My rant of the week is on the prescribing module in EMIS. Where to begin… well the obvious place is the way too many warnings.
Its just insane how many warning pop up with little intelligence. The one that drives me most insane is the low eGFR warning – everything it pops up I think – “oh I didn’t know this patient had a low eGFR” then I look it up and they don’t. 1. Why can’t it only show me the warning if they do and 2. why can’t it show me useful information like that on the screen? At this point, I usually have to cancel the prescription and go to the results screen. Another one that drives me mad is – “Care giving steroids!” Well, 1 given I’ve been a doctor 20 something years and I only give them when I think they are useful – yes I’m taking care. Also, I do a lot of joint injections where we inject steroids and I’d like to know what it thinks I should do instead. Others that insense me are Care it’s an Old person and OH you are giving antibiotics – the patient might be ill have you assessed them – to paraphrase. Like many people, I just stop reading them and perhaps there are some that are important but I’m not sure I’ve seen one. Ideally, they should be intelligent – I have the patient open so it should be able to warn me about things only relevant to the patient. Ideally, i’d like the ability to customise which I saw, some I could turn off, some I might say don’t show me these again for a while.
Moving on, why oh why are all the drugs in the lightest shade of grey you could imagine. OK, I’m getting older and my eyesight is going and I’ve ranted before about how EMIS doesn’t utilise the screen space well enough but seriously put all the drugs in the lightest shade of grey! in the smallest font in the smallest box. Why doesn’t it put most common drugs first! It also does crazy things – I select Fenbid cream – it changes it to ibuprofen, Then OptimiseRX or Scriptswitch pop up telling me the preferred drug is Fenbid, ARGHH!!!! Yes, I know EMIS changed it!!!!!
I also think they could make it a lot easier to get the right dose for children – the BNF for Kids is published, EMIS knows the age of the kid, why every time do I need to look it up.
As stated why not put some of the latest results on the screen – so if I’m prescribing a diuretic I can see the last eGFR and Pottasium.
Why do I need to turn off the EPS to press store. We use it a lot of PA drugs. It’s a radial button on the bottom on the pop-up. It means don’t print this – store it to be printed later. ADmin they print them in a batch and give them to finance to claim. Given the whole point of pressing it is not to print it – why do i need to tell it not to send it EPS before it will go live. It’s an extra click that is eating up my precious life.
The whole PA drug system could, in my opinion, be improved. It’s far too clunky – you have to enter too much data each time – you could automate it so that you picked which drug you were giving from a list, perhaps had the scripts go to finance automatically, let them also know when stock was running out. It’s not something that I’ve thought about a lot but I’m sure it could be seriously improved. It always strikes me as odd that come Flu vaccine time we have to write a protocol to enter the flu vaccine and EMIS doesn’t do it automatically.
This is a subtle one and perhaps not all will agree, but there aren’t enough inboxes on the prescribing screen. We encourage our patients to order online. However, their requests come into the same inbox that we as doctors use. We would prefer a separate admin inbox. We employ two pharmacists and a team of 6 techs to process and check the meds before a doctor sees them. Check that the patient has had the appropriate tests/checkups etc. Sometimes its just the patients requests a different amount or something from past drugs. We try to minimise the workload on the GP as much as possible (see top 10 high impact actions). The problem is having it all drop into one inbox is a pain. There needs to be an online request inbox and a ready to sign inbox. The problem we have is the GPs sometimes accidentally process the request without either doing the checks or the request. – It might be easier to show you but it drives us mad and is one of those things where it drives me mad that we have to cope with the inadequacies of an IT system that doesn’t actually match the way we work. Why can’t we have a system work the way we want to.
A bigger is syncing the meds. I think I’ve seen a news item that Vision has sorted this – but the amount of times people ask to sync meds. One drug is on one month scripts, one is on two month, or worse they are all on two months but out of sync and they are coming in monthly when they don’t need to. To sync them you need to work out how many they have left and how many of each they need to align all their meds, it’s a manual process that takes time, I cant see why it cant be automated.
I’ll stop there – I might revisit this topic!