When Epic was fully implemented at Massachusetts General Hospital (MGH) in 2016, many things changed, but many things also stayed the same. Implementation focused on increased efficiency and interoperability, but it also focused on keeping the qualities of care that already existed and only enhanced or added to the quality of care given in their facilities. Still, the infrastructure, workflow, and processes definitely changed, and MGH is on a rocky road to interoperability amidst a sea of hospitals who are struggling far worse. There are still gaps within the MGH environment, but there are multiple solutions available that can change health care infrastructures in a positive manner, resulting in the triple aim of better healthcare outcomes, experiences and costs.
The current infrastructure at MGH is much like its predecessor, except for information at each providers’ fingertips instead of on a green chart that may or may not be easily found. Clinicians previously kept vital signs on a green chart physically placed nearby the patient and then kept in a paper chart. Following the Epic role out, all vitals were available from the electronic medical record (EMR). While this would seem to be a perfect solution, some resident physicians noticed that there were numerous ways to access vital signs. Part of the acceptance of a new EHR were customized features that fit physician-specific wants. As a result, different information was obtained regarding vital signs dependent on which avenue chosen to retrieve that information. Clinicians also had to adjust their workflows and terminologies. Some workflows were created without the input of experienced clinicians, and this slowed down the process. Likewise, terminology limitations led to problems when prescribing treatments or dosages that strayed from the norm (Harding, 2016).This highlights a goal issue, where standardization could be prioritized above patient-specific care.
Gaps and issues within the MGH environment remain to be seen, but one primary gap is gaps of understanding of clinical practice by administrators and IT professionals who did not have medical experience. The primary problem among clinical workers was that charting was not set up in a way that led to efficient information gathering, and extra time was spent on data entry (Harding, 2016). Workflows are an important aspect of efficiency in a new system, and defects in workflows lead to disgruntlement among workers. As the goal of EHR implementation is efficiency, this did not coincide with goals.
Solutions to the gap of clinical knowledge can be solved in numerous ways, some more costly than others. The absolute zero-cost method would be to engage employees or clinicians in the decision-making process. In this way, the experienced worker can lead credence to an old idea or facilitate new idea generation. MGH administrators have sought the advice of residents and providers to improve their system (Harding, 2016). However, there is no real zero-cost alternative, as the implementation has already cost MGH and its parent company 1.2 billion dollars (McCluskey, 2016).
One of the current technologies that can change the current infrastructure in healthcare if implemented nationwide s the Queriable Patient Interface Dossier (QPID). This platform was created in MGH’s radiology department, and it is now an easier way to flag patient data. This program leads to better health management, health prediction, surgical risk assessment and preventive outcomes (Bresnick, 2016). MGH is reluctant to discard any progress made in the interoperability of medical records, so they have chosen to implement QPID in any case regardless of votes whenever allowable.
The last technology that is significant to interoperability of health care records is cloud computing (Singh, 2016). Many organizations will remain with their legacy systems, primarily due to cost. They have withstood significant investment in the face of diminished returns, and it turns out these returns may be diminished regardless of the process. Those who have strong feelings against cloud computing simply don’t understand computers and the need for cloud computing.
In 2009, only 12 percent of hospitals had electronic medical records. CMS penalties and meaningful use resulted in over 75 percent of physicians on electronic medical records today. Legacy solutions have minimally met the needs of physicians today, but large systems such as Epic are showing positive trends in implementation.
Narinder Singh recommends looking at new technology and advertising uses in the cloud (2016). The more people understand how useful the cloud is, the more people will want to use it. Cloud-based technologies will allow personal health information to be stored on the cloud, so it can be readily accessed by those who need it most. The question is ensuring privacy, but all healthcare systems are working on it.
The current infrastructure at MGH is largely unchanged from its days previous to Epic implementation, but the transition has left scars on those who were negatively impacted by the change. Thankfully, most were not negatively impacted by the change, and this has led to the implementation of many smaller groups that are willing to work on finding solutions to healthcare rather than complaining about regulations. The future of healthcare at MGH is remarkably stable, as the organization strives to thrive and conquer every adversary. However, there is always room for improvement, and MGH needs to work on its relationships between providers and clinical staff. The biggest thing to remember in a hospital it that ancillary staff is the common point where education meets healthcare knowledge, and it must be promoted.
- Bresnick, J. (2016). QPID, Epic EHR combine big data analytics at Partners Health. Health IT Analytics. Retrieved from http://healthitanalytics.com/news/qpid-epic-ehr-combine-for-big-data-analytics-at-partners-health
- Harding, A. (2016). MGH goes Epic: What I learned in the trenches. Xconomy. Retrieved from http://www.xconomy.com/boston/2016/05/10/mgh-goes-epic-what-i-learned-in-the-trenches/
- McCluskey, P. D. (2016). Mass. General launches Epic health records upgrade. Boston Globe. Retrieved from https://www.bostonglobe.com/business/2016/04/05/epic-upgrade-mass-general/9NIikFtLwWS8rysvZOxxyH/story.html
- Singh, N. (2016). US Healthcare – the cloud computing sequel, part 1. Diginomica. Retrieved from http://diginomica.com/2016/05/11/us-healthcare%E2%80%8A-%E2%80%8Athe-cloud-computing-sequel-part-1/
