Epic Update: The Minnesota
Epic User’s Group Advance Care
Planning Project
Sharing the Experience:
Honoring Choices Minnesota Conference
July 19, 2012
Minneapolis, Minnesota
Jonathan R. Sande, MD
Objectives
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Introduce Epic/Minnesota Epic Users Group (MN EUG)
Review fundamentals of Advance Care Planning (ACP)
Discuss MN EUG ACP efforts since June, 2011
Summarize current situation regarding Epic/ACP
Discussion
Epic and MN EUG
• Epic
• MN EUG
– Allina
– Altrua
– Centracare
– Essentia Health
– Fairview University
– Health Partners
– Hennepin County Medical Center
– North Memorial
– Park Nicollet
– Sanford
Fundamentals, Advance Care Planning
• Definition of ACP
– “an organized process of communication to help
individuals understand, reflect upon, and discuss
goals of care for future healthcare decisions in the
context of their values and beliefs” (p. 14).
– Hammes, BJ and Briggs, L., “Building a Systems
Approach to Advance Care Planning.” (Gundersen
Lutheran Medical Foundation, Inc.,: LaCrosse, WI,
2012).
Fundamentals, Advance Care Planning
• Based on “Five Promises” (p. 29)
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“We will initiate the conversation…”
“We will provide assistance…”
“We will make sure plans are clear…”
“We will maintain and retrieve these plans…”
“We will appropriately follow these plans…”
Fundamentals, Advance Care Planning
• Three basic requirements
– Leadership (commitment of both senior leadership
and leadership specific to ACP program)
– “Hardwire” ACP into the healthcare system’s
procedures, expectations, quality improvement, and
mission
– Dedicate the necessary human/financial resources
Fundamentals, Advance Care Planning
• Four key elements
– Systems design (documents, storage/retrieval, ACP
team and ease of referrals…)
– ACP facilitation (ongoing hardwired dynamic process,
with coordinated teams of trained facilitators at
different stages [steps]…)
– Community education/engagement (including all
healthcare organizations, religious institutions,
attorneys…)
– Quality improvement (standing QI team with
commitment to ongoing data collection/analysis and
dynamic [responsive] policies/procedures…)
MN EUG ACP Efforts
• “Hot Topic” Session, June 2011
– Panel discussion: HCM, HCMC, Health Partners, Allina
• Session summary: Epic suboptimal for ACP
– No consistent place for code status, advance directives, living
wills, advance care planning
– No central template; different cumbersome and time consuming
work-arounds at MN EUG institutions
– Inpatient vs outpatient issues
– ACP issues not a priority at Epic, nor at MN EUG institutions…
– Negative impacts on patient care, especially compared to what
seems possible…
MN EUG ACP Efforts
• Approved by MN EUG Board in September, 2011
– Form working group with representatives from all
members
– Develop core ACP template; all MN EUG institutions
to have identical (and transferable) solutions
– Core template to be based on “wish list,” and work at
Allina over 18+ months by Sandra Schellinger and
colleagues
– MN EUG to use this initiative to “encourage” Epic to
share this work with others
EMR “Wish List”/Design Principles
• ACP documentation in one location and consistently documented
across continuum
• ACP documentation is first thing all caregivers see in chart
• Information displayed is most current version
• Discrete data fields required for high priority items
• Links included for scanned documents
• Display most important documents first
• Activation of power of attorney when patient deemed incapable
• Ability to aggregate advance directive data
• Revisions to advance directive tab
• ACP review with decision tree
• Linking of discussions to process
MN EUG ACP Efforts
• Since June 2011 “Hot Topic” session…
– Late summer, 2011
• Allina/Gundersen/HCM/Essentia conference call;
“Gundersen solution”
– September, 2011
• Presentation at Epic Verona
– December 2011 Epic response
– January 2012 conference call
• Epic/HCM/Allina/Essentia/others
– Spring 2012 collaborations
– May 2012 Epic proposal
• Monthly national conference call re Epic/ACP
MN EUG ACP Efforts
• Questions to Epic:
• Timeline for fully functional ACP Epic product?
• Is “Gundersen solution” compatible with future Epic
products?
• Answers:
– No firm timeline; “committed to looking at it” in 2014 release
– “Gundersen solution” is NOT incompatible with the 2012 release,
but whatever shape Epic development takes “it won’t be in the
format of encounter level flowsheets... If customers use
[Gundersen’s approach] they will run the risk of having a large
project on their hands to convert the flowsheet data into
whatever format we eventually end up using…”
MN EUG ACP Efforts
• June 18, 2012 MN EUG ACP Working Group meeting:
– Common shareable solution within MN EUG
– Collaborate with Epic and others nationally
– Have useable Epic/ACP product as soon as possible
• MN EUG ACP Working Group Agenda
• Define key ACP terms
• Identify “essential elements” of ACP template
• Identify key data points
• Determine how best to capture/measure
MN EUG ACP “Essential Elements”
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ACP functionality in one standardized location
ACP functionality portal accessible through first screen shot
ACP functionality accessible/functional throughout care continuum
Hyperlinks for all scanned documents
Assure that all information displayed is most current, with older
information available
• Discrete data fields required for high priority items
• Most important information displayed first
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