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April 8, 2013 Readers Write 27 Comments

Epic’s MyChart Signup
By Anonymous

To borrow from a physician’s comment, “When technology understands what people want from healthcare, our system has a chance. “

Last week while at my physician’s office, I signed up for MyChart. Since my healthcare provider organization went live on Epic about four years ago, my experience from a patient perspective has deteriorated significantly, becoming worse each year. I suspect this is also a result of cost-cutting actions and trying to do more with fewer people. 

My primary physician is terrific, but even she seems to now be distracted by data entry during our annual visit. I took my question list in and we talked about them.  She entered data and then I got home, realizing a couple of the issues were not ultimately addressed with a proposed solution, both of us sidetracked by data entry.

I have to say that I was totally underwhelmed by MyChart.

All I could really see in the record was a list of my meds, the ability to request a refill, and my most recent vaccines. The Health Summary stated that I have no "Health Issues," yet I was referred to a specialist for more tests and treatments.

Test results: I could not view any of my labs  or history of lab results. The message said, "On occasion, there are minor abnormalities reported with patient lab tests which are not significant. Any significant abnormalities will be addressed by your physician, who will give you the appropriate instructions.”

Medical history:  under Diagnosis, there was "anesthesia." I wonder if that diagnosis is for appearing "anesthetized" while navigating my healthcare?

There was more history on my parents than on me in MyChart.

Appointments: they did score here. My past and future appointments did appear. But to schedule the appointments, I had to go through nightmare IVR. One appointment scheduling system left me on hold for 11 minutes before reaching a person to schedule.

I received my first electronic message from one of the specialist’s assistants I am seeing. It was annoying to open the e-mail to find I have to go into the portal (yep,now what is my user name and what is my password…I have forgotten) to merely see an e-mail they sent with a link to an online education for a procedure, easily available to me if I Googled the topic. I was annoyed by the required time to retrieve message and the fact I thought it might be important and require my immediate attention. And later, to go back in to send a response.  

So I didn’t send an electronic response — I called them back. This "assistant" seems to know very little about the procedure. Every time we speak, there is a new tidbit of info which impacts my planning and what happens pre- and post-procedure. When I asked her why I wasn’t told this before, she responded, "I am just reading it now.”  

I still have no clear answers to questions I am posing as an informed healthcare consumer and advocating on my own behalf. I cannot imagine how my parents would navigate through this. In fact, they would not be able to do what I am having to do and would have been no-shows. 

Although I have now signed up for this revolutionary change in healthcare, I see minimal benefit to electronic messaging. I would put money on my actual physician not likely choosing to communicate with me through this portal in the near future.

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Currently there are "27 comments" on this Article:

  1. Don’t blame the tool, blame the contractor. My experience with MyChart is very different. After my annual physical I stopped at the on-premise lab for a quick blood draw. By the time I got home about an hour later the first lab tests were waiting for me online. About four hours later I received another email telling me that additional results were available for viewing. Twenty-four hours after that was another email alerting me to the last of the results. Less than a day later I had a comprehensive review from my PCP telling me which results she liked and which she wanted to retest in six months (which, six months later, were easily compared to my previous results). All of this information was pushed directly to me, no effort on my part required other than logging in to view it. Even everything we had discussed during my physical was online and available for review too.

  2. Agree with everything in this story as it mirrors my experience with MyChart. I find the only thing vaguely useful about the application is the ability to print copies of my own lab results rather than relying on the physicians office to mail me a copy. However, this applies only to lab results, I still have to stop by and pick up radiology reports or have them mailed to me. Adding to the frustration of “improved electronic health records”, several important consultant reports were mysteriously lost when the medical office converted from a previous EHR application to the EPIC system. My state-of-the-art health record is incomplete thanks to an incomplete conversion process.

    I see very little of anything useful to facilitate meaningful interaction between the patient and the provider.

  3. Your experience seems very odd and I wonder if it is somewhat a reflection of some of how your provider charts and keeps up with results.

    Also, why didn’t you just do your appointment on MyChart rather than an IVR??? That seems really odd.

    My sense is that your doctor or your health system isn’t thinking through what they are putting out there for you.

    In My MyChart – I get All my labs and other test results, All my health issues, All my immunizations, All my meds, All my allergies, My upcoming health screening items, All my appoints (past and future), All my visit summaries from each visits, All my billing and insurance information. Plus something called My Health Trends which I shouldn’t looked at because it is pointing out a potential problem I probably should act on.

