Epic is Now Live Thanks to Everyone’s Hard Work

Early last Saturday morning we flipped the switch and Epic went live. While things are not perfect, Epic is running smoothly and patients now only have one record at GBMC. This has really been a big team effort.

Cindy Ellis, RN, the Epic Project Director shared a few facts with me:

--We had 200 Epic team members offering ‘at-the-elbow’ support during go-live;

- Care Everywhere patient data is flowing in over 1,000 patient transactions. Organizations across Maryland and as far away as Texas and Colorado are pulling records as we share information and better coordinate care;

- Our Epic Command Center is open 24/7 and has resolved 48.72% of support tickets.

- A few inpatients are now trialing MyChart Bedside to view health information, message with their medical team and better plan for the day during their hospital stay.

Dave Hynson, GBMC’s Chief Information Officer, told me that he thinks that overall the implementation has gone better than even he anticipated. None of the issues that have come up have surprised him. There have been some issues with system access and printing, but these are things encountered by all hospitals that have implemented Epic. Dave believes that when you look at the grand scheme of things, we are implementing simultaneously more modules than most other hospitals, and we have had tremendous success to date. Dave is pleased with the work of the users, their support, optimism and enthusiasm and how they’ve been patient in working to resolve issues that come along. He points out that the team members from Epic headquarters have been impressed with our problem solving skills and the low amount of frustration among all parties involved.

One of the areas where the rollout has gone very well is in the Emergency Department. Mike Santiago, MD, one of our ED physicians who has been very involved in building, testing and implementing Epic for the ED said that our Emergency Medicine team took this transition very seriously and as a result this monumental change has gone relatively smoothly. Mike points out that behind the smooth transition of the physicians and nurses however, was a lot of not so visible hard work and preparation. There was direct clinical input every step of the way as the GBMC analysts and Epic team customized our ED workflows and orders in the system. Without this direct collaboration we would not be experiencing this initial success. Every one of the providers came to a training class and were encouraged after this class to practice in the “Epic playground” environment to familiarize themselves with the program. They were also encouraged to come in during designated times to work with the Epic masters customizing their order sets, their smart phrases and their other documentation tools. Without the engagement of the providers in this process our transition would have been much more painful. On top of this preparation, providers in the group have eased the transition by coming in on their own time for 2 to 3 hours to decrease the overall department workload and practice their initial documentation on a handful of patients. This provider directed effort has decreased the burden and the stress during go-live. It has been a major factor in the ED’s ability as a department to get up to speed as quickly as they have.

Kimberly Vohrer, RN, the Nurse Manager of Unit 38 said that one of her biggest concerns, prior to go-live, was that the system would be turned on but then crash. Kim is happy that the system has stayed live so that her team could focus on all of the changes that were taking place. Kim points out that over the last few days, what’s been a major help has been the interdepartmental collaboration, with the physicians and pharmacy for example, and basically everyone coming together to tackle any issues that come up. Kim adds that the nurses have been “rolling with the punches” and learning. They’ve also had support ‘at-the-elbows’ which has been very helpful and the fact that various members of leadership, directors and managers, round constantly and are being visible has also been a huge help. All this has really allowed the nurses to focus on taking care of their patient and with their responsibility in completing their documentation.

All of our team at Gilchrist Services should be commended as well for their great work in implementing Epic. Since so many of our Gilchrist patients are in their homes or extended care facilities, this made the task of one patient - one record even more difficult. They have done a marvelous job at getting the system up including in our 3 inpatient units.

Our employed physician offices have done very well, too. They had the added challenge of not having all of the data from their previous electronic record move seamlessly into Epic. I am very grateful for their efforts in making the transition work.

There is clearly more work to be done in the “stabilization” phase and no one denies that the learning curve is steep. We have gotten over the early stress of the implementation and our patients and staff are already beginning to reap the benefits of this wonderful new tool. Stay tuned as we optimize the system over the months and years to come!

National Physician Assistant Week

Please join me in celebrating all GBMC physician assistants (PAs). This week is National PA week (Oct. 6-12) and is a time when we celebrate PAs and their profession and showcase the value they bring to today’s healthcare team.

