Jonathan Dort, MD, is Medical Director of Minimally Invasive Surgery in the Department of Surgery at IFH. He learned and used Epic as a surgeon at Carilion Clinic in Roanoke. Dr. Dort shares his wisdom and offers advice to his Inova colleagues in preparation for the transition to Epic.
Q: What are some of the biggest challenges that physicians will face as Inova implements the Epic system?
A: Learning the system and the conversion will probably be the toughest and give people the most angst. As with any new thing, unfamiliarity causes a certain level of frustration in trying to figure out where to find information, how to enter that information, etc. In the initial stages, it can double or triple the time it takes to do simple tasks such as write an order.
I equate it to moving to a new city. The first day you drive to work, you have your maps and navigation system and spend a lot of time trying to figure things out. Later, after you’ve driven the route one thousand times and know your way around, it’s second nature; you don’t think about it.
Epic is the same. Initially, you will have to read and reread instructions and figure out how to input things, but after you are immersed in it, there’s less stop and go, less frustration.
Much of Epic is intuitive, but much of it also requires knowing where to look for things.
Q: What are some of the biggest benefits that physicians will experience with Epic?
Everything is on one system. As a surgeon, it’s easy to find all the information you need on patients with just a click of a button – previous visits, progress notes, labs and X-rays, ER visits. Every time a patient makes a visit to a physician office or outpatient facility, his or her allergy and medication list is updated. You have one-click access to all that information as well.
Universal access. When you are rounding on patients on the floor, you can access all charts from the nearest computer. You don’t waste time walking around the nurses’ station looking for charts. You don’t have to share charts with anyone, so there’s no risk of something going missing. You can access information from anywhere in the hospital, or in your office, or in your house, if you need to. With remote access, you can sit and look up all the new labs or X-rays and write notes. No more searching for charts or calling for X-ray results. In this sense, the system is incredibly time saving.
Clarity and legibility. Nurses and other clinicians no longer have to try to make sense of illegible handwriting. They can tell exactly what was written and when. This cuts down on medication errors and improves patient safety. It’s helpful for us physicians as well – we don’t have to worry about legibility when reading prior physician notes on inpatient progress or outpatient clinic notes. We can actually read what was written.
More efficient care. Epic gives you the ability to have pre-op instructions and orders automatically ready for anesthesia or people taking care of the case. They don’t have to wait for the surgeon to walk in with a handful of paper in the morning. Everything is electronically accessible anywhere there’s a terminal.
All of these factors – single system, easy access, legibility – make patient care and everyone’s jobs a lot more efficient. No time is wasted hunting down X-rays or charts, or printing off copies of reports.
Improved research. Epic will be invaluable to Inova’s efforts to broaden its research efforts. Databases can be collected in one place and clinicians can access that information at a terminal instead of under piles of charts in Medical Records. Epic has the ability to collect patient lists, user groups, procedure codes. It allows all sorts of manipulations of data and access that you don’t have with paper charts. Inova’s Centers of Excellence will be able to maintain and update required patient databases much more easily and accurately.
Q: Do you have any advice for your colleagues regarding Epic?
A: Be patient with it. The transition may be tough and painful, but try not to be too skeptical. Once you’ve developed a comfort level it will make your life so much easier. When you no longer have to spend half your rounding time looking for a chart, when you’re able to get all information on a patient with just one click, when your office staff doesn’t have to spend time scurrying around for information – you’ll reap the benefits.
Go to meetings now to help develop a more user-friendly end product. The output is only as good as the input.
And make a full commitment. If some people are still using paper from the outside, the system won’t be as efficient or useful.