Audit Report on the Epic Electronic Medical Record System That NYC Health + Hospitals Implemented at the Elmhurst Hospital Center

Executive Summary

We audited the Epic Electronic Medical Record System (Epic EMR) that NYC Health + Hospitals implemented at the Elmhurst Hospital Center (Elmhurst HC) to determine whether it is performing as designed and planned.

NYC Health + Hospitals (H+H) was established by the New York State Legislature in 1969 as the Health and Hospitals Corporation (HHC), a publicly-funded, public benefit corporation, to provide physical and mental healthcare in New York City.^[1]  H+H is comprised of more than 90 patient care sites throughout the City, including hospitals, neighborhood health centers, long-term care facilities, and it provides home care services.  As such, H+H is the largest municipal healthcare organization in the country.

On January 16, 2013, H+H entered into a 15-year, $302 million contract agreement with Epic Systems Corporation (Epic Systems) to replace H+H’s then-20-year-old electronic medical record (EMR) system with an Epic EMR system at all of H+H’s patient care facilities, including 11 hospitals, 4 long-term care facilities, 6 diagnostic treatment centers, and more than 70 community-based clinics.  An EMR is a digital record of a patient’s complete medical and treatment history that can be accessed by a medical office or hospital.

The Epic EMR roll-out at H+H is a large-scale, multi-year capital- and expense-funded implementation project involving third-party software, hardware, interfaces, implementation services and application support.  As of June 30, 2017, $94 million had been spent of $144 million budgeted for the Fiscal Years 2013-2019 implementation phase of Epic EMR.^[2]  H+H’s Enterprise Information Technology Services (EITS) group is responsible for implementing Epic EMR across all H+H facilities.  EITS is also responsible for providing user support for Epic EMR as well as other information technology operations within the agency.

Elmhurst HC’s various departments and facilities use Epic EMR to record and process the flow of information regarding patients seeking and receiving medical care at the hospital and its affiliated clinics, from intake to discharge and subsequent follow-up care.  Overall, 18 Epic EMR modules (each representing a set of clinical specialty functions or features) were installed at Elmhurst HC for its various user departments.

H+H’s EITS operates a centralized helpdesk to support Elmhurst HC’s Epic EMR users.  The centralized helpdesk addresses users’ general support issues such as resolving access and printing problems.  Moreover, the EITS helpdesk, in accordance with its Service Level Agreement (SLA) with Elmhurst HC, is responsible for resolving Epic EMR Service Restoration issues that either limit or interrupt functionality or work flow.^[3]

Audit Finding and Conclusion

Our audit determined that Elmhurst HC’s Epic EMR, which became operational in April 2016, is generally performing as designed and planned.  H+H’s Enterprise Information Technology Services (EITS) has a sufficiently strong computing environment (hardware, software, communications infrastructure) to run Epic EMR, as well as the technical resources to help maintain the Epic EMR for continued day-to-day operations.

However, the audit revealed an area of concern: although EITS maintains a 24-hour, 7-days-per-week, agency-wide helpdesk facility to support users in need of technical assistance, its data indicated that the average time frames in which it resolved higher-priority service-restoration issues affecting the Epic EMR at Elmhurst HC significantly exceeded its own targets.  Of particular concern, we found that on average, EITS takes more than two times longer than its own targets to address “Medium, High, and Critical” service restoration requests.  This is a condition that, if not addressed, could potentially affect the delivery of services to patients.^[4]

Audit Recommendation

The audit made the following recommendation:

• EITS should assess its helpdesk operations with regard to the resolution of reported Service Restoration incidents to identify the probable causes for missing SLA targets, such as, if applicable, a lack of resources, inadequate training, or others, and develop solutions to improve the timeliness of its resolutions.

Agency Response

In its response, H+H agreed with the audit finding and reported that it has implemented the audit recommendation by adding skilled resources and training in the Epic helpdesk oversight.

[1] The NYC Health + Hospitals name was established in November 2015 as part of a rebranding initiative of the New York City Health and Hospitals Corporation.

[2] The FY 2013-2019 implementation phase of the contract is funded by $76 million in capital funds and $68 million in expense funds.

[3] Epic EMR Service Restoration issues are incidents impacting users or workflow that require a fix.  A Service Level Agreement is a written agreement between a service provider and its customers defining services to be provided in qualitative and quantitative terms.

[4] The helpdesk facility provides agency-wide operational support relating to general computer application performance or usage issues, and provides support for Epic EMR issues.