First time using Epic – initial thoughts and impressions

By | January 16, 2015

Epic is an Electronic Health Record (EHR) used in hospitals all over the country. If you work in healthcare you know who they are. Epic is the top EHR system in the U.S. and they continue to gobble up market share.

According to the Epic website, the pharmacy information system (PhIS) inside Epic is officially known as the “Willow Inpatient Pharmacy System”. However, I commonly hear it referred to as simply Willow.

Over the span of my 19 year career I’ve used several pharmacy information systems, but never Willow. For whatever reason the hospitals I’ve worked in have used other EHR and/or pharmacy system vendors; GE, Siemens, MEDITECH, IDX, etc. Recently I had the opportunity to spend a couple days learning how to use Willow. I was pretty excited. I’ve heard a lot of good things about Willow, and some bad. I’ve been wanting to get firsthand knowledge for quite some time.

Disclaimer: These are my initial impressions. Two days of training isn’t nearly enough time to learn all the ins and outs of a pharmacy system. I’ve recently accepted a position where I will be using Epic, albeit not in a full-time capacity, so I’m sure that my thoughts and opinions will evolve over time.

Initial thoughts and impressions for Epic Willow:

Positives:

  • The system is well thought out and polished compared to many pharmacy systems that I’ve used.
  • Order entry has some nice features around dosing, routes, etc.
  • The web-like interface should feel familiar to anyone in this day and age.
  • A notebook-like interface with tabs across both the top and left side of the screen. Personally I like it because it reminds me a bit of the Microsoft OneNote interface.
  • Pharmacists have access to an impressive array of things like the nursing MAR, lab results, physician notes, radiology results, etc. without having to leave the primary work screen.
  • Speaking of the MAR, the UI in the pharmacist’s view is pretty slick. The information is presented completely and concisely. In addition the user has the ability to drill down for additional detail.
  • Good integration with certain ADUs, in this case Pyxis. The information provided is valuable and easily accessible.
  • Automatically selects appropriate tablet sizes during order entry. For example: enter an order for prednisone 12.5mg and the system will pick the most appropriate dosing regimen based on available tablet sizes, i.e. two and a half 5mg tablets or perhaps six 2.5mg tablets, etc. I’m not sure how the algorithms are built, but I love this feature.
  • Similar feature as above, but with iv piggybacks. I.e. the system will automatically pick the appropriate package size based on dose. Really slick. Creates quite a bit of flexibility in the CPOE component of Epic.
  • Ability to build lists for tracking things like vancomycin patients, warfarin patients, patients on medications with black box warnings, and so on. There’s a fair amount of flexibility here, although there’s also a negative that I’ll touch on below.

Non-positives:

  • The screen is cluttered. Even though I like the web-like look and feel, and the notebook layout, it’s very cluttered. In Epic’s defense, there is a lot of information that needs to presented, but the entire screen is taken up with tabs, text, headers, etc.
  • Upon first seeing the pharmacist order entry area I thought it was poorly laid out. It’s like reading through a large body of text. This may just be a personal gripe, but it’s not my taste. I got used to the look and feel pretty quickly, so take my comments for what they’re worth.
  • Functionality is not centralized within any particular work area. You can easily perform required tasks, but often times these tasks can be done in multiple places. Sometimes the different locations may offer a slight difference in how things are done. Sounds cool, but in my opinion it’s not. It feels like developers of the system added buttons as they went along, i.e. “Hey, wouldn’t it be cool if we could “do x” from here?”. Unfortunately is creates inconsistency for users.
  • It takes an army of people to maintain the system. Is Epic the preferred system because it’s the best, or because it has more support staff than any other system? Does it matter? One 600 bed hospital I spoke with had five, yes five, “Epic analysis” assigned to maintaining the system: three pharmacists and two technicians. There’s not another piece of pharmacy technology on the planet that gets that kind of love and attention. The last time I worked as a full-time IT pharmacist it was at a 500 bed hospital. The total staff for maintain all the pharmacy technology – including the pharmacy information system, the carousel, the inventory management system, the ADUs, the report databases and reports, the labeling system, the automated packaging system, etc – was two FTEs. Yep, a full-time pharmacist plus a full-time IT analyst. Others chipped in from time to time, but you get the point.
  • Expanding on the item above, the system requires a lot of manual maintenance. Much of the magic that pharmacists see on the screen is done via manual manipulation on the backend. Again, does it matter how it happens or is the outcome the most important thing? I think you could make a compelling argument either way. Whatever they’re doing seems to be working.
  • The lists I mentioned above in the “Positives” are great, but someone has to create the availability of information first before you can use it. That is to say that if you want to follow patients on a specific drug someone has to make that drug available for your lists. I can’t just wake up one morning and decide to add all furosemide patients to one of my lists.
  • Speaking of lists, while you can create a lot of lists, the system isn’t smart enough to alert you when you have something pending. For example: say you’re following a group of patients receiving vancomycin and you order a trough. The system won’t alert if the trough value comes back outside the defined range. Crud, the system won’t even tell you when the result is back. I think it’s incredibly inefficient to look at lab values when they’re within normal limits. The system should tell you when something isn’t normal, i.e. SCr, positive culture, trough above defined range, etc. Why systems don’t do this is beyond me. In the current model a hospital has to use a third party surveillance system to accomplish this. Crazy.
  • Confusing lingo. Epic decided somewhere along the line that they’d get cute with their terminology. That’s fine, but it’s not standardized by any means. For example: Epic uses the term i-Vent for “intervention”. That’s fine, but when you want to view the interventions you click on an “Intervention” tab on the left side of the screen. Of course there are also a few other places where you can view, edit, or start i-Vents. Another example is what Epic considers a “first dose”. In my mind a first dose is, well, the first dose. Epic views it differently. Their first dose terminology describes two similar, but distinctly different situations.

That’s basically my initial thoughts on Epic Willow. Overall I think it’s a great system. It offers some functionality that I’ve never seen in another pharmacy system. I hope to get better acquainted with it over the next few months. I’ll try to update you as new thoughts and impressions pop into my head.

3 thoughts on “First time using Epic – initial thoughts and impressions

  1. Ivy Andreica

    That’s a very good analysis. I have the same thoughts on the clutterness. I am working on a project with a hospital that utilizes Epic and is also integrated to smart pumps. I have come to wonder the thoughts of Epic on some functionalities that allow the nurse to change the rate of a drug in eMar ( fixed ordered rate not titrateables) then send to the pump with no review by the pharmacist or MD. Overall I like Epic but not in love with it. There are opportunities to close the loop and make all this technology do what it was supposed to do…improve safety. Ivy

  2. John

    Good observations, but keep one thing in mind. The user’s access is based on his/her security/permissions, which is defined by the client organization, usually at the operations level for specific workflows. If the nurses in your facility have the capability to change medication administration rates without provider/pharmacist review, that’s likely because someone in the organization signed off on that security level. Epic modules are almost infinitely configurable, and it shouldn’t be considered the vendor’s responsibility to analyze the organization’s policies and procedures regarding specific workflows and security levels. Just something to think about.

  3. Jerry Fahrni Post author

    Thanks for the information. I understand what you’re saying but I would disagree that “it shouldn’t be considered the vendor’s responsibility to analyze the organization’s policies and procedures regarding specific workflows and security levels”. For a $120 million (conservatively) enterprise system, I would say the vendor should be knee deep in looking at and helping facilities make the most of it. It’s this lack of involvement that creates the problems that I see.

Leave a Reply

Your email address will not be published. Required fields are marked *