For the last two weeks I’ve had my head down jumping through hoops, working hard to personalize Epic so my
JEFF HEINZ/The Globe Gazette
documentation is accurate, thoughtful and describes the patient’s story to the reader. We’ve had the usual glitches with hardware and software but the major problems have eased. I still don’t like the “dumb” thin clients which lock me out of the patient’s chart and have me walking up and down the hallway in order to close the software in one location so I can put orders in or finish my note in another. It is a terrific waste of time.
So what do I like about Epic?
-The interface is pleasant to the eye.
-The ability to make physician-specific templates of things I say to patients and staff repetitively on-the-fly, as I see patients.
-The big screen format.
-The ability to communicate with patients via the MyChart portal in a more robust manner.
-Releasing patient notes to them in the portal (although it sure would be nice to have a default button so I wouldn’t have to choose that option every time).
-Having an online community on the Epic site to discuss software “fixes”.
-In March, all of my system’s employed physicians, Immediate Care facilities, hospitals and ERs in my area will be onboard. Since the chart is patient centric, I’ll be able to see what’s going on in those facilities.
-Some true intraoperability–I can access patient information from any other Epic source in the country, including across town. This is huge and has already impacted patient care in a positive way.
-Having support in Verona, WI (home to EpicCare) with the expertise and desire to help you.
What I don’t like about Epic:
-Everything we do with patients is an “encounter”. I have to open one to write an order, document a telephone conversation, etc. If I open one and change my mind, I still have to sign the darn thing instead of just cancelling out of the encounter.
-It is too “clicky”. Things that should be accomplished in one click takes multiple. Thank goodness there are plenty of keyboard shortcuts but for individuals that aren’t used to using them, that is of little help.
-The lack of a Verona-based Epic expert in our office the first day of GoLive. We spent so much time figuring out simple things that someone with more training and experience could have told us in seconds.
-My work environment is not designed well. I have to strain my neck to keep eye contact with patients, or turn the computer away from them. I’ve got to work on this. There has to be a better way.
-The most annoying thing, and a big backward step for me, is the inability to get email notifications when a patient messages me on the MyChart Portal. Since 2013 my patients have had answers to their medical questions at odd hours of the night or on weekends. That is not possible with MyChart, although I guess I can get a one time notification in the evening if someone has sent me a message IF my system Leadership approves (and why would they not OK that?). This is definitely a step backwards, and in a time when patient engagement is considered so vital, it seems odd that the arguably “best in Klas” EHR doesn’t have that functionality.
Oh, and did I mention how much I dislike the thin clients?
Second day of Epic training went well. We were taught Inbox processing and how to interact with the patient portal. This was miles more straight forward than documenting a patient encounter. The following morning was “personalization lab” where things that are done every day can be made into macro-like phrases or entire notes, to make documenting faster. Unfortunately on arriving for my training, I couldn’t get into the live environment. For an hour and a half. Our trainer kept calling the IT security folks who would say “She should be able to get in now”. Nope. After one and a half years of preparation for this moment, they waited until the day before to give us access. Seriously? Since anything that can go wrong does, why was that felt to be a good idea?
The afternoon was spent in a dress rehearsal. Thank GOODNESS we did this before seeing live patients. The hardware, which had been tested with two previous technical dress rehearsals, did not work as expected. Multiple issues ensued and I have minimal hopes that GoLive will not see similar problems crop up. It took up to two minutes for the Epic software to load on our thin clients . In order for us to get faster loads we had to get rid of the ability to open up our previous software in the exam rooms. This means, in order to see the patient’s old charting, I will have to carry another piece of hardware or leave the room. Not efficient, especially since there is also trouble with the database with all our scanned information. Next we discovered that logging into the thin client took us to our patient schedule instead of straight into the patient’s chart. Not only an efficiency problem, but a compliance issue since a patient could theoretically see other patients’ names and reason for visit.
We had software issues as well but those were minimal. Of course with no trainers to help the end users, we could accomplish only the minimal tasks our eight hours of training gave us. Go Live should be interesting–my associate has armed us with dark chocolate M&Ms (since alcohol would be frowned upon) and is bringing a cowbell to make sure she has no trouble getting the trainers’ attention.
Cowbells, chocolate and a shiny EHR software right out of the box. What could go wrong?
“Ambulatory 100” went well. The trainer, Joel, was knowledgable and went through a reasonably accurate episode of care with a patient. I think I can write an adequate note today IF the problem was not very complicated and IF I had thirty minutes to do it.
Over the weekend we will be able to access a “playground” and get a better idea of what the program looks like and how it functions. A physician acquaintance, who uses both Epic and our present EHR in her daily work, assures me that life will get better and patient care improve on Epic. This is encouraging.
Abundantly clear, even in early interaction with the program, is how personalization can make workflow better in the creation of a note. Will this improve diagnostic thinking over my present system? Hope springs eternal. Dropping charges looks like a breeze (there’s a surprise) especially with ICD10. Concern about how well the patient’s story will be documented lingers. When I’ve seen notes from ERs in other Epic systems, the narrative is often poorly done. We are told this is due to the way the system is set up rather than the fault of the EHR.
One of my present EHR’s big downfalls is how long it takes to process patient-related information outside of the note itself. Referral letters, lab results, radiology exams and other testing take forever to “verify” that I have looked at them. It’s a monumental task for a primary care physician , frequently feeling as if there are too many cats in the cage full of hoops to jump through. Hopefully we will cover this Wednesday in Ambulatory 200.
In exactly two weeks my office will “GO LIVE” with Epic EHR (Electronic Health Record) 2015. This is a much anticipated systemwide move from our present EHR software and has been heralded with a circus analogy, a horde of analysts and other HIT experts, inconceivable amounts of money, two years of planning and general dis-ease among the doctors who are about to experience the change (see what I did there?). We are going live before the rest of our statewide system and I give credit to my associate, Dr. Diana Irvin, for not killing me when she learned that we would be one of the two pilot offices. Of course there is still time for her to rethink that…
We begin “for real” training this morning, the first of three sessions. I participated in pilot training three weeks ago. This was poorly done and now worries me as to how today will go. For a software product that has been around for so long, it was astonishing to me that the pilot was so badly organized. Epic disavowed any responsibility for that in the voice of its representative at our last GLRA (Go Live Readiness Assessment) meeting. Fortunately I have every confidence in our Medsys consultant and Chief Medical Officer (CMO) to make the training more meaningful and efficient for physicians. They have impressed me over the last two years by having an understanding of how to make things work better for the doctors in matters of our developing EHR.
As a Physician Champion for this effort, the most meaningful training I’ve experienced occurred last week when I sat down with three IT analysts and went through a couple of scenarios specific to my workflow. After almost a year of Epic video examples I could finally see the power of the software. It’s clear that it needs a lot of personalization to make it hum, but I caught a glimpse of possibility. As a geek that makes me excited. As a physician, I don’t know. How much will this tool speed up my ability to see patients while amassing helpful data and improve patient care? Will I finally get home before 7 pm every night I work? My colleagues just want to take care of patients. They are not interested in software and most of them are not digital natives. How much can I help my associates in my role as Physician Champion, to speed up the tool? We’ll see.
I hope the circus analogy doesn’t make clowns of us all.