My hospital recently changed from its old system, Cerner, to EPIC. We were told it was more powerful, more useful, more intuitive, and would facilitate communication between the hospital and outlying clinics. We heard this in emails, newsletters, and at department meetings. It seemed everyone was almost giddy with excitement. Everyone except the physicians, that is.

We had been through this before. I had been through this four times in three hospitals. It was always the same. The new system promised to revolutionize medical care and make everything better, only it didn’t.

The hype was always the same, promising a new era of improved medical care for doctors and nurses. You would think we were entering a golden age of medical documentation. After hearing this multiple times, you stop listening and resign yourself to just bending over to take the hit.

Physician training for EPIC was six hours of classroom instruction and a dozen online training modules. At the end of that I was still unable to write a single note or enter an order without help. The irony in my case was that I had already taken EPIC training at another hospital months earlier and still struggled to use it. Intuitive? Don’t make me laugh. To accomplish certain tasks, I had to know that a certain tiny icon at the end of a task bar on a given page had to be clicked to open up a column of selections and I had to scroll down that column to find the command I needed. This, by the way, was not mentioned in any of my so-called training. I am not a luddite. I have a cell phone. I use apps. I can send emails and ever deposit checks on my phone. I use my computer every day. I learned the old EHR system to where I could navigate it reasonably well, but it took many months to do this. It did not happen overnight. 

Then came “go live” day.” I knew there would be problems, delays, chaos, and confusion. What I did not expect was the difficulty and delays in getting good support. This was an acute care hospital after all. It wasn’t like a physician could sit around for an hour or more waiting for help to put an order in when other patients were waiting to be seen. I repeatedly hit a wall when trying to enter patient orders. It was especially bad when seeking remote support on the phone. I would be given a ticket number and told someone would call me, a call which not come for an hour or more because the system was so overloaded. A week after “go live” I had still not successfully entered an order by myself.

As with every program I have seen, EPIC had multiple flaws. One was to not route messages received into the central answering service to the appropriate medical offices. When this was discovered, there were nearly 12,000 messages that had never been forwarded. These included questions from patients, requests for prescriptions and medical refills, referrals to other specialists, requests for appointments, and scheduled screening for things like mammograms. Needless to say, when this was discovered, the you-know-what hit the fan. This was only one ‘glitch’ of many. Patients, as you might imagine, were irate. Some threatened to sue.

In one case I am personally aware of, a patient needing emergency, life-saving surgery was delayed in the emergency room because the frantic surgeon could not enter the required admission orders. Fortunately, all turned out well.  

New EHR systems do not allow physicians to give verbal  orders to a nurse, something done since time immemorial. The physician must find a computer terminal, log into the system and enter the order manually.

Are these exceptions? Unfortunately, no. The more recent rollout of EPIC in another hospital I work at was even worse, if that is possible. Why are EHR’s not getting better and easier to use, but rather more complex?

I, like most physicians, do not believe EHR was ever intended to improve patient care. It was intended to mine data for use by insurance companies, pharmaceutical companies, and the government to be used in further controlling the practice of medicine and taking it away from its primary providers- physicians.

I will be happy to conclude my professional career never having installed EHR in my office. I will continue to use reliable, trusted paper charts until I retire. Most of my colleagues with EHR envy me.

Richard T. Bosshardt, MD, FACS