    All that and I can schedule appointments, do some sort of electronic visit template, pay my balance, update my insurance and demographics.

    They also have a nice health library online.

    I also use it on my iPhone/iPad and it gives me pretty much all that stuff there as well.

    Seems sort of useful to me.

  4. “Although I have now signed up for this revolutionary change in healthcare, I see minimal benefit to electronic messaging. I would put money on my actual physician not likely choosing to communicate with me through this portal in the near future.”

    Then get angry! Go complain to your doctor! Complain to the nurses!

    I appreciate your need to vent anonymously on the internet, but the only way things are going to change is if providers and nurses know that you find value in communicating with someone electronically. It’s good when it works (I think), so you need to convince them that it’s something you expect from a doctor in 2013. It’s part of the whole reason why 65% of doctors don’t think that YOU need access to your medical records electronically.

    Re: email -> No patient portal can send PHI unencrypted through email, hence why you need to log into the portal. Non-ideal, I know.

  5. As with the entire Epic suite, which functions are activated, what content is presented and at least some of the navigation is determined by the health system implementing. Hence the expression, “When you’ve seen one Epic implementation, you’ve seen one Epic implementation.” This sounds like a sub-standard implementation. I have seen and personally use better instances.

  6. The email with a link (vs information in the email itself) is a privacy/HIPAA requirement.

    If the author wasn’t happy with the patient education sent by the provider- what would be the alternative… send nothing? ‘That’s been the norm.

    The fact that a patient CAN go find materials via Google is really not the point. Not enough patients DO go find/read patient education. So providers are being asked to SEND information to patients.

    The provider-centric world of healthcare will not become more patient-centric until patients are proactive, insist on having reasonable access to their record (in digital format), expect to get proactive information re: the tests, drugs, procedures, devices, etc. that are part of their care. While likely imperfect, the patient portal (in this case My Chart) is an important first step.

    30+ years ago the first ATMs arrived- they were user-unfriendly, capable of little and generally horrible. Many people complained and rising consumer expectation was met with rising functionality. Hopefully the same happens in healthcare where sadly meaningful demand for consumer control has been limited to date- ‘perhaps based somewhat on the fact that often someone else is paying the bill.

  7. I used ATMs 20 years ago and they were just fine then as they are now for 99% of what I do. Put in a plastic card, punch in a our digit code and ask for some cash.

    The only really new feature that I am aware of is that now I have to tell it each and every time that I speak English because it can’t seem to remember that from one time to the next.

    And banking is the role model we hold up for health care??? What a joke.

  8. Sounds like your clinic stuck you with a featureless EPIC MyChart. Mine was introduced 3-4 years ago, and I haven’t spoken to an actual scheduler since then, and I’ve paid bills online. When I get to the office, I even check in on an airport style kiosk so I don’t wait to talk to someone then, either. Granted, my care has been pretty simple (primary care, allergy, specialist follow ups). I’ve messaged with my PCP a few times and that seems to work fine. I broke a rib and had to visit the ED, and all of the med instructions and care for the rib were recorded online. When I visit my PCP, he spends a good deal of time typing but he’s facing me with the computer between us, so at least we’re have a quasi conversation. I’d rate it up there with my online banking which pretty much serves it’s purpose. I have a lot of other complaints about the experiences at my clinic, but MyChart seems to work as advertised where I go.

  9. This article smacks of ulterior motives. I’m not saying it comes from an Epic competitor, but…

    I agree with the other commentors, if the “writer’s” feedback is from a real MyChart site, then it is the result from the provider failing to optimize the systerm and offer all that MyChart has available. My favorite things about MyChart: online scheduling, medication refills, test results, appointment history. When configured well, it is a great patient portal. When I left Epic and the Madison area and didn’t have MyChart, I was so confused using my insurer’s website to find docs and there was no online scheduling. I want to go about my business without having to get on the phone to schedule an appointment, want to go to the doctor without having to speak to a person while checking in and Epic provides all of that. Epic understands the current generation and is making software that fits with our lives. This coming from a guy who no longer draws a paycheck from Epic.

