Digital Information is Great, but Only if it’s Accurate

I am a patient at two local healthcare provider organizations that use the Epic suite of clinical information system modules for their base EHR. Both organizations must not yet have installed Epic’s CareEverywhere because currently, the two Epic systems do not talk to one another (or even look / act like one another). But with time, the installation of CareEverywhere should occur at both.

However, the reason I write this article is that either there is a flaw in Epic’s MyChart, the organizations do not know how to correctly configure MyChart, or there remains an important Epic user training issue. When I visit my providers at both organizations, I receive a hardcopy summary of my visit, which I must assume gets generated by MyChart because also I can view the data online via MyChart. Among many items listed on the summary are Current/ Future/Recurring Orders.

1) Orders listed on the summary and in the system cannot be corrected easily by an organization user, even the provider. I don’t know whether this is a user training issue (e.g., how to easily DC or cancel electronic orders that have been performed but, for some reason, not automatically canceled as Future Orders), a system flaw, or a poor implementation of the function. But for one set of lab orders, I was repeatedly asked for lab work to be performed when the lab work was performed months ago and I had the documentation to support this. Unfortunately, it took several handwritten notes and phone calls from me to the provider to finally update and delete the already performed lab orders from the system.

2) If orders listed on the patient’s hardcopy visit summary are incorrect (e.g., numbers of milligrams, duplicate orders, q 4 months not q 2 months, etc.), again these orders cannot be easily corrected by an organization user. That’s because, according to the organization’s users, these orders come from a different “database” than the “real” orders, which are correct in the system, but don’t print to the hardcopy correctly!

3) Either the Epic clinical system does not include or the provider organizations have yet to install or know how to install the following clinical decision support function: Recently, when my provider at one organization ordered a routine TB test, there was nothing in the system to alert the provider that the same, routine TB test was performed at this organization in July 2009. Consequently, this test was repeated in February 2010 at a cost of $398. When I complained about this, the provider organization commented that it is the provider’s responsibility to look back at all the orders in the system to see if a TB test had been performed within the last several years. I don’t blame the provider for not wanting to scroll through several years of past orders to determine this. And I was sorry I didn’t have my “paper” PHR, which I have kept for at least 30 years, with me at the time to double check this.

Now that electronic PHRs and visit summaries are appearing and patients are beginning to “use” (indirectly) organizational EHRs, not only will the organization’s internal users be complaining about system flaws, poor configurations, or outstanding training issues — but external users, the patients and recipients of health information exchanges, will be added to the lists. Consequently, it’s time our industry professionals address the management of the information, not just the technical and operational mechanisms for the sending and receiving of the information. Because it’s great to receive digital PHRs and visit summaries from provider organizations, but only when the information is accurate! Just ask ePatient Dave!

(Originally posted: http://histalk2.com/2010/03/24/readers-write-3242010/)