Epic update: Yale Internal Medicine Associates goes live

The group hopes its experience will pave the way for other practices

alt textHillary Marino, right, poses as Matthew Ellman’s patient to demonstrate the doctor-patient-computer “triangle.” 

Hillary Marino, right, poses as Matthew Ellman’s patient to demonstrate the doctor-patient-computer “triangle.”

In the marathon, the first runner over the finish line used to receive little more than a laurel wreath. In the long-distance race known as the implementation of the electronic medical record (EMR), Yale Internal Medicine Associates (YIMA), the lead Yale Medical Group practice to go live with the EpicCare Ambulatory application, expects to receive a considerably richer prize.

“This is giving YIMA the opportunity to look at and improve all aspects of patient care,” said practice director Matthew S. Ellman, MD. “And because of the close working partnership we’ve developed with the Epic team, what we’ve learned will help the other YMG practices make their EMR implementations as smooth as possible.”

alt textWilla Marion abstracts data from YIMAs more than 5,000 paper charts 

Willa Marion abstracts data from YIMAs more than 5,000 paper charts

YIMA will formally begin using Epic on October 19, and the switchover from paper to electronic records represents what Dr. Ellman described as “a clean sweep.” Not only is the practice making a monumental change in the way it deals with patient information, YIMA has also had to deal with wholesale changes in geography: The practice has moved twice in two years. In 2010, YIMA left its longtime headquarters in the Dana Building on Howard Avenue for new offices across the street on the second floor of the Yale Physicians Building. A year after the practice settled in, it moved again, this time from the second to the third floor.

alt textStacey Covington takes vital signs. Epic will give medical assistants a bigger role. 

Stacey Covington takes vital signs. Epic will give medical assistants a bigger role.

“They’ve done an amazing job of coping with all of this,” said Marie Follo, YMG director of practice management. Follo, who has played a key role in shepherding both moves and the Epic implementation, explained that the two events have helped planners deal with a crucial aspect of the switchover to an EMR: the fear of technological intrusion.

“I’ve had patients tell me, ‘I used to have a heart doctor, now I have a computer doctor,’ ” said Dr. Ellman. “Because internal medicine is such a cognitively based field—with examinations, interviews and counseling being key components of what we do—we had to make sure that computers didn’t get between us and our patients.”

The move and the need to reconfigure the new space gave Follo, Dr. Ellman and their colleagues a chance to learn how other health care institutions have avoided this pitfall. “There’s a science to this,” said Dr. Ellman. “You have to maintain a triangle, with the computer equipment off to the side so that it doesn’t interfere with eye contact between the patient and the provider.”

One of the hallmarks of the Epic EMR is the ability to share information, and this is something the triangle arrangement makes easy. But what at first glance seems simple and intuitive required a complete redesign of YIMA’s examination rooms to make such a setup possible. The Epic implementation has made possible other kinds of redesigns as well. “We can use Epic as a catalyst to make some important work flow changes in the practices,” said Follo, “and we’re really excited about this.”

One of those changes—an increased involvement in patient care for the practice’s certified medical assistants—came about as a result of the abstraction training that almost all of the practice’s staff took part in last August. Being involved in abstracting data from the more than 5,000 charts in YIMA’s paper files gave the medical assistants a “greater understanding” of why such EMR entries as allergies and medications are so important. “The assistants will now be more fully engaged in updating this kind of information with every patient visit,” said Dr. Ellman.

“Epic is going to change everyone’s job,” said YIMA practice supervisor Hillary Marino. “From the telephone operators to the triage nurses, everything we’ve worked on in the planning stages will make our work smoother and quicker.”

For his part, Dr. Ellman lauds Epic’s ability to more efficiently “manage patients with such chronic diseases as diabetes,” but he offers an antidote to any unrealistic expectations. “Epic is simply a tool,” he said. “But once it’s fully implemented and fine-tuned, we expect that it will improve the quality of patient care that people have come to expect from us.”