It's important for clinicians to know their patients, especially in emergency situations, and now patients at CHI Memorial hospitals can have their health records shared with 28% of America's other hospitals, including Erlanger Health System.
This November, Memorial switched its electronic health record system to Epic - the most popular electronic health record software for acute care hospitals in the United States. The move cost Memorial more than $67 million and took 18 months of "intense" preparation and about 60,000 hours of training across the health system, according to the hospital's Chief Operating Officer Anthony Houston. About 250 people from outside Chattanooga, including experts, consultants and trainers, had a hand in the transition.
"Like many things in life, when you invest some good, upfront work and learning and studying and practicing, there's a real payoff in the end," Houston said. "It's an amazing record that allows us to do many things we couldn't do before."
Memorial "went live" with Epic for inpatient services at its three hospitals on Nov. 4. All Memorial clinics and physicians' offices - which use a combination of fragmented electronic and paper record systems - will transition, too. Memorial officials said an Epic "go live" date for outpatient services hasn't been set yet.
The decision to switch to Epic was partly corporate. About 40% of CHI hospitals are already on Epic, Houston said. The software is considered the "gold standard" for acute care hospitals and promises to improve care and efficiency. However, the move was also for the community, he said.
Now, if a patient undergoes treatment at Memorial and later visits a different hospital that uses Epic, clinicians at the other hospital can view the patient's previous Epic charts. This feature can be life saving in the case of a serious injury or illness when a patient may be unable to communicate their medical conditions, allergies, medications and other vital health information.
Houston also expects the new software will save patients and the hospital money, since all imaging and lab results will be in one place, eliminating the need to reorder tests that were already done.
Memorial has the advantage of being part of CommonSpirit Health, the largest nonprofit health system based on revenue in the United States. The Chattanooga hospital used the same Epic framework as CHI St. Luke's Health in Houston.
Erlanger underwent the same feat of converting its antiquated record system to Epic two years ago. Dave Peterson, Erlanger's chief information officer, said the health system started seeing benefits from day one.
"The data doesn't lie. We can show you exactly what we did, what the recommendation was, what the outcomes were," he said.
But those benefits come with a large price tag. Erlanger invested $100 million to rebuild its IT infrastructure from the ground up. At the peak of implementation, Erlanger had 150 employees dedicated to the installation and replaced about 5,000 computers, Peterson said.
It took six months to work out the kinks and longer to recoup from delayed billing, causing Erlanger to end fiscal year 2018 barely in the black. Erlanger's Chief Financial Officer Britt Tabor said in an email that Epic has since improved efficiency, but "a dollar figure has not been computed due to the complexity of assumptions."
Some health systems fare far worse. In 2016, the MD Anderson Cancer Center in Houston attributed its $405 million decrease in adjusted income - a 76.9% drop - to Epic implementation.
The federal government began pushing hospitals to use electronic health records about a decade ago, and although it's helped on the reimbursement side, Peterson said a major flaw has been that different software systems don't communicate with each other. This lack of "interoperability" has kept electronic health records from reaching their full potential when it comes to improving patient care.
"No matter what hospital [patients] go to, to provide the best health care possible they need to share that information," Peterson said. "At least now Memorial and Erlanger can work together for the better of the community."
In 2018, Epic controlled 28% of the electronic health record market share, according to a report from the research firm KLAS. The next most popular software with 26% market share was Cerner, followed by Meditech - which Parkridge Health System launched in 2014 - at 16%.
In addition to the high cost and data sharing problems, electronic health records are frequently cited as a source of frustration among medical providers. Physicians across all specialties gave the usability of current electronic health record systems an "F" grade, according to a study published last week in Mayo Clinic Proceedings. That study also found a strong relationship between health record usability and the odds of burnout.
Another study in the American Journal of Emergency Medicine found that emergency department physicians spend significantly more time entering data into electronic medical records than on any other activity and performed nearly 4,000 mouse clicks during a busy 10-hour shift.
Dr. Kumar Murukurthy, Memorial's chief medical informatics officer, said while there have been some bumps, growing pains and grumbles, overall the transition to the new system is going smoothly. He attributes the success so far to bringing in experts, studying workflow and training on the front end.
"Throughout history there's always going to be slow adopters - People that didn't like the stethoscope, people that didn't like electricity, people that didn't like the internet, people that didn't like email," Murukurthy said. "But I don't think we can live without any of those things right now. This is the same story."
Contact Elizabeth Fite at firstname.lastname@example.org or 423-757-6673.