  10. This is a short step away from saying “My hospital went live on Epic and now I hate the font my statements use and that I am expected to pay them.” You’re complaining about design decisions (statement font / results release schedule) and federal requirements (having to pay / HIPAA email guidelines), *not* the underlying technology. Same with the inability to schedule directly in MyChart (though many hospitals understandably restrict that only to the more vanilla appointment types).

    There *are* some pretty big problems underlying MyChart the technology (and if it were up to me I’d push for a ground-up rewrite to flush its path dependencies) but this op/ed addresses approximately none of them.

  11. I worked for a non-EMR health care company that also sent PHI and tried to skirt the secure issue by generic-izing information being emailed. There was always a big concern about how people would not want to login. I really do not get this because I get multiple bills and communications from my bank, my credit card company, my electricity company, etc, etc. None of them sends me info via email, all require me to login. You really want your healthcare info sent unsecured and waiting on a Gmail server to be hacked?

    I’ve used MyChart in a couple different flavors. It’s fine, very basic, but I get the info I need and can do what I want. It has all my tests and the ones that come back normal just show up. Unfortunately some are also forced to make their portal less useful through poorly written state regulation. The work I hear they’re doing to have hospital visits show up will be nice I think.

  12. Ex-CIO as hit the nail on the head. I can actually even remember a staff meeting where Judy herself was addressing this topic – that the mychart functionality between the three major hospital systems in Madison isn’t even the same. The situation presented in the original post has happened because either (a) the hospital system made the decision to set mychart up that way, or (b) somehow the ‘other’ functionality slipped through the cracks of implementation.

    Given that Judy and Co. regularly harp on getting customers to take ALL OF THE FUNCTIONALITY, me thinks (a).

  13. “All I could really see in the record was a list of my meds, the ability to request a refill, and my most recent vaccines.”

    Sounds like that’s what your doctor’s practice decided to implement, Wow, there’s so much more they could have decided to implement. Your doctor could use your help in advocating for a broader implementation of MyChart. I bet you will find they have a staged plan for increasing functionality.

    “Test results: I could not view any of my labs or history of lab results.”

    This is the most commonly implemented part of MyChart. Why your doctor’s practice did not implement this is a puzzle. It’s my favorite part of my own MyChart account with my doctor.

    “Medical history: under Diagnosis, there was “anesthesia.””

    MyChart can show only what data has been entered. If no one entered your history, let them know you noticed. Sounds like they could use some encouragement that this information is important to you. I know my own internist needs this encouragement, too.

    “One appointment scheduling system left me on hold for 11 minutes before reaching a person to schedule.”

    Not really part of MyChart. But encourage them that you would like online appointment creation. It’s a win for everyone, believe me.

    “It was annoying to open the e-mail to find I have to go into the portal ”

    Write your Congressman and ask her to repeal HIPAA. Until then, appreciate that this is part of keeping your information secure.

    Talk to the people who run your medical group. Congratulate them on bringing the basics of MyChart live (I promise it was a major effort). Listen to their plans for how they are going to roll out more features. Encourage them that a full implementation will make your life easier. Let them know you are noticing. It’s the most motivating force in health care administration!

  14. Somebody post the part of HIPAA that says that email to a patient can’t have PHI in it, I’d love to see it. I’ll save you the trouble, though, it doesn’t exist. Patients aren’t covered under HIPAA, and therefore do not need to meet any of the HIPAA requirements in the technology that they use, and neither are non-healthcare intermediaries, like email providers or telecoms. Once the email passes out of the provider’s encrypted and secured bubble, which is covered under HIPAA, the law stops applying.

    You can make a privacy argument about sending PHI that way, and the HIPAA Privacy Rule still applies (the patient has to agree to receive information that way), but HIPAA places no other limitation on it.

  15. Like many others have stated, your physician’s practice (or organization as a whole, most likely) has decided for whatever reason not to implement the key features that make MyChart a good tool for patients.

    I’m currently seeing an OB at a small non-Epic practice and their patient portal for their EMR really stinks…very similar to what the poster describes. Pales in comparison to the MyChart features I have with my PCP, who works at a clinic that’s been a long-time Epic customer.

