They learned that implementation is only successful when everyone is engaged
When orthopaedics went live with the Epic electronic medical record (EMR) in early March, four practice managers and one physician had a strategy in place that applied what they had learned from their predecessors, along with insights from their own staff.
“We had a few rough spots in the beginning,” Connie Rinaldi, practice manager, admitted a few weeks after the start-up. “But we’re now feeling great about how far we’ve come.”
At that point, orthopaedics, which had followed the Epic team’s guidelines to reduce patient volume by 50 percent for the two weeks following their go-live date, was already back at 75 percent of its pre-implementation level. In fact, some doctors felt ready to return to 100 percent, but held back to give everyone time to manage significant workflow changes.
“We need to add staff, either medical assistants or abstractors, to handle entering all the data into the EMR,” Rinaldi said. Some other issues still need to be worked out. “I think it is fair to say we have come a long way, but that there is still a long way to go. We will continue to work at it in a positive mode, but some of this is beyond our control,” she said.
Pointers for starting the process
Rinaldi and her colleagues—Maureen Carey, RN, and Linda Tafuto, RN, nurse managers; Kelly Anastasio, clinical research and billing manager; and orthopeadic surgeon Jonathan Grauer, MD—offered pointers to practices yet to enter the Epic era.
“It sounds elementary, but our implementation was a success because, right from the beginning, we took a teamwork approach,” said Anastasio. “We tried to bring everyone out of their silos.”
Six months before Go Live, the orthopaedics staff and the Epic team assigned to the practice held a kickoff meeting to introduce the EMR and build enthusiasm. “There’s no way this works unless everyone is engaged,” said Rinaldi.
Regular meetings, often every week, including the orthopaedics managers, Dr. Grauer and the Epic analysts, ensured that everyone in the practice remained in the implementation loop. “It helped that we were all very excited about getting an EMR and avoiding what we’d been calling ‘death by paper,’” said Tafuto. “Nursing is all about documentation, documentation, documentation, and with Epic, we knew that we’d finally have everything at our fingertips.”
The managers used this enthusiasm—and a little bit of psychological subterfuge—to make sure the providers got up to speed. “We capitalized on the competitive nature of surgeons,” said Rinaldi.
In the weeks leading to Go Live, the managers, doctors and Epic analysts fine-tuned many of the department’s forms, particularly the primary patient encounter form. The latter, in its basic version, features drop-down menus that encompass some 17,000 diagnostic codes. These were whittled down to the codes most likely used by the various orthopaedic subspecialties. The group edited and reformatted the forms to better reflect a clinic visit.
“We all worked through various levels of frustration and met in the middle,” said Dr. Grauer, who helped develop templates and what are known as “dot phrases,” a kind of medical shorthand to automatically pull entered data into notes, similar to a macro.
Listening to the experience
Another key to the success experienced to date is a series of meetings orthopaedics had with other practices that had implemented Epic ahead of them. Some of these candid sessions were positive, while others suggested what seemed like doomsday scenarios.
“We heeded their warnings, picked up every crumb of information, and resolved that we were going to make this a positive experience,” said Rinaldi, who is paying it forward by inviting teams from practices gearing up for implementation to meet with orthopaedics. “We owe it to our colleagues to share what we’ve learned.”
Still not a perfect world
Meanwhile, the team in orthopaedics continues to meet weekly with its administrative leadership, as well as other live and pre-go live departments, as it continues to work through what Anastasio called “the growing pains of a system with much potential, but still in the early stages of implementation.”
While she said most of the faculty and staff have acclimated quite well to the rollout, “we are not working in the ideal Epic world at this point, and many of us are working in three plus worlds, due to the staggered roll-out schedules of the ambulatory practice management revenue cycle and inpatient services modules, as well as the new clinical research system.” But, “the majority of the faculty and staff have, in fact, acclimated quite well given the fragmented roll-out of this EMR and other necessary systems needed to provide exceptional patient care and healthy daily operations.”