Bend Memorial Clinic is flipping the switch next week to a digital patient health record system.

The transition to Epic is 14 months in the making, much of which has been spent training providers, receptionists and billing staff how to use the new software.

Perhaps the most noticeable change: Every exam room will now have a computer attached to the wall by a rotating arm. While they’re in appointments with providers, patients will be able to see information entered into their charts.

“It’s pretty empowering,” said Christy McLeod, BMC’s chief operating officer.

Switching electronic health records is a massive undertaking, and patients should expect their appointments to take a bit longer than usual while providers adjust to the new system.

The biggest lags will likely be seen at BMC’s three urgent care clinics, none of which take appointments. It’s going to take longer to check patients in, McLeod said. The appointments themselves will take longer, too.

“We’re just going to ask for their patience while we get used to the new system,” she said.

All patients will need to show their health insurance cards and IDs following the switch, McLeod said. Another change that’s “likely to be quite confusing” for patients is they’re probably going to get two bills for a period of time.

That’s because BMC will still use its old EHR system, Allscripts, for bills generated before Aug. 6. Bills for any services after that will come from the Epic system.

“If a patient comes on Aug. 5 and then comes back on Aug. 7, they could get two different bills instead of one bill,” McLeod said.

A change patients are expected to appreciate is the ability to access their health records over the Internet. Epic uses a patient portal called MyChart to access lab results, order prescription refills and request appointments.

Giving patients access to information about their health care was one of the reasons BMC chose Epic as its new vendor.

“More and more patients want to be in control of their own care,” she said. “They want to know what’s happening, and they want it to be easy. Epic gives us all of that, which is really great.”

Epic: a popular choice

The decision to switch to Epic is a very common one among health care providers.

Federal data show Epic is far and away the most popular electronic health care vendor. More than 109,000 nonhospital providers said they use Epic in a March survey by the Office of the National Coordinator for Health Information Technology. The second most popular vendor, Allscripts, saw fewer than half that amount, with roughly 49,000 users, the survey found. Among hospitals, Epic was the third most popular EHR vendor below MEDITECH and Cerner, the ONC found.

Providers feel pressure to switch to Epic because while EHRs are not adept at sharing information across platforms, it’s easier among providers who use the same platform, said Ross Koppel, an adjunct professor of sociology at the University of Pennsylvania and a senior fellow in its Wharton School.

But Koppel and others who research EHRs have warned that Epic’s market dominance could contribute to an “our way or the highway” attitude that could cause the vendor to be unresponsive to providers’ needs.

In Koppel’s mind, that’s already happening. Epic and other popular EHR vendors offer products that would have been state of the art in 1997, he said.

Physicians in Central Oregon have described their frustration with EHRs, and some said the systems are causing colleagues to retire early.

The issue stole the show at an American Medical Association conference in Atlanta last week. Media outlets reported the physicians spent much of the time complaining about EHRs’ lack of ability to communicate across platforms, their high cost and how difficult they are to use.

Ultimately, Koppel said, patients pay the price in the form of distracted doctors.

“You can’t focus on the patient if you‘re focused on clicking away through forms,” he said.

A number of theories exist as to why EHRs spur so many complaints.

Many familiar with the subject, Koppel included, maintain that EHR vendors rushed their products to market before they were perfected because of the massive demand from providers who were trying to adopt them quickly to receive federal incentive payments to do so.

“They pumped them out, whatever they had, claiming that the systems could do all kinds of things,” Koppel said, “which, in fact, they couldn’t.”

Angela Rose with the American Health Information Management Association, a professional organization that helps providers manage their data, takes a different view.

The government deserves some of the blame for failing to create uniform standards around how EHRs should function, she said, but it’s also the users’ faults.

Physicians’ attitudes on EHRs vary according to their generation, she said. Those fresh out of medical school don’t know anything but EHRs, so they’re fine with it, Rose said. Those in the middle of their careers mostly accept that they have to use them, she said.

It’s the older physicians that don’t want to adjust, Rose said.

“I remember arguing with doctors who said, ‘I don’t want to learn an EHR. Just let me practice in peace until I retire,’” she said.

‘Tip of the iceberg’

BMC’s reason for choosing Epic is simple: “They’re best in class,” McLeod said.

KLAS, a company that researches EHRs for vendors and health care providers, gave Epic its highest ranking for usability, tied with athenahealth, on its 2015 survey of nonhospital health care providers. The ranking was based on EHRs’ ability to prescribe electronically, compare medications and enter information, among others.

Epic tends to be more expensive than most EHRs on the market. Koppel said his employer, the University of Pennsylvania, is spending $1 billion to implement Epic. Harvard University is spending $1.7 billion to do so, he said.

McLeod declined to say how much BMC is paying for the software.

Some people might wonder why BMC is launching Epic on a Thursday. McLeod said it tends to be a slower day in health care, whereas Monday is the industry’s biggest day. It will also give them the weekend to work out any kinks that surface, she said.

BMC has scheduled fewer appointments at the outset of its Epic launch to give providers more time to adjust, McLeod said.

“As things change so rapidly in health care, we’re going to continue to make it better and better and find a lot more things we can do with it,” she said. “This is really the tip of the iceberg for us, and that’s really exciting.”

— Reporter: 541-383-0304,

tbannow@bendbulletin.com