    As an Epic Consultant, I have seen some of Epic’s bigger and longer-standing customers be more focused on aquiring new clinics and hospitals, rolling out their cookie cutter “vanilla” version of Epic, and moving on to the next site without ever stopping to pause and take some optimizations. I wonder if that happened at your clinic…

  16. Thank you for all your interesting posts and great dialogue. Responding to a couple of the posts – disclosure — no, I am not with a competitor to Epic. I have worked with Epic and with competitors 6+ years ago.
    I suspected it was the implementation but it isn’t just about the functionality of MyChart. The frustration hits on many points. Ultimately, the user experience – the steps taken for patient engagement not going well for the general population. Vendors/providers/payers need to step away from their world and look at the world from Joe Plumber and not just the tech-savvy idea folks.
    The post from “another ex-Epic employee” praises the ability to do the mundane tasks of their personal healthcare online. I suspect this person has not dealt with chronic disease, elderly/ill parents, seriously ill children, or an aging body that requires more and more intervention. Handling Rx refills, test results, scheduling is the “entry point” – the basics for personal healthcare management. The holes start appearing as you move to the next level.
    PHI and HIPAA – I realize this is price I pay for secure and confidential which necessitates the portal. What I don’t want is an alert in my email without a way to determine the level of alert. Yes, all our personal businees transactions require portal entry for account management. The more I am required to do this, the more I find it tedious. User name and password maintenance, especially to stay one step of hackers. And waiting for screen changes and info to upload or download. And crossing my fingers the printer doesn’t jam if I have to print something out. As for scheduling appointments, one of the responders was accurate – only the most basic “vanilla” is offered to self schedule. The level of frustration was raised with the lack of information provided regarding requirements for pre and post procedure. This required even more phone calls. Provider failing.
    Navigating healthcare electronically can be a major challenge for the aging population. Coordinating care is almost impossible.
    Bottom line – I am very capable of advocating and navigating, even the worst experiences. What is frightening, is knowing how difficult this can be even with the experience to do so. And I suspect my experience is the reason my mother was a no show for procedures that would have improved her quality of life and instead, led to her death. MyChart does not necessarily = patient engagement, The variables are many – and yet too often the industry chatter positions technology as the answer to the ills. It’s not about the nuts and bolts of technology.
    Back to my opening line where I quoted a physician –
    “When technology understands what people want from healthcare, our system has a chance. “

  17. Anonymous MyChart User,

    I suspect you are right in that your specific experience has more to do with the implemenation at your provider than any specific application itself. It’s also important to understand that MyChart is just a portal and the data presented in it is dependent on the underlying systems of record. For example, if your provider uses third party systems for LIS and scheduling, and has not fully interfaced those with their Epic HIS, it’s probably reasonable to expect less than full data in the portal and a somewhat disjointed workflow for patients (and providers by the way). From personal experience, if the implementation incorporates most of the native Epic modules or has deeply interfaced the ancillary systems, the experience can be quite good as supported by many of the comments on this thread.

    The only thing I would take issue with is your statement that “When technology understands what people want from healthcare, our system has a chance.” In almost every case I have been involved with over 20 years, it’s rarely the technology that needs to understand, it’s the people themselves who need better understanding. That goes equally for vendors, provider IT folks, and clinicians.

  18. Anonymous14:

    The patient isn’t covered under HIPAA but the provider certainly is, and there are several justifiable reasons why hospitals won’t consider email to be a HIPAA compliant release:

    1. It’s not direct to the patient. An email can pass (completely unencrypted) through a dozen third parties’ systems on its way to your email server. If anyone malicious had access to those systems, either authorized or unauthorized, it would be trivial to intercept and copy an email in flight.

    2. A typo in an email address, or an old email address being reused, could send information to the wrong person. As it stands, the wrong person might receive the email notification today, but they wouldn’t have the right password to access the secure content.

    3. From a legal point of view it’s not clear who owns the content of an email while it’s on the email server. It’s conceivable that you could release information “to the patient” that becomes owned by the patient’s email provider.

    4. Email services such as gmail parse the contents of your emails looking for keywords to serve you advertisements. Even though Google doesn’t claim ownership of the contents of your emails, they do parse all of them and associate key words with your account. Do you really want to see ads targeted at your health problems every time you visit any website that uses google ads?

    Unless email with end-to-end encryption becomes the norm, you won’t see any health care system who would dip their toes into those waters.

  19. Yes I believe every implementation is different. Our network has a similar MyChart. Can’t schedule appointments, patients can’t view labs despite having an interface with the lab, practitioners may take a week to reply to an email. I have heard some don’t at all. So I find no value in it as a patient. Just use the phone instead and talk to a person and wait for them to hunt for the right screen!

