A Q+A with UVM Medical Center Interim President Stephen Leffler, MD.
The University of Vermont Health Network is undergoing a significant upgrade to its electronic health record system, which will impact the Network’s patients and providers across Vermont and northern New York.
To better understand these changes, we invited leaders from across the Network to sit down for one-on-one Q+A conversations. This is our conversation with Steve Leffler, MD, interim president at the UVM Medical Center.
What makes this so important for the Medical Center?
Dr. Steve Leffler: Basically, this is a game changer for our patients because when we receive transfer patients from our partner hospitals, the current state is, they come with, typically, a paper version of the record. Whatever happens there, it’s not in Epic, so we can’t see what’s been done there. We can’t see their medication list, their allergies, their problem lists, or what happened even yesterday. You have to go through all the paper records.
When we have Epic across our system, every patient will be connected to the same records, so when they move to the Medical Center, we’ll know what’s going on, what’s happened in their hospital, and when we send them back home to their primary care docs, that record will go with them. So, it’s truly a huge benefit to the patients that we serve.
What has that experience been like so far?
Dr. Steve Leffler: Whenever you change how you document something, whether you go from paper to electronic, or change your electronic system, it’s difficult. People get used to what they know. They want to focus on the patient and this is something that changes how you put in orders.
So, we went to Epic initially in 2011, and the truth is, it’s hard. It’s hard to change from what you’re doing, but over time as you make it better and you get more used to it, then it becomes a tool that you’re comfortable with. For the Medical Center in this upgrade, many parts of our system have already been on Epic and this is a pretty easy upgrade.
For the emergency department, where I’m from, it’s not a big change, what we’re doing. For other parts of the institution, like the lab, radiology, peri-op, the operating room, this is a major change for them. And it will be as hard for them as in 2011 when the rest of the hospital switched to Epic. So, it’s a big change for them and they’ve been working very hard to prepare for that.
What are the biggest changes that patients will see and experience?
Dr. Steve Leffler: The biggest change is if you go to Porter Medical Center in Middlebury today, and see your primary care physician and they refer you to see cardiology at the medical center or see a specialist, when you come, your record will come with you. We’ll have all of your information; we’ll have all of your registry information. That’ll all go in the same records.
When you go back to primary care, the care will be seamless. Your record will follow you perfectly — so important for our patients and for our providers. It’ll actually save our providers a lot of work because they know people will come with accurate information.
How does that improve care?
Dr. Steve Leffler: I still work in the ER Friday mornings. And right, this Friday, if we get a patient transferred from CVPH, our partner hospital, it’s only eight miles away across the lake, and they’ve had a complex workup, a really good workup at CVPH, they’ll come with maybe 100 to 200 pages of paper of everything that was done there. If they’re sick, and they arrive, no one has time to go through those 200 pages and know exactly what was done.
What was their last lab value? Exactly how was their CAT scan done? How wide were the cuts and where did it go? When you’re in a time crunch like that, we repeat things on people sometimes because we have to.
Them coming with the record in our system already, we’ll be able to review that before they get here. We’ll know it was done ahead of time. We’ll know exactly what we should order. When patients see our specialists and go back home, the record will go with them. A lot of that registration information we’ll already have. We’ll have very accurate medication records for them, very accurate problem lists and allergies.
So that’ll make it easier for our patients to access the care they need. They should see less repetition of people asking them the same questions again, and they’ll be able to see their whole record. We have a portal within the EMR that now will expand out to all the patients that we serve in our network.
Will this prevent patients from having to memorize their own health information, such as medications?
Dr. Steve Leffler: We still encourage people to be an expert on their own health care, but it should really help, yes. And it really will help get away from people having to come with the paper list that they kept in their wallet or the folder.
There will be times when that’ll still be helpful and useful, but within the electronic medical record, we should be able to sit down with our patients and, in real time, go over that information and make sure it’s accurate and make sure that what’s there, once again, follows them wherever they access the system.
This transition has been a lot of work and it’s been many years in the making. What are you most proud of when you think about that process?
Dr. Steve Leffler: This impacts almost everybody at the medical center in some way. And we’ve been very busy. So, we’ve had a very high census. We recently opened the Miller building. And on top of that, we’re layering on a new electronic medical record for parts of our system, but everybody’s having some change, so I’m very proud of everyone stepping up and doing the work that needs to be done.
I’m grateful to them because this was more work on top of their regular day jobs. But I do think everyone realizes how important this is for the patients that we serve and they were willing to make that commitment, but I really do thank them.
Did you know what you were getting into when you took on this administrative role?
Dr. Steve Leffler: I knew we had some big issues coming up as I took over in February. I knew that we were going into the Miller building in June. I knew that we were going to do Epic. We have great teams here. That was really reassuring to me, but it’s been a big task. It’s been a big task for our people out there doing it and for our leaders, helping make sure our people are ready to have what they need to make this transition.
You experience the shift as both a provider and an administrator. Is there a distinction, in that difference, in how you view this project?
Dr. Steve Leffler: I mean, as a provider, what you really want to make sure of is that the record in front of you is accessible. You know how to use it. You can put in orders you need in a timely way, and that you have the information you need to take great care of people. So, I did my training last week, like all the other providers, made sure I have what I need. I’m going to do a little practice here before we go live next week.
As an administrator, I see my job as making sure that the people here, our staff, have the resources they need to upgrade this record, to have it be ready, that they have the time they need to get trained, and that they have everything they need so that when we flip the switch, they’re ready to go. And I’m happy to tell you that people are ready.
What’s your message to patients as this process rolls forward?
Dr. Steve Leffler: We’re going to take great care of you. When this is live, things will feel a little stressful for a day or two, but your providers are ready. They know how to take care of you. We’ve practiced for all the contingencies. And on the backside of this, three or four weeks from now, when we’ve gotten through the harder part of getting all the pieces worked out, it’s going to be amazing for our patients.
I’ve been saying it for months–it’s going to be a game changer for our patients, because having your record follow you, an accurate record, is so helpful in your care–for efficiency, for safety, for high quality care.