BY SIEW-MING LEE, MD MEDICAL DIRECTOR OF QUALITY AND INFORMATICS
Almost two years following Epic go-live in our private surgery office, I am still learning the nuances and intricacies of an electronic medical record (EMR). This is certainly shared by many of my partners, and a recurring theme at lunchtime conversations. The change has been revolutionary and for true believers, evolutionary. The power of an integrated medical record is now being realized as the numbers of ambulatory Epic sites multiply. Connectivity of the medical record allows for easy access to inpatient and outpatient lab, radiology, and other important reference information. More importantly, it provides access to progress notes, consultations and other vital records particularly important in the comprehensive outpatient management of chronic disease and a growing demographic of geriatric patients. Moreover, consultation requests between Epic primary care sites and specialists is easy to coordinate. Communication between connected offices is paperless and simplified. However, nothing can replace the personal telephone call between practitioners. For Epic ambulatory physicians, these benefits are optimized, but for those not connected to a large integrated inpatient and outpatient EMR network, such as Epic, there are additional challenges. Many of these can be optimized through interfaces and innovative workflows. Physician Network Advantage (PNA) remains the most experienced and comprehensive local resource to address these challenges and has been integral in the smooth deployment of Epic in the community.
While we are all to be commended for the successful integration of Epic into daily patient care, there are many opportunities for improvement. When finished with an Epic workstation it is important for the practitioner to logout. This 1) prevents HIPAA violations, and 2) puts Epic into the logon screen that makes it quicker and easier for the next user to access the patient’s chart. Another area is coding and documentation. This is especially true since the upgrade from ICD-9 to ICD-10 is around the corner. ICD-9 to ICD-10 transition will go from 13,000 to 68,000 codes. We are in the process of streamlining a coding and ICD query process in Epic that will be vital to ICD-10 adoption. In the meantime, it is important that practitioners develop effective documentation and coding practices since these skills will assure the success of both the practitioner and our facility. Indeed, ICD-10 will require alignment of both physician and hospital to succeed. Look for more updates on ICD-10 in the near future.