A physician assistant (PA) is a nationally certified and state-licensed medical professional who first completes a bachelor’s degree and then an intensive three-year PA program with at least 2,000 hours of supervised clinical practice.  They then must pass the Physician Assistant National Certifying Exam (PANCE), which is administered by the National Commission on Certification of Physician Assistants (NCCPA).

The GBMC PA staff practice in many areas from the outpatient offices to the inpatient units in a wide variety of specialties. Please join me in thanking our PAs for their hard work and for their important role in moving GBMC towards our vision.

GO-LIVE IS FINALLY HERE!!!

One patient, one record…this phrase has been on the tip of my tongue now for more than 20 months. We are less than 24 hours away from implementing Epic, our new clinical and administrative information system, going from an idea to a reality. I am very excited about this implementation because each patient will have only one record in our system, and it will make it easier to treat everyone the way we want our own loved ones treated.

The road to this day started a couple of years ago, when we realized that it was not possible to coordinate care for our patients when their information was in multiple places, electronically and on paper. We met with several vendors, and after a thoughtful process we chose Epic. 

In early 2015, I traveled with members of our team to Epic headquarters in Wisconsin and had the privilege of meeting Judy Faulkner, principal owner and founder of Epic. We met with many people who explained to us the capabilities of the software and the importance of building it for GBMC in a way that would allow us to get the most out of it. We got a “test drive” of the software and we were all really impressed.

Technology cannot create a vision or change a culture, but it certainly can accelerate the rate of change toward a vision. I can’t stress enough how the Epic implementation is a strategic move for the GBMC HealthCare System. “One patient, one record” is critical for us to deliver the kind of care we want for our own loved ones to everyone and Epic provides the tools that will make it much easier for our patients to communicate with us and be involved in their care.

  

Getting to go-live with our new electronic medical record system has required a phenomenal effort and many hours of hard work by thousands of our people. Getting us to one patient, one record for all served by our employed and GBHA aligned physicians, our hospital and our hospice, clearly has not always been easy. Yes, there is no doubt that there will be much to do and issues to be addressed even after launch, but, we have so many smart, hard-working people who are ready to help us during and after Epic implementation.

I want to take a moment to thank Cindy Ellis, Epic Project Director, and Dave Hynson, GBMC’s Chief Information Officer, who oversaw the entire design, testing and education process, and their Epic team for all their hard work in getting us ready to go live.  

Also, I want to thank all of our physicians, those employed by GBMC and in private practice, all of our nurses, all of our nurse practitioners and physician assistants, all of our other clinicians, patient access representatives, billing personnel and every GBMC family member who has helped build the system, test it and get us to this point of readiness. I know how hard you have all worked and I am very grateful for all of your efforts. I am also grateful for the hard work and expertise of our colleagues from Epic. 

Lastly, I want to express my gratitude to all those who worked in PP North and also at our Owings Mills site, entering several thousand appointments from the hospital and our physician practices into Epic. Recently, our team worked very hard on the schedule and registration conversion from Meditech and eCW. They posted more than 6,000 original Meditech appointments into Epic and an estimated 22,000 appointments from eCW. The team also completed an estimated 10,000 total registrations! Gilchrist Hospice manually converted the records of more than 750 patients.

Thank you all!

Some Records Are Made To Be Broken…

And boy did we break one! In case you didn’t know, GBMC Healthcare set the Guinness World Record for the longest ever awareness ribbon measuring 7,593 feet and 1 inch – more than 1.5 miles – during the 16th annual running of Legacy Chase steeplechase event at Shawan Downs last weekend. The lavender ribbon is a symbol of GBMC’s commitment to continually reduce the scourge of cancer.

Beyond breaking the record, this year’s event was a huge success. Cool weather, beautiful horses, a picturesque countryside setting and many family and friends – there were approximately 10,000 attendees this year – coming together equaled a spectacular time.  And it was all for a good cause, as the money raised benefits oncology support services at the Sandra & Malcolm Berman Cancer Institute. The Institute is the only comprehensive community cancer program certified with distinction by the American College of Surgeons Commission on Cancer in the Baltimore region. GBMC has invested in talent and technology to provide the best for oncology patients. Whether they are in need of outpatient, inpatient, home care, hospice or survivorship services, the more than 2,000 new cancer patients annually at GBMC get the best care.

