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CA Nurses Sound Alarm Over Epic EMR System

 |  By smace@healthleadersmedia.com  
   August 16, 2012

A multimillion-dollar "go-live" implementation of the EpicCare EMR from Epic Systems Corp. came under intense scrutiny Tuesday when two nurses approached the governing body of a California hospital with patient safety concerns.

Those concerns stem from an incident at a Contra Costa County hospital clinic at the West County Detention Facility in Richmond, CA, where one nurse says the Epic system's recommended dosage of a heart medication "could have killed the patient."

"We're unable to document our medication administration correctly," said an emotional Lee Ann Fagan, speaking to the Contra Costa County Board of Supervisors in Martinez, CA.

A nurse familiar with the patient's medical history was able to override the system and adjust the amount of medication.

The story immediately spread via local media in the San Francisco Bay area, and highlighted concerns throughout the county hospital system about the Epic implementation.

"The Epic system decision support technology interferes with the RN's duty and right to advocate in exclusive interest of their patients," said Jerry Fillingim, a labor representative of the California Nurses Association.

Since the July 1 go-live date at two jail-based clinics—the West County Facility and the Martinez Detention Facility—and one based at the John A. Davis Juvenile Hall in Martinez, nurses have filed 142 notices of Assignment Despite Objection, a form used by CNA.

It requires that members notify supervisors and seek a solution before filing the form. Many of the forms' complaints speak of improper or incomplete training.

In an interview Tuesday night with HealthLeaders, Contra Costa Health Services executives responded that fixes had been made to the system since July 1, but communication of those fixes to line staff has been inadequate.

"We need to look a the process that we're engaged in now, and we need to improve that," says Anna Roth, RN, CEO of Contra Costa Health Services, whose 164-bed county hospital as well as ambulatory services and clinics at detention facilities switched to Epic on July 1.

"The introduction and implementation of an EHR in and of itself is a huge change in workflow, but I do know we put a great deal of effort into working with front line staff designing the workflow," Roth says.

Scott Mace is the former senior technology editor for HealthLeaders Media. He is now the senior editor, custom content at H3.Group.

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