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Dome - A Change of Epic Proportion

Dome October 2012

A Change of Epic Proportion

Date: October 5, 2012


"Before Epic goes live, we need to create an efficient workflow process that benefits patients and doesn't waste clinical resources," says John Flynn, Epic medical director.

While gathering tips for Johns Hopkins Medicine’s conversion to the Epic electronic medical record system, internist John Flynn heard the same advice from associates around the country. “When I described the Hopkins ‘do it yourself’ way of getting work done, colleagues at our peer institutions said, ‘John, if you don’t change the process, you will fail,’” says Flynn, Epic medical director.

Teamwork is the only way to tap Epic’s full potential to integrate medical records, improve patient care and safety, and yield valuable data for research, Flynn says. Without teamwork, the initiative will likely falter. “We have to do it right,” he says.

Now, whether he’s speaking to the Clinical Practice Association board of governors, clinicians spearheading the Epic rollout, or members of the faculty senate, Flynn urges listeners to embrace a new, collective health care delivery model. Clinical autonomy must give way to standardized practice, says Flynn, who has worked with clinicians, support staff and administrators across Hopkins to build an Epic readiness plan.

The plan spells out the work ahead in preparation for April 4, 2013, when the EpicCare Ambulatory system goes live at the Johns Hopkins Outpatient Center, clinic locations at East Baltimore, Green Spring Station, White Marsh, the Johns Hopkins Bayview Medical Center campus, and all Johns Hopkins Community Physicians clinics.

Consolidating resources is critical, Flynn says. Today, for example, Johns Hopkins patient data are stored in more than 200 information systems, making it impossible to develop a single standard of excellence, much less a cohesive approach to health care delivery, he says. “How do you address process change in an institution that’s so decentralized? That’s our heritage, and it presents so many great strengths and opportunities, but also great challenges.”

The Health Information Technology for Economic and Clinical Health (HITECH) Act has set 2014 as the deadline for activating systems that adhere to “meaningful use” standards for evaluating clinical care coordination, timely data entry, and giving patients access to their clinical records. By meeting those measures, eligible providers and hospitals can qualify for substantial Medicaid and Medicare bonuses. Penalties await those who don’t.

“The incentive program lines up beautifully with many processes that we want to improve anyway with Epic,” says Peter Greene, chief medical officer for Johns Hopkins Medicine.

Gene Green, vice president of medical affairs for Johns Hopkins Community Physicians concurs. “People have proven over and over that standardization increases patient safety.”

Under four “dimensions of readiness” (people, workflow, technology and preparations communication), Flynn’s workgroup has identified prerequisites for an effective Epic rollout. Small leadership teams, each a mix of clinical and administrative expertise, have been enlisted within individual clinics to oversee Epic training for staff and to promote cooperation and accountability. 

Using Epic efficiently also depends on well-defined clinical processes and workflows. Epic assigns a role to each clinical team member. A patient access specialist, for example, schedules appointments and records them in Epic. The medical assistant takes vital signs, collects medication information and schedules additional appointments and other tasks. The nurse coordinates chronic disease care and enters patient plans into Epic.

For the system to work, the leadership teams must first conduct audits of staffing ratios, patient volume, exam rooms, available computers and weekly clinical practice hours. Where gaps or surpluses are found, resources will need to be realigned. Also under scrutiny is whether the work performed by caregivers in each clinic corresponds with their scope of practice.

The goal is to have the right mix of people performing the right jobs and entering the right data, explains Renay Tyler, director of nursing for ambulatory care, who is leading that department’s rollout. 

Other rudiments of readiness include investing in an adequate supply of computers and other electronic devices, converting digital and paper charts to Epic and creating seamless interfaces with other electronic systems, instituting a clearinghouse for accurate information and forming technical support teams.

The concept of readiness also applies to physicians, who need to participate in building and validating the systems that will soon define their practices. Says Bruce Blaylock, administrator for ambulatory services at Johns Hopkins Bayview, “For providers who are thoroughly engaged in this process, once their clinic goes live, it will be a smooth transition.”

—Stephanie Shapiro

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