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Published in CenterView on January 13, 2014

UMMC gets high marks for EHR implementation, integration; still more to do

By Bruce Coleman

It was the most comprehensive systems implementation in the history of the University of Mississippi Medical Center, and it impacted health-care delivery like nothing the UMMC community had ever seen.

The organization-wide launch of the Medical Center’s electronic health records system on June 1, 2012, involved more than 800 support personnel, including virtually every Division of Information Systems staff member, and impacted more than 3,000 UMMC employees – practically everyone who has a role in providing health care at the institution.  
 
It was, indeed, “Epic” in every sense of the word.

Eighteen months after “Go-Live” – the day the electronic health records switch was irrevocably flipped at UMMC – EHR has transitioned into the Medical Center’s culture so seamlessly that patients have come to view computers, tablets and smartphones no differently than stethoscopes, blood pressure cuffs and IV poles as typical tools of the medical trade.

Now, those responsible for helping take Epic from “sci-fi spectacular” to common vernacular describe the EHR’s current impact on the organization and lessons learned from the implementation.

Preparation and support

Swoger
Swoger

Were they to do it again, the Epic training team might have taken a less-generic approach to staff preparation, according to Ellen Swoger, chief applications officer.

But considering the challenges involved with not only introducing a comprehensive electronic health records system to an organization as vast and diverse as the Medical Center, but also helping employees become proficient enough to use it in a matter of weeks, she said the results could be considered no less than phenomenal.

“This was a monster effort,” Swoger said. “We could have focused on the specific day-in-the-life needs of each clinic, have the training team make a more conscious effort to make it more realistic.

“But when you do a huge rollout that affects so many different clinical specialties, it’s very difficult to try to make the training very specific.”

The success of the initial Epic training had a lot to do with staff accountability, Swoger said.

“The training reached out to every area, but it was more successful in those areas that had accepted it and were interested in it,” she said. “When we went live, you could definitely tell which areas had embraced it more than others. They stepped back, looked at the workflows in their department, took ownership and asked questions.

“All in all, it was well done based on how specific end-users took the training and ran with it.”

Now the challenge facing the Epic training team lies in re-invigorating the “super-user” program. Super-users are UMMC employees who have received more specialized EHR training. Imbedded into various departments and units throughout the Medical Center, these super-users lend on-site assistance to those just becoming familiar with Epic and serve as ongoing liaisons between the DIS Epic team and their departmental staff.

“Most of the original super-users have either transitioned out of their roles or have been assimilated into other areas,” Swoger said. “We’ve had to make it (the super-user program) much more of an ongoing commitment, make this a more dedicated role within their current positions.”
   
Swoger said wider acceptance of electronic health records in the medical community and revisions to the Epic training program has helped move EHR education forward rather rapidly.

“Epic training is really very different now,” she said. “When a new employee comes in, most of their training is done in their department by credentialed trainers. Instructional designers – the new term for Epic principal trainers – provide the latest and greatest information on the current Epic applications, upgrades and modify curriculum for the credentialed trainers who train the staff.

“This training process also continues to ensure that an individual is proficient in an application before they get a login (to use the application).”

Despite the constant turnover in the super-user program, Swoger said the Epic training curriculum remains stable yet malleable to workflow changes, module adjustments and inevitable upgrades.

“I think the organization has kept up with all that overwhelming change pretty well,” Swoger said. “I know we’re much more ready than if we’d stayed with the applications that we had 18 months ago.”

Provider acceptance

Showalter
Showalter

Physicians don’t always have the best reputation when it comes to adapting to change – especially change as fundamental and overwhelming as EHR.

But one of the main keys to the successful integration of Epic at the Medical Center has been the medical staff’s willingness to embrace Epic, said Dr. John Showalter, assistant professor of medicine and chief medical information officer.

“There are things we are definitely still working on to get implemented into the workflow,” Showalter said. “We’ve had some really meaningful but moderate clinical gains.”

For example, Showalter said Epic recently added automatically generated reminders for clinical staff about preventive clinical screenings for certain qualified patients. Although an excellent function, he said it creates a more challenging workflow when a couple hundred more patients each year get scheduled to receive mammograms, colonoscopies or other screening tests.

On the other hand, by recording their patient encounters directly into Epic rather than speaking into a telephone for future transcription, physicians have reduced dictation costs from approximately $2 million a year to $250,000 – and the clinic notes are much more readily available.   
 
“Across the board, physicians have adapted to the new technology really well,” Showalter said. “The main thing we’re looking to improve is the efficiency of the practice, which is a good place to be, considering many institutions are just trying to get their physicians to use the technology.

“We definitely had some physicians who were very concerned about the technology (at Epic Go-Live), but they embraced it and use it effectively.”

So effectively, in fact, that the Medical Center is one of only 15 health systems in the nation to attain a 6 or better score out of a possible 7 in both the inpatient and ambulatory categories of the Health Information Management Systems Security’s national scale.

“That’s objective criteria from an external report, and it shows our physicians are some of the best users of EHR in the country,” Showalter said. “We thought we could be able to achieve that within the first year, but we were able to achieve it nine months after Go-Live.”   
    
