YSM, System enter Epic agreement: work begins immediately

Letter from the CEO

Yale Medical Group CEO News is a newsletter from David J. Leffell, MD, deputy dean for clinical affairs for the Yale School of Medicine. He covers topics of interest to the practicing physicians. Write to Dr. Leffell at david.leffell@yale.edu.

David J. LeffellDavid J. Leffell 

I am writing with exciting news about a major transformation at Yale Medical Group and Yale-New Haven Hospital. Yesterday the Yale New Haven Health System (YNHHS) and the Yale School of Medicine entered into a multi-year agreement with Epic, headquartered in Madison, Wisconsin, for an electronic health record (EHR). This triggers what will likely be the most substantial change in medical practice in the history of Yale Medical Group and the Health System.

While the potential rewards of the EHR are huge, the cost in dollars and in time will be daunting. The opportunity to redefine how we practice and to have the ability to capture our clinical data for research purposes will help ensure our position as a leading academic practice and medical school. What is especially significant about Epic, and this project in general, is that the EHR will be one record, driven off a single database for inpatient care, ambulatory care, and care provided in the private offices of community physicians who choose to participate. The deployment of the EHR will help knit together specialists, primary care doctors, system hospitals (Yale-New Haven, Bridgeport and Greenwich) and doctors affiliated with those hospitals.

How we chose Epic

The process we followed to get to this point has been thorough, diligent and lengthy. For many years we have talked about an EHR, explored various products, and analyzed the implications of moving forward with an integrated EHR.

In 2008, almost a year before federal legislation that provides financial subsidy for physicians using an EHR was enacted, the school and the hospital initiated a comprehensive consultation to identify a vendor of choice for an ambulatory EHR. More than 150 faculty and staff helped evaluate software products.  At the end of this period, we elected to pursue a contract with Epic, the number one vendor of integrated EHR solutions in the country. Epic is being implemented or is in use in such major health care systems as Cleveland Clinic, Kaiser Permanente, New York University and University of Pennsylvania.

Epic has major advantages and a very broad range of features. In addition to the conventional components of an ambulatory EHR and complete integration with the inpatient system, Epic has a superb patient portal that will improve our communication with patients and with referring physicians. You may want to spend some time exploring the Epic website for more information.

The EHR is about patients and care

Implementation of an EHR is complex and stressful under the best of circumstances. Yale Medical Group physicians are distributed over a broad geographic area, function within individual sections and departments, and have developed idiosyncratic clinical workflow systems that could benefit from ”re-engineering.” In this regard, the deployment of an EHR is more about workflow than it is about technology. It is, in fact, about our patients and their care. It is about how we conduct our practice and how we relate to referring physicians. Importantly, it is about how the public perceives us.

While YMG’s practices will be among the first in the system to implement the EHR, we have not yet determined our rollout sequence. We know that most of us in the ambulatory environment will be converting from a paper record to an electronic record. In some ways, this will be more challenging than the process will be for clinical areas currently using Centricity, since they will be able to migrate their data to the new system. Before any implementation takes place, months of planning are necessary, and your input during this phase will be critical.

Faculty involvement will drive our success

One of the attractions of Epic is that the vendor provides model templates for each medical specialty. Ironically, because we have delayed implementation of an EHR while others proceeded ahead of us, we will benefit from their experience.

There is limited need for customization, and we believe there will be no need to “reinvent the wheel.” At the same time, we have a unique perspective as practitioners of academic medicine, and will be providing many opportunities for faculty to contribute to improvement of model templates and development of additional functionalities.

The EHR will boost clinical research

One of the most important considerations for us in selecting the EHR application was the degree to which the software would be able to serve our clinical research needs. In that domain we have several considerations: first, interfacing with a clinical trials management system that will permit seamless integration of all of the components of clinical trial activity; second, medical billing compliance related to clinical trials; and third, the ability to build a clinical research data repository. The repository will bring together data from a wide range of disparate sources so that we will be able to leverage our huge patient population for clinical research.

Communication in the coming months

Over the coming months, we will visit your department and talk with you in detail about the nature of the implementation. We will rely on your participation. It is well-known that successful implementations depend on physician engagement. I believe we are all eager to benefit from a system that will improve our workflow, improve efficiency, and allow us to enhance the quality of care that we deliver to patients.

Given the complexity of this endeavor and the number of people that will be involved (it is estimated that across the system 150 employees will be required on a full-time basis to implement and maintain the system), we know there will be a great need for accurate and useful information. To that end, we are collaborating with YNHHS to develop a formal communications strategy.

Please feel free at any time to send me your comments, thoughts or suggestions for improvement. If at any time you feel that we are not communicating adequately, please let me know. When we work with departments to develop clinical leadership teams, I hope that you will participate energetically.

Shared CMIO position will set a new tone

I’d like to mention one other exciting bit of news: We are in the final stages of hiring a chief medical information officer who will be accountable both to the School of Medicine and to Yale-New Haven Hospital. This shared position sets the tone for the context in which the EHR will be implemented. Following the precedent that we created by pursuing a joint due diligence process, this position will help change the way we all think about hospital, school and system relations.

It is critical to emphasize that Epic will be implemented across the whole Yale New Haven Health System and will provide more opportunities to interact with our colleagues throughout the system. We believe this will provide great advantages over time. While there is inevitably some anxiety about any new relationship, given the national expectation of broad, integrated EHRs, the system-wide approach will put us in an excellent position to create accountable care organizations and health information exchanges.

The YMG leadership team looks forward to working with you to make the implementation of your EHR a major success. Thank you in advance for your participation.