An Epic Update
for IS/Epic Quarterly Staff Meeting
April 1, 2011
Our system vision
Together, as people of Providence, we will
answer the call of every person we serve:
“Know me, care for me,
ease my way.”
One ministry committed to excellence
The goal
We want …
• Safer, more reliable care
• A connected, compassionate experience for
patients
• Consistent workflows for caregivers
• Streamlined administrative processes
Consistent, seamless, compassionate care
What is Epic?
An integrated suite of health care software
that supports all the functions related to
patient care, including:
•
•
•
•
•
Registration and scheduling
Ambulatory and acute clinical systems
Ancillary systems for lab, pharmacy, radiology
Billing and financial information
Patient portals for medical record access
4
The power of Epic
• All Epic applications leverage the same
central database
• Creates a single medical record for each
patient across all care settings
• Connects patient information between our
clinics and hospitals
5
An integrated software system
Epic and
Non-Epic Users
Everywhere
Patients
On-the-go
Providence
Hospitals
Patients
At Home
Community
Physicians
Physicians
On-the-go
Providence
Medical Group
• Personal health
records and portals
• Clinical
– Ambulatory
– Inpatient
– Departmental,
specialty and
ancillary services
– Health information
management
• Access
• Revenue
• Reporting and
analytics
• Enterprise systems
6
We are doing this together
This is a Providence wide implementation,
involving all four of our regions:
• Allowing us to share information across Providence
in new ways
• Spread knowledge faster for the benefit of our
patients
• Speak the same language and use common metrics
To improve health outcomes and the patient experience
7
What this means
• We must have Providence wide agreement
on administrative and clinical standards and
workflows
• We will need input from people across
Providence, both clinicians and business
operations experts
We will implement best practices
Guiding principles
• We will center our work on the patient to
ensure positive quality outcomes and a
compassionate patient experience.
• We will work together as one ministry
committed to excellence as we engage in
this Mission-critical systemwide effort.
• We will value simplicity as we strive for
“good” and not “perfect.”
9
Guiding principles
• We will reduce unnecessary clinical and
administrative variation.
• We will ensure that decisions affecting
clinical care will be made by clinicians.
• We will set realistic schedules and will
resource this initiative appropriately.
• We will make project decisions respecting
both excellence and stewardship.
10
Epic phases
Phase 2:
Collaborative
build, validation
and adoption
Phase 3:
Localized build,
testing and enduser training
Guiding principles
and scope defined
Integrated validation
sessions conducted
Integrated testing
conducted
Current workflows
and needs discussed
Additional design
and build completed
Model system
adapted
Workflows approved
Super users,
managers, and end
users trained
Master filed data
gathered and loaded
Go live readiness
assessed
Training plan and
materials created
Go live planning and
dress rehearsal
completed
Project team
formed; roles and
accountability
defined
Project team
certified
Interfaces designed
Super users and
training staff
identified
Help desk resources
and support
procedures prepared
GO LIVE
Phase 0-1:
Foundation,
planning and
team training
Phase 4:
Go live, support
and stabilization
Phase 5:
Rollout
Post live review and
user proficiency
assessed
Rollout planning,
engagement and
training
Transition to longterm support model
initiated
Networks and
hardware prepared
Preparation for
rollout underway
Ongoing
measurement of
benefits realization
conducted
Additional build and
testing conducted
Dress rehearsals
completed
Go live support,
transition to support
and optimization
with each site
provided
11
Building Epic together
Three key tasks:
1. Clinical content development
2. Collaborative workflow validation and
build process
3. Third-party vendor and scope
discernments
12
Providence model system
Providence
model
system
Collaborative
build
Providence
Alaska
build
Model
system
13
13
Roles
Champions and Readiness Owners
– Physician
– Other clinical
– Non-clinical
Subject matter experts
– Physician
– Other clinical
– Access and revenue
Informatics
Super users and trainers
14
Oregon Region Champions
• 37 Physicians in 24 specialties
• Nursing
– Med/Surg, ED, Surgical Services, Critical Care, L&D,/PP,
Newborn, Pediatrics, Behavioral Health, Informatics
• Other disciplines:
– Lab, Rehab, Pharmacy, Respiratory Therapy, Nutrition
Services, Diagnostic Imaging, Spiritual Care, Care/Case
Management
• Readiness Owners
– Access/Scheduling
– Revenue Cycle
15
Clinical guidance
Clinical knowledge and decisions
Content
Workflows
Clinical
advancement teams
Collaborative build
sessions
16
Clinical Advisory Council
CAT Teams
Work
Groups
32 specialty Clinical
Advancement Teams
Review
Teams
Review
Teams
Safe Medication Formulary
Workgroup
Interdisciplinary Content
Review Workgroup
Physician Content Review
Workgroup
Clinical Decision Support
Workgroup
Review
Teams
Clinical ROI Workgroup
Collaborative
Build
CAT Teams
ID
Wave 1: Early Readiness or Long
Review Cycles
ID
Wave 2: Shorter Review
Cycles
ID
Wave 3: Delayed Readiness or
Short Cycles
1
Adult Primary Care
13
Dermatology
24
Behavioral Health
2
Hospital Medicine
14
Orthopedics
25
Occupational Medicine
3
Pediatrics
15
General Surgery
26
Rheumatology
4
Urgent / Immediate Care
16
Pulmonary / Sleep
27
Rehabilitation Medicine
5
Emergency Medicine
17
Neurology and Stroke
28
Infectious Disease / Travel
Medicine
6
Endocrinology and Diabetes Care
18
Neurosurgery and Spine
29
Otolaryngology and Audiology
7
Obstetrics
19
Nephrology
30
Wound Care
8
Women's Health / Breast Health /
Gynecology
20
Pain Management /
Anesthesiology
31
Radiology
9
Heart and Vascular
21
Urology
32
Ophthalmology
10
Oncology
22
Gastroenterology
11
Physiatry
23
Critical Care
12
Palliative Care
A “mountain” of experts
Clinical
Advancement
Teams
Translates clinical
input from many
subject matter
experts
This is where the
real work is:
Regional and
Ministry Review
How will we engage the
rest of the organization?