  20. I as well don’t really see the point of My Chart. Doctors don’t take the time to enter any information…. or whomever is suppose to be doing it. I always end up calling anyway.

  21. MyChart is an EPIC flop! I signed on to MyChart today for the first time and couldn’t drill down into any lab work. I am just guessing that the reason EPIC can not get lab results to display on their MyChart is because they can’t figure out how to get lab results from various labs across the country to populate the record seemlessly. EPIC is not an INTEGRATED PLATFORM it is written in ANCIENT code. MyChart is just the tip of the iceberg on problems to come for them.

  22. Just saw this thread and wanted to add my two cents. I hate MyChart because the user interface was not well thought through. Who creates an email system where you cannot respond to the email you received? Seriously, that’s terrible design. Also, what’s the point of sending my test results if someone like me, who is not a medical professional, cannot interpret them without help? That’s totally useless. Every interaction I have with MyChart just leaves me more frustrated and disappointed. They could make technology that would be so helpful to patients. Instead they opt for this clunky piece of crap software solution that doesn’t serve anyone’s needs. MyChart is a big fail!

  23. Hmm. All this talk about MyChart is funny. I have a MyChart and I can do all the stuff you are talking about it not being able to do. Maybe you should talk to your providers about fixing their broken system at their organization because it seems to work for those of us going to other organizations. I work in hospital IT for a NON-EPIC customer I know most issues (75%) are not the system’s fault they are user error. I also know our system can’t do many things that other Cerner systems can but I don’t go around saying Cerner can’t do x, y or z or has failed at an attempt for an app because it doesn’t work well at my organization.

  24. From this patient’s POV, Epic blows. Terrible mobile apps, no connection with my standard calendars or messaging or email, PITA med test reports, useless tech support that blames the doctor/ medical facility when the appointments in Epic don’t match the calendar the appt desk has, or when you try and send a message and it goes to the wrong dept.

    And I am not working for a competitor and I use it in a major hospital in NY.

    Back story:

    Epic is huge with Obamacare because the CEO donated big to Obama campaigns:

    http://www.creators.com/conservative/michelle-malkin/the-obama-crony-in-charge-of-your-medical-records.html

    More Epic fail:

    http://cnsnews.com/commentary/michelle-malkin/ebola-electronic-medical-records-and-epic-systems

  25. Agree with the writer above , who states that he/she cannot understand the med. jargon in which My Charts “reports” to us are written, as well as its alarming, incorrect conclusions: Early on it declared that I was in danger–or “borderline danger” of various serious diseases–When I asked my MD with great concern, he said “No way”…–I can’t understand it , either ( despite the fact that I was a UN interpreter and a government intelligence information specialist, and am now a college language professor) —Earlier on I decided ( out of pure frustration with its incomprehensibility and malfunctions) not to use My Chart–Today, though , I decided to use it one time to confirm my regular check-up date — Because I needed a reminder about my ID ( not having used the darn system for months), and because , as many will know, it’s hard to keep ca. 100 “slightly different” online ID’s straight) , My Chart asked me a “security question” ( “What high school did i attend ?” ) –that should be simple enough : I only attended one high school and know its name well ( Fitch High School, Groton, CT) –for some reason, My Chart didn’t accept my answer –so I tried about the variations on the name ( adding “Robert Fitch”to High School, Groton, Connecticut, the location to the title, etc. —-AND IT DECLARED THAT , “due to too many attempts” my account was blocked!?!?!?–Geez, I know the name of my high school already —but that’s yet another #$&*! thing that happens when you use this ^&*! thing : Never again….

  26. It is dangerous crap that is further degrading health “care.” These EHRs are transmitted throughout the entire health care system and, despite what patients are told about privacy, are accessible by anyone. MyChart doesn’t, however, allow a patient to counter the wildly inappropriate comments sometimes made by practitioners who write, “patient obtuse,” or, tell the jerk who wrote the notes that, “No. I said there was not pain at the moment, because, as I told you, the level 9/10 pain was intermittent. So, your saying that complaint of pain without evidence of pain THEN, only tells me that I was considered a nutcase, even though I have a hole in my leg.

  27. I’ve used all of the major patient portals and MyChart is by far the best so it’s more of a knock on the whole space rather than just MyChart.







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