At midnight tonight UCLA Medical Center will go live with CareConnect, their name for their implementation of the Epic electronic health record. With this, four of the five University of California Medical Centers (Davis, San Diego, San Francisco, and Los Angeles) will have the same EHR infrastructure.
A handful of us from San Francisco, including my colleagues Carolyn Jasik, Ellen Weber, David Robinowitz, and I, are spending four days here helping support their clinicians and their go-live team. The two institutions have a lot in common, and several physicians from UCLA visited UCSF during our go-live to provide support and meet with our leadership team. It will be fascinating to see the similarities and differences in our respective builds and in how the clinicians work through their first days with the system.
We’ve been live on Epic now for a little over 1 month. Our newly-minted interns started work on June 21st and a flock of new upper-year resident physicians and fellows began July 1st. One of the most enjoyable aspects of practice at UCSF is the phenomenal quality of students and trainees we attract, and as hoped, our new trainees have taken to the EHR and computerized provider order entry especially smoothly. In some respects they are more comfortable with the workflows than the senior trainees who directly supervise them because the new arrivals have no prior expectations from how things at UCSF used to work. We also have the advantage that something like one-third of our new trainees come from a hospital system that was itself an Epic customer.
Total call volume to our “provider” (physician, NP, and PA) and general help desks, starting with the go-live date.
The interaction between Epic CPOE and our lab and radiology systems continue to have some challenging wrinkles. Epic offers an integrated laboratory system called “Beaker” and a radiology system called “Radiant”. (Epic likes to give cute names to its software components) For reasons of project scope among others, we chose to stay with Sunquest and IDX/Rad for lab and radiology (respectively) for the time being. Although these are each leading systems and widely used elsewhere, the workflow integration between Epic and these ‘outside’ systems remains a work in progress in edge-case scenarios.
The only workflow to date we’ve backed out of is using Epic to satisfy the CMS requirement for an attending physician to document their face-to-face evaluation of an inpatient to qualify them for home care. We built this in Epic as an ‘order’ with all the required elements, and the Case Manager could tee this up (‘pend’ it in Epic jargon) for the attending’s review and signature. For reasons of workflow and the competition for attention, we’ve backed off on having this be electronic for now and reverted to the paper form.
I wear a Fitbit digital pedometer, a gadget my colleague Dr Aaron Neinstein wrote about recently. Below is what our EHR go-live night looked like in terms of footwork, with the “T minus 2 hour” midnight mark at far left, and “T plus 22 hours” at far right. Fitbit’s online graph insists on displaying calendar days so the afternoon and evening run-up to the go-live does not show here. The stretch of inactivity at midday is me getting some sleep.