Over the past year, inpatient made the leap to an integrated Electronic Health Record, including scheduling, billing and order entry (installed by Epic, one of the national leaders in EHR although it happens to be locally-based). I have to say Epic has been pretty responsive adapting the system for us, even my relatively small department.
UW Rehab, in particular, has put a lot of effort into setting up the Flowsheets so that they automatically send information into notes and reports. More specifically, each visit or day I enter basic data into this flowsheet template (distance walked, level of assist, type of assistive device used) and then hit a button in my narrative so that all this information automatically flows into a particular template, such as consult or progress note or discharge summary. By and large it's a good system, and we're able to create our own note templates individually, although there is an effort to vet them through the team so that we are meeting our regulatory mandates. I have a few coworkers who keep tweaking the templates and share them for me to use. There is also potential for diagnosis-specific templates which could streamline documentation further and in all honesty improve care by standardizing some of these interventions.
As far as the flowsheets go, I am a believer in using discrete data points - it's my understanding that the US military has saved the lives of many wounded soldiers by finding patterns in similar type of datapoints. With the way the data "populates" the note it doesn't feel like so much duplicate effort and in the future maybe we can get rid of some of the SOAP type notes altogether. Plus the flowsheets do make it easier for me to quickly figure out what level my patient was moving at the day before.
On the downside, there is a huge amount of information and pretty much there has been continual change. After $10s of millions invested, the organization is still making updates that affect my workflow. I've experienced some hardware glitches (with a portable tablet-type device in particular) and so still rely on the desktops. There are probably too many different ways to do things. I'm not paper free, although actually am moving that direction. There is still some redundancy in the system, but seems to be recognition of this at higher levels. My manager is clinical and understands this issue, so I'm reasonably optimistic he can help pare it down for us. It has become manageable, but there is a long road ahead. Still, it's better than working in a stagnant system, and I do like the ability to experiment and potentially shape some of the changes.
Parking is expensive on campus (although I do use a covered ramp). We are offered free bus passes but this hasn't been practical for me in a while. Otherwise, really no complaints.
