Physicians throughout the Trinity Health system in Michigan are recommending that patients not make appointments for the week of January 27. The reason: at precisely one minute before midnight on Friday, January 24, the electronic health record (EHR) system Trinity uses to schedule appointments, record medical histories, track test results, and issue bills at St. Joe’s and its other Michigan hospitals will shut down. Nurses, IT staff, and administrators will transfer data to an all-new system known as Epic, which will go live in the wee hours of January 25.

Jackie Lapinski has been working toward this day for two years. “Our network will have the biggest changeover in Epic history,” says Lapinski, who’s overseeing the Epic transition in southeast Michigan for Trinity.

Many patients love the EHR portals that let them view their records and contact their caregivers online. Many doctors, nurses, and other health professionals also look forward to Epic’s enhanced charting and networking abilities. But others are expecting some major headaches and glitches until Epic becomes fully operational–and some find the change so daunting they’re planning to retire.

Physicians around the country are frustrated by demands for documentation that have them working overtime and typing on computer keyboards in the exam room. (See “The Trouble with EHR,” March 2017 Observer, or the November 2018 New Yorker article “Why Doctors Hate Their Computers.”) Patients say they feel the difference, too.

A local resident who suffered a traumatic brain injury in a car accident says EHR impaired his relationship with his physiatrist. “At first, he gave me all the time I needed for questions and examinations, but as soon as the computer came into his office, our relationship changed,” the young man says. “I had visits where the doctor didn’t look into my eyes once.”

Some specialists use a “scribe” to sit in on visits and make notes so they can focus on their patients. Many more may do so during the early weeks of the new system. Unlike specialists, though, few primary care physicians can afford assistants.

Lapinski stresses the benefits of the new system: Cerner requires “nearly fifty other products to perform all the functions Epic will offer,” she says. “The reason for the changeover is a combination of evolving technology and the fact that the current system doesn’t connect all the pieces of a patient’s history in one comprehensive file … Right now, it’s like a person trying to coordinate four different calendars. There are better, far more efficient ways of handling records–and for us, Epic is the best.”

The switch to Epic (which is also used by Michigan Medicine) is indeed epic.Trinity employs 24,000 doctors and nurses, more than 20,000 support staff, and 400 people at its headquarters in Livonia.

“Epic has very high standards for training,” Lapinski says, and everyone at SJMH and Trinity will be retrained. The level of training varies from two to three hours for those in housekeeping services to as many as sixteen hours for doctors.

“Last spring we started recruiting doctors and nurses to serve as trainers and internal experts,” Lapinski explains. Starting January 1, sessions will run seven days a week, days and nights.

As the January 24 deadline nears, “we’ll have people from all across the U.S. here to help us and answer questions,” Lapinski says. “We’ve structured help for the first two to four weeks, to ensure the records are all safe and everyone is comfortable with the new system.”

For Trinity, this is just the beginning. “Our Michigan sites are leading the way,” Lapinski says. Facilities elsewhere will switch to Epic “in waves, over the next three years,” she says.

“Within three years, a patient living in Ann Arbor will be able to visit a Trinity hospital in Florida or California, and the health care professionals will be able to view all the patient’s records immediately.”