RCRC’s Executive Director, Jody Hoffer Gittell, shares her reflections on what she learned during her recent visit with Epic Systems in Verona, Wisconsin:

I was in Madison last week to speak at the University of Wisconsin School of Business, hosted by friend and fellow MIT grad Chip Hunter who is now a dean there. Led by Chip’s colleague Mark Covaleski, we were invited to spend much of the day with Epic Systems — soon to be the largest EHR vendor in the US it would seem based on current trends — they serve several of RCRC’s partners and clients including Dartmouth, Kaiser, Group Health and most recently Partners Healthcare. I could say a lot about the people of Epic (Katie O’Brien and Jacob Engel and Sarah Carroll and Leela Vaughn are terrific) and the funky campus they have built (somehow weaving together cow themes with intergalactic themes if you can picture that)! Also a fun sliding board from the second floor to the first if you need to get down quickly…

jody at epicBut for now let me share just a few things. Epic was started in 1979 by Judy Faulkner, who programmed data for some MDs who were doing research in an outpatient setting. They started with 3 people, then up to about 400 people 10 years ago, now at 6,200 and moving toward 11,000. Their product has taken off for many reasons but one in particular I think – they were designed from the start for the outpatient setting, moving eventually into inpatient but with a solid foundation in coordinating the complexities of outpatient care, including a well-developed interface with patients and families. Other EHRs have tended to start in inpatient then move to outpatient from there eventually. In the emerging era of accountable care, with the likelihood of rewards for delivering good population health, outpatient care is now KEY and Epic was designed to support it.

Of course there is always room to do this even better, for example going beyond the technical infrastructure to support the relational infrastructure of care coordination. As a colleague in one major health system said: “Tying Epic to RC would be huge in terms of what we are doing here.” The same could be said for other EHR vendors.

 

RESPONSES FROM THE RCRC COMMUNITY

From Paul Levy, former CEO of Beth Israel Deaconess:

Another view! http://runningahospital.blogspot.com/2012/10/the-stockholm-syndrome-and-emrs.html

From a colleague in a multi-state healthcare system:

“Using the patient-centered information in the medical record to connect the provider care team with RC’s focus on shared goals and shared knowledge would seem to be a very powerful and exciting combination.”

From a colleague in a Georgia healthcare system:

“[We just adopted Epic because] it is widely regarded as the best clinical solution in the marketplace today… You are correct in pointing out that Epic is built around the ambulatory side, and it will be interesting to see over the next few years the extent to which the patient is allowed to view their own patient record in the network. It is very much dependent on the provider, and typically a very limited view is allowed. For instance, the functionality exists on the provider side to track and graph patient vitals, A1C, lipids over time, and the patient view of their record (PHR) can be a reflection of the provider view (EHR). But for most networks, the patient view (PHR) is highly restricted; in our personal case it is just an email system to and from the office providing notification that lab tests are complete! Legal issues are the main reason for this restraint, but I hope that over time this changes, so that all the money spent on these systems is allowed to provide benefit to patients themselves.”

From a colleague in a California healthcare system:

“I love the direction you are going. Linking the technical with the relational – just what is needed. There are so many possibilities.”

From Tage Kristensen, Danish consultant/academic:

“Thank you so much for this and many other informative mails. The issue of EHR vendors is of course relevant in many countries. I looked at a quality assessment in which Epic was only ranked as the 6th best. (Although it had the highest number of users).”

http://www.medscape.com/features/slideshow/EHR2012#4

From Shirley Gibson, Virginia Commonwealth University Health System:

“Relational coordination is pervasive in every piece of work I do on a daily basis…You have uncovered the basic theory of all interactions. As I read these interesting reflections on Epic, I thought I would ask you if you wanted to consider doing any comparisons with other information systems. We are a Cerner platform and are working with our Deputy Director to coordinate a visit for Secretary of Health and Human Services, Kathleen Sebelius. Cerner is a competitor so comparison might be relevant? Just a thought!”