Friday, June 22, 2012
Greenwich Hospital's 'epic' upgrade
Greenwich Hospital's 'epic' upgrade
Published 01:00 a.m., Tuesday, June 19, 2012
When Lynne Hone went to the doctor for her annual physical last month, there was no seemingly endless pile of forms to fill out.
Instead, the 65-year-old resident of Old Greenwich sat at a computer at Dr. Franklin Loria's Stamford office and entered her medical history and medications into a secure program. Later, she received a code to create an account on MyChart, part of the electronic medical records system recently launched by Greenwich Hospital.
Hone's appointment was on a Friday. The following Monday morning, Hone got an email that there was a message from her doctor. Logging on to the MyChart system, Hone saw her blood test results, and a note from Dr. Loria with recommendations based on her appointment.
"I just find it so convenient and a great way to stay in contact with your physician," Hone said. "It's so much better than doing phone tag."
After two years of planning, Greenwich Hospital launched its new electronic medical records system in April. Designed by Verona, Wis.-based Epic Systems, the software creates a single electronic medical record that follows individuals everywhere -- from their community doctor's office to the hospital's Emergency Department to the outpatient laboratory facility and back home to the patient's computer.
The system will eventually connect the various branches of the Yale New Haven Health System, which, along with Greenwich Hospital, includes Bridgeport and Yale-New Haven hospitals, as well as the Yale Medical Group and the Northeast Medical Group, two physician groups affiliated with the system. Greenwich Hospital was the first to go live, with the rest coming on board by 2014.
In Greenwich, the system is mainly in use at the hospital, where doctors and staff in all departments have been trained to enter patient information, such as drug allergies and medical history, into the system as soon as someone is admitted. All of a patients' vital signs, such as temperature and blood pressure, as well as doctors' notes, laboratory tests and X-rays, are also entered.
The Epic system replaces an old electronic records system at Greenwich Hospital, whose officials say Epic has many functional advantages over the old program, designed by a company called MEDITECH. How the new system mainly differs is in the connectivity -- doctors throughout the community also have access to Epic, and when their patients are in the hospital, they can get updates in real time on their office computers, as well as their smartphones or tablets.
CHANGING PATIENT CARE
Most of the major changes have been noticed by the hospitalists, or doctors who specialize in the care of hospitalized patients.
Dr. Herbert Archer, director of Greenwich Hospital's hospitalist program, said the new system provides many opportunities for doctors to save time. For example, Archer saw a patient who had had a CAT scan at Yale-New Haven Hospital. While other hospitals in the system aren't "live" with Epic yet, they have started inputting patient information. If the scan hadn't been in the system, Archer may have repeated the test, or the hospital would have had the scan FedExed, and the Greenwich Hospital doctors would have had to interpret the results.
"As hospitalists, it's really changing the way we focus on the patient," Archer said. "There's no fax that has to be transmitted, no FedEx package that needs to be sent."
Doctors in the community also receive information as soon as a patient is discharged. It can be sent via computer, or set up to automatically fax information to doctors who prefer the hard copy.
"My time at the computer has decreased," Archer said. "It frees me up to talk to patients, talk to family members."
A small number of doctors, like Loria, also use Epic in their own offices. The office system allows them to offer the MyChart feature, which lets patients access their medical information themselves.
Only about a quarter of Loria's nearly 1,000 patients are on MyChart. Surprisingly, it's not mainly the younger, tech-savvy patients who have embraced it.
"I have 70- and 80-year-olds that love it," Loria said.
Loria thinks that may be because young people don't take as much of an active role in their health care.
Loria, who was previously director of the hospitalist program at Greenwich Hospital, recently opened a private practice as part of the Northeast Medical Group. He said Epic has made some aspects of the practice easier.
Recently, Loria ordered tests for a patient, who then had to go to Greenwich Hospital. If the patient had gone to Stamford Hospital instead, Loria would have had to print the information out and fax it over.
"They had everything in their hands when they arrived," Loria said. "That's the power of an integrated system."
It will cost the Yale New Haven Health System $250 million to install Epic. Greenwich Hospital's share of that is $30 million. Greenwich Hospital's President and Chief Executive Officer Frank Corvino says the cost is worthwhile.
"I think it's a major step forward for patient care," Corvino said. "I think it will improve patient quality and patient safety."
The other advantage is a widespread adoption of Epic. A large number of U.S. hospitals use the Epic system, including such high-profile institutions and managed-care organizations as the Cleveland Clinic and Kaiser Permanente, and 140 million Americans are registered, said Quinton Friesen, Greenwich Hospital's chief operating officer and the executive in charge of the project here.
"It has the potential, if you're in Florida, a doctor there could, with the proper permission, access your information here," Friesen said.
While all Greenwich doctors have access to the Epic system, to use when their patients are in Greenwich Hospital, very few have decided to use it in their own practices.
Every spare closet and shelf in Dr. James Brunetti's Cos Cob office is filled with patient charts. Brunetti, an internist, knows he will eventually have to transfer the information in the files to a computer, because of the mandate from the Patient Protection and Affordable Care Act requiring hospitals and doctors' offices to have electronic medical records by 2014.
