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Dome - Epic Emergency Prep

Dome June 2014

Epic Emergency Prep

Date: June 5, 2014

The Johns Hopkins Hospital's Emergency Departments' clinicians aim for a harmonious transition to the electronic medical record system.

The departments of Emergency Medicine and Pediatric Emergency Medicine at The Johns Hopkins Hospital can be hectic, unpredictable places. On any shift, treatment could be needed for heart attacks, broken legs, toothaches, gunshot wounds or the flu.

Doctors must be able to prescribe medications and request lab work, and they need to see the results of tests and treatments, even after patients are transferred to inpatient departments or referred to specialists.

Emergency Department clinicians are leading a two-year effort to make sure the Epic electronic medical record system will be ready to handle all the tasks of the busy Johns Hopkins Hospital emergency departments.

Since April 2013, Epic has been rolling out across Johns Hopkins Medicine, bringing a unified electronic medical record system to community, outpatient and research clinics, as well as to Sibley Memorial Hospital and Howard County General Hospital. Suburban Hospital switches to Epic on July 1, followed by the Johns Hopkins Hospital emergency departments on August 6.

Though Howard County General and Sibley are already using Epic in their emergency departments, the system needs substantial changes for The Johns Hopkins Hospital. “The clinical needs [of the Howard County General and Sibley emergency departments] are vastly different from a large academic teaching hospital,” says emergency room pediatrician Jean Ogborn, a physician champion helping to structure the new system.

While all of Howard County General and Sibley are now using Epic, the same is not true for The Johns Hopkins Hospital, so one challenge is creating interfaces between Epic and legacy electronic medical record systems in the hospital’s inpatient units and radiology and lab departments. Those connections will make it possible for doctors to create unified records, which patients can access through their MyChart portals, even with Johns Hopkins Hospital departments that will not move to Epic until 2016.

In addition, Epic must “harmonize” across entities, so any changes aimed at improving the process for The Johns Hopkins Hospital also must make sense for Howard County General, Sibley and Suburban. “We are working with many, many stakeholders to figure out how we want to tailor the existing products,” says Ogborn.

The work includes painstakingly comparing the current electronic system, Allscripts HMED, with the Epic Emergency Department program, called ASAP, says Stephanie Figueroa, lead physician assistant for the Department of Emergency Medicine and an Epic “subject-matter expert” working to make sure the system will be ready. “If you want to be satisfied with the end product once you go live, you have to give input,” she says.

Because emergency departments can’t scale back their schedules while adjusting to the new system, training in advance of the launch and extra staffing in the weeks following it will ease the transition, says Peter Hill, clinical director of the Department of Emergency Medicine, who is leading the Epic Emergency Department project.

After the system goes live, there will be opportunities to tweak and improve, a process known as optimization.

Both Ogborn and Figueroa remember the Department of Emergency Medicine’s smooth 2008 transition from paper medical records to Allscripts and predict that the switch to Epic will be even easier. “Because we’re an emergency department and we’re used to dealing with the unexpected, there’s a certain resilience there,” says Figueroa.

—Karen Nitkin


Newsletters with Epic optimization updates are published each week and can be found by clicking “Read the Epic Newsletter” on the right-hand side of the Epic website,

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