A foundation for Epic
Date: February 9, 2012
For three days in January, 400 physicians and clinical staff from Johns Hopkins Medicine gathered to participate in a collaborative process for developing and reviewing a standardized workflow for Epic, the new electronic medical record system. The ultimate goal is to ensure that Epic will make patient care seamless throughout the enterprise.
Epic is being deployed first in all ambulatory sites. For the inpatient electronic medical record, Howard County General and Sibley Memorial hospitals are implementing Epic ahead of The Johns Hopkins Hospital, Johns Hopkins Bayview Medical Center and Suburban Hospital. This creates the opportunity to consider areas for standardization as a physician community, in advance of the Epic system coming to all hospitals.
“We have an unprecedented opportunity to standardize clinical practice as well as the electronic record, and we are getting terrific participation and input,” says Peter Greene, chief medical information officer for Johns Hopkins Medicine.
Last month’s session, which the Epic project team is calling the “foundational build,” was part of three phrases of validating best practices and establishing standards for using the electronic medical record. That was followed by two Community Division validation sessions over six days in late January and early February.
Participants in these sessions are addressing issues specific to each area, such as procedures, administration, order entry, medication reconciliation, and coding, among others. Content standardization will follow other processes led by application teams and business owners throughout the build phase of the Epic implementation project.
These standard workflows will eventually be put into place and followed by users wherever patients are seen and treated throughout the enterprise.
The goal of the foundational build phase will be to ensure core uniform processes and practice in key areas across the entire system. This will allow for more consistent patient care, improved productivity and ease of use for providers who work in multiple settings, and better system maintenance, reporting and efficiency.
“When you think about someone coming in for a certain procedure or treatment—whether that patient is at Howard County or Sibley or our community physicians—we want that patient to be treated in the same way” explains Wayne Smith, Epic project director. “To do that, we need the same workflow in place for each specific diagnosis.”
Some workflow processes may be considered “local,” meaning they will be built or maintained on a hospital-by-hospital basis.
Last November and December, the project team held more than 49 workflow-validation sessions over six days, gathering input from hundreds of Hopkins staff.
For example, over four dozen “physician champions,” representing specialties from inpatient and ambulatory to clinical research and surgery, participated in the sessions, notes John Flynn, Epic medical director. The champions offer the physician perspective in integrated discussions.
These validation sessions are the first step to determine how the institution will define those standard workflows. One group of staff involved in that area or specialty might look at the Epic workflow for general office visits, while another might study medication orders and a third might examine problem lists. Responses are categorized by color code, from green (“that should work”) and red (“we need to adjust and/or revisit this workflow”), to not applicable. Each person’s opinion is taken into consideration allowing issues to be identified early and resolved.
Areas that are primarily red will be assessed by one of six councils—one for each of these groups: physicians, nurses and clinicians, technical, training, revenue cycle and coordination. If the councils are unable to resolve certain issues, then those will be brought to a governance council that includes representatives with a variety of expertise from across the system.