I’m a doctor and have used Epic and other EMRs extensively. The most accurate thing I can say is that Epic is the least horrible EMR available. It’s probably a 3/10 overall while everything else is much worse.
I would love to see more wide spread adoption of FOSS EHR systems, once with actual feedback and development input from doctors. I don't think it will happen. Meaningful use and interoperability have basically made it so Epic and Cerner and the other big players have an advantage due to resources for development.
I had a glimmer of hope, Ohio (where I'm from) was considering allowing a companies to bid on a contract to to host a low-cost/subsidized OpenEMR instance and letting healthcare systems use it. Sadly nothing ever came to fruition.
For all that CPRS - the old VA EMR, paid for by the federal government and thus openly available - got a lot of flak from all angles, not least of which was IT (the whole thing is written in MUMPS and the CLI underneath the GUI could be charitably described as "arcane"), it was a fairly easy EMR to "get", and once you learned how to filter things, you could at least see everything going on.
With Epic, Cerner, and the others, you don't. You have a silo'ed role. Early on in our Epic migration, I discovered that I had been misclassified by the system. I was a doctor, yes, but I had a range of options open to me that were appropriate for an ICU doctor, not an anesthesiologist - I simply couldn't do a lot of things that were my bread and butter. Finding information outside your normal specialty is difficult and requires a very precise set of clicks (which are not in any way intuitive) to get to the information you want. I stunned one of the cardiac surgeons by showing him how to get access to the OR status board (which he had, just not as simply as we do) and how to customize it to show him everything going on in every cardiovascular surgery room and in the cardiac catheterization lab. Now, when a cardiologist calls him to say "I'd like to consult you about the patient I just did a cath on, think he needs bypass surgery instead of stents", he can skip getting a medical record number and just open the chart directly from the list.
I can't read nursing notes. I've tried, and I know the information is there somewhere, but unless I've been given access to a flowsheet that shows it (and that is another obscure thing), I can't see it. Labor and delivery nurses don't have access to anesthesia records, so they can't see what medications their patient got during a C-section, and end up having to call one of us to tell them precisely what was given and when. Most surgeons don't know how to look at the anesthesia records (it's not easy) for their own cases, let alone their partners' (when covering call), so again - they have to call us to ask. I had to open up one for the head of the peer review committee to show her what had happened in the operating room after a patient death.
There are always going to be privacy concerns, but these systems all have aliasing ability, and in any case retail-level, one-by-one accessing of sensitive people's info is going to raise a lot more flags than data breaches involving millions. Not letting me see what went on before, during, and after for a patient I have to care for is far worse.
And if a guy who has their own IT staff telling them it can't/won't happen, despite actual onsite EPIC staff saying it's entirely possible, you see why. When you tell users to go away, and tell interested users that they can't share their improvements, not even privately, you are doing a disservice and you owe me at the least an explanation of why doing it is bad. Maybe there's a good reason that I should be allowed to mess my own system up but not let anyone else enjoy it that way, but I struggle to understand why. The whole thing can be re-imaged if I screw up too badly, after all.
Are you talking about custom chart review filters? Also not sure why that's blocked, I use those a lot and we can copy them from other user profiles without going through IT. But yes to have this be a default for new users we still need IT approval which no one has bothered with.
This sounds like draconian institutional policies are the limiting factor.
Draconian institutional policies are indeed an issue. WiFi calling is blocked, despite the fact that a significant part of our first floor has zero cell signal.
If you get bored, PM me and we'll set up a time where I can show you some samples. I'll need a few days to sanitize them of identifiable info.
There's a developer sandbox as well that's more feature rich but from what you're describing I doubt they would have enabled access for you although most hospitals do. I would ask someone in IT you know to either give you a superuser role in the playground or access to vendorservices.epic.com
You can't PM on here but my e-mail is in my profile. If you're hitting a dead-end shoot me an e-mail and I can add you to my developer playground to mess around with.
Still, sad that I have to go to HN and actual tech workers in completely different places to figure out how to use a system that is nominally under control of my own hospital. I don't blame you for not giving doctors admin access; I don't need it and quite a few would make a total hash of things, but I'm a lot more curious and a nice free playground where I could do things like schedule cases would be fun. If I break it, so what? It will reset tomorrow, and I'm fine with that. If I have a play day, I'll apply my notes for everything I have done and ask the IT team to make a snapshot.
Again, thanks.
Some places are better, most institutions I've been at have given me full access because I have a tech background and had a previous relationship with Epic but occasionally I've hit similar brick walls to you.
Hope it works out.
Every hospital I’ve worked at has used Epic and every one has a different “custom” version with different UI and user role configuration.
Even within the same hospital the UI and default displays widely varies based on context and role selection when logging in.
Nursing notes are definitely accessible in every version I’ve used and I also read them fairly frequently (often more useful than MD progress notes) so your hospital may be hiding non-provider notes from you. It would be strange though, are you sure you don’t have “show provider notes only” checked off (or that box hidden)?
This limitation isn't an Epic default feature and must have been set by your institution or whoever created the anesthesia role for some inexplicable reason, there wasn't actually a justification or privacy concern for why this was set this way for radiologists at my institution and seemingly was set by someone in IT thinking it was extraneous to us.
Dunno, at this point I'd settle for being able to establish custom filters for my status board. But I've learned that a lot of weirdnesses have to do with interfacing with other software.
With all those requirements, even the smallest feedback might require many hours to implement so things don't break or piss someone else off.