The Lehigh Valley health care scene has long been dominated by two huge, fiercely independent providers that have trouble talking to each other about the many patients they share.
That is about to change, however, as both Lehigh Valley Health Network and St. Luke’s University Health Network migrate to an electronic medical record system called Epic. For both organizations, this is an enormous undertaking — both financially and in manpower.
“What Epic brings to the party is a single database, a single repository of information,” LVHN Chief Information Officer Harry Lukens said. “It’s going to be a transformational change.”
LVHN is spending $200 million. St. Luke’s has had to hire more than 100 additional workers, and St. Luke’s Chief Information Officer Chad Brisendine calls it “the single biggest technical investment” in the network’s history.
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Though LVHN and St. Luke’s arrived at the decision to adopt Epic independently, officials of both institutions describe it as an investment that will directly benefit their patients in a variety of ways. Once their computer systems are converted, they say, the two networks should be able to freely exchange patient information, reducing unnecessary paperwork, duplicate testing, time delays and medical errors.
“At the end of the day, we have to do things more efficiently,” Brisendine said.
LHVN’s transition to Epic is taking place in phases over four to six years. The network’s outpatient offices, comprising more than 200 sites, will be the first to make the switch — on Feb. 18.
Once the network’s hospitals, advanced intensive care units and other inpatient care facilities also migrate to Epic, all of a patient’s information will be recorded on a single electronic medical record — and the patient will be able to access that record via a secure website.
Basically, a patient using a smartphone, tablet or laptop will be able to view medical test results, schedule appointments and pay bills.
At St. Luke’s, the Epic transition will start with the network’s hospitals early next year and be extended to outpatient locations at a later date.
Essentially, Epic is a computer software system specially designed for large hospitals and physicians’ offices. It is made by Epic, of Verona, Wis.
Since its founding in 1979, Epic has become the dominant software developer in its category. Today, Epic is to medical records what Microsoft is to personal computers, and Epic’s founder, Judith R. Faulkner, is a billionaire.
Just as Microsoft, at its peak, became a target for criticism, so too has Epic. At a House Energy and Commerce Committee hearing in July, then-U.S. Rep. Phil Gingrey, R-Georgia, cited a report from Santa Monica, Calif.-based RAND Corp. that found Epic to be largely incompatible with alternative software systems and, therefore, an impediment to the federal government’s goal of achieving electronic medical record “interoperability.”
To motivate health care providers, the government has used a combination of carrots and sticks. In recent years, it has given health care providers billions of dollars to help defray the cost of new information technology systems. And under the American Recovery and Reinvestment Act of 2009, it gave providers five years to demonstrate “meaningful use” of electronic medical records in order to maintain their Medicaid and Medicare reimbursement levels.
“Is the government getting its money’s worth?” asked Gingrey, a doctor. “It may be time for the committee to take a closer look at the practices of vendor companies in this space.”
Of the various electronic medical record systems on the market, Epic offers “the biggest bang for the buck,” said Dr. Michael Sheinberg, LVHN’s associate medical director for quality and safety.
At LVHN, Epic is replacing more than two dozen computer systems, many of which are from General Electric, maker of the Centricity electronic medical record system. At St. Luke’s, Epic will replace a McKesson Corp. system at the hospitals and Allscripts Healthcare Solutions Inc. software at outpatient locations.
New regulations due to take effect in 2018 meant the McKesson system would soon be out of compliance, according to Brisendine.
“We had to look at alternative solutions,” he said.
Unlike LVHN, St. Luke’s already offers patients an online interface, which it plans to continue using for the time being.
Among Epic’s fiercest critics is Ross Koppel, a health IT sociologist at the University of Pennsylvania. He questions whether the system is worth its high price, which, he said, is passed on to patients.
According to LVHN’s Lukens, the $200 million earmarked for the transition to Epic represents the project’s entire cost, covering everything from software, hardware and data conversion to additional personnel.
“Somebody has to pay for that,” Koppel said.
But the larger problem — and irony, considering medicine is a science-based profession — is the lack of proof that Epic or, for that matter, any other electronic record-keeping system actually leads to better health care outcomes, he said, since studies on the impact of information technology are lacking.
“Health care information technology is seldom objectively measured … Evidence of its efficacy is at best spotty, and often influenced by self-promotion,” Koppel wrote in an academic article published in 2013 by the International Medical Informatics Association. “Most measures, especially those associated with cost-benefit analyses, are aspirational or hubris transubstantiated into numbers.”
Officials at LVHN and St. Luke’s say Epic will allow their networks to operate more efficiently, lowering costs and saving money over time. Patients, meanwhile, will enjoy improved care, they say.
“Patients will benefit more than anybody,” Brisendine said. “It’s about the patients. It is patient-centered care.”
Though LVHN and St. Luke’s will both have Epic systems, each network will maintain its own records on individual patients. The networks, however, will have the ability for patients who consent to exchange data from those records.
“What we’ve heard from other communities that have EPIC is that this is a very, very beneficial thing,” Brisendine said.
Date: February 8, 2015