January 2009 Volume 33 No. 1
Epic teams enhance support, apply lessons from earlier rollouts

Support for physicians has been bolstered and remains a key objective of the CIS-Epic team in 2009 following the successful launch of the electronic health record (EHR) in five outpatient clinics in October.

A series of coaching sessions, one-on-one at-the-elbow support, and drop-in help sessions at locations targeted to be convenient for physicians [see schedule below], continue in January, said Pravene Nath, SHC’s chief medical information officer, and Christopher Sharp, associate chief medical information officer, who has been involved with the CIS-Epic launch since early planning stages and is leading the ambulatory rollouts.

Recent “Gold” stage outpatient launches have provided lessons which will help the CIS-Epic team develop systems to make upcoming clinic launches and the overall performance of the EHR serve patients and caregivers more effectively, Nath said.

Key elements of upcoming clinic transitions to CIS-Epic will involve clinic managers early in the process of changeover logistics and activities, as well as making both group and one-on-one physician training more subspecialty specific when possible, he said.

Five clinics — Gynecology, Surgical Specialties, Urology, Vascular Surgery and Integrative Medicine — went live on Oct. 28. The Cancer Center is scheduled to launch on Feb. 3. Five more clinics are set to go live on March 10, and finally, 10 more clinics will be launched on four dates between June 23 and Oct. 13. [See launch schedule]

On March 17 the Cancer Center will activate the Beacon system, which will enable physicians to electronically schedule and order chemotherapy protocols and other treatments to better meet the needs of individual patients.

By mid-December, Nath, an emergency physician, and Sharp, who practices with Stanford Medical Group, said that all physicians in the activated clinics were using Epic functionality, and that many are using the EHR for all of their charting needs.

“What we are seeing is that the EHR is evolving from an alien system that has been added to an already busy practice schedule to a useful tool that caregivers are integrating into their practice with an eye toward eventually saving time and effort while increasing safety and accuracy. Realistically, this is not seamless yet, but it’s on track to become so,” said Sharp.

Staff has become comfortable with the system and that scheduling was on track to reach 100 percent of volumes typical of pre-Epic practice. Sharp noted that during the transition, patient appointment schedules were temporarily reduced as much as 50 percent to ensure caregiver comfort with the system, “and we expect that this cutback followed by prompt escalation to a normal schedule will continue in new clinics being launched.

“We will be scheduling an array of support and training, including small group presentations that will include user tips based on real life questions and scenarios,” Sharp continued. “We have also found that the drop-in sessions are a relatively stress free way for clinicians to share ideas, learn from Epic experts, and have specific or systemic questions answered,” Sharp added.

Nath and Sharp emphasized that physicians must complete the requisite eight hours of training, which is the minimum instructional time recommended by Epic Systems, the EHR vendor.

“And we have found that physician clinical absences must be minimized during the weeks following launch to ensure that everyone is becoming proficient at a time when we can offer maximum support to each clinic during the transition,” Nath said.

The leadership MIDWG (Medical Informatics Directors Work Group) has endorsed a hospital policy that successful completion of training is essential to continued practice in SHC clinics.

“Without sugar coating this need, it’s worth noting that proficiency in the EHR is a win-win situation — it enables both caregiver and institution to utilize the benefits of the always available EHR and the rich supply of information — such as real time monitoring of drug interactions,” said Sharp, who uses the system as a practitioner.

“We expected and we found that it is even more important for attending physicians to become proficient in the EHR in the clinic environment than in the inpatient setting. In the hospital, housestaff typically perform most of the charting duties, whereas in the clinics, housestaff turn to their attendings to learn site-specific rules and procedures” Sharp added.

“We’re counting on the continued support of our attending physicians” said Nath. “What we ask of them is not trivial. It includes a commitment of time to provide content for the build and to train, a temporary reduction in scheduled patients, and compromises on shared content standards and workflows. Our physicians seem to understand that EHR implementation is crucial to maintaining competitiveness as an organization, but it’s not an easy process.

“Overall, it’s happening. Our dedicated crew of physician, IT nursing, administration and systems experts are working closely with the caregivers in the clinics and it’s paying off,” Nath concluded.