It's even worse, in a way. Mt Sinai uses Epic, as do many (most?) other larger hospitals in the US.
The stops - which in my experience (anesthesiologist, not ER doc, so I don't get sepsis warnings but I do get some of my own) are not popups, per se, but warnings that prevent you from leaving the screen until you have dealt with them. In this case, he could not place an order for at least some of the sepsis bundle of orders without placing all of them or making the sepsis warning go away - permanently. And the inexperienced trainee was told by the experienced supervising physician not to order the antibiotics and x-ray until at least preliminary labs had come back. At least for the antibiotics, this is good stewardship - we don't want to be giving people antibiotics for viral illnesses.
I have fought against incomprehensible ordering systems so much that when I order a chest X-ray (usually to confirm the placement of a large central IV), I have found it best to call the radiology technician and tell them what I want and let them order it under my name, because if I don't, I'll inevitably screw up some minor detail and they will have to re-order it anyway. "Chest x-ray to confirm internal jugular central venous catheter placement" (well, "CXR to check IJ CVC") is what I would have written in a paper chart; now it wants to know vast amounts of detail that I often don't know.
So this story comes down to a gripe about data systens that is as old as these systems themselves: the designers and implementers come up with data models and workflows that feel like they cover every possible case and they deliver a system that is a perfectly rigid implementation of these flows because they seem complete. Inevitably, these systems meet the messy real world and users find themselves unable to do what they need to do for the occasinal really weird case and get hopelessly stuck because they run up against stubborn rule checks.
This plays out every time when two workers look at each other and go "How do I enter XYZ without ABC?" - "You can't do this. Here's our workaround".
It’s not even a weird case. I have to specify, but don’t care if it’s back-to-front or front-to-back. Or where the x-ray is taken (yes, doctors have to specify that). That matters to the radiologist reading it (plain x-rays are like a camera obscura, so things close to the emitter cast a larger shadow), but for my purposes, it doesn’t matter because the level of detail I need is not that.
So in your case the SW is a poor fit. That feels underwhelming from a package that is used widely and presumably should have the flexibility to adapt to the requirements of very different customers.
Yes, all major inpatient EHRs do have the flexibility to adapt to those requirements. But that level of customization is itself a huge effort, and many hospitals lack the resources to do it well. The other problem is that hospital administrators and IT staff often give in to internal pressure from clinicians to customize every little thing even when it doesn't actually improve productivity or care quality. Sometimes it's better for humans to adapt to the software rather than vice versa. "Vanilla is the best flavor."
As a clinician, I wholeheartedly agree that adapting myself to the software is usually better than spending tons of money to try to make the software fit me, but at the same time the software really should fit the general norm of practice style.
This is more about unnecessary complexity. Medicine is hierarchical and like any hierarchy those at the top should be giving orders that leave lots of leeway for those who have to make them happen. EHRs often push all that onto the physician who never learned how to do that and really shouldn’t.
It’s like the old story about a green lieutenant in the army. Commander says, Lieutenant Smith, I want a flagpole on our parade ground. The dumb lieutenant tells their sergeant precisely how to do it. The smart lieutenant says, “Sergeant, the commander wants a flagpole right here. Make it happen.”
Whenever a question arises (and it will), the sergeant with a dumb lieutenant has to go back and clear every step. The smart lieutenant’s sergeant doesn’t have to call until they encounter something they don’t know how to do or can’t approve on their own authority.
> the designers and implementers come up with data models and workflows that feel like they cover every possible case and they deliver a system that is a perfectly rigid implementation of these flows because they seem complete. Inevitably, these systems meet the messy real world and users find themselves unable to do what they need to do for the occasinal really weird case and get hopelessly stuck because they run up against stubborn rule checks.
No. Those systems have nothing to do with the real world. They are just a project manager's idea about "the real world". Have you used any Microsoft product lately ? Every day it tells you: "Hey , i have a new feature".
But that is 41% for a single vendor out of 10. So market leader. And it looks like the data is based on hospital installations but not normalized based on quantity of patient served or patient case complexity.
Edward’s Hospital in Plainfield, Il and Mt Sinai are two different use cases and should not count equally.
That is something to keep an eye on. The system that owns the hospital where 95% of my work happens uses Epic and they subsidize it for hospitals that aren’t formally part of our system but could be a good referral base.
Catholic hospital, so it has its own internal issues, but it’s definitely not PE-controlled.
The stops - which in my experience (anesthesiologist, not ER doc, so I don't get sepsis warnings but I do get some of my own) are not popups, per se, but warnings that prevent you from leaving the screen until you have dealt with them. In this case, he could not place an order for at least some of the sepsis bundle of orders without placing all of them or making the sepsis warning go away - permanently. And the inexperienced trainee was told by the experienced supervising physician not to order the antibiotics and x-ray until at least preliminary labs had come back. At least for the antibiotics, this is good stewardship - we don't want to be giving people antibiotics for viral illnesses.
I have fought against incomprehensible ordering systems so much that when I order a chest X-ray (usually to confirm the placement of a large central IV), I have found it best to call the radiology technician and tell them what I want and let them order it under my name, because if I don't, I'll inevitably screw up some minor detail and they will have to re-order it anyway. "Chest x-ray to confirm internal jugular central venous catheter placement" (well, "CXR to check IJ CVC") is what I would have written in a paper chart; now it wants to know vast amounts of detail that I often don't know.