Epic rollout progresses smoothly

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Photo by Amir Sharif.

Roughly a month after launching a new, more sophisticated electronic health records system (EHR), Yale Health is making a smooth transition to the new software.

On Jan. 27, Epic, an electronic health system used in hospitals and clinics across the country, launched at Yale Health. Epic allows Yale Health to integrate its medical records with those from the Yale-New Haven Health System (YNHHS) and Yale Medical Group (YMG). With 75 support staff members from Epic at Yale Health for the introduction, the rollout experienced only minor glitches, said Paul Genecin, Yale Health Director. To further ease the transition, Yale Health also temporarily reduced the number of patients doctors are treating.

“We were repeatedly reminded by the Epic people that this was the smoothest implementation in the whole [Yale medical] system,” Genecin said.

Yale Health had been using another EHR, Allscripts, for a decade before adopting Epic. The launch marks the first time Yale Health will be able to share medical information with the other components of the Yale medical system. Genecin said the transition went smoothly because Yale Health’s doctors are already acquainted with EHRs. When YNHHS and YMG completed their transitions to Epic in 2013, neither institution had used EHRs before, Genecin said.

While Epic aims to integrate records across institutions, mental health records from Yale Health will remain internal and separated from other departments. According to Genecin, the decision to keep these records on paper came from concerns in the Yale community.

“It’s a decision every school has to make,” he said. “We found that at Yale we have many students who are seeking mental health treatments would be really troubled by electronic medical memory as they seek security clearance or run for political office.”

Yale Health is also trying to improve the accessibility of MyChart, its new patient portal, which is run by Epic. In order to create an account, a patient must request an activation code that can take a week to arrive in the mail. Genecin said Yale Health is aware of the issue and working to expedite this process for students by sending the codes over email. Until these and other issues have been resolved, Genecin said Yale Health will delay its efforts to recruit students to MyChart.

Yale Health is the last of the four major hospitals and more than 200 physician practices within YMG and YNHHS to adopt Epic, and so has learned from the experiences of the other institutions, wrote Daniel Barchi, Chief Information Officer of YNHHS and Yale School of Medicine, in a Tuesday email to the News.

When Epic was first implemented in a YMG office of five doctors back in the fall of 2011, more than 200 glitches arose even with 50 Epic staff support members on hand, Barchi wrote.

At the Yale Health rollout, the staff to physician ratio was significantly smaller, and only a handful of glitches have come up, he wrote, adding that this success was a testament to how much the Yale medical community has learned about the technology in the past three years.

While no major problems have surfaced, Genecin said that every day brings a new, albeit small, issue.

“All of these programmers are on site fixing little problems,” he said. “I don’t think there are huge problems at this point, but we’re still feeling our way in a number of areas.”

After doctors adjust to the new interface, Epic will help Yale Health work to streamline it, said Allen Hsiao, associate chief medical information officer for the Yale School of Medicine and YNHHS. He added that the goal is to reduce the number of clicks physicians have to make, so the process can be as efficient as possible.

Even with the general success of the rollout, the transition has not been smooth for all physicians.

“It would be nice if the system could be simplified,” Christiane Nockels Fabbri, a physician at Yale Health, said in an email. “There seems to be a fair amount of redundancy. You cannot imagine the number of options, buttons, checks, double-checks, pull-down menus … that are all crowded onto one screen.”

Still, she said, moving to Epic was a logical next step for Yale Health, as it centralizes information from a number of sources and prevents unnecessary duplication of tests.

Epic, which is based in Verona, Wis., employs about 7,000 workers.

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