Inside Duke Medicine

Proven, streamlined electronic patient record will improve care quality

Working in collaboration with front-line care providers, Duke University Health System has selected a proven system that will provide a single, streamlined and comprehensive electronic medical record for each ambulatory clinic patient.

“The adoption of the EpicCare Ambulatory electronic patient record,” said Art Glasgow, Duke Medicine’s chief information officer,” provides a powerful tool for providers and clinic staff that will assist them in delivering improved care while ensuring patient data is accessible and organized.”

“Duke has long been committed to using technology wisely and strategically in order to improve the quality and safety of patient care,” Glasgow said. “Epic is the next step in the evolution of the electronic record at Duke and represents a milestone in reaching a goal we have shared for a long time – a single, streamlined electronic patient record.”

In April, the DUHS Board of Directors made a major investment in the future of patient care at the health system by approving a nearly $50 million plan to purchase and implement the EpicCare Ambulatory electronic patient record in all primary care and ambulatory specialty clinics. The Epic system is a proven technology in use by peer institutions in North Carolina and elsewhere in the country.

“This is an important thing for all of us at Duke that will affect our clinical operations and provide a resource for research,” said William J. Fulkerson, Jr., M.D., DUHS executive vice president. “But foremost, this decision is about making the investments necessary in the state-of-the-art technology we need to provide even better evidence-based care to our patients.”

The key advantage of Epic is that it is a single system. Instead of several independent electronic systems each handling one of the various parts of a patient’s record, such as prescription ordering or physician order entry, Epic combines those functions into an integrated, powerful tool. Once Epic is in place, there will be a seamless system for accessing and creating clinic patient records, electronic prescribing, computerized physician order entry and charge capture.

But even more than efficiency, Epic will improve patient care and overall wellness by reducing duplicate entries and assuring that providers have access to all information for a patient from across the health system in a single, unified record. Patients will see enhanced functions on Health View, the Duke patient Web portal, including the ability to communicate with their providers through secure electronic messages.

In addition, Epic will provide a powerful source of high-quality data that can be used to manage whole panels of patients as well as efficiently alert providers to diagnostic and preventative care, such as diabetic eye screenings, for example, that will improve wellness.

“Duke physicians are very excited about this,” said Ted Pappas, M.D., a surgeon and executive medical director of the Private Diagnostic Clinic, the group practice of Duke physician faculty. “An all-in-one system, or as near to that as possible, is the ideal tool we’ve been seeking. This is the right tool to use and the right time to do this.”

Successfully implementing Epic will require a strong partnership with all members of the clinical staff to ensure success, Glasgow said. Health system IT professionals and their clinical champion counterparts, led by Karen Rourk, are currently working with Verona, Wis.-based Epic in developing the timelines and plans to ensure success. Current plans are to have the new system go live in the first Duke ambulatory clinics in the third quarter of 2012. The system is expected to be in use in all Duke Primary Care, Duke specialty and sub-specialty ambulatory clinics about a year later.

Providers and clinic staff will all receive in-depth training on the Epic system. A detailed implementation plan is being created for the orderly roll-out of the system through the clinics without impacting patient care.

The decision to go with Epic was made following in-depth research and a series of vendor demos that were held last summer. A two-day site visit was organized to give 300 Duke clinicians a hands-on demonstration of the Epic system.

“A survey of those clinicians following the site visit was overwhelmingly positive,” said Jeffrey Ferranti, M.D., a pediatric specialist and an associate chief information officer for DUHS. “Epic provides an integrated care environment aimed at improving quality, enhancing efficiency, and propelling Duke further into the era of data-driven medicine."