I spent the last couple weeks picking the brain of a colleague. He uses Epic with an organization I won't name. As with most EMR's productivity and time issues were a huge negative point. One of the problems I observed was the necessity for a 3 layer log in. That might have been an organization level issue and not inherent to Epic. Once in, I got the impression of Epic as a giant jar of jelly beans with lots of colors. The question was how do you get to the jelly bean you want? It was nice to have see an incredibly vast number of choices available to the clinician. I wonder how much is too much though. Three, five, or 8 ways to do essentially the same thing is perhaps a bit too much? My Epic user friend has always been a technophile. He felt that as voice recognition software improves, when touch screen computing advances some more, and productivity issues improve (he still spends an extra 1 and a half hours daily documenting as many of us do) the overall EMR industry will gain tremendous momentum. We also discussed the common occurrence of "over documentation" or unnecessary documentation that occurs these days. Why? Liability fears, fears of not getting paid, billing fraud etc.

Whatever happened to pertinent positives and negatives?

The beauty of open source is the collaboration of multiple parties to drive things towards ease of use and applicability to the task at hand. Vista did just this at the VA to be able to do the job of a physician in the hospital. Just what is needed, nothing you don't need. I taught myself how to use OpenVista. I'm not sure I could have done that in Epic or Touchworks. Epic had tremendous functionality, but this was at the expense of navigational complexity. I also spoke to a nurse at a different Epic organization. I asked her for her thoughts. She said, "Its okay, but it takes a long time."

When I demonstrate OpenVista most people say it seems pretty intuitive. I spoke to some medical students about their VA experiences with Vista software and most said they liked it. I do think that open source will continue to drive physicians towards the desired goals of ease of use, productivity, clinical applicability, and the ultimate goal of enhanced patient outcomes. I welcome any and all feedback regarding these and other issues.