In July 2010, Yale New Haven Health System announced that it would implement the Epic system which would provide each of its patients with one patient number and one electronic medical record. This record allows staff to securely access each patient's information online and ultimately will support improved patient care throughout YNHHS.
Since that 2010 announcement, an Epic Implementation Team was formed; the Epic clinical and administrative systems were built to support all of YNHHS, the Yale Medical Group and many private practice physicians; the Greenwich delivery network went "live" as did many physician practices; and detailed planning prepared the YNHH delivery network for the third largest "go-live" in Epic's history.
On January 31 at 4:30 p.m., the much anticipated go-live on the York Street campus kicked off. "Epic is a huge investment and major contributor to what we can do to improve patient safety and quality," said Richard D'Aquila, president and COO, before pulling the switch in the auditorium at 55 Park Street.
"Epic is more than good technology — it ties together so much information that will help us drive superior performance. This is a major step towards making Yale-New Haven an even stronger organization."
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On Saturday afternoon, the Surgery/Trauma Unit had five admissions – and staff were ready to admit and care for them using Epic. Marna Borgstrom (left) asked the nurses on the unit to show her how they signed in on Epic. Shown (l-r) in first row are: Borgstrom; Cheri Kaszeta, RN; Tara Noonan, RN; and Super User Jennifer Berardo, RN. Standing behind them are: Super User Devin McDermott (left), RN; and Sue Fitzsimons, RN, PhD.
At 10 a.m. on Day One of go-live, PFAS staff in the East Pavilion were engaged and prepared to admit the day’s patients using Epic. Seated were: Super User Lauren Ullrich (left), admitting associate; and Rose DeRosa, admitting associate. Standing were (l-r): Super User Richard Ullrich, senior verifier; Michael Bethune, supervisor, Patient Access; and Super User Yvonne Montagna, senior patient account representative.
Epic enhances the safety of medication delivery to patients. Nurses now scan the barcode on the patient’s identification and then scan the barcode on the medication package label to verify that the medication and dose match what the patient’s physician has ordered for the patient. After scanning the patient ID badge, Amy Dulude, RN, Hematology Bone Marrow Transplant Unit, will scan the pill package and verify both on the screen behind her.
Although her parents hadn’t planned it, at 8:10 a.m. on February 1, Olivia Hope Robinson was the hospital’s first baby to be born on the first day of Epic go-live. To celebrate her arrival, Jeannette Hodge and Olivia’s Labor and Birth team presented her parents with an epic-sized basket of goodies. Shown (l-r) are: Jill Franco, RN; Randy Robinson, father; mother Tanya Robinson holds her new daughter, Olivia; Hodge, director, Patient Relations, Volunteer and Guest Services; Sarah Valerie, RN; and Joanna Brandon, RN.
With help from the hospital's Epic champions, D'Aquila pulled the lever which signified the gradual shutting down of the systems — SCM, CEMR, GE POINTS — that had supported patient care for years.
Less than 12 hours later, at 3:18 on Friday morning, a cheer went up at the Epic command center at 55 Park Street as staff began to use Epic for clinical documentation, order entry, results retrieval, patient registration, scheduling and billing.
As dawn broke on Friday morning, purple-shirted Super Users and Epic Team members fanned out across the York Street campus, Temple Medical Center and Shoreline Medical Center to provide at-the-elbow assistance to staff to assure that admissions, order entry, medications and discharges went smoothly. During the day, 450 Epic employees arrived from Wisconsin to support the York Street go-live over the next four weeks. In addition, York Street benefited from Saint Raphael Campus and Greenwich and Bridgeport employees who are also contributing to the effort.
"The training and preparation the York Street employees have done is evident in how smoothly this integration is going," said Daniel Barchi, chief information officer, Yale New Haven Health System and Yale School of Medicine "This is a complex medical center with many moving parts but it is impressive to see how well clinicians are already using the system. They are the ones who are making this transition a success."
In the days before the go-live, Patient Relations prepared letters for inpatients, outpatients and families explaining the hospital's adaption of Epic and its advantages for patients and patient safety. A team of Epic Helping Hands made up of employees and volunteers distributed go-live kits — including purple stress balls — to all units and clinics. On Thursday, Helping Hands visited each unit and placed new Epic identification bands on each inpatient. Only a few hours later, staff used the Epic bands to enter orders, give medications and prepare discharge plans of care.
"Everywhere I have gone since go-live, I am impressed with the can-do attitude of our staff," said Marna Borgstrom, CEO, as she returned from the command center on Saturday to visit additional units. "Our employees have embraced Epic and it is obvious that they trained well for go-live. I am so proud of the teamwork throughout this organization."
Yale-New Haven's go-live is Epic's third largest and the first that the company started on a weekday. YNHH wanted to begin on a Thursday night and see exactly what issues came up on a typical Friday — with a census of more than 950 inpatients and busy ambulatory sites.
"Issues have been identified, of course," said Barchi of his tenth Epic go-live, "but we have a talented team committed to addressing them. By Monday morning, we had resolved the vast majority of issues so for our staff and patients, it was business as usual, but with completely new information technology."
In addition to thorough pre-go-live preparation, staff credited the early success of the go-live to the 500 intensively trained Super Users. "We picked the right Super Users to help us," says Cheri Kaszeta, RN, patient service manager (PSM), Surgery/ Trauma Unit. "Our staff really engaged in the training and the Super Users on our unit have been outstanding."
Jennifer Ghidini, RN, PSM, Medical Intensive Care Unit and the Medical Intensive Care Stepdown Unit, was impressed with the structure in place to deal with the inevitable issues. "We experienced printing issues but we have the structure in place to deal with problems," said Ghidini. "As a result, we haven't been frustrated because everyone is so responsive to what we are reporting."
Ghidini also noted that family members responded positively the letters that Patient Relations had given staff to distribute. "Our families appreciated that we told them about Epic and that it might have an impact on their experience — but so far, everyone has been positive," she said.
"When you consider the size and complexity of Yale-New Haven, this conversion is an enormous success," said Lisa Stump, vice president, Epic Project.
"We were also able to build on the success of the Greenwich Hospital conversion and apply it forward to this one — and we will do the same for the Saint Raphael Campus on June 1 and Bridgeport Hospital in September," said Stump.
"With Epic in place, we have a much stronger platform that will help us improve quality of care and patient safety and satisfaction. I'm so proud of everyone who contributed to the success of this go-live."