A rollback of CIS-Epic’s launch from Feb. 29 to April 25 was only one question on the mind of a diverse group of SHC’s medical staff attending a January luncheon discussion about the new Epic Electronic Health Record (EHR).
“For most physicians questions about how to get up to speed on the electronic health record (EHR) trumped questions about the delay,” said internal medicine specialist Topher Sharp, SHC’s recently appointed associate chief medical information officer. “We were able to answer questions about the launch timetable, including how physicians who have already or will soon train can make sure their skills are optimal after ‘go-live’.”
Here are some frequently asked questions (FAQS) that Sharp and leaders of the more than 200-member interdisciplinary implementation team fielded during the luncheon and in the days surrounding the announcement of a changing timetable:
Q: Okay, so why was “go-live” postponed?
A: Ninety-three percent of the CIS-Epic system is built and has been tested successfully. However, in order to guarantee a safe, successful “go-live,” SHC needs to ensure that 100 percent of the system is ready and thoroughly tested. During the coming months, the system will be comprehensively (end-to-end) tested twice. The new schedule provides time to conduct the first test, make any necessary changes, and then test the entire system a second time to ensure it is operating as designed. After final testing, SHC will need 30 additional days to conduct dress rehearsals, finalize workflows and set up command centers. [At the luncheon Sharp noted that schedule delays for EHRs are common and that colleagues at other institutions are impressed with Stanford’s relative ability to maintain a tight schedule. “Nevertheless, of course we’re disappointed that we are not meeting the announced schedule,” he told physicians.]
Q: Will the entire system “go-live” on April 25?
A: No. However, all of the departments originally scheduled to “go-live” on Feb. 29 will be launched on April 25 with the exception of the Infusion Treatment Area (ITA), Apheresis, BMT Lab and the Patient Service Center (PSC) Outreach Labs. A launch date for those four areas will be announced. Outpatient clinics will now be phased in between the April launch and August 2009. Registration and billing is expected to “go-live” in Oct. 2009 as previously announced.
Q: How does the implementation change affect training?
A: Training dates remain the same and physicians and staff who have not completed training should continue as planned. The Epic Transformation Team is looking at a number of options to ensure that users keep up with their new skills, including use of the Epic “Playground,” an actual version of Epic that physicians can use to write orders and practice on simulated patients in SHC-specific units and situations. [See related article this issue]. Epic refresher courses will be available, and the number of SuperUsers, including M.D.s, will be increased during “go-live.” While this was not the intent, the delay will give users more chance to practice skills using realistic simulations.
Q: What steps have been taken to ensure that the transition makes sense for clinicians and their patients?
A: Many of the steps have been widely discussed, but a few highlights include the use of the SuperUsers, several hundred individuals, including physicians, who have received training to a level that allows them to interpret issues for other users, troubleshoot minor issues with the system, and help bridge physician concerns and lingo with the technical talk of the IT professionals who may be called in to troubleshoot. Another innovation is 30 Triad teams which so far have searched for and identified more than 250 SHC workflow changes that will occur when Epic is launched. The interdisciplinary teams are developing strategies to make those changes work effectively for users. Triad members are widespread “gap bridgers” and include SHC administrators, technical personnel and physician users. Most of the Triad teams concentrate on specific units and clinical areas, although several teams are looking at institutional issues. These teams are in place now and will continue after “go-live.”
Q: I’m more concerned about what happens after “go-live”. For example, I’ve heard that orders, including medications, will be input using templates or order sets. I’m used to customizing individual orders for each patient. Can I still do that?
A: You can still dictate transcribed notes, but our colleagues at other institutions have told us that the templates may be faster once caregivers get used to them. Order sets for many of our colleagues at sister institutions have become the veritable soul of the system and represent a key tool for physician practice much as a stethoscope once was. The order sets include a wealth of reference material discussed in training, including real time links to Lane Medical Library’s diagnosis-specific LaneConnex portal, and they help busy practitioners work through a decision tree that can often be useful. Additionally, the online order system is noticeably easier for our physician, nursing, pharmacy and administrative colleagues to read and interact with at their own workstations, and prescriptions can be e-faxed to the patient’s chosen pharmacy. But all that being said, specific alterations to orders can always be made in order to tailor these to a specific patient’s need.
Q: We understand that a firewall has been built into the system to safeguard confidential information (more securely than paper records). But psychiatric information and certain other information, such as references to criminal activity, require more specialized protection. How is this handled in Epic?
A: Designated protected records receive special handling and a higher level of access control. If a user needs to access these special areas, the system warns that person it will track and record their activity. This is a significant deterrent to abuse and allows monitoring of access to such records.
Q: I’m used to writing discharge orders on paper and processing those orders at the end of the stay. Are you telling me that this new system will be faster and easier?
A: It won’t be faster initially and may never be, although again, users at other hospitals say inputting the information in real time ultimately improves patient care and workflow for the practitioner. In a fast moving world, this will make life easier for everyone — particularly patients who will find that their prescriptions have been e-faxed and are ready at the pharmacy when they arrive, referrals are handled promptly, and ultimately, financial information is processed concurrently with medical information. Discharge orders input in real time generate specific instructions patients can take home with them, hopefully preventing many repetitive and routine follow-up questions — and delays in getting answers to patients.
Q: With all of us doing more at computer workstations, are we going to have to wait in line for our turn in the hospital to access Epic?
A: The hospital has taken this into account and has bought 361 wireless laptop/tablets available for physician rounding and to support ancillary department clinical documentation. In addition, SHC has added nearly 470 new or replacement big screen COWs (computers on wheels) throughout the hospital for nursing and and 125 for physician use. More than 500 desktop fixed workstations will be available throughout the hospital and clinics and will support physicians either directly or indirectly. These numbers, by the way, don’t include the 273 computers in use in training facilities in the hospital and at the North Campus training facility in Redwood City.
Q: Can I start using these computers now to access Carecast (which will be going away when Epic is launched)?
A: No, but you can use the new computers to access the Epic “Playground” to sharpen up your skills in preparation for “go-live”. You can receive instructions on how to log into Playground, from any workstations throughout the hospital by contacting the Help Desk at Stanford.learning@accenture.com or (800) 394-7970.
Q: Can I log in using my own computer?
A: Yes. You will need an SHC Enterprise Login account, and Internet Explorer or Firefox browser with a security program (Citrix Client) downloaded to assure security. If you’re accessing the system outside the Stanford firewall, you’ll also need a secure identity token (FOB), which will enable you to access and manage charts from virtually any internet connection or wireless hotspot anywhere in the world. If you don’t know your Enterprise Login ID or you wish to request a FOB, you can all the SHC-IT Help Desk at (650) 723-3333.
Q: I need to complete training, need a refresher and/or I’d just like to practice my skills a little more. Whom do I contact?
A: To register for in-person classes and to complete your on-line courses:
http://sumlms.stanfordmed.org/sumtotal
Training desk help: Stanford.learning@accenture.com | 800-394-7970
To download a brochure explaining “How to Access the Epic Playground,” go to: [http://med.stanford.edu/shc/update/guide.pdf]
Frequent updates will be available to accommodate late-breaking news surrounding the CIS-Epic transformation. Training includes further instruction on log in and access to the system, including use of Epic outside the SHC firewall.