This wonderful event would not have been successful without the support of our loyal volunteers, who helped us break the record and really made this year’s event very special. I thank all those who attended and all those who donated time or treasure. Special thanks to the GBMC Philanthropy and Marketing Departments, who worked so hard in putting the event together and for helping us break the record!

We Will Break the Record!

This coming Saturday, Sept. 24, we will have our 16th annual Legacy Chase steeplechase event at Shawan Downs in Hunt Valley.  This year’s event will again benefit GBMC’s oncology support services at the Sandra and Malcolm Berman Cancer Institute.

Legacy Chase has become a signature event for GBMC HealthCare combining the excitement of steeplechasing with a celebration of our patients and the services we provide to the community. There’s more to the event than great horse racing and there is something for everyone.  Past events have attracted more than 7,000 equestrian fans, friends, and families from across the region who’ve enjoyed the rail-side tailgating, live music, great food, and family-friendly activities. Many of the crowd-pleasing traditions continue this year—such as the kids’ Stick Pony Race, — and we have added some exciting new components to help make the event another memorable success.

This year we will celebrate our commitment to fight all cancers with an attempt to break the Guinness World Record for the longest cancer awareness ribbon—right in the infield of Shawan Downs.  Stretching a mile and a half long, the lavender ribbon is a symbol of GBMC’s commitment to continually reduce the scourge of cancer.  I’m really excited about this and I am sure with everyone’s support we are going to make it happen!

GBMC HealthCare has worked to perfect cancer care over the last 51 years.  The only comprehensive community cancer program certified with distinction by the American College of Surgeons Commission on Cancer in the Baltimore region, GBMC has invested in talent and technology to provide the best for oncology patients. Whether they are in need of outpatient, inpatient, home care, hospice or survivorship services, the more than 2,000 people with newly diagnosed cancer that GBMC diagnoses and treats annually receive the best care possible. 

I want to thank all those who’ve donated time or treasure and to the GBMC Philanthropy and Marketing Departments who’ve worked so hard in putting together the event and for taking a run at the record!

So, make this year’s event a family affair and come and enjoy a day in the country.  I hope to see you there!

Working Very Hard to Get Ready for October 1

We are less than THREE weeks from our Epic go-live date of October 1. Last weekend, I was really impressed to see so many of my GBMC colleagues working in our command center in the North Pavilion and also at our Owings Mills site to enter appointments from both the hospital and our physician practices into Epic. Our team worked very hard on the schedule and registration conversion from Meditech and eCW. They posted 6,881 original Meditech Appointments into Epic and an estimated 21,052 appointments from eCW. The team also completed an estimated 10,000 total registrations! Gilchrist Hospice began manually converting the records of approximately 750 patients yesterday.

These phenomenal efforts are only the most recent example of the many hours of hard work that literally thousands of our people have done to move us to one patient, one record.  It clearly has not always been easy and we are not yet done, but, I am humbled by the efforts of our family. They have collectively worked through many barriers and completed countless hours of training to get us to this point. The transition will be hard, but once the hospital, our hospice, and all of our employed and GBHA affiliated physicians and other providers are using this system, it will be easier for us to move towards our vision faster. Please let me thank all of our physicians, both employed by GBMC and in private practice, all of our nurses, all of our nurse practitioners and physician assistants, all of our other clinicians, patient access representatives, billing personnel and every GBMC family member who has helped build the system, test it and get us to this point of readiness. I know how hard you have all worked and I am very grateful for all of your efforts. I am also grateful for the hard work and expertise of our colleagues from Epic. Thank you all!

Healthcare Environmental Services Week
This week is Healthcare Environmental Services (EVS) & Housekeeping Week (Sept. 11—17) and I am proud to acknowledge the dedication and professionalism of our EVS staff as we celebrate them.

