EMR Recommendations

Electronic Medical Record Software Rollout Strategies

Electronic Medical Record Software

Epic Systems software is recommended. The rollout at comparable institutions has cost tens of millions of dollars in installation, licensing, training and operational costs. The PTTF considered the issues, as follows.

Pro:

• Epic software investments can be readily relocated to a new hospital when it is constructed. The servers and computers utilized are also portable to a new facility.
• Epic software is robust and has the major functionalities important to PFF clinical care.
• Epic Systems, Inc. is a software company with market penetration sufficient to sustain its business.
• Epic has excellent customer service and is located nearby in Madison. Training and customization will be more readily available that other vendors.
• Epic has penetration at CMH and commitments for deployment from key IM leaders.
• Epic compares well to similar products and is ranked in the top three in overall performance by independent reviewers at the AAFP.
• SmartSets can be created in our implementation and would permit data extraction using customized Clarity Reports or SmartForms.

Con:

• Epic software does not yet have built in tools for supporting clinical research projects.
• EMRs are a relatively recent invention and several long term archival issues are unresolved.
• Unlike paper, the EMR will evolve, requiring upgrades in software and storage systems to maintain records
• Epic is becoming a big company. With the landing of a multi-billion dollar Kaiser contract the company's culture and responsivity may change.

Epic Software recommendations and its relation to legacy systems is summarized in the chart below.

Functionality		Proposed Solution		Existing Software		Transition
Ambulatory Scheduling		Cadence®		Cadence®		continue
Ambulatory Registration Benefits Engine		Prelude® Registration Epic Tapestry		Prelude® Registration		evaluate insurance coverage at time of registration
Ambulatory EMR		EpicCare		EpicCare (Allergy only)		rollout across divisions in Hyperspace
In-patient EMR		EpicCare		Carevue		replace Carevue
ER Record		Epic ED		None
ICU		Epic ICU		Carevue®
ADT		ADT/Prelude®		Teletracking®		no recommendation
CPOE		EpicCare® Inpatient Clinical System		None
Nurse Charting (in-patient)		EpicCare® Inpatient Clinical System		Carevue®		migrate to EpicCare as soon as possible
Radiology images		PACS		PACS		continue; incorporate images into EpicCare
Billing Benefits Engine		Epic Resolute® Epic Tapestry		IDX®		switch to internal or collaborative billing. Epic Tapestry adds further capabilities which should be evaluated; no recommendation at present.
Transcriptions		Axolotl		none

Rollout Strategies

The PTTF reviewed several rollout strategies. About 80% of the EMR was considered "generic" across disciplines and therefore easier to implement across the enterprise. The remaining 20% will require customization. To make this manageable, only a limited number of methods should be employed in customizing components. This represents ongoing work that is proposed for the Pediatric Technology Group, working in concert with other development groups that may be established.

There are high return items for the entire enterprise which should receive priority in the rollout. These include:

1. Medication lists
2. Problem lists
3. Complete list of physicians involved with a patient
4. MyChart to facilitate patient / customer service functions
5. Transcription processing into electronic documents that are incorporated into the Epic EMR
6. Epic's Resolute for physician billing

Populating the records with these data could occur prospectively, with inputing of data as the patients come to encounters. Alternatively, medical records technicians could populate the database with archived information. Many divisions retain electronic versions of dictated reports and these could be integrated into the EMR, rather than scanned in as digital images.