There are two doctors I work with: those using EPIC in my hospital network and those outside of EPIC.

Increasingly, the experience with the two providers is very different.

EPIC practice. I have full access to everything that’s ever been done to a child. After I see a patient my findings and impression are immediately available to the referring doctor. As labs are resulted, I sign, document, and release to the family with brief commentary. Patients message our office on MyChart. Engagement and documentation is baked in to the system. Email with patients is a thing of the past as adoption of EPICs comms features have taken hold. I seem to have a constant conversation with doctors inside of our EPIC ecosystem.

Non-EPIC practice. Care for a patient from a practice outside of our EPIC network is different. Bottom line: I have no access to anything that allows me to make decisions about complicated children. If I’m lucky, the patient arrives with a pile of paper. Otherwise, I call the referring office to request what I need. Shrinking margins have created shrinking staff. So I wait and wait and ultimately pass the on-hold line to my nurse who is, in turn, delayed in rooming my next patient. The wrong labs without the growth chart arrive an hour later by fax after the child has been discharged with a disposition and orders that may or may not replicate what was already done. When my chart is complete a ‘letter’ is generated that is printed on a piece of paper, put in an envelope and given to a man who carries it in a truck. The labs that I ordered interface with EPIC and change the plan long before the truck ever arrives at the the referring doctor’s mailbox.

I could go on and on but you get the picture.

The difference is between a system that functions in almost real-time versus one moving at the speed of paper, fax machines, land lines, trucks and marginal staffing. A dynamic, breathing digital interface versus a system defined by processes of the past.

The contrast is striking, really, but not necessarily new. For me, it raises serious questions about an evolving digital divide and the minimum standards for interoperability, communication and continuity of care. While EHRs certainly have their own shortcomings, when is a system so obsolete that it presents a serious compromise to patients?

For fun, some early thoughts on our EPIC integration from 2011.