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Michael Pfeffer, MD, FACP

Chief Medical Informatics Officer, UCLA Health
Assistant clinical professor of medicine, David Geffen School of Medicine at UCLA
Associate program director, Internal Medicine Residency Program, DGSOM

When did you first use Epic? I used it at Kaiser Permanente in West L.A. and at Queens Hospital in Hawaii. 

You've been working here at UCLA without an EHR. How is that going for you? It's very challenging , actually. To be honest, when I had the EHR as a hospitalist, it saved me time and paperwork and significantly increased the time that I could spend with patients. It's really phenomenal.  The No. 1 benefit was time savings. All patient information is located in the system. You don't have to go searching. 

What benefits did you experience when using the Epic system? A lot of my time here at UCLA is spent searching for information and compiling it, and then regurgitating that back into a note. With the EHR, that was eliminated. So it freed up a tremendous amount of time.

For example, the physicians' pre-rounding was automated with an EHR. It would give me my patient list, tell me what the vital signs are and important labs ... a tremendous time-savings right off the bat!

Then there are other things such as order sets, which help guide you so you don't forget anything. There are flags that pop up if you're prescribing a medicine [your patients are] allergic to, or if there are potential medication interactions. For prescriptions, it tells you if the medication is part of the patient's formulary, and then prints out the prescription so all you have to do is sign it. From the beginning of the admission all the way to the discharge, [the electronic health record] is always helping.

Anything else that was dramatically better for you about having an EHR? One thing I love about it is that it has something called a time stamp. So after you reviewed everybody's labs or studies for the day, you'd time-stamp it. On your patient list for the day, you'd have a column where an icon would light up if a new test came back and it would tell you whether it's a normal test or an abnormal one just by the icon. In the morning, I'd look at everyone's labs; I'd time-stamp everybody. Then by the end of the day after I saw everybody and wrote all my orders, I'd come back to that list and in literally one second, I knew exactly whose labs and studies were resulted and what I needed to see. So that was fantastic.

The second thing I liked about the Epic system was the ability to monitor resident orders. You can see orders going in-in pretty much real-time on your patients. You can keep a really good eye on what the residents are doing. You can give them real-time feedback. Ninety percent of the time, they enter everything appropriately and there's really nothing to do. But occasionally, you'll pick up some discrepancies, or you might want to discuss a teaching point with the residents regarding a particular order. It also helps track orders written by other physicians and care providers preventing duplication. Here, in order to do that, you literally have to go to everybody's chart and flip through all the orders and trying to figure out what's going on.

Third, I like that the orders are on just one screen. You don't have to flip through pages and pages... it's very clean. You know exactly what the patient is getting, exactly what medicines you've prescribed.

Did the training you received prepare you to use the system at go-live?
Yes. I was trained at Kaiser on Outpatient, and Queens on Inpatient. The Kaiser training was very minimal, so there was a little bit of a steeper learning curve there; but once I got up to speed it was fairly quick.  At Queens, we had extensive training courses and I felt it was a bit too much.

Everybody has different levels of experience: Some are technology-averse while others very technology-savvy. I think a tailored approach would probably be better for training.

When you first learned Epic, what did you find was the most challenging part of the system? As a resident, I used the UCLA system so I thought everything about Epic was heads above everything I had been used to. Initially, I think the Medicine Reconciliation piece of it was the most challenging part. I think it's been updated since that point to be a little more user-friendly.

What are you hearing around the hospital from your colleagues about it?
I think there is overall buzz that this is going to be great, but there is also an anxiety that there's going to be impact on productivity. In the inpatient setting where the time structure is different, you have more flexibility than in the outpatient setting. I think, overall, people are excited about it.

What advice would you give your colleagues? It is going to be much better. I don't think anybody needs to worry. The system is very well tested. Once they see it in action, they're going to be excited about it.

How long did it take you to feel like you didn't have to think about it anymore? In the Outpatient setting it took weeks, while in the Inpatient setting, it took only a few days. When you begin to use it on a daily basis, you're seeing about 15 to 20 patient encounters a day. In three days, you've already used the system for over 20 hours, you've written 60 notes, and very quickly do you begin to get acclimated with the system. That's why it's important from the very beginning to learn the tips and tricks, so you can use them right from the start.

Anything else you'd like to share with your colleagues? I think it's going to be very exciting. I think UCLA is a world-renowned place... When we get up to speed with such a robust system in place, it's going to be amazing. Just take one example: not having to write 15 scrips down on a prescription pad (especially with Medi-Cal patients that require special prescription pads) and then rewrite them on discharge instructions, and then again in the discharge summary. Think of the time savings! Before you know it, you're getting to spend more time with your patients, you're less frustrated about the system and overall you're going to be happier.