MGH resident shares Epic go-live experience from the front lines

Massachusetts General Hospital in Boston went live on its Epic EMR April 2, and for one resident at the hospital, the transition to the new software has been surprisingly easy. 

Alex Harding, MD, is a resident physician in Mass General's internal medicine department. In a post on Xconomy, he discussed his experience with the transition to the new software.

Overall, Dr. Harding said the transition has been quite easy. Epic "super users" were readily available for nurses and physicians to seek out for help, and approximately six weeks after the go-live, Dr. Harding wrote he's not only comfortable using Epic, but it saves him time as well.

However, he does outline some challenges he faced and offered three lessons learned along the way.

1. "Simplicity is a virtue." Dr. Harding said parts of the software, such as pathways to access vital signs, are complex. "There are about seven different ways to access the vital signs in Epic, and each way provides slightly different information," he writes. Part of that is how Epic is configured, but part of that is because MGH's parent company, Boston-based Partners HealthCare, sought this degree of customization when building the software. Dr. Harding writes that while some of the added features are helpful, many are problematic, and Partners is trying to reduce some of the customization.

2. EMRs should be flexible. Many user pathways in Epic are standardized, which Dr. Harding writes can be both a blessing and a curse. This type of standardization is a safety measure that helps ensure users adhere to protocol. "However, this approach falls apart when a situation is atypical, requiring an atypical management approach," according to Dr. Harding. "We need to recognize that not every situation is typical and there should be a way to work outside standard operating procedure."

3. Front-line providers should be involved in EMR design. Dr. Harding writes that some of the features of Partners' Epic EHR "clearly reflect gaps in understanding of clinical practice," such as pop-up warnings that slow down workflow and desensitize users to potentially serious alarms. He writes one of the default orders makes it easier to order 12 days' worth of intravenous fluids than 12 hours' worth. Dr. Harding writes hospital administrators have already started working with residents and other providers to initiate improvements. "This approach is key: While glitches and obstacles are inevitable in an EMR rollout of this size, MGH is taking the right step in gathering the voices of users to make improvements based on practical experience," he writes.

More articles on EHRs:

Can EHRs predict flu outbreaks? 
NY Gov. Cuomo allocates $6M to upgrade IT for children's behavioral health 
Just 2 in 10 consumers use EHR data to make medical decisions 

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