CA Doctors Say Epic Install Is Creating Massive Turmoil

Not long ago, Contra Costa County, California spent $45 million on an Epic Systems installation designed to tie different sectors of the county health system together. The implementation, which the county dubbed “ccLink” went live on July 1st. The tale that follows here is all second hand, taken from a great piece in an area newspaper, but it’s quite believable, as you’ll see.

To wit, emergency department waits at the county’s hospitals have shot up, with one in 10 patients leaving without being seen due to the backlog.  One patient waited 40 hours to get a bed, according to Dr. Brenda Reilly, who spoke to county board of supervisors earlier this week on behalf of doctors working in county facilities.

In addition to live testimony, 15 doctors co-signed a letter to the board pleading for hospital administrators to cut back on physician workload further — some cuts have already been made — as physicians feel they’re unable to keep up and provide adequate care under the circumstances.

“We were not ready for Epic and Epic was not ready for us,” pediatrician Dr. Keith White told the board, according a report in the Contra Costa Times.  “As a result, the providers are struggling to provide safe and effective care…many doctors have left and all are considering leaving.”

This week’s protests follow earlier complaints in August, when nurses at the county’s detention facilities told supervisors that ccLink was jeopardizing patient safety due to the rapid install of the system.

Dr. William Walker, the county’s health services director, told the audience at the hearing that he plans to create teams of medical care providers formed to make the doctors’ paperwork trials easier.

As things stood, however, doctors weren’t mollified, calling ccLink “clunky and time-consuming, designed more for bureaucrats than physicians,” the paper reports.

Given their Epic obstacles, which have seemingly slowed medical care to a crawl, doctors are seeing half or fewer of the patients they’d been seeing.

With those patients seemingly spilling over to the emergency department, the average time a patient spends waiting in the county hospital EDs has gone from three to four hours, arguably as a result of the Epic install issues. It’s hard to argue that the new EMR is at least partly responsible for the logjam.

To be fair, I’ve heard of many an EMR installation which created temporary havoc and pumped up wait times in the ED for a while. But the level of paralysis I’m reading about hear seems to be setting some kind of record.

P.S.  A side note: I called the nice young man who wrote the story to give him a backgrounder on Epic and some of the interoperability and just plain functionality problems I’ve gotten wind of elsewhere.  He told me he’d gotten tons of calls already! Seems the Epic critics/watchers have their teeth into this one.

About the author

Anne Zieger

Anne Zieger

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

7 Comments

  • This and similar reports are interesting because Epic has a reputation of doing very good implementations, and studies such as those from KLAS indicate very high physician satisfaction levels. Up until recently all I ever heard from Epic sites was good things. Fair disclosure, I worked for Cerner and also for health systems that use Cerner so this was kinda “watching the enemy”, and we were always jealous of their apparent success.

    I wonder if they and other vendors are getting caught up in the rush to implement everyone at once, and are cutting corners? Or is it possible that organizations are trying to do these projects on the cheap, with untrained resources, and on an unrealistic timeline to make their budget plans for the bonus money?

    Just sayin’ that even if the technology itself meet the specs, the success will entirely depend on how well the systems transforms from paper to automation – and this is a very hard project to do.

  • Joe,

    I’ve never seen EPIC’s ER module; I’m assuming that you consider it to be a good product, so that one would suspect either an implementation problem (perhaps not customized to how this ER does things, network or hardware or database problems, etc.) OR training issues or both. Is this a reasonable assumption?

    To (inexperienced) me, I would think a well designed and implemented EHR in an ER would maybe take a bit more time when the doctor is with the patient, but that overall it would greatly improve work flow – especially in terms of orders and lab results.

    This being an EPIC installation, I ask because I was recently introduced to EPIC Ambulatory and its patient portal. The internist in question had to pop in and out of multiple screens just to get basic vitals and exam results in. Lots of wasted time. A lab test via the house lab got ordered via paper, and ePrescribe didn’t catch that a prescribed antibiotic was extremely expensive and NOT formulary (let alone available in area drug stores).

    The lab results were not available in the Lab Results section of the EPIC patient portal; it’s not clear that they even made into the EHR in digital form (except by hand entry by the doctor, perhaps). We heard that lab results went to the doctor by fax (absurd for an internal lab even if in a different building).

    Now I don’t know how well EA works with labs; in particular ones that are part of the practice, or how well its patient portal works. EITHER it’s not all that good, or perhaps there were optional modules not ordered, or there were implementation problems. So to me, the questions about these 2 EPIC installations are about the same.

    FWIW, I’ve no opinion on EPIC one way or another so far.

  • I’ve worked closely with these doctors in the emergency department in the past and they are an incredibly hard working and dedicated group but they are dealing with some systemic inefficiencies that no HIS could solve. There were problems as well with previous attempts to install Meditech EDM. One thing I am always surprised about is how IT people are surprised that many clinicians have trouble with Epic. From a clinical perspective it is very similar to Meditech and all the first generation EMRs. And, as with any system, you need to examine your workflow before automation, not after.

  • Joe,
    I bet your analysis is likely. Too much growth and so you can’t keep up with the number of implementations, don’t have enough experienced staff, you push forward too quickly, etc.

    Troy,
    I’m told the Epic LIS is terrible compared to other lab systems. Of course, the hospital CIO doesn’t usually put much thought into the Lab’s needs when making the EHR decision.

    Brian,
    A very important point. Technology doesn’t fix existing problems. Although, I’d also say that some EHR fit your workflows better than other EHR.

  • A fair message coming from clinicians and many of you have state some truthiness with how implementation timelines are being rushed, all in the name of return money, but at the cost of quite a bit, including patient safety and satisfaction. Employee satisfaction is not ranked high on the requirements list, however, which always leads to challenging.

    Contra Costa was understaffed in many areas and the fact that the LIS and materials management was still in Meditech at the July go-live, many of the issues stemmed directly from the poor integration between Epic and Meditech. Orders and results were delayed at go-live with an ever growing issues list surrounding their ailing Meditech product.

    To be fair, the install was a big bang. It was fast, there were several implementation challenges that were resolved late, and training was one of them. Epic did a great job at keeping the project moving, but the organizational change management for a County run healthcare system is much different than others out there. Growing pains were apparent throughout the project, but overall, the system is operational.

    With any EHR system, the end product is only as strong as the weakest link. Having personally lived through implementations and as a former Cerner associate myself, I always find those links to be in old workflows and systems that do not integrate well. Contra Costa is in a stabilization and optimization phase now. The stabilization phase will likely take much longer than the first phase, with old systems replaced with ones that integrate. Hopefully being done on a equally fast time schedule.

  • Key words in the original article…”Essentially, the county’s doctors, nurses and medical staff switched from paper to computers on July 1, after months of preparation.” I don’t think it would have mattered what system they went to, they would have still had issues going from paper.

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