It’s one of the leading hospitals in North America, and tomorrow at 4 a.m. everything changes.
That’s when The Hospital for Sick Children (SickKids) in Toronto will flip a switch and activate Epic Systems, an electronic health record (EHR) system that will place every medical record into a single system, removing all paper documents and bringing the hospital into the twenty-first century—at least when it comes to recordkeeping.
The switch must be executed perfectly to work effectively and everyone in the hospital has to be an expert on the system when it goes live.
This is no easy feat, even for a smaller healthcare provider. But SickKids is not small. Established in 1875 and now serving as one of the leading pediatric hospitals in the world, 15,000 children go through SickKids’ doors each year, staying in over 450 inpatient beds. Over 300,000 visits are made to the 100-plus clinics, while emergency staff treats 50,000 children and surgeons perform 13,000 operations.
Helen Edwards is the director of clinical informatics and technology-assisted programs at SickKids. Having practiced at the hospital for 37 years working her way up from bedside duties in the ICU to leading transformational projects, Edwards knows the ins and outs of SickKids. This update to the EHR system is a long-time coming for her.
“When I started here, it was paper and pen. Nothing else,” she says. “All of those different systems, all of the paper, in one fell swoop at 4 a.m. in the morning will go away, and we will turn Epic on and it will be everywhere. Every patient will have every bit of their data in the system, regardless of where they are in the organization.”
It’s a lot to fathom.
“To date, this is probably the largest undertaking SickKids has ever gone through, and we’re incredibly proud we’re coming in on time and under budget,” she says as her directorial pride begins to shine through.
Despite maintaining deadlines and not wasting money, the shift still presented a precarious problem for Edwards to address: she had to approach it from the informatics perspective, meaning she was not necessarily tinkering with computers but instead focusing on the collection, analysis and use of patient information. The new digital system had to collect and disseminate records, and if it couldn’t do that, then it was essentially useless. That was problem number one and something Edwards could hopefully solve by looking at how Epic had been used before.
Epic is not necessarily a revolutionary piece of software, at least anymore. It was founded in Wisconsin in 1979 but only debuted the full end-t0-end service in Canada in July 2017 at the Mackenzie Richmond Hill Hospital. Since then it has added a few clients in the country, including the entire province of Alberta, but its adoption is much larger in the U.S. where companies like Kaiser Permanente use the software for all their facilities. But Canada is a different beat for Epic, and they’re still learning the ins-and-outs of the country’s healthcare system.
The importance of Epic to SickKids comes down to how the pediatric hospital—ranked second-best in the world—will now able to manage data much easier through a “one-child, one-record” system, a massive improvement for any party involved.
Though SickKids did not have a single integrated system before Epic, the hospital has been a pioneer in the electronic healthcare world. Around 1993, the hospital was one of the first to bring in electronic order entry for physicians, as well as online charting for the inpatient area and nurses’ medication. But at that time, vendors often sold hospitals a single product, and the idea of being “digital” meant shoving a bunch of completely-separate features together and using each one independently. As healthcare became more complex, it was clear this method would not fly.
SickKids’ relationship with epic began in 2015. In total, it took about three years for SickKids to choose and implement the software. It was 18 months of due diligence and RFPs to sort through on the admin side, then 18 months of prepping the hospital for the shift.
“The evolution of patient care, not only at SickKids but throughout the entire health-care system, has become incredibly complex and fragmented,” said Dr. Michael Apkon, president and CEO of SickKids when the hospital first announced Epic. “We need to work towards creating a more coordinated system to improve care across the province; a system where a child’s entire care team, including their family, can contribute their expertise and access their health information.”
Even though there are a few competitors like Cerner and MEDITECH, Epic was an easy choice for SickKids. It all comes down to the software’s integrated nature as it boasts a single database. Other companies will often buy up third-party features and brand them together as one, bringing back headaches from the nineties.
When Epic goes live, any piece of information entered by a staff member will be saved and accessible when they need it again. This eliminates the annoying “start-from-the-beginning” problem many repeat patients and families face. So now when an allergy, diagnosis, symptom, or anything else is entered, the right clinician can see it all.
This data is protected by permissions and what’s called navigators, so only the correct staff member can see pertinent information. Say an inpatient nurse logs on to do an admission: they would click the admission navigator and be provided with a customized order for the assessment of the patient and questions they need to ask.
Another pivotal reason that SickKids chose Epic is due to the hospital’s role as an academic health science centre. Doctors and staff are constantly researching and allocating resources to new initiatives such as medtech VR and genomics, and SickKids was ranked as the second-best research hopsital in Canada for 2017. So when SickKids found out that the U.S.’ top 10 pediatric hospitals all used Epic, it was clear.
“We felt that we would be joining a community where we can share and collaborate on different things, using Epic as a tool to support those practices,” says Edwards, though she’s careful to clarify that doesn’t mean exposing private data about patients.
“It’s all about speaking the same language when using the same database,” she says.
Edwards, along with other SickKids staff, speak of Epic almost as if they are customer service reps trying to sell the software. That’s a testament to just how effective it is, and how big of an improvement it will be for the staff and patients. The improvements don’t stop at improved collaboration though.
SickKids will launch their first-ever patient portal with Epic, called MyChart. Families can access certain aspects of their medical record, such as after-visit summaries, lab results, diagnostic images, and more. Patients may soon be able to register for appointments, update personal information, answer questions and access learning materials as well.
Epic will quickly bring SickKids into the digital age, but it’s been a journey to get here. Training all of the close-to 6,000 staff members has been an incredible undertaking. No one gets access to the new systems until they complete and pass their required training.
That means the hospital had nearly 60 leaders teaching over 1,500 classes for those 6,000 staff members, spread over 28 classrooms, from 7 a.m. to 11 p.m. Monday through Saturday. Staff completed some training on their own then attended class to anchor their lessons. They could also hop on a nearby computer when they had some downtime to practice with the new system ahead of time.
“Everyone is saying ‘I’m a bit nervous but I’m really excited that we’re going to be getting what we’ve been asking for over the last 10 years,’” says Edwards. “What I found and what I hear from all the staff is that it’s a really intuitive system. Its patient-centric and workflow-driven.”
“It’s exciting, but it’s going to be a challenging process; one that will force us to reimagine the way we do our work and deliver care to children and their families,” said Sarah Mutitt, SickKids’ chief information officer.
But the “big-bang, all at once” approach can lead to some problems. Once 4 a.m. comes tomorrow morning, everyone will be thrust into the new system and there’s no looking back. Many will be overwhelmed and nervous which could lead to slightly slower service. In fact, for the first week, SickKids has recommended over social media that patients should consider visiting a closer emergency room if there is one nearby.
Bringing in a change as big as Epic means there have to be multiple stakeholders involved in every level of decision—over 600 actually. Decisions had to be double and triple-checked, and doctors and staff had to work extra hours to attend meetings and solve problems, on top of normal hospital work. That led to long days and tired mornings.
It was all worth it though because the transformation is not for the nurses, the doctors, the clerical staff or the executive board. It’s for families and children, so they can focus on what matters most: getting healthy. The paperwork and admin tasks should never take away from that, and this digital shift is putting time back into the hands of those who cherish it the most.