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Dome - Going With the Flow

Dome February 2013

Going With the Flow

Date: February 1, 2013


Going with the Flow

Although Epic won’t go live in ambulatory settings across Johns Hopkins Medicine until April 4, positive reviews are pouring in from clinics where patient care teams have been test-driving the new clinical workflow since September.

Participants in pilot projects in the Department of Medicine say the Epic workflow fosters patient-centered care. As one physician noted in a recent survey, Epic’s “electronic prescription capability, along with the medical assistants’ support, is a big time saver.”

A certified medical assistant who accepted more documentation responsibilities within the Epic workflow reported an “increased sense of teamwork with providers.” Patient feedback included this observation: “I especially like how my prescriptions were automatically transmitted to my pharmacy.”

For Department of Medicine administrator Patti Engblom, such evaluations confirm Epic’s promise “as a tool for us to change the way we deliver care within the clinics.”

She says the traditional physician-centric model, in which each specialty clinic has its own set of preferences, creates “paper-heavy processes” that hinder the cycle of patient care in a department that handles more than 250,000 outpatient visits annually. Epic reframes and standardizes clinical workflow and redistributes documentation tasks to care team members according to their role.

So far, 40 Epic pilots have been completed in primary care and specialty practices within adult medicine. “We plan to continue them so that all of the providers are involved,” Engblom says.

Although paper medical record forms are used in the pilots, they mirror Epic processes and pinpoint opportunities for streamlining patient flow, from check-in to check-out.

Many physicians, for example, are concerned about how much time Epic requires and how they can avoid falling behind on seeing patients, says Stephen Sisson, associate professor of medicine and co-leader of the department’s transition to Epic. So far, pilot data have uncovered opportunities to offset physicians’ time-consuming charting duties by assigning more responsibilities to certified medical assistants. “We looked to see where a medical assistant could collect patient data instead of the doctor,” Sisson says.

The pilots also address the need for more standardized patient scheduling, Engblom says. Physicians have “traditionally defined how they want their template to look. We’re finding we have to reappraise the templates to ensure the most efficient flow of new and returning patients.”

Patients largely approve of the workflow redesigns, Engblom says. “Only 7 percent of responses have been negative. In my mind, that’s pretty good.”

—Stephanie Shapiro

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