UPMC Pinnacle manages roll-out of new data system
Aiming to avoid the pitfalls typically associated with electronic health records, UPMC Pinnacle has taken a new approach to its roll-out of Epic software at some its facilities in Central Pennsylvania.
UPMC Pinnacle outpatient centers in Carlisle, Lancaster and Lititz are now using the Epic electronic health records system, a popular software product for managing and sharing patient data between providers. The company said it began training providers at 47 sites in November and will be broadening the use of Epic to other inpatient facilities in Central Pennsylvania in April.
"There are multiple benefits of Epic to our patients," said Laura Wagner, COO at PinnacleHealth Medical Group, who said Epic will enhance doctors' ability to monitor updates to patients' record regardless of which facility they go to for care.
in Epic, patient information is kept in a single record, and any UPMC Pinnacle provider or specialist will be able to access it, said Wagner. Epic will also provide physicians with patient updates and notify them of testing results and medication records.
"Epic allows the patient record to be shared across any group that uses Epic - including patients themselves," added Andrew Brown, director of clinical applications for UPMC Pinnacle, who oversaw much of Epic's implementation in the midstate.
Patients can access their electronic health record, or EHR, through MyPinnacleHealth, a system-wide patient portal that also allows patients to send messages directly to providers.
Epic, produced by a Wisconsin-based software company of the same name, is the most widely-used EHR systems in the country, with the company boasting that its records cover 190 million patients around the world. According to a 2016 survey by Medscape, 28 percent of responding providers use Epic as their EHR system, with Cerner a distant second place at 10 percent.
Speaking different languages
Although they are popular, EHR systems like Epic are notorious among providers and patients for being less efficient in connecting providers who use different systems - a feature known as "interoperability." This can result in unnecessary testing by a doctor using one EHR software who cannot access the patient’s record stored in a different kind of EHR.
Brown emphasized the waste this can cause.
"My example would be lab data," said Brown. "We don’t want patients getting multiple labs for different doctor offices, and that data is not as exchangeable as it should be."
Brown said the the Health Information Technology for Economic and Clinical Health, or HITECH Act, and the Centers for Medicaid and Medicare Services "don’t go far enough" in fostering universal messaging platforms between different EHR systems. The lack of standardization means providers are often forced to conduct their own tests in order to treat patients.
"If one hospital calls that result ‘A’ and another hospital calls that result ‘B’, how do you map it correctly in the [electronic medical record] so it works correctly?" said Brown. "I think every provider system would say we’re not sharing enough information, and I would say every EMR has a lot of opportunity to make this better."
Many hospital networks see a solution in health information exchanges - private partnerships between providers in different networks to share patient information. Brown touted such a venture UPMC Pinnacle has formed with Penn State Health Milton S. Hershey Medical Center, which recently partnered with UPMC rival Highmark.
Since 2016, Epic has partnered with other major EHR providers in Carequality, a framework that claims to connect a majority of providers in the United States.
Still, said Brown, outside providers using different EHR systems can be reduced to sending patient information by fax.
"All information comes in centrally." said Laura Wagner. "They then take that information and they populate it straight into the database as they would with [Epic]."
Providers also frequently cite EHR systems as expensive and inefficient. In a 2014 study by the American Medical Association and AmericanEHR, 74 percent of physicians said EHR systems for decreasing workload were difficult to use, and 54 percent found they increased overall operating costs.
It’s one reason UPMC Pinnacle wanted to tackle training for Epic differently than past approaches.
"Our rollout process is something we’ve finely tuned," said Wagner. "We actually had physicians that use Epic today. They went to Carlisle and Lancaster for us and stood elbow-to-elbow with physicians that are learning how to use Epic."
Wagner said the mentoring program served providers by connecting them with colleagues who have already implemented Epic into their practices.
"While there are challenges with EHR, and you cannot minimize that, providers today are pretty used to EHR and Epic is pretty intuitive," she said.
Keeping patients safe
One hope in more efficient links between EHRs is helping to monitor prescriptions of opioids and other addictive substances. In October of last year, the Pennsylvania Department of Health unveiled a new push to help providers integrate their prescription records with the state’s own Prescription Drug Monitoring Program known as PMP Aware.
"We do have PDMP functionality," said Wagner, "and providers are able to see what’s being prescribed across pharmacies."
PMP Aware is also part of Governor Tom Wolf's declaration of emergency over the opioid crisis. Under the declaration, the Department of Health will be able to share information from PMP Aware with other state agencies including the Department of Human Services and the Department of Drug and Alcohol Programs.
One of the benefits of Epic is its notification for drug interactions. "For patient safety, we have drug interactions built into Epic so even more than just any opioids they’re on," said Wagner, "it allows providers to know everything that’s being prescribed."