After a shaky start, the University of Michigan Health System is settling into its new and improved filing system.
In summer 2012, UMHS made an enormous shift — moving from paper medical charts to Epic, an electronic health records system. The UMHS version of Epic is called MiChart. Two and a half years later, University Health Service, the primary source of health care services for the campus community, is beginning to take advantage of Epic and its many features.
Epic currently holds the medical records of nearly half the patients in the United States. A version of Epic comparable to UHS’ MiChart has been adopted by every medical center in the health system. However, in an interview in September 2013 — very soon after the shift — Doug Strong, CEO of the University of Michigan Hospitals and Health Centers, said the health system was suffering.
“It caused us to slow down because it was complicated and people had to learn it,” Strong said. “As a result we were suffering more financially than we had been previously … as we speak we are resurfacing from that.”
UHS Medical Director Robert Ernst agreed that the change to MiChart was a major step for UHS, particularly because they were transitioning from paper charts to computers.
“It was a really major shift in our practice when we moved from paper records to an electronic record system,” Ernst said. “And I don’t think you can underestimate the disruption.”
Two and a half years later, UHS members have become much more comfortable with the inner workings of MiChart. With familiarity has come success, and in many ways the UHS online system is thriving and nearly all of the paper charts have been moved online.
“People who have been users of this system have had an opportunity to build a record, and that took some time,” Ernst said. “There were instances when we were working with both the paper record and the electronic, and we’ve kind of grown out of that now.”
Electronic records have resulted in bidirectional communication between the health care provider and the patient. Using an online health portal, MyUofMHealth.org, students can request prescription renewals, view test results and make appointments. Previously, students had to call or even come to UHS to perform these tasks.
The convenience of care has brought increased patient satisfaction. Ernst said patient satisfaction with ability to view test results was 70 percent without the portal. Since then, this number has now climbed to 90 percent.
“That addresses what we had known as a gap,” Ernst said. “We’ve really made a tangible improvement in that.”
UHS is still looking to improve student usage of the portal, which about half of students currently use. UHS has taken measures such as putting portal information on business cards and having kiosks at checkout with computers for patients to make portal accounts.
Though 50 percent of patients are actually using the portal, only 5 percent are making appointments through it. Ernst said he is looking to increase this number over time.
UHS is the only site within UMHS that offers patients the option of scheduling an appointment online. Ernst is an advocate of this feature particularly because it encourages continuity; patients can only make appointments with a doctor they have seen in the past, a feature that is supported by studies indicating a link between a consistent patient-doctor relationship and better quality of care.
“It’s not as intuitively obvious to most students that they would benefit from continuity until they’ve had it,” Ernst said. “Then they really find it to be satisfying.”
The biggest challenge that persists with the online system is internal communication within UHS, Ernst said. Rather than making a phone call or going to see them in person, doctors can contact their medical assistants and nursing staff through the system, and Ernst said staff members are still working out this part of the routine.
“It has become almost something else to do,” he said.
Epic is not a simple system. Ernst said there are other, less advanced systems that are tailored specifically to college health centers and might be easier to work with initially. However, Epic’s functionality results in greater efficiency once its capabilities are well understood. UHS is now reaching that point.
UHS has begun to launch screening algorithms to encourage protocol-based features such as STI screenings for women. Ernst said this functionality has greatly improved efficiency because it takes advantage of a patient’s presence at UHS. A patient can receive — or at least schedule — the routine check that day.
“That is the high-end Epic functionality that is not associated with the off-the-shelf, more tailored college health electronic records,” Ernst said.
The use of Epic is also crucial because it allows UHS to be on the same system as the rest of the University hospitals. This would not be the case if UHS were using the less complex programs typically meant for college health systems.
“The fact that we’re using the same system as the medical center has really eliminated this loss of information,” Ernst said. “If a student goes to the emergency room … that sort of sharing of information when there needs to be sharing of information has been fantastic.”
MiChart is continually becoming a useful tool for UHS. Just last week, UHS launched online nutrition services.
“We’ve really settled in now,” Ernst said, “so we’re much more efficient with it than we’ve been before.”