Just 10 years ago, truckloads of paper lab results made the daily journey from Brownstown to Lancaster General Hospital.
The pre-Epic era may seem like a distant memory now, but not too long ago, physicians and nurses charted on paper. Providers in the hospital used an electronic system only to view clinical results and dictations.
In February 2007, Walter L. Aument Family Health Center kicked off LG Health’s transition from paper to electronic charting, scheduling, registration and billing. Over the next four years, additional practices, LGH and Women & Babies Hospital came online, and independent practices joined Community Connect.
Michael R. Ripchinski, M.D.
Michael R. Ripchinski, M.D., Physician Executive for Quality, said the Epic implementation was driven primarily by LG Health’s mission to improve the health of our patients and support the growth of LG Health Physicians. The project cost over $100 million, mostly due to additional labor needs.
“Implementing Epic was an investment we made to benefit our patients and our community,” he said. “We needed an electronic health record to enable continued growth, remain competitive and unite our physicians around standards to improve outcomes.”
To build support and excitement for what was dubbed “Project Atlas,” team members received slide rules and hats with the slogan “Failure is not an option.” (That quote was borrowed from a movie about the heroic efforts to return Apollo 13 safely to Earth.)
Dr. Ripchinski said physicians and nurses -- who helped choose Epic, then worked within IT to build the system – played a key role in the successful implementation. Clinical e-Health analysts and clinical informatics liaisons continue to support physicians to maximize Epic use, including efficient ordering and proper documentation to accurately capture patients’ illness severity.
Learning the new system led the average provider to temporarily reduce patient volume by about one-third over the first month in the practices, he said. Some providers still report spending more time on documentation after hours.
Although change can be difficult, especially after many years in practice, Dr. Ripchinski said most providers now recognize Epic’s value. In particular, the system is beneficial for population health and disease management tasks, such as quickly identifying opportunities to screen or treat patients.
“Now we’re able to screen more patients and help them to better manage their conditions,” he said. “We can design new processes and put them into order sets and care pathways in Epic to make it easier for providers.”
With Epic now solidly in place, Dr. Ripchinski said the next phase will focus on optimizing patient engagement and disease management.
“The next 10 years will be about driving value and reducing burnout,” he said. “We’ll be looking at how to make the EMR really work to take care of these populations of patients, to make things easier for providers, and to bring technology and processes together to engage patients and improve outcomes.”
Other physician perspectives
Bill Bakken, M.D.
Philip J. Billoni, M.D.
Edward Chory, M.D.
Bill Bakken, M.D., of Family Medicine Abbeyville: “Ten years of Epic? Wow! At times it seems like an eternity. In all honesty, as with all technological advances, there are pros and cons--- especially for those of us who grew up with slide rules rather than computers.
“Briefly: On the positive side, Epic keeps me on my toes and allows me to see the big picture for my patients with a speed that was impossible previously, medications can be refilled quickly and patients can email me directly. On the negative side, you can never really get away from work, it slows you down, prolongs your work day and likely fuels professional burnout. All this and the next update rolls out tomorrow.”
Philip J. Billoni, M.D., of LG Health Physicians Hospitalists: “Although Epic has its frustrations, I could not imagine doing the work I am doing without it. As a Physician Advisor, I need to review a variety of cases from a utilization, documentation and quality perspective. With Epic, I have real-time access to any chart. The in-basket feature also lets me connect with providers without paging them if the issue is not time-sensitive.
“I also participate in the Readmission Committee and Mortality Committee, which requires in-depth chart review. Efforts to find trends or meaningful data would be difficult and labor-intensive without an EMR. Finally, as a practicing hospitalist, I depend on quick access to Radiology images, Lab data and outpatient records to provide efficient, quality care.”
Edward Chory, M.D., of The Surgical Group of LG Health: “Epic is an amazing, powerful tool that allows easy access to medical information, but it is still evolving and struggling to fulfill its potential for two reasons: one practical and one philosophical.
“… The ability of all systems to share information may be a tall order, but to truly fulfill the promise of EMRs, it must be realized. I should be able to see CT or MRI images, operative and pathology reports from other health systems.
“… Also, the primary focus is data collection, predominantly to maximize billing. Relevant clinical information is often difficult to find, buried in a giant pile of clinically unimportant information.”