April 15, 2009

You can’t pick up a newspaper these days without reading about the growing importance of information technology in the field of medicine. President Barack Obama has underscored this trend with his plan to remake healthcare over the next decade, which includes a proposed $19 billion to help America’s hospitals and physicians computerize their medical records. The move, experts say, will save money through increased efficiency, while improving overall quality of care.

For NYU Langone, the timing couldn’t be better. This fall, the Medical Center will become the first healthcare institution in the New York area to implement computerized medicine on an enterprise-wide basis when it begins rolling out Epic, a state-of-the-art information system that promises to revolutionize NYU’s storage and retreival of patient information. Within several years, all medically related operations — inpatient and outpatient offices, along with physicians, nurses, pharmacists, claims specialists, and patients themselves — will be fully integrated through a single, vast online network.

While NYU Langone has long been at the forefront of computerized medicine, many of its current systems were installed piecemeal over a period of time. “Different areas typically have their own computer systems and platforms, making it very difficult to share data or enable efficient workflow,” explains Paul Conocenti, vice dean and chief information officer, whose department will support and implement the new system. “The new system enables everyone to be integrated under one platform, creating effective workflow between care settings, levels of care, and departments.”

Among other things, this means the days of filling out multiple registration forms will soon be over. Instead, the first time a patient sees a physician affiliated with NYU Langone, his or her complete medical file will be entered into the Epic system. On subsequent visits to any caregiver within the Medical Center community, physicians and staff simply log in to register the patient and review, update, or add to the electronic file. No paperwork is needed, saving time for the patient and staff and reducing the risk of errors. The system also has built-in safeguards to ensure that confidentiality of all patient information is protected in strict compliance with HIPAA regulations. In addition, the process will be in strict compliance with the Stark Law, which regulates relationships between independent physicians and their affiliated hospitals.

Epic is much more than a gee-whiz electronic medical records system, however. It will also be used to order tests, prescribe medications, file insurance claims electronically, and schedule and bill patients. In short, Epic will in some way impact up to 85 percent of the Medical Center’s core operations.

The system will be rolled out over the next 20 to 24 months. The first site to go “live” will be NYU Langone Trinity Center in downtown Manhattan this October. In the months that follow, NYU’s other ambulatory centers will come onboard one by one. Voluntary physician affiliates will also have the option of joining the network for a fee. The next big step occurs in September 2010, when the scheduling, registration and billing centers at Tisch Hospital, the Rusk Institute, and NYU Hospital for Joint Diseases are incorporated into Epic. Two later phases, as yet unscheduled, will extend the system to inpatient clinical care and special ancillary units.

By linking off-campus sites to the hospitals, the system facilitates NYU Langone’s ongoing expansion beyond its midtown “hub” into the outer boroughs and suburbs. It will also enhance the focus on patient-centered care. Patients will be able to access Epic anytime to, say, view their medical record, schedule an appointment, or pay a bill.

“In addition to being respectful of people’s time, Epic will improve our medical outcomes,” says Bernard Birnbaum, M.D., chief of hospital operations. “For example, evidence-based best practices will be embedded in the system, prompting a physician to consider certain tests or treatments.” Patient data that is not personally identifiable, he adds, will be compiled in a virtual warehouse that can be mined for research and educational purposes.

“Ultimately, the new system will touch everyone and help us do everything better,” says Andrew Brotman, M.D., vice dean for clinical affairs and strategy. “And from a competitive standpoint, the ability to connect our hospitals, doctors, and patients will give us a quality
and service advantage that is immeasurable.”

“This is probably the single most difficult thing we’re trying to do,” said Dean & CEO Robert I. Grossman, M.D. “But it’s the keystone of our efforts to become a truly world-class academic medical center. If done correctly, it can be transformative.”

EPIC: A WIN-WIN-WIN SYSTEM

When fully implemented, Epic will benefit virtually everyone at NYU Langone Medical Center.

Patients

• One-time registration allows appointments to be scheduled paper free.
• Medical, billing, and insurance information is permanently stored in a single file accessible from any computer.
• Educational materials about medical conditions and NYU Langone’s medical services can be quickly accessed.
• Privacy safeguards ensure medical records remain confidential.
• Online access enables patients to promptly request appointments and prescription refills, view and pay bills securely, and communicate with their care team.

Caregivers

• Integrated network provides authorized caregivers to access relevant medical records.
• Automated management system results in faster referrals, reduced errors, and far fewer follow-up calls and document searches.
• Patient file stores documentation from all caregivers, providing complete, real-time information to the entire team.
• Diagnostic and treatment prompts can be tailored to fit departmental workflows.
• Suggestions based on evidence-based guidelines and best practices are provided automatically, including warnings of potential drug allergies or contraindications.

Medical Center

• Integrated records and management systems will improve workflow and medical outcomes, enhancing NYU Langone’s competitive position.
• Easy access to patient records will foster holistic, patient-centered care.
• Enterprise-wide data bank will facilitate clinical research.

Originally published in News & Views, March/April 2009. The PDF of the full newsletter is available here.