Friday, June 07, 2013

My EPIC Meltdown


The hospital where I work one morning a week is changing it's electronic medical record system.  I've never like the current EPR because of privacy issues -- anyone with access can get into anyone else's record.  As an employee of the hospital, I don't like that so many people I know could read my medical record if I got my care there, and so I get care elsewhere.  HIPAA violation, you say?  Yes, but there's no up-front stop on looking at anyone's record, the violation and sanctions come if you get caught.  

Aside from the privacy issue, psychiatry does not add outpatient notes to the record.  Appointments are recorded, and medications are placed in the system, but no notes.   The current system is easy to navigate, I can read medical and surgical notes if it's helpful to me, There's a problem section, a medication section, labs (what I need most) which easily let you click on one to compare the value to those in the past, and a radiology section.  I'm not sure exactly why the upgrade to EPIC, but for a mere $100 million dollars, EPIC is being phased in.  I'm in the third wave.  And yes, psychiatry notes will be included, though there is some system to mark notes as sensitive, and to get into these notes, the reader must click through an extra screen, a process called "breaking the glass."  A psychiatrist has been designated to monitor who breaks the glass, one more responsibility in his already busy job description.

Monday I went to the first day of my two-day training to use EPIC.  The screens are busy.  The instructors were good, but the booklet was not-- we were told to read several sentences ahead, meaning you couldn't just read and follow along.  I was not in the best mental state to concentrate, and  two hours into the training, I just shut down.  I got lost in the screen-after-screen and annoyed by the privacy issues --- good news, now any doctor in the hospital can go in and look at any other doctor's schedule to see which patients are scheduled.  Why is that necessary?  

At some point, I realized that the new system means I'll have to sit with each patient at every appointment and start with the screen to verify allergies.  Each time.  As is, I have template forms I have to fill out at each appointment.  Now I can do all this while staring at a screen.   This is psychiatry?  What happened to listening to the patient?  Is there a screen for that.

I let my screen go black.  One of the instructors came by and asked about that.  "I'm done."  My brain stopped.  No more screens.  This is not the psychiatrist I want to be.  I sat through the rest of the day and and scored a 95% on the test module.  I went home and sent an email to the clinic: I'm resigning.  

So I actually do want to go to the second day of the training.  I want to understand what it is I'm railing against.  I'll work until the end of July, just long enough to test out EPIC, not long enough to master it.

Maybe it's a mistake?  Maybe EPIC will add value to the practice of psychiatry?  I can't really say that I'm leaving because of EPIC, after 15 years, it's time.  I may be the psychiatrist with the longest tenure there now, and I've long ago lost count of how many different social workers I've worked with.   EPIC was the last straw, but I've been thinking of leaving on and off for a long time --oh, did I mention I've quit 4 times before?-- and I needed a nudge.

So does your institution use EPIC?  How's it going?  Is it good to have psychiatry notes in the electronic record?  Has your hospital had security breaches?  Tell me your stories, I'm all ears.