By O’Neil Britton, MD, Chief Health Information Officer, Partners HealthCare

Since July, 2012, Partners HealthCare has been moving forward with the implementation of a fully integrated electronic health record to benefit the patients of each of our member institutions.  The timeline for implementing what we call Partners eCare across more than a dozen hospitals and hundreds of community-based practices was five years.  Back then, this seemed overly long to those who were eager for the convenience, care continuity and coordination benefits it would bring.  Conversely, it seemed overly aggressive to observers who know how slowly change often occurs in healthcare.

Whether it is banking, air travel, car repairs or our favorite shopping websites, most of us today expect our personal information to be maintained, secured and thoughtfully coordinated for better service, support and for products tailored to our needs.  The clinical care of patients, however, is a complex endeavor supporting human lives, and there is much more at stake than whether the gate agent at Logan gets your luggage on the plane you are taking to Los Angeles.  Despite these underlying complexities and the amazing advancements made in the treatments we can now offer to patients, the process of care and how we deliver it has suffered due to the healthcare sector lagging behind almost every other industry in technology integration.

The scope remains staggering, and each number represents a critical piece of the diagnosis and treatment puzzle: More than four million allergies, ten million patient problems, 17 million immunizations, 19 million blood pressure records and 43 million lab tests were converted.

Boiling down the steps of a major EHR implementation to a few words risks gross oversimplification in the name of those who have spent untold hours managing extreme complexity and interdependent steps, but we can try:  It requires taking an inventory of the systems to be replaced, validating the new work flows, designing, building, testing, training, implementing, stabilizing, and finally, optimizing.  If we just look at the first step alone – workflow validation – more than 3,000 staff members participated in “stoplight validations” for each of the steps our clinical and administrative teams take to accomplish their work every day.  Subject matter experts voted with green cards to confirm a particular workflow, and red cards to initiate discussion around concerns of moving forward with another.  It was painstaking, tedious, time-consuming and completely worthwhile. 

Together, we validated the best of the best clinical and administrative practices which then served as the basis for adding clinical content and functionality.  All of this was necessary to support one of the broadest and deepest benches of clinicians, researchers, and teachers in the world.  

The scope remains staggering, and each number represents a critical piece of the diagnosis and treatment puzzle:  More than four million allergies, ten million patient problems, 17 million immunizations, 19 million blood pressure records and 43 million lab tests were converted.  All of this was imbedded in more than three million patient records; most of it in separate systems.  The numbers do not tell of the disruption and culture shifts that must accompany change of this scale. 

Today, our system processes nine million database requests – per second.  Almost 60,000 professionals across Partners HealthCare, our affiliated institutions and community-based practices use our integrated health record in about 85 percent of our patient interactions. Our implementation will be complete in fall, 2017.  

How hard can it be?  Very hard.  While the technical accomplishments have been largely successful, we know there is much work to be done. We have asked a lot of our staff across Partners and they have risen to the task. Moreover, the burden of learning new systems and new workflows while committing full attention to their work has tested the patience of many caregivers.  Still, we are on time and on budget and, as we continue to expand Partners eCare, patients are increasingly feeling the benefits of our integration as we care for them within the community, inside our academic medical centers and in their own homes.  

This is part of an occasional series on Partners eCare, a Partners HealthCare initiative to bring the benefits of a fully integrated electronic health record to our patients. See the first article, The Path and Promise of Partners HealthCare, to see how Partners eCare is already delivering results for our network.