YIMA marks an anniversary: One year alive and well with Epic

Doctors, staff and patients are happy with access, MyChart and other benefits

Yale Medical Group Practice Manager Johanna Torres chats with clinical receptionists Racquel Miller (left) and Roseanne Gagne about their experience with Epic.

On the morning of October 19, 2011, on the third-floor of the Yale Physicians Building, Yale Internal Medicine Associates (YIMA) became the first practice at Yale to go live with the Epic electronic medical record (EMR). A year later, it’s business as usual—but that business, say YIMA providers, has changed dramatically, and, more or less, for the better.

“From a clinical perspective, Epic has had some big upsides in helping us provide the best possible patient care.” said YIMA practice director Matthew S. Ellman, MD.

Among the benefits, Dr. Ellman cites the way the Epic EMR gives providers “rapid access to all sorts of clinical data: lab and imaging results, letters and consultation notes, to name a few.”

He is particularly impressed with improvements in the quality of medication lists. “You have immediate access to update med lists, order medications electronically and verify what the pharmacy has dispensed,” said Dr. Ellman.

Epic also is able to target potential drug interactions, one of the application’s so-called “smart features.” And though these warnings may sometimes be spurious and “create a bit of a slowdown,” said Dr. Ellman, “all you need is one useful reminder out of a thousand.”

Diana Alvarez (left) and Theresa Harris are using Epic in the YIMA call center.

Better access, efficiency

Little of this was possible in the paper records era that YIMA left behind. According to members of the practice, Epic has resulted in other important changes as well.

“It’s made us more efficient,” said practice supervisor Hillary Marino. “For example, we’ve noticed a big improvement in the speed of our call center operation. As more practices went live with Epic, we had much faster access to notes, so we could schedule referrals much quicker. We didn’t have to wait around for anyone to send us charts. They were all right there in the EMR, so we had accurate and complete information at our fingertips.”

Another plus, noted Marie Follo, director of practice management, who plays a continuing role in Epic implementations throughout the clinical practice, is that the EMR has “given us the opportunity to monitor staff activity better and more fully engage our medical assistants.”

YIMA’s experience with the application has also led to a front-desk improvement that has rippled throughout Yale’s clinical practice. “With Epic, we’ve been able to standardize our intake process,” said Follo. “Every patient going in is asked the same set of questions and goes through the same procedures of updating meds and having vital signs done. This standardization is a good thing that will lead to better and more efficient care. But it’s too soon to see if it will translate into cost savings.”

Members of the YIMA staff gathered to mark one year on Epic: (seated, l-r): Christine Golden, Orimena Givens. Standing (l-r): Hillary Marino, Raquel Miller, Yvonne Augur, Tonya Daniels, Donovin Gianfredi and Blossom Linton.

Patients like MyChart

YIMA’s recent Press Ganey numbers provide evidence of significant improvements in patient satisfaction. Of course, it’s hard to know how much exactly the Epic EMR has contributed to the uptick, admitted Dr. Ellman. But, “patients tell us they really like the quick, easy access to their test results on MyChart,” he said.

He predicted that as more clinical practices and then Yale-New Haven Hospital go live, everyone will reap the benefits. “I’m really interested in taking advantage of Epic to be able to practice ’population medicine’ and proactively manage groups of our patients. For example, once the reporting functions are available, we’ll be able to reach out to groups of patients due for preventive health screening or monitoring of their chronic conditions,” Dr. Ellman said. “In the long run, I know that Epic will enhance the quality of care in our practice.”