“The good news is that across the house, every area that planned to use Epic is using Epic and is using it as planned,” said internist Topher Sharp, associate chief medical information officer.

“Right now we are right at the cusp of no longer asking, ‘What do we need to fix?’ Epic is fundamentally working, so now we are asking, ‘How do we make it work even better?’ We are evolving from reacting to problems to an approach focused on making those methodical changes that will make the system work more effectively,” Sharp said in a May 30 interview.

“My sense is that most physicians, nurses and other users are moving away from feeling that they are being bowled over by the system, but they don’t feel up to speed compared to their prior efficiency. Doctors and nurses are telling us, for example, ‘It’s taking me longer to do medical reconciliation, but at least I know how to do it.’”

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“We’ve already received great feedback, even if it was sometimes expressed in frustration,” he added.

“Overall, I think the launch has gone a lot smoother than any of us anticipated and hitches are being actively worked out, said surgeon Andy Shelton, a member of the MIDWG (Medical Informatics Directors Work Group), which helped direct the launch.

Issues with the system were well documented. Sharp noted that more than 4,000 issues were logged as “tickets” by May 5, but only about 100 were classified as high severity and required urgent corrections.

“We brought rapid closure to most of the issues in the first days, and we are now looking at those requiring more time to make improvements. That’s part of the transition from tactical to strategic improvements,” Sharp said.

A serious problem was identified when discharge prescriptions initially wouldn’t print. “We got right on top of that one,” Sharp noted.

Other glitches, involving inconveniences not urgent patient care issues, still need to be fixed. For example, Sharp said the implementation team is trying to find ways for physicians to more easily identify chart notes they haven’t finished. That’s become an issue because Epic only flags those notes that haven’t been completed in the patient’s chart.

“In the past, a physician could put his or her paper notes in a back pocket, take them out later and finish up. Now we have to remember which of those electronic notes require further attention. This is not an impediment to care, but it does slow us down when we have to open each chart to find out if we’re finished. This is one area we didn’t anticipate, and we’ll soon fix it.”

So why didn’t anyone think of this?

“Fair question, but the reality is that we’re not perfect. We found many issues in dress rehearsals and in preplanning over the months prior to go-live, but we missed many as well, and these are the ones that we are now taking care of.

“Some of the unexpected issues involved unexpected workflows. We may have tested a process to take someone from point A to B to C, but we didn’t account for the unusual situation where someone goes from A to H and then back to B,” Sharp said.

Overall, many of the issues encountered in the first month involved in-patient transfers to different levels of care. “The transfer process in Epic is significantly different from our prior method, and it is not as intuitive as desired. This has sometimes required nursing staff to seek verbal clarification from the physician who wrote the initial order before the patient was transferred. We are actively taking a multi-disciplinary approach to improving this.”

A smooth functioning EHR is a combination of providers becoming increasingly more familiar and more skilled with using the system, and then tweaking the system itself over time to make it continually better. “It’s a double barreled approach,” said Sharp.

“What we’ve seen is that doctors are getting much better at using the tools.” One benefit of the relatively smooth launch from a technical perspective has been that members of the implementation team had time to work individually with providers who needed some extra one-on-one support. Some of our most excellent physicians, whom we thought might be having trouble with Epic, became competent and comfortable when we were able to dispatch someone to offer one-on-one support.”

Initial support included hundreds of physicians and other caregivers specially trained as Superusers to help colleagues, as well as easily identifiable “Red Shirts” to provide rapid onsite technical support.

“But it was not as well known that we also brought in Epic master users from other institutions whom we dressed up as ‘GreenShirts’ primarily to help doctors. These ranged from physicians fluent in Epic to personnel who were responsible for managing launches at other institutions,” explained Sharp. “In addition to helping individuals, these people were able to help us anticipate problems by telling us such things as, ‘What your institution is doing is correct, but watch out for x or y downstream in the coming days.’”

“While the learning curve continues, I don’t think any of us as physicians look back fondly to the days when we had to leave our clinics to track down a patient chart somewhere on a table in an inpatient unit or clinic. While we are still encountering some issues when multiple users try to access an electronic patient record simultaneously, the fact is that records are where we need them, not in a single, often elusive, location,” Sharp said.

“I also want to emphasize how impressed I was with the morale of our staff as they learned the system. The patience and perseverance of physicians and staff to assure the best care during this implementation has been tremendous. Some have been impressively quick learners, too. On the first day, I approached two interns and asked them several times if everything was going okay. Basically, they dismissed me by saying, ‘Of course everything is okay. We’re SuperUsers.’”