We will use existing
structures and
relationships, only
creating new ones where
necessary. We will “cast
a wide net” for feedback.
19
Casting a wide net
Resource
Councils
CAT Team
Local
Clinicians
Service
Line
Groups
20
Peggy
ElliottZolner, CNS
Jane
Erickson,
MSW
Susan
Reinhart,
CNS
JJ Osmin,
RN
Steven
Vogt, MD
Tracey
Sayre, RN
Rima
Chamie,
MD
Jo
Jacovone,
RN
Elizabeth
Eberwein,
RN
e
Michael
Brian
Young, MD Duncan,
MD
Shannon
Fife, DO
r
Ca
Chad
Cecilia
Byars, MD Frey, RN
Ty
Eric
Mary Lou
Gluckman, Bernstein, Hart
MD
MD
ive
Mark
Shatsky,
DO
Sean
Kirsten
Tushla, MD Crowley,
MD
Nanette
Laurel
Kellie
Bultemeier Durham, RN Canchola,
RN
at
Kimberly
Capp, DO
Melinda
Lee, MD
Mary
Waldo, RN
lli
Pa
Jane
Burke, RN
try
Thanh
Nguyen,
FNP
ia
ys
Ph
Chris
Anderson,
MD
gy
lo
Ben
LeBlanc,
MD
co
On
ne
e
Jason Kuhl, Brent
MD
Kimberly,
DO
tri
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ar
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a
di
Pe
M
ar
Patrick
Campbell,
MD
ar
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sc
Va
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Em
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Ur
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ta
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i
sp
Ho
ul
Ad
Jim
Carlisle,
MD
Sarah
Booth,
LMSW
Ricci Susick Woody
English,
MD
Bill
Linda
Genevra
Doug
Brenda
TBD
Gillanders, Helsley, RN Enfield, RN Niehus, MD Fisher, RN
MD
Rob Luck
Katie
McRae,
CNS
Rose
Owen, RN
Lindi
Goins, RN
Dorry
Norris, MD
Brad
Bavesh
Tom Lee,
Massey, RN Rajani, MD MD
Aaron
Partsafas,
MD
Justin
Nicholls,
PhD
Lynne
Patton
Andrew
Zechnich,
MD
Natalie
Macdonald,
RN
Steve
Reinhart,
MD
Elaine
Ritchey, RN
Daniel
Rosenberg,
MD
Andrea
Roast, MD
Mark
Thomas
Nicole
Schmidt,
MD
Mary
Weissig,
RN
Liz
Stephens,
MD
Pam
Keuneke,
RN
Michael
Klotz, MD
Oregon participants by CAT
21
Clinical guidance
Clinical knowledge and decisions
Content
Workflows
Clinical
advancement teams
Collaborative build
sessions
22
Collaborative build goals
• Incorporate the best clinical, revenue
and operational practices
• Reduce unnecessary variation in
patient care across system
• Increase ability to leverage reporting
and outcomes across Providence
• Minimize long-term maintenance and
costs
23
Collaborative build schedule
Session
Focus
Dates
1
All
April 25-27
2
All
May 10-12
3
All
June 7-9
4
Inpatient only
June 28-30
5
Inpatient only
July 12-14
6
Inpatient only
Aug. 2-4
7
Workflow walk through
Aug. 16-18
24
Workflow Demo
Decision Points
#
Decision Point
1
The nurse rooming the patient will
document the reason for visit.
2
The nurse rooming the patient will
document the temperature and source.
Height and weight will be documented
using English units by the clinical staff
3 rooming the patient.
The clinical staff rooming the patient will
verify allergies and “mark as reviewed,”
4
and document any new allergies in the
allergy navigator section.
5 You will track goals with your patients.
Nurses will place orders for certain
6 procedures per protocol and a co-signature
is not required
Comments
Voting
Green:
This looks good.
Yellow:
The workflow
has a few issues
but I could live
with this. It
could work.
Red:
I can’t move
forward with
this.
Sequencing
= Go live
Roll out – all Alaska clinics
1st hospital
California
Oregon
Build
Roll out – all Alaska hospitals
1st clinic
1st PMG
clinic
Roll out – all California clinics
Roll out – all Providence
Medical Group clinics
Local build, testing
and training
Wash./Mont.
1st clinic
1st hospital
PSVMC
PPMC
and
PMH
PWFMC,
PNMC, PSH
PHRMH
Roll out – all Wash./Mont. clinics
Roll out – all Wash./Mont. hospitals
PMMC
ICD10
1st clinic
Clinical content
Hospital
ARRA
Alaska
Project planning,
staffing, governance
Physician
ARRA
Systemwide