Cleanliness is everyone’s job at GBMC, but, our EVS staff are the experts in cleaning who work tirelessly to get the job done. They spend countless hours in their vital role in preventing infections, patient safety, and patient satisfaction, maintaining sustainable buildings, lending a helping hand and working to ensure that our healthcare facilities are always presentable and ready for business.

There are over 100 EVS associates working “around the clock” at GBMC in a variety of roles servicing over 1.2 million square feet of facility. Their work is vitally important to the health and safety of our patients, so, please join me in honoring all the men and women of EVS.

A Collaborative Effort for Better Care

GBMC is a fabulous place to have a baby and everyone knows it. Our clinical outcomes for mothers and newborns are excellent!  While our patient satisfaction scores for maternal and newborn are always among the best in inpatient units in Maryland, there is always room for improvement especially if we compare ourselves to hospitals in the Midwest and West. In these comparisons, we are still very good as we find ourselves in the top 25 percent.

Recently, Jodie Bell, RNC, BSN, IBCLC, Clinical Director, Postpartum and Newborn Nursery, got together with leaders from food and environmental services, Kelly Bechtel, General Manager of Food & Nutrition Services and David Fatokun, Quality Assurance Manager with Sodexo, and through Lean Daily Management started studying the mothers’ beliefs about their care, how their room was being maintained and their thoughts about the food.  As a team, they have been working on courtesy and friendliness and auditing their performance. They have begun to study things like how a food tray does not always have what the patient ordered or why the food that is supposed to be hot is not always hot when it is delivered.

This new higher level of collaboration and inquiry has already begun to yield results! 

In August, patient surveys scored the courtesy of the person serving their food at 92.9 (99th percentile in MD and the 80th percentile nationally) and their room cleanliness score at 90 (97th percentile in MD and the 70th percentile nationally). On the so-called “overall” HCAHPS score, where patients are asked to rate their hospital stay on a scale from 0-10, where 0 is the worst hospital ever and 10 is the best, the Maternal and Newborn Health team, so far, are now scoring 86.7 (99th percentile in MD and 94th percentile nationally)! 

I am so grateful for all of their hard work and their learning and tests of change. When you see Jodie, Kelly, David or anyone on their team please congratulate them.

Designing Patient Flow

Patient flow in healthcare continues to be a daunting challenge. It is not the same as building a car. All patients are different and their clinical needs and rate of improvement vary. The hospital doesn’t get to choose how many patients it will serve in a day. It serves all who need care. Because of the variability in these inputs, it is very important that we approach patient flow the way an engineer would. We study the patient demand and try to have just the right number of clinicians and support staff to serve them. And we design the system of patient movement to minimize the waste of time and energy.

Previously in the blog, I have discussed the concept of synchronization.  It’s a change concept that brings the players or processes in a design into “harmony.”  When we synchronize processes in patient flow, we allow the operators to organize their work so they can be ready to act at a specified time. In order for success, all parties involved must align their work to be ready for the chosen time.

People do not like to feel overwhelmed in their job. When we don’t synchronize, we run the risk that the “downstream” function isn’t ready to accept the patient when we want to move them. An example of this is the emergency department calling an inpatient unit to move a patient to them but there is no nurse ready to accept the patient. The emergency department gets upset because they want to get the patient out so that they can see the next patient. The inpatient unit gets upset because they feel they are being ‘jammed’. Both groups feel that the other doesn’t respect them.

Synchronizing flow from one unit to the next begins with a conversation before the patient moves. Information is shared about the patient and a time is chosen with the input of the sender and the receiver with enough advance notice for both to be ready.

Monica Goetz, our clinical nurse manager for the Medical Intensive Care Unit (MICU -- Unit 57) and her team felt that the previous process for moving patients out of the MICU was leading to many challenges as well as dissatisfied and frustrated staff on both ends of the transfer.  This is why they redesigned the process and are now studying it during LDM rounds, helping them to focus on how best to complete the transfer they redesigned the process.

