Epic: Changing the Way Medicine is Practiced
On the clinical side, Epic’s seamless flow of data enables collaboration among physicians; facilitates communication between providers and patients; improves access to health information; and helps to standardize care. From the research standpoint, having a wealth of data in one place represents a potential that investigators are just beginning to explore. While the system is refined and updated continuously, clinicians are becoming increasingly comfortable using it. “There was a steep learning curve, but we wouldn’t want to go back to the way things were,” said Allen Hsiao, M.D., associate chief medical information officer for Yale New Haven Health System (YNHHS), and associate professor of pediatrics (emergency medicine) and of emergency medicine. “We’ve all gotten used to having a better understanding of our patients and their illnesses as a whole because of all the information we have available to us now. Having ambulatory, inpatient, emergency department, and operating room information all in one place has dramatically changed the way we practice medicine for the better.”
The Big Bang
Yale’s implementation of Epic—completed under budget and on time—is nationally recognized for its efficiency and is serving as a model for other institutions. Over the span of three years, Epic has been implemented at Yale-New Haven Hospital; Greenwich Hospital; Bridgeport Hospital; the Yale Medical Group (YMG); Northeast Medical Group; and Yale Health, the health plan for Yale employees and students. There are currently over 1,200 physicians using Epic in their offices and more than three million patients enrolled in the system. “We moved quickly, but always with an eye toward patient safety and the care we provide,” said Lisa Stump, VP, associate chief information officer for YNHHS, who served as project director for the Epic implementation.
Yale chose a “big bang” approach to implementing Epic, bringing the entire system—comprising clinical care, scheduling, and billing—live simultaneously at each site. “That makes it a much more robust experience for the end user, and the users get the benefit of seeing an integrated record,” said Lisa Edwards, director of clinical applications for YNHHS. Rather than getting bogged down in perfecting each element, Yale took a broad approach in soliciting input from all stakeholders and user groups, following a clear plan that included standards for building and testing as well as adhering to a strict timeframe. Physicians from across the health system collaborated to create standardized protocols, using their collective experience to create a single source of content. As a result of careful planning, the collaborative build phase, in which decisions were made on ways to customize Epic for Yale’s needs, was completed in just six weeks for the ambulatory application and 12 weeks for the inpatient and revenue cycle applications. Every time a site went live, the Epic team immediately addressed problems, allowing the team members to devise solutions and improve each successive go-live. For example, when the first YMG practice went live in October 2011, there were more than 250 trouble tickets for issues that needed fixing; when the last YMG practice went live in November 2013, there were only three.