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An interview with Daniel Barchi

With Epic now in place at all YNHHS delivery networks, what positive changes have you seen since implementation?

People are beginning to see the value of an integrated electronic medical record, how having data all in one place allows us to care for patients more safely and efficiently. Hundreds of times a day, the system helps catch potential safety concerns before they become problems.

How has Epic helped improve the quality and efficiency of care?

Clinicians don't have to go to multiple sources for patients' medical histories, lab results, physician notes and other information. Epic brings this all together, across the different physicians, and settings where patients receive care. Epic frees clinicians to do what they do well, which is clinical decisionmaking.

Are there other Epic benefits?

Epic also includes tools for revenue cycle management, including billing. The ITS (Information Technology Services) and Finance teams have built a clinical trials management system that helps determine where we should send bills for patients who receive care from the health system and are also involved in a clinical trial. For example, if a patient has an X-ray as part of the clinical trial protocol, the bill must go to the government agency or company that sponsors the trial. If that same patient has an X-ray because he or she tripped and broke a bone, the bill should go to the patient's insurance company. Since we implemented the clinical trials management system, the average amount of money tied up in unbilled clinical trials claims has dropped from $9 million to $2 million per month.

What are some opportunities for improvement with Epic?

We are constantly working to improve the system and make it easier to use, which is what Epic optimization is all about. Best practice alerts (BPAs) are an example. The ITS team is building BPAs which alert physicians to drug and allergy interactions, indicate when a patient is due for a mammogram or colonoscopy or if the patient is a candidate for a clinical trial. In addition, we have many opportunities to evaluate new features in Epic — modules we have not yet implemented that have significant potential for workflow efficiency, safety and patient engagement.

What are some other Epic optimization projects?

There are many that involve clinical, revenue cycle and practice management enhancements. One recently completed project is an Epic diabetes registry that allows care coordinators to access information on all diabetes patients and sort that information according to certain criteria, for example, when patients were last seen, their other medical conditions and test results. This type of registry will help care providers proactively manage patients' health. We also made notable enhancements to the facility boards on the inpatient units. These displays provide real-time data in the form of easy-to-read icons that point clinicians to key facets of the patient's care, such as readiness for discharge or risk for certain negative events. Changes like these have a very tangible impact on the way YNHHS clinicians provide care.

Why is Epic optimization necessary?

Optimization is as important or more important than the Epic go-lives. Our Epic team did a great job installing a tool; it's now our shared responsibility to customize and constantly improve that tool so that it is responsive to the ever-increasing demands for more-efficient, higher-quality patient care.

What does Epic optimization entail at YNHHS?

There are formal and informal processes that allow Epic users to provide feedback and suggestions for optimization. Users may complete a form on the ITS page on the YNHHS intranet; we receive a couple hundred of these forms a month. Epic team members also solicit feedback when they're doing formal training with users. Informally, ITS staff members are always talking to users about their ideas to improve Epic. We also work closely with colleagues at Epic Corporation on features and modules that align with YNHHS organizational strategic goals.

How is Epic optimization benefitting patients and staff?

By helping care providers better identify patients — which is critical to patient safety — and easily access as much information as possible about patients' conditions.

Because Epic is system-wide, care providers at any YNHHS delivery network can access one, up-to-date record for each patient, no matter where in the system a patient is being treated. The hospital recently received an email from a patient's family member, who works in health care and is familiar with Epic.

The family member said that with all her loved one's information in Epic, doctors and nurses were able to provide treatment faster and avoid problems with medication allergies.

When will optimization be complete?

Optimization is ongoing; it is a continuous performance improvement process. One of the best ways to continue optimization is to ensure the health system is using the most up-to-date version of Epic. This August the system will upgrade from the 2012 to the 2014 version. In one move, YNHHS will gain the benefit of two years of Epic's development and optimization work. The upgrade will not require any new training, but our users will see many improvements and fixes when they use the system.

I couldn't be more proud of all the ITS teams that have worked so hard to implement and optimize the electronic medical record and improve the end-user and patient experiences.

 
Yale-New Haven Hospital news release
ynhhpublicrelations@ynhh.com

Yale-New Haven Hospital is a nationally recognized, 1,541-bed, not-for-profit hospital serving as the primary teaching hospital for the Yale School of Medicine. Yale-New Haven was founded as the fourth voluntary hospital in the U.S. in 1826. Today, the hospital's two New Haven-based inpatient campuses include Yale-New Haven Children's Hospital, Yale-New Haven Psychiatric Hospital and Smilow Cancer Hospital. YNHH has a combined medical staff of about 4,500 university and community physicians practicing in more than 100 specialties. YNHH's York Street campus and associated ambulatory sites are Magnet-designated by the American Nurses Credentialing Center.

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