The MICU team redefined the term “ready to move” as when both the sending and receiving nurse could safely perform a patient inclusive bedside handoff. Now, when the patient’s room is ready, the ICU nurse calls the new unit to identify a time, within the hour, that they both will be prepared to meet.  This allows both nurses to plan their work to be ready. At the agreed upon time, they meet in the new room, perform bedside handoff, review the patient’s belongings & share the “getting to know you” form. The “getting to know you” form is a tool used by the MICU team to learn about who a patient is as a person; their hobbies, things they enjoy when they are not in the hospital, fun facts, and things they want us to know about them.  

Monica shared a recent story to illustrate how the new design is working;
We had a patient (87-year-old male), with many co-morbidities and more hospitalizations than he could count.  He has always hated hospitals, the feel of being in them, and how he is treated…until this hospitalization.  He went on to describe that the care he received was like a well-orchestrated symphony.  Everyone in tune and working in harmony.  From the conductor (manager) to the lead violinist (the charge nurse) ...all setting up to tune for the concert (the shift).  Everyone worked together to make the beautiful music that we call patient care.  

This story is a good example of the work that the MICU is doing with patient transfers…. moving our patients in “synchrony”.  Working together to find a time that is agreed upon (within the hour) and then performing the handoff at the bedside – making the transition not only safer but patient inclusive.  This design demonstrates improvement from the back and forth phone tag, impersonal phone report and leaving a patient in a room alone until someone on the new unit is able to greet them.   I am very proud of Monica and her team and all of the nurses and others who have designed this new system. Let’s hear it for synchrony!

A Story That Illustrates How GBMC is different

We have been building our system of care to drive towards our vision for six years now. In 2010, we put a stake in the ground that we would become the health care system where everyone, every time, got the care we would want for our own loved ones. Our vision statement talks about physicians leading teams to deliver this. We have had a dialogue among us in the GBMC family, that we want the best health outcome and the best care experience with the least waste of time and money with the most joy for those providing the care. We chose the patient centered medical home as a design to deliver this. We already had a great hospital with excellent physicians and nurses and a great hospice, but, the medical homes were required if we were truly going to maximize people’s health and not just wait until they got really sick and needed to be admitted. Our patient-centered-medical homes are different from typical primary care because they are no longer dependent on a visit to the doctor. This model is about a relationship between a physician, her team and a patient. It is about a promise to that patient to work with him or her to maximize his or her health. It is about having the time to reflect on a patient’s health between visits, to make sure that they are getting what the evidence says will keep them well.

On a bad day, I am concerned that many people in our community don’t know how we are different or don’t believe that we are different. So let me tell you a recent story in the words of Dr. Sarah Whiteford, of Family Care Associates:

“I wanted to share this wonderful letter from a very appreciative patient whose life was quite possibly saved by the efforts of PCMH and our population health outreach.  In brief, this lovely patient of mine received a call from our care coordinator, Shelly Deckelman (go Shelly!), who was going through the list of patients aged 50 and older in our practice who had not yet had a colonoscopy.   This day of Shelly’s call happened to be her 50th birthday and her name clearly “fell onto the list.”   She was quite surprised to receive the call but it prompted her to immediately schedule her colonoscopy (which she admitted would have likely been many months later if left to her own devices).  Much to everyone’s surprise, her colonoscopy revealed a large, ominous rectal mass.  She had no symptoms at all. Despite a negative initial pathology, she was sent for urgent surgery for removal of this mass as its malignant potential was quite high.  Fortunately, her surgery was successful and the mass was ultimately a very high grade polyp which most certainly would have become malignant if not removed in a timely manner.” 

Dr. Whiteford thanked all of her team and congratulated them for making the medical home concept a reality.

Physicians and other clinicians practicing in regular primary care are smart and care about their patients just like Dr. Whiteford and her teammates. It’s just that in regular primary care after the visit, it’s on the patient. If the patient never comes in for a visit, and they don’t know the evidence about care that can save a life, they are not likely to get that care unless someone is looking out for them. This story is one of many that shows how we are different. Without the patient centered medical home, this patient may not have had her mass found until it was too late!  Let me add my thanks to all of my GBMC colleagues who are moving us closer every day to our vision.