Health IT, Hospitals

MetroHealth celebrates electronic medical records, but much promise still unrealized

MetroHealth System employees and leaders are spending much of today celebrating the 10th birthday of their electronic medical record system, called Epic. Lauded by The Obama administration for its potential to lower cost and raise the quality of care in the nation's health care system, health information technology like Epic has yet to fulfill that promise at MetroHealth.

Updated 4:13 p.m.

CLEVELAND, Ohio — MetroHealth System employees and leaders are spending much of today celebrating the 10th birthday of their electronic medical record system, called Epic.

Epic keeps track of patient records, alerts doctors about medication conflicts and provides data for research projects at MetroHealth, which is owned by Cuyahoga County. The Obama administration has gotten behind health information technology like Epic for its potential to lower cost and raise the quality of care in the nation’s health care system.

Despite MetroHealth’s leadership in this technology, much of Epic’s promise to reduce health care costs and raise care quality at the health system has yet to be realized.

Dr. David Kaelber and Epic go way back. The chief medical informatics officer at MetroHealth was introduced to Epic – an electronic medical record system made by a company with the same name — in 2000 when he returned to Cleveland as an internal medicine resident in pediatrics.

By then, MetroHealth had been using Epic in its medical practices and community health centers for about a year. This summer — 10 years later — MetroHealth installed Epic in its hospital settings, putting in place the second fully implemented electronic medical record (EMR) system in Cleveland. The first is at the Louis Stokes Cleveland VA Medical Center.

“MetroHealth is a leader in informatics, is a leader in terms of its health information technology deployment,” said Kaelber. “I don’t think we’ve done enough to publicize this huge investment and huge accomplishment that we’ve made.”

MetroHealth has invested $32 million over a decade in its Epic system, which stores patient records, like laboratory results and medical images, along with exam, medication and other information in a digital file for each patient. Doctors and other caregivers  in the health system can access the files from any computer.

This summer’s installation put MetroHealth in the top 10 percent of hospitals nationwide for adoption of health information technology, according to HIMSS Analytics, a not-for-profit unit of the Healthcare Information and Management Systems Society.

Judy Faulkner, chief executive of Epic Systems Corp. in Verona, Wis., is visiting Cleveland today to help MetroHealth employees and leaders, including Kaelber — now the chief director of Epic at that institution – celebrate the 10th birthday of their electronic medical record system.

MetroHealth was Epic’s first safety-net hospital client in 1999, Faulkner told a group of MetroHealth leaders at a breakfast round table Thursday morning. With its latest installation, MetroHealth bucks the trend of a widening digital gap among hospitals that care for the poor – safety-net hospitals — and those that care for other patients, as well, according to a study in Health Affairs.

Most  doctors like Epic for the vast amount of clinical information it stores in one place. But that vastness also can be a limitation. Dr. David Rosenbaum, a MetroHealth cardiologist and director of the system’s heart and vascular center, told Faulkner that Epic needs a search engine to quickly find specific information. “It’s about giving doctors the tools to filter the vast information that’s there so we can better care for patients,” he said.

Dr. Shari Bolen has learned to look past some of  information she doesn’t need to help patients like Laurence Overton, a diabetic who is having trouble controlling his blood sugar. Overton, a patient at MetroHealth’s Lee-Harvard Health Center, had a recent visit to the emergency room. Bolen was alerted to the visit and followed up the next day.

Without the Epic alert, Bolen wouldn’t have known about Overton’s emergency room visit and wouldn’t have had an opportunity to review or adjust his medications. Epic “brings the patient back into the system quicker” than the patient usually does, thanks to the care coordination it offers, Bolen said.

Overton likes how this coordination cuts down on his trips to medical offices. He also likes the information he gets from his Epic record, which Bolen shares with him. “I know what’s going on with me,” Overton said. “I like that, being knowledgeable about my body.”

Kaelber said information on 1.5 million patients, 10 million patient visits, 100 million laboratory reports and 500,000 imaging studies that is contained in MetroHealth’s Epic system “is a gold mine. We just have to figure out what are the right questions” to best mine the data. For instance, he used Epic to figure out that doctors often under-treat children for hypertension. He wrote a 2007 journal article on the study, which was well received and led to new target blood pressure ranges for children.

MetroHealth and other local institutions also are using information from their Epic systems to help Better Health Greater Cleveland, a non-for-profit that is collecting information on chronic diseases. Starting with diabetes, Better Health Greater Cleveland wants to find the best ways to treat the diseases. The organization is beginning to identify those best practices from Epic data.

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