Epic Update: Three new users assess the electronic medical record

While change can be difficult, some are starting to see results

Fifteen Yale Medical Group practices have gone live with the Epic electronic medical record (EMR) since October. Each of these practices started with a kickoff meeting, underwent a workflow review, installed new hardware, began the massive task of abstracting data from paper records and prepared by training.

While change may not be easy—and people’s experiences with it vary—some practices are seeing results. We asked three new users to share their stories.

Smoother than imagined

alt textAnushree C. Shirali, MD 

Anushree C. Shirali, MD

Anushree C. Shirali, MD, a kidney specialist, began using Epic when Yale Nephrology went live in January. While she was “pretty familiar” with electronic records, “a fully integrated EMR like Epic was definitely new to me,” she said.

Yale Nephrology previously had kept all of its records on paper, and Dr. Shirali, like many providers, looked at the transition to Epic with "a lot of trepidation." However, she found the implementation "smoother than I'd imagined."

In particular, she touts Epic’s In Basket suite of communication tools. "All of the patient information is in one place, which makes it easy to communicate with other providers,” she explained. “This can be a real time-saver."

That benefit will increase as Epic is phased in throughout the Yale New Haven Health System, and the current divisions between the inpatient and outpatient worlds vanish. A single Epic EMR will offer “a seamless avenue of patient information,” said Dr. Shirali. “We’ll be able to take care of everything at once without having to look in multiple places.”

That’s the goal, but at present, Epic remains “a work-in-progress,” she said. “It will take time for everyone to adjust.”

Speedy results with MyChart

alt textDaniel Barchi 

Daniel Barchi

Daniel Barchi, chief information officer for the Yale School of Medicine and the Yale New Haven Health System, is one of the senior administrators overseeing the Epic implementation and knows all the capabilities of the software. When it came time for him to schedule his annual physical earlier this year, he made the appointment with Matthew Ellman, MD, director of Yale Internal Medicine Associates, in part because he wanted to experience Epic himself as a patient.

“I’d never had a physician who used an EMR, and I especially wanted to see what MyChart was like from a user perspective,” said Barchi. After his exam, he went for blood work. “I was not a good patient,” admitted Barchi, who waited a few weeks before getting around to having his blood work done. He finally went to the Yale Physicians Building for the blood-drawing procedure and, because all his information was already in the system, was on his way to work by 7:15 a.m.

At 9:20 a.m., during a lull in a planning meeting, he found a MyChart message on his iPhone. “Not only did I have the results and a note from Dr. Ellman, telling me that everything looked good, but my doctor also told me that he’d e-prescribed a supplement that I could pick up at my pharmacy. All this happened in about two hours, just like clockwork,” said Barchi. “This was way beyond what I expected. From my perspective as a patient, Epic’s opening up a whole new world.”

Improved communications

alt textCyrus Kapadia, MD 

Cyrus Kapadia, MD

Gastroenterologist Cyrus R. Kapadia, MD, is a veteran when it comes to working with EMRs, but while he could see computerization’s immense potential, he noticed a problem with the inpatient and outpatient systems developed at the hospital. “They didn’t easily communicate with each other,” he said. “They were grossly handicapped.” Having one system will eliminate that difficulty, Dr. Kapadia said.

Since Epic went live in Digestive Diseases in January, he has discovered its usefulness in eliminating another drawback. When physicians working in busy primary care clinics sent subspecialty consultations, there was often a delay in finding out what the subspecialist had recommended. Tracking down the information “could be very labor intensive,” he said. “Epic’s remarkable ability to generate and fax letters immediately makes this a thing of the past. Every medical resident is in the Epic database and associated with a fax number, and thus far, they’ve received what I sent about their patients one hundred percent of the time. This is a phenomenal advantage.”

Of course, transitions are not always smooth and Dr. Kapadia has seen a few challenges—“something out of the ordinary comes up almost every day, and that has created its share of frustrating roadblocks” he said. But in his experience the Epic trainers and support staff have been “highly professional and have the patience of angels.” He said, “It will take a little while for Epic to become a well-oiled machine, but overall, I see only positivity.”