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Dome - Engineering a Smooth Path to Epic Improvements

Dome May 2014

Engineering a Smooth Path to Epic Improvements

Date: May 1, 2014


Engineering a Smooth Path to Epic Improvements

After Epic went live at Howard County General Hospital on June 1, 2013, a procedure for ordering tests proved cumbersome for Emergency Department physicians. First, the doctors had to decide if the tests would be classified as routine or advanced. Then, they would scroll through long lists in each category before clicking on the desired one.

“It was just difficult to navigate,” says emergency medicine physician Ryan Shanahan of the structure, which was based on a previous system at The Johns Hopkins Hospital.  

Seeking improvements, Shanahan created mock-ups of two alternate designs—one that divided order sets by disease, such as diabetes or asthma, and another that divided by type of test, such as blood work or imaging. Both were evaluated, and now the test-divided system is being rolled out across Johns Hopkins Medicine emergency departments.

Shanahan is one of about two dozen “physician builders” at Johns Hopkins Medicine, a category of Epic expert with “a unique role in deeply understanding the system,” says , chief medical information officer for Johns Hopkins Medicine. Epic has been providing physician builder training since spring 2013, inviting doctors to its headquarters in Verona, Wis., for sessions that teach them how to modify the system. Johns Hopkins’ goal is to have at least one physician builder at each entity and one in each clinical department, says Greene.

Johns Hopkins has about 60 “physician champions,” doctors from various specialties who have been trained to help clinicians navigate the system and advocate for improvements. The ones who become physician builders learn to actually make the changes. Physician builders are paired with Epic experts to work on improvements that are reviewed and tested before becoming part of Epic. 

Says Shanahan, “One of the recurring issues with Epic is the translation between what clinicians want and what programmers think they want.” Bridging that communication divide, he says, shortens the length of time between request and change. 

Michael Boland, an ophthalmologist and director of information technology for the Wilmer Eye Institute, says his physician builder training helps him “translate what the clinicians think they need versus what the system can do.” Since completing the course last spring, he has worked with Kathy Sapitowicz, senior project supervisor for Epic at Wilmer, to streamline “some fairly complicated workflows” related to documenting in-office procedures, such as ocular imaging, he says.

“It’s incredibly valuable for any department that wants to take better advantage of their physician champion,” Boland says. “The goal is to actually train clinicians to help with the building and configuration of Epic.”

Howard Levy, with joint appointments in the Division of General Internal Medicine and the McKusick-Nathans Institute of Genetic Medicine, has been working to improve digital record-keeping since completing physician builder training in November. For example, he added space in MyChart, the online portal for patients, so users who self-monitor blood pressure can enter comments and other information. And he’s planning to create data collection systems requested by physicians engaged in clinical genetics services and research.   

“I see my role as a physician builder as a win-win,” says Levy. “I get to learn new tools and work under the hood a little bit, and I also get to make things better for my colleagues.” 

—Karen Nitkin