April 4, 2016 - As the Epic electronic health record (EHR) is implemented at BJC and Washington University School of Medicine, having the appropriate clinical content is crucial to making the system work.
To make sure the tools offered by Epic are the ones needed in both the community and academic setting for the daily care of patients, the Epic team has relied heavily on the involvement of those who will use the tools, including a large number of physicians.
“This is a large project that incorporates both inpatient and outpatient care,” says John Krettek, MD, BJC vice president and an Epic clinical champion. “A project on the scale of the implementation of Epic as our electronic health record has not been done before -- involving academic hospitals, community hospitals, employed physicians, WUSM Faculty Practice Plan, and importantly, over 1,000 private practices. It also involves adult and pediatrics. We have to engage all in the design and build for this tool.”
“We have made the effort to have physicians, nurse practitioners, nurses and others involved all along the process,” says Keith Woeltje, MD, BJC chief medical information officer and co-chair for the Epic program. “They are helping us decide questions like, ‘How do we document?’ and ‘What are the rules we put in place?’”
“We are making as many decisions as close to our end users as possible via design sessions and operations groups to keep the process moving,” says Dee Jones, ambulatory core build project manager. “Their input is providing the foundation for our new EMR system and that input has been invaluable. Seeing these brilliant minds in action working for us across two organizations has been amazing.”
Epic comes with pre-defined settings, sample reports, and clinical and specialty starter kits. However, the software provided needs to be customized to standards at BJC and WUSM and to include the organization’s own workflow.
“We examined other Epic hospitals to determine how Epic was used to improve patient care needs,” says Pat Mueth, inpatient clinical team director. “The physicians attending the operational group meetings were very helpful as we continue to ask the questions, ‘Why not use Epic? If it worked for the other Epic hospitals, why would it not work for us?’ Their discussions were very powerful, and the physicians and other providers have helped us understand things we might not have been able to figure out on our own.”
Standardizing Order Sets
Order sets have been carefully developed by a team of physicians and clinical specialists from both the academic and community environments within each of more than 80 specialties. An order set is a grouping of orders for a specific diagnosis or treatment need.
“When we started looking at the existing order set at the hospitals, there were 406 at Barnes-Jewish Hospital, 416 at Children’s Hospital, and about 200 at each hospital in the community,” says Dr. Krettek. “As we work toward standardization, our subject matter experts review the order sets from Epic and add to or remove from those orders to come as close as possible to what will work best for us.”
As the order sets are finished, they are being sent in “waves” of 14-18 specialties at a time to physicians and other end-users to review. Order set review sessions will be held at the end of each wave.
Providers can join these sessions in-person or via WebEx. The order sets will also be published at the end of each wave on a website called “BJC Induct.” This platform gives physicians the opportunity to leave feedback in a social media environment, view colleagues’ comments, and contact the project team with questions. Reviews should be finished in 2016.
“We started in January with the physicians developing the order sets,” says Stacy Larkin, inpatient orders team project manager. “Physicians are the most critical piece to this process, as they are the ones who will be using them. Having their involvement and engagement has been crucial.”
Work has started to decide what documentation tools will be used for the organization. “Nursing and ancillary documentation is well underway, and now it’s time to begin provider documentation,” says Sandy Dugan, inpatient clinical documentation project manager. “When they use Epic, physicians will be able to pull vital signs or lab results into notes as they choose. Our providers know their workflow and what works and what doesn’t, so their input for documentation will be critical. It may take longer initially, but it will be beneficial in the long run.”
Involving Physicians From the Start
Physicians and other provider involvement started back in 2014 during site visits for the selection of one electronic health record for BJC and WUSM.
Dr. Woeltje says he was impressed with the diligence shown during that process. “The process was long, but very thorough, with multiple opportunities for clinician input -- and not just physicians, but nurses, pharmacists and other health care professionals as well. This was especially true during the demonstrations, which were held at multiple sites to allow for maximum participation.”
All agree that the involvement of physicians and other providers has been key in making sure the Epic Program is the right fit for BJC and WUSM.
“The physicians have incredible stories to share of experiences they have had in the past that they want Epic to solve,” says Mueth. “They are vocal and passionate about their work, so we in return are passionate about the design in order to make their lives better as a result.”
Go to epic.wusm.wustl.edu for more information.
Who’s Who in Clinical Leadership on the Epic Team
- Providers on the Health Information Partners Board: Jim Crane, MD; Vicky Fraser, MD; Regis O’Keefe, MD; and Clay Dunagan, MD
- Primary physician leaders/executive sponsors: Clay Dunagan, MD, and Jim Crane, MD
- Clinical champion chairs: Keith Woeltje, MD, chief medical information officer at BJC; and Sam Bhayani, MD, chief medical officer at Washington University School of Medicine
- Program directors: Chero Goswami and Troy Burrus
- Clinical champions: Eight clinicians serve as clinical champions. They are advocates for other physicians and clinicians and will support them as they adopt the new system.
- Sam Bhayani, MD, Washington University School of Medicine chief medical officer
- Keith Woeltje, MD, BJC chief medical information officer
- John Krettek, MD, BJC vice president
- Geoff Cislo, MD, Barnes-Jewish Hospital internal medicine
- Pele Yu, MD, St. Louis Children’s Hospital chief medical information officer
- Rick Chole, MD, Washington University School of Medicine otolaryngology department
- Michele Thomas, MD, BJC Medical Group director
- Marianne Fournie, BJC chief nursing officer
- Provider Advisory Council: There are 24 clinicians currently serving on the Provider Advisory Council for Epic and a large number of specialists and subspecialists involved in the content build.
- Subject matter experts: Of the more than 140 subject matter experts, almost all are physicians. They help the project teams make decisions to move the project forward.