UCSF Medical Center Catches Up With EHR Deployment

UC-San Francisco Medical Center might be a late bloomer, but it’s making up for lost time.

The hospital’s first go at an electronic health record system in 2005 started the ball rolling toward a comprehensive system but stopped short of developing an ambulatory component.

In 2010, UCSF moved away from its custom-built General Electric EHR, which kept information only on patients who were admitted to the hospital, to a new vendor — Epic Systems — to link providers and patient records among its more than 100 clinics, emergency department and hospital.

At that time, the “clinics were still using paper,” said Michael Blum, director of information services for the medical center.

Blum said that 2010, when the health care environment was in the midst of transformation, was the right time for UCSF to create a new comprehensive EHR system.

“Patient expectations around clinical data access, quality and safety of care, and provider communications have all increased significantly over the last several years. Regulatory requirements and government and payer incentives to deliver and document quality, efficient care have grown in scope and complexity,” he explained. “Our ability to attract and retain the highest-caliber faculty, trainee and staff talent depends more than ever on our use of leading information management technology, including advanced EHR technology.”

EHR adoption received a boost from the 2009 federal economic stimulus package, which established criteria and financial incentives for adopting, implementing, upgrading and demonstrating meaningful use of certified EHR technology. UCSF could be eligible for some of the funds if it’s able to demonstrate meaningful use of its new EHR system by 2012.

UCSF’s new EHR system went live in April, and the medical center has completed two of its four phases for ambulatory services. UCSF anticipates the system will expand to include clinics, inpatient care, pharmacy and administrative processes by mid-2012. The final price tag is expected to be $160 million.

UCSF’s Previous System

Elise Singer, chief medical officer of the California Health Information Partnership and Services Organization, said UCSF started with a bare-bones system out of the box in its first attempt to adopt an EHR system.

“While the medical center coordinated efforts to customize the system, departments just didn’t talk to one another; each one had developed its own workflow pattern and way of doing things,” Singer said.

The key to success, Singer said, is balancing the depth and breadth of an EHR so the system doesn’t get hung up in one department. She said a centralized database is more favorable than a patched-quilt approach.

According to Singer, UCSF at the time lacked a clear understanding of the resources necessary to develop a successful EHR system.

Value in Making Adjustments

“It was critical to UCSF that we install a system that would help make a patient’s experience as seamless as possible and give our clinicians the best tools with which to communicate and provide safer, higher-quality and more-efficient care,” Blum said.

The new UCSF EHR system provides a single database across a patient’s experience in any care setting and allows health care providers to communicate with patients via an integrated, Web-based patient portal, MyChart, as well as electronically prescribe and refill medications. In addition, UCSF will be able to exchange patient data with other facilities, such as its children’s hospital and cancer center.

Blum said he has learned the objective is to not build a perfect system at first but to implement it and then optimize. “There is nothing wrong with making adjustments after you identify how the system will fit into your environment,” he said. “And it doesn’t hurt to have support from the highest levels of the organization, such as medical school deans and the medical center CEO.”

Blum said that being a teaching and training hospital adds another layer of complexity to EHR implementation. In addition to the clinical component, EHRs in teaching institutions serve as educational tools as well.

“We provide sophisticated care and teach the new generation of providers at the same time,” Blum said. “That’s just who we are.”

Other Bay Area Hospitals’ EHR Sagas

Before UCSF contracted with Epic, the company’s EHR systems were in place in several other Northern California organizations, including Kaiser Permanente, Mills-Peninsula Hospital and Stanford Hospital and Clinics.

Mills-Peninsula Hospital’s first steps toward an EHR were not that sure-footed either.

“Before we got on track, we had to develop a new organizational and leadership structure, including a local medical director of informatics and a team approach to implementation,” said Michael Reandeau, regional chief information officer at Mills-Peninsula. Integrating an outpatient and inpatient EHR took 18 months and cost $50 million. The project was finished in April 2009 — right on budget and schedule.

Mills-Peninsula is the first hospital under the Sutter Health umbrella to implement the Epic EHR system. Physicians from the Palo Alto Medical Foundation, many of whom refer patients to Mills-Peninsula, have been active users of Epic as an ambulatory EHR for 11 years.

Delores Gomez, chief operating officer for Mills-Peninsula, anticipates that members of the Mills-Peninsula Division of PAMF, a newly formed not-for-profit medical foundation, along with physicians in the Mills-Peninsula Medical Group will be converted to Epic to complete the integrated system next year.

Reandeau said the success of the EHR system rides on communicating with and training clinical users. “Engagement is clinically driven; it’s not about the technology but about patient care,” he said. “While we are deploying the new system, we haven’t missed a beat in patient care. It’s the organization, not the software.”

San Mateo Medical Center, San Mateo County’s public hospital with 230 clinicians and 400 medical staff members, spent $2.4 million on it outpatient EHR system — all funded through grants. The system is used at the hospital and 11 clinics.

Chester Kunnappilly, chief medical officer for San Mateo Medical Center, agrees with Reandeau that the EHR system is not just a technology issue but also a quality and performance project. EHR adoption will be successful if it has consistent processes backing it up, he said.

One of the things the EHR system has enabled the medical center to do is improve quality of care by tracking clinical outcomes and health care provider performance. “The implementation of an EHR is a change management vehicle which could mean updating the system as we change the way we do things,” Kunnappilly said.

EHR systems in Northern California range from relatively small to enormous. Kaiser Permanente, headquartered in Northern California, spent $4 billion over seven years to build its EHR system across its entire nationwide network,  encompassing 13,000 physicians in 421 medical offices and clinics and 36 hospitals, including 34 in California.

What’s Next

Blum said he knows there will be challenges in the journey ahead but is confident the new EHR system will ultimately help improve care.

“We will continue to focus on using the system to improve patient safety, quality and efficiency of care,” he said. “We see the system evolving so that it is more of a safety net and watchful eye than a speed bump and warning sign.”

He also foresees that the EHR will improve communication with outside hospitals and referring providers, assisting UCSF clinicians with better and faster decision making to reduce the risk and cost of care and improve accessibility. “We will be able to adjust therapies proactively instead of reacting to symptoms, which is often too late,” he said. “Doing so will help us keep patients out of the hospital and at home.”

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