The obvious goal for the next 18 months, Showalter said, is becoming one of only three institutions in the country to receive a perfect 7 in both categories.

“We are right on the cusp,” he said. “This was achievable because of the way our medical staff continues to respond to challenges. They are very engaged and extremely willing to make the changes that are required of them.”

Quality and safety

One of the major selling points of any electronic health records system is its capacity to reduce medical errors, thereby enhancing the patients’ experience.

Epic has undeniably achieved both, according to information provided by Christina York, hospital pharmacist.

At a recent University Hospitals and Health System leadership meeting, York presented findings from a recently completed Epic study that indicated the total number of reported medication errors have decreased by 39 percent since the implementation of EHR.

“Medication errors are associated with increased cost, increased patient length-of-stay and potential further monitoring or treatment to reverse the effects of the medication error,” said York, who compared Epic data taken eight months preceding the Go-Live to post-implementation statistics generated from four months after the EHR had been up and running. “They can have a significant impact on patient satisfaction.”

The results of the study, she said, were quite telling.

Since Epic has the capability of sending immediate alerts for potential medication conflicts – such as duplicate prescriptions or possible patient allergies – and because pharmacists no longer have to transcribe physicians’ orders, York’s study indicated a 48 percent reduction in prescribing errors and a whopping 95 percent reduction in transcription/verification errors.

She said another component of EHR at the Medical Center that has shown by the study to improve patient safety is bedside barcode scanning.

“The nurse or therapist scans the barcode on the patient’s wristband, scans the medication, and if it’s the wrong drug, the wrong patient or the wrong time, it flags them,” York said. “There’s a direct correlation – as our compliance with barcode scanning increased (from just above 60 percent to approximately 90 percent in 12 months), the number of wrong-drug, wrong-patient errors consistently decreased.”

Not only has the overall percentage of reported medication errors plummeted, so, too, has the number of errors that actually reached the patient.  
  
“We have seen a strong reduction in errors with Harm Scores of 3,” she said. “Errors that reached the patient have been reduced by 37 percent from eight months pre-Epic to 16 months post-Epic.”

Despite the statistical improvements, York, who recently left UMMC, said the study underscores the need for clinical staff to continue to report medication errors and to communicate with the Epic training team to improve the patient safety process.

“We see that this technology is helping to reduce errors by augmenting what clinical staff do and adding another level of safety,” she said. “The frontline staff have been through a lot with the Epic implementation and barcode scanning, and the results show that their work is meaningful.”

Moving forward

Chou
Chou

Despite its impressive strides implementing electronic health records, the institution still has plenty of room for growth in EHR, according to David Chou, chief information officer.

Chou, who joined the Medical Center more than a year after Go-Live, said he was impressed by the results of the Medical Center’s Epic implementation efforts, but further optimization is required to realize significant revenue growth.

“Globally, we did a great job in rolling it out within the original timeframe,” he said. “Are we done? No, we’re not even close.”

He points to a Joint Commission mock survey in November that revealed some deficiencies in how the system is being used as evidence that more training is necessary. And he said a system upgrade scheduled next month also will address some functionality issues within the software and improve workflow.

“Right now, our utilization is at about 45 percent, and we want to get it to 80 percent or better,” Chou said. “It’s been a pretty good success story so far, and we have the leadership team on hand to make various changes.”

Chou said the Epic implementation strategy moving forward will be mobility – whether smartphone, tablet or laptop.

“Mobile devices will get us to the next level,” he said. “Doctors will be able to use Epic anywhere, anytime. Staff will use applications outside of Epic.” 

And he said patients will have even greater access to their health-care information through the MyChart function of Epic, the personalized, secure, online health portal for UMMC patients that has gained in popularity during the last 18 months.  

Indeed, Swoger said approximately 15,000 patients have signed up to use MyChart since Epic Go-Live.

“It’s incredible how the world has changed with the acceptance of having your personal electronic medical records ready and available,” Swoger said. “The providers are more willing to push the results to the patients automatically. It’s amazing to see the difference, both on the patients’ side and the physicians’ side.

“It’s a different world.”

National HIM organization recognizes UMMC for innovative health care

The American Health Information Management Association (AHIMA), the credentialing body for coding, electronic health records and health data analytics, has named the University of Mississippi Medical Center one of four finalists for its second annual Grace Award.

Truman Medical Centers, Kansas City, Mo., received the overall award in October.

Named for AHIMA’s founder, Grace Whiting Myers, the award honors health-care delivery organizations that demonstrate effective and innovative approaches in using health information to deliver quality health care.

Leigh Williams, director of revenue cycle, credited the 55 employees in the Health Information Management Department, specifically those in Electronic Health Records, Hospital Coding and Clinical Documentation Improvement, for helping the Medical Center obtain the national notoriety of being a Grace Award finalist.

“AHIMA is our premier professional organization and the Grace Award is the premier award in HIM,” Williams said. “To be considered a finalist means our national organization is recognizing our HIM work as some of the best HIM work in the country.”