1. Gould, Kathleen Ahern RN, PhD

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Summer is a time to refocus and rejuvenate. Traditionally, it is a time to take a well-earned vacation, relax with friends and family, and enjoy life's changing cadence. The gift of time is offered through longer days and warm weather.


Often, summer is a time to invest in growth opportunities and learn new skills that prepare us for life-changing strides. Children travel to summer camps, learning outdoor skills such as sailing, hiking, and new athletic skills. Camps also offer academic enrichment, opportunities for travel and exploration, or a chance to practice music or artistic skills. It is a time to learn from new experiences, often with an opportunity to work and play in new environments.


Each summer offeres something new. Young adults rush to earn internships and jobs to help them select a life path, career, or calling. Often, we find what we love, and even more important, we find an opportunity to change direction and search for something that we are passionate about. Sometimes, we move toward new things because our world changes. Personally and professionally, we continue to learn and grow-recharge and refuel. This year is no exception as I learn to manage a new electronic medical record system.


The trajectory of e-health inspires new learning and allows us to be part of an exciting wave in health care. The future is here and there is no turning back! The electronic health record (EHR) is transforming the way health care is administered and practiced. The Health Information Technology for Economic and Clinical Health Act allocated $19.2 billion to incentivize adoption of the EHR. Since 2009, Meaningful Use Criteria have dominated information technology (IT) strategy. Health care organizations have struggled to meet expectations and avoid penalties to reimbursements from the Centers for Medicare and Medicaid Services.1


This summer I learned to use EPIC, a health care software program. The system is a product of Epic Systems Corporation, a privately held health care software company, named for the term epic-a glorious recounting of a nation's events. The company states, "Like the Iliad or the Odyssey, our electronic health records chronicle the story of a patient's healthcare over time."2


Preparation as a new system begins is extensive; hospitals staff up and plan for long hours of classroom instruction, online practice, and go-live support. The process is tedious, expensive, and time consuming. It is important that coaches, instructors, and super-users allow learners to use existing skills and address specific fears. I found it helpful when instructors would allow me time to practice and refer to systems I was comfortable with, such as adding columns as with excel programs. I could see that the system was built on many platforms and philosophies currently used in health care, education, and electronic publishing. Much of the work was intuitive and included elements of lean thinking and evidenced-based practice. Many of these concepts are incorporated into entry areas and care plans, as knowledge links and best practice alerts were easily accessible.


The learning curve is not as steep as I had anticipated and certainly not as frightening as I had imagined. Information and preparation were key elements to success. Educators and super-users are supportive and patient as they explain that the only way to it was through it. One wise e-instructor was extremely patient. I watched her work with an older staff member who wanted to retire early, rather than learn a new system. The instructor quietly reassured the anxious staff member, saying, "You have a wealth of experience and are so accomplished-don't let a software program determine your career path or keep you from a job that you love!"


Through this experience, I have come to think of Epic as an event, a machine, and a system, now simply a part of our current environment. We have new vocabulary with acronyms that are now familiar-HIT for health IT; EMR, electronic medical record; EMAR, electronic medication administration record; and CPOE, computerized provider order entry. This technology is exploding.


In March 2016, Epic reported, "in the last 12 months, nearly a quarter of a billion patient records were exchanged using Epic's Care Everywhere platform-up 300% from the year prior. Records were exchanged with groups using other EHRs, HIEs, HISPs, entities connected to the eHealth exchange, and members of the Epic Community. The Care Everywhere platform supports all Epic's clinical users, which includes over 28,600 clinics and 1,200 hospitals. Organizations using Care Everywhere make up the nation's largest EHR-based exchange group, covering a patient population of approximately 181 million."2


User groups also include patient platforms or portals, billing systems, technology designers, and researchers. The goal is to create an information highway that is user friendly and meaningful for everyone-including the patients and families.


One example of this is captured in an Epic post. A pilot program allows families to enroll in a new study that turns the iPhone into a sophisticated tool for home health monitoring linking EPIC, Apple's HealthKit, and providers. A pilot program supports data from a child's glucose monitor to travel to family members and health care providers using a Bluetooth-connected continuous monitor. The data then travels to a smartphone via Apple's HealthKit. From there, health information is sent to the medical record through an app that his doctor uses from Epic Systems. The provider can subsequently send a secure message through Epic's app, which is called MyChart. Family members can access the data in real-time as the designated caregiver.3


National initiatives will focus on improving patient safety and family involvement through greater use of health IT. A recent study examined the association of hospitals' EHR adoption and occurrence rates of adverse events, suggesting that improvements are possible as cardiovascular, pneumonia, and surgery patients exposed to a fully electronic EHR were less likely to experience in-hospital adverse events.4


As I learn this new system, I see evidence of excitement, preparedness, and anxiety. Nevertheless, providers are mindful that this journey will improve patient care and make patient information more accessible. Change will take time and require patience, but institutions that support this effort though training and meticulous planning will thrive and emerge stronger.




1. Kruse CS, DeShazo J, Kim F, Fulton L. Factors associated with adoption of health information technology: a conceptual model based on a systematic review. JMIR Med Inform. 2014;2(1):e9. doi:10.2196/medinform.3106. Accessed April 1, 2016. [Context Link]


2. Epic. A quarter billion records exchanged. March 21, 2016. Accessed April 1, 2016. [Context Link]


3. Farr C. How this teen uses an iPhone to manage his diabetes the future of you, 2016, KQED Inc. November 17, 2015., Accessed April 10, 2016. [Context Link]


4. Furukawa MF, Eldridge N, Wang Y, Metersky M. Electronic health record adoption and rates of in-hospital adverse events [published online ahead of print February 6, 2016]. J Patient Saf. Accessed April 10, 2016. [Context Link]