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December 2007 Volume 31 No. 11
Epic update


Registration and training has begun for physicians on the new Epic Electronic Health Record [EHR], scheduled to “Go Live” Feb. 29, 2008.

The system will allow physicians to review and edit their charts virtually anywhere. The days of searching for scraps of paper, or patient prescription information will be ended, notes the physician leaders who have worked to make sure that the transfer to a paperless medical record will happen successfully. Now it is time for “no physician to be left behind,” quips Topher Sharp, an internal medicine specialist and medical director for clinical informatics. He’s been responsible to his physician colleagues, including Kevin Tabb, physician chief quality/medical information officer, to help smooth a transition to the EHR.

While the benefits of an integrated, paperless record have been touted literally for years, maybe decades, the reality is that training and registration on the system “is not an option,” notes Tabb, who adds that the installation of the EHR is the largest system installation in the institution’s history.

We talked with Sharp after a physician luncheon, held in November, to answer questions that medical staff members have about making the transition to Epic.

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Q: Why should physicians sign up for Epic training now?

SHARP: To make the system work effectively, we all need to complete physician registration now.

Q: But the system doesn’t “go live” until Feb. 29. Why not wait until next year to register? In any case, what if I do better with “just in time learning?”

SHARP: Fine. If you register now, you can schedule your training when it makes the most sense for you. For example, if you want to train in mid-February, sign up for that time now. On the other hand, if you register, say in January for a February date, the optimal dates and times might be filled, especially for slots we’ve reserved for physicians onsite at SHC. Late sign ups might mean attending class at North Campus in Redwood City — which some physicians might prefer but others won’t. We’ve scheduled classes at a variety of times in and outside business hours, but again, some slots are likely to fill earlier.

Q: My nurse and residents do all the charting. Shouldn’t I be exempt from a hands-on course?

SHARP: No, because just as today you need to sign your paper charts, you’ll need to “sign” charts electronically. It is not appropriate to have even a trusted assistant use your personal password anymore than it would be appropriate to have your assistant sign your personal checks with your name. More importantly, however, you will need to understand how the chart flow operates. Ask yourself: “Would my effectiveness as a physician be compromised if I were unable to understand or negotiate today’s paper chart?”

Q: Fine, so does that mean all physicians need to be trained?

SHARP: Any physician who wants to continue practice at SHC will need training and certification. That being said, the amount and kind of training is privilege and practice specific. For example, physicians who need and want full access to the Epic EHR will sign up for eight hours of training. Physicians will have some flexibility on how much of that training will be classroom vs. e-learning, depending on their comfort level with computer learning. Beyond that physicians, such as those who practice in the clinics only, will have shorter training courses designed for their needs. [See chart 3]. For example, the shortest training package for physicians is 30 minutes of e-learning for clinicians who already use Epic in their daily practice (mainly at Palo Alto Medical Foundation) and only need view only access to Epic at SHC.

 

 

 

 

 

 

Q: So what if people are unsure about the system after eight hours of learning?

SHARP: Many people may want to practice either on their own at home or in a computer lab where expert users will be available to answer questions. That’s another good reason to register and sign up for classes right now, so you can play with the system and answer all of your questions before you actually have to use Epic after Feb. 29.

Q: Is there any flexibility on the training length?

SHARP: The SHC MIDWG (Medical Informatics Directors Work Group), which includes physicians, is making a few schedule length changes for categories of doctors as we learn subtleties about various subspecialties. For example, at today’s [Nov. 28] physician information luncheon meeting we identified a small group of ophthalmologists who only perform outpatient surgeries and never admit patients. Our plans called for all surgeons to complete the entire inpatient training, but we are reevaluating that for surgeons who practice only in the outpatient mode. Our only goal is to make this process work.

Q: Can you remind us why we are making the conversion to EHR in the first place?

SHARP: It will provide a single, integrated health record to improve quality of care, increase patient safety and improve patient and provider satisfaction. These sound like clichés, but in 2008 the alternative is not the status quo, but instead, a deteriorating paper-based record system that will simply not continue to work in the future.

Q: How do you know Epic will work?

SHARP: We’ve seen it for ourselves and we’ve reported this to the Medical Staff. Most recently, several Medical Staff leaders, including surgeon Jim Badger, anesthesiologist and Medical Staff President Bryan Bohman, hematologist Sue Sorensen, otolaryngologist Winston Vaughan, and gastroenterologist Harvey Young visited Swedish Medical Center in Seattle. That hospital was only two months into an Epic EHR launch, and we were very encouraged that while not seamless initially, the transition was highly successful and offered added value to physicians and patients. What we know from all of our candid discussions and research is that the system won’t work unless every physician who uses the system knows how to use it.

Q: Can you recap how you’ve used physician input in the process?

SHARP: We don’t have enough time or space to reiterate all the ways that physicians have been involved in innovating and vetting the entire EHR process. Several of us are working halftime on the implementation. My fellow Epic medical informatics directors are a diverse group of practitioners, faculty and community physicians, and include surgeon Jim Badger, anesthesiologist Chris Egger Halbeis, oncologist Ellie Guardino, emergency medicine specialist Jim Quinn, surgeon Andy Sheldon, Menlo Medical Clinic cardiologist/internist Charlie Tucker, and thoracic surgeon Richard Whyte.

Q: Can you tell us once more how our lives will change?

SHARP: My pleasure. Physicians will find centralized, immediate information that is available everywhere — office, home, hospital, Starbucks or an overseas conference — via secure access. Scans and images will be available as well in this single integrated patient record. Your patients’ pharmacy records will be consolidated in a single online list shared by all SHC providers — and more. It’s all coming to SHC.

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Here are the key contacts for Epic registration and training:

Just go to
http://sumlms.stanfordmed.org/sumtotal
to register.

Here are instructions for physicians to access online training after registration. This includes some tips developed in response to frequently asked questions:

1. Log into the Learning Management System: http://sumlms.stanfordmed.org/sumtotal

2. Your username is your dictation number (you must use a total of 6 digits, with leading zeros: If your dictation number is 12345 you would have to enter 012345).

3. Your password was originally your last name (The first letter must be capitalized and all other letters would be lower case; it is case sensitive: If your last name is tabb, you must enter Tabb). However, you were prompted to change it when you initially registered. You should now use your new password. It will not be your last name unless that is what you chose after initially registering.

4. Some physicians have asked, “What do I do next?” So …. Click the little green square with the arrow to the left of “Basics – Intro to Epic”. This is the only place you can click to launch the learning module. You will find this just below the “Current Registration” heading. If the learning module does not launch, you may have a popup blocker on your browser. You must disable your popup blocker if this is preventing the learning module from popping up.

Physician Epic questions?:
Email Help:
CISLearningServices@stanfordmed.org

Phone Help:
(650) 644-7966.