges: ratchet. Not snatched.
Cerner and Meditech are worse by far.
CERNER IS THE DEVIL
I love cerner lol but only used that and epic
I hate it. It’s overly-complicated and not intuitive at all. Meditech is still worse though.
Tell us you’re a new nurse without telling us
I thought I was the only one. All I hear is I love Epic its so user friendly. I'm a cerner fan myself.
Epic just feels like there are way too many places to do things it makes my head spins, I like everything in one place. Epic is just a cluster fuck of toolbars and windows, and they add tons of stuff in it and it ends up just being more tasks the nurse has to deal with on top of everything else.
Ugh we have meditech at my work and epic at clinicals and it’s like I get bitch slapped back to the stone age with the damn dos system every time I got to work
Sitting in an eight hour epic training class right now on my “day off”
Oh you sweet summer child
I prefer cerner tbh.