The Cleveland Clinic has relied on its EMR for quite some time. In fact, it adopted Epic in the 1990s, long before most healthcare organizations were ready to make a bet on EMRs. Today, decades later, the Epic EMR is the “central data hub” for the medical center and is central to both its clinical and operational efforts, according to William Morris, MD, the Clinic’s associate chief information officer.
But Morris, who spoke about the Clinic’s health IT with Health Data Management, also knows its limitations. In an interview with the magazine’s Greg Slabodkin, he notes that while the EMR may be necessary, it isn’t sufficient. The Epic EMR is “just a digital repository,” he told Slabodkin. “Ultimately, it’s what you do with the technology in your ecosystem.”
These days, IT leaders at the Clinic are working to streamline the layers of additional technology which have accreted on top of the EMR over the years. “As an early adopter of Epic, we have accumulated quite a bit of what I’ll call technical debt,” said Doug Smith, interim chief information officer. “What I mean by that is multiple enhancements, bolt-ons, or revisions to the core application. We have to unburden ourselves of that.”
It’s not that Clinic leaders are unhappy with their EMR. In fact, they’re finding ways to tap its power to improve care. For example, to better leverage its EMR data, the Cleveland Clinic has developed data-driven “risk scores” designed to let doctors know if patients need intervention. The models, developed by the Clinic’s Quantitative Health Sciences group, offer outcome risk calculators for several conditions, including cancer, cardiovascular disease and diabetes.
(By the way, if predictive analytics interest you, you might want to check out our coverage of such efforts at New York’s Mount Sinai Hospital, which is developing a platform to predict which patients might develop congestive heart failure and care for patients already diagnosed with the condition more effectively. I’ve also taken a look at a related product being developed by Google’s DeepMind, an app named Streams which will ping clinicians if a patient needs extra attention.)
Ultimately, though, the organization hopes to simplify its larger health IT infrastructure substantially, to the point where 85% of the HIT functionality comes from the core Epic system. This includes keeping a wary eye on Epic upgrades, and implementing new features selectively. “When you take an upgrade in Epic, they are always turning on more features and functions,” Smith notes. “Most are optional.”
Not only will such improvements streamline IT operations, they will make clinicians more efficient, Smith says. “They are adopting standard workflows that also exist in many other organizations—and, we’re more efficient in supporting it because we don’t take as long to validate or support an upgrade.”
As an aside, I’m interested to read that Epic is tossing more features at Cleveland Clinic than it cares to adopt. I wonder if those are what engineers think customers want, or what they’re demanding today?