A Q+A with Adam Buckley, MD, chief information officer at the University of Vermont Health Network.
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 Adam Buckley, MD, chief information officer at the University of Vermont Health Network.
What are the challenges of different hospitals and clinics using different electronic health care records systems? What is the promise of a single record?
Adam Buckley: There are two main challenges. The first is that that requires a lot of effort. Just technically to maintain that many systems that are that different, and the expertise that’s required is a heavy lift. We spend about 70 percent of our time in IT just maintaining these systems as opposed to building new capabilities for the patient and the provider. To move to a single record, we hope to invert that so that our staff is spending 70 percent of their time creating new functions and new capabilities with the record, and only 30 percent of the time doing the maintenance of it.
The other big change is that keeping 20 different systems that were never designed to talk to each other talking to each other accounts for a significant amount of that 70 percent. Quite a few systems do integrate a little bit, but many of them don’t really integrate at all. The information, say, at CVMC, if I’m in the ambulatory practice I’m in one record. Then if I go to the emergency department I’m in another record. Then if I get admitted, I’m in a third record. Some of that information moves back and forth, but most of it doesn’t. It doesn’t necessarily move in a way that makes it accessible for the provider.
For the patient who wants to see into the record with a patient portal, often can’t, or only sees parts of what they can see, because only maybe the ambulatory record has a portal. That means that the patient may not see into all of their care. Other providers may not be able to see into all aspects of the care of the patient.
What challenges does that present for a health care provider?
Adam Buckley: I can use my chosen specialty, which is OBGYN. Say, there’s a complex obstetrical patient who’s coming over from New York who needs services or care that can only be rendered in Burlington. If the patient goes to CVPH and is seen in their emergency department, that’s one record. If they’re transported to, say, the emergency department and then labor and delivery or the floor at UVM Medical Center, that’s a whole lot of information that doesn’t move seamlessly.
I might actually go to the emergency department and find the patient with a big stack of paper. I’m going to have to pile through that paper and hope that everything got printed, that I don’t miss a lab, that imaging is readily available. I might have to repeat that if I can’t find it in the paper record.
What is the benefit of the Epic electronic health record system?
Adam Buckley: The benefit of Epic is anywhere in the country someone goes, if they’re seen by a provider who has Epic, we will seamlessly share those records provided the patient gives consent.
In fact, I myself have had quite a few reasons to seek care over the years, and I’ve been at Cleveland Clinic and NYU and Partners HealthCare and UVM Medical Center, and all of those records are shared. My providers have linked those records with my permission in a way that allows them to see every visit I’ve had everywhere else, every lab I’ve had everywhere else, all the imaging I’ve had everywhere else, the operative reports.
Once you’re in the Epic system, or “Epicverse” that I like to call it, 60 percent of patients in the United States get care at one place or another that has Epic. All those records can be shared with the patient’s permission. You have an ability to see into care for people who spend the summers in Vermont and the winters in Florida. That ability to share information and share records is really exponentially greater with Epic.
How secure is Epic and how safe should patients feel with their records?
Adam Buckley: Epic takes security very seriously. They achieve it with flying colors every time we have to review them for both the technical way it’s built and the implications that it has for security: the ability to audit who has access; the ability to make sure that people only get to the part of the record that they’re allowed to see; the fact that we don’t have 20 different records cobbled together gives fewer ports of entry for people who are trying to get that information.
One features of Epic is the patient portal known as MyChart. Can you explain MyChart is and how patients can utilize it for their benefit?
Adam Buckley: MyChart is the patient portal, so it can be an app on their phone. It can be accessed through the Internet. I’m an avowed user of it. I think it’s the greatest thing ever. I send all my messages to my physicians that way through the secure portal. I ask for renewals on my prescriptions. I can see all my notes and all my records and all my lab and imaging results through MyChart–again, not only for UVM Medical Center, where I get care, but also from all those other Epic hospitals that I’ve seen care.
I can get appointments through MyChart. It has a capability to allow you into the physician’s schedule so you can actually pick an appointment for certain types of visits. It allows you to pay your copays. It really allows the patient as much control over how they access the health system, and that is something that we find that patients love.
This transition has been years in the making. What has it taken to make this happen?
Adam Buckley: The type of project that this is touches every employee and touches all of our patients. It’s involved everyone in the health network from HR, to IT, to the clinicians, to physicians, and leadership. It’s really been something that touches everyone. As a result, we’ve taken a very different approach with this. Historically, these big implementations were created as an IT project. This isn’t an IT project. This is a health network project.
Not only have we pulled in HR to help us get people to understand the changes and why we’re making them, and how it’ll impact them, and to some degree get them excited for that; we’ve really partnered with really everyone in the health network. Because this is the first, not the first, but one of the biggest health network projects we’ve done, all these hospitals are working together in a way that’s transformative.