Though Brunetti sees the advantages of the Epic system, especially when it comes to accessing information about his patients when they're hospitalized, he prefers not using the system for patients in his office, and having that information be accessible throughout the hospital system.
"When you go to an internist, or your gynecologist, the door's shut," Brunetti said. "If we're able to select what we can share, I think that will be better for the privacy of the patient."
LAYERS OF SECURITY
Hospital officials and doctors involved with implementing the system say there are layers of security to protect the privacy of patients.
Daniel Barchi, chief information officer of the Yale New Haven Health System, said most of the security in place is focused on observing who is viewing the files, and making sure the private information is seen only by the people who are working with the patient. Aside from encrypted passwords, there is a system in place that monitors who is looking at records.
"In most cases, the greatest risk is people on the inside," said Barchi, who installed Epic for an eight-hospital system in Virginia before coming to Connecticut. "Very infrequently does someone outside have access."
There are different classes of employees who can see certain information. A clerk in an office who is on Epic wouldn't be able to see anything more than a patient's name, address and insurance information, Barchi said.
If a doctor who is not involved in the care of a patient enters their chart, that is tracked. If something seems suspicious -- for example, the doctor is the patients' neighbor -- the doctor's name will pop up. Similarly, if someone looks at 20 records in one day, that would also raise an alarm. Random audits are ongoing.
"At all times we are randomly looking to see who is accessing what records and looking at any kind of inappropriate access," Barchi said.
If someone sees a doctor out of state who uses Epic, the patient would have to sign a form allowing the release of their medical records.
Dr. Dickerman Hollister Jr., an oncologist who was part of a team that evaluated various physician practice electronic medical records systems, said there are more ways to preserve privacy when the records are computerized.
"In a paper record, people can come in the office and take a chart," Hollister said. "If someone peeks at a paper chart, you don't know who did it. ... Is it perfect? I don't know if it's perfect, but it's very, very good."
People also shouldn't be worried about their medical record being changed, which is what happened in a scene in the 1995 Sandra Bullock movie "The Net."
Nothing can be removed from a record, and any change would be a replacement, Barchi explained, and the program would show who made the change and when.
"It's always adding to, never subtracting from," Barchi said.
SYSTEM ADDING TIME BEFORE SAVING IT
Privacy isn't the only concern Greenwich doctors have about Epic. While Archer, the hospitalist, says his time at the computer has decreased, other doctors have found it challenging to adapt to a new system.
"The good news is Epic does everything," Hollister said. "The bad news is Epic does everything."
Hollister says there are difficulties navigating around the program, because it does so many things. Doctors, who spent hours learning Epic before getting their login credentials, are also complaining about the amount of data entry.
"It's too early to judge the success of it," Hollister said. "It's slowed everybody down, there's no question about that."
There are some other aspects of the system that need improvement. Dr. Steven Mickley says, for example, it can be hard to find a patient in the system after they've left the hospital. Once they're discharged, doctors can't search for them by name, and instead have to scroll through the list of discharged patients.
"In four days, that's 1,500 people," said Mickley, an internist.
Brunetti said that while he appreciates that he can see all sorts of information about his patients before he visits them in the hospital, he and other doctors spend more time in the system to make sure they include everything that they need to.
"There's a lot of confirming right now, and I think there's a bit of paranoia," Brunetti said. "You don't want to be too secure in the system, but you want to take advantage of the information that's there."
Brunetti said he and other doctors also worry about losing "face time" with patients.
"When you talk to a patient, when you're on a computer screen you're talking to the screen," Brunetti said.
Loria said he's gotten around that challenge by tilting the computer screen toward his patients when he's using it, to show them what he's doing.
THE UPSIDE OF A CONNECTED SYSTEM
Despite the steep learning curve, Hollister sees advantages, especially since many of his patients get treatment at Yale. Before, with the paper record, he would write his notes by hand, and either dictate a letter or fax his handwritten note "of varying degrees of legibility."
Now, Hollister can pick a doctor's name in the system, and either send the note electronically or automatically fax what he typed.
Doctors and patients would see real value with more private specialists entering information into the system, Hollister said. Now, when someone sees a dermatologist, gastroenterologist and cardiologist, each doctor has their own chart. If they all used Epic, the doctors would be accessing the same medical record. They could see, for example, how one doctor is treating a patient's hypertension, and how another doctor is treating the patient's anemia.
"We do think it will eventually make care safer and more efficient," Hollister said. "What I would like to see in the years ahead is more of the independent community practices in Greenwich using Epic. The more physicians who are using it, the more valuable it is."
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Dr. James Brunetti in his Greenwich office, Thursday, June 14, 2012. Photo: Bob Luckey / Greenwich Time
Dr. Herbert Archer, who is director of the Hospitalist program at Greenwich Hospital, uses Epic Systems Wednesday, May 16, 2012. The software is intended to enhance patient care by creating a single electronic medical record that follows individuals everywhere. Photo: Helen Neafsey / Greenwich Time
Lynne Hone uses MyChart, a component of a new electronic medical records system being used at Greenwich Hospital and associated practices, at her Greenwich home Monday, June 5, 2012. A patient of Dr. Franklin Loria, Hone uses MyChart to check her health records. Photo: Helen Neafsey / Greenwich Time