October 2020 Next chapter

Now that all Ballad Health hospitals and clinics have transitioned to the Epic EHR system, we are now one patient, one record. This implementation was three years in the making, and although no project of this size is without challenges, the Epic rollout has been considered a tremendous success.

Buzzwords

From Tips from an Epic MD: Working on a Small Screen

Wrench icon: Shows areas you can personalize in Epic, like columns in
the In Basket and speed buttons for the diagnoses you use the most. This
saves clicks and reduces scrolling.

Chart Search: The search bar in the upper-right corner of the screen (or
under the patient’s name on the left side of the chart) that can check for
details like recent labs, mammograms or colonoscopies, and can search
for providers’ names in the chart.

Magnifying glass: Makes the information bigger so it’s easier to read.

Progress notes – Providers

The Patient Safety Surveillance Dashboard was demoed at the Sept. 15 Physician Readiness Team meeting, and a tip sheet on how to get to the metrics was shared. The training team worked with the providers to get them in class, pass the post-test and complete their Personalization Labs. Order Set alignment was completed with 613 Order Sets moved to production prior to the Oct. 1 go-live. We are able to compare patient safety metrics across all facilities. Congratulations to the providers at Franklin Woods Community Hospital, Johnston Memorial Hospital, Norton
Community Hospital, Russell County Hospital, Smyth County Community Hospital and Sycamore Shoals Hospital who achieved 100% Discharge Medication Reconciliation within the first five days of using Epic. Providers at Franklin Woods Community Hospital achieved 100% Problem List Management on day four. All go-live facilities are doing a great job with
Signed and Held Orders prior to the day of surgery. Departmental and hospital leadership have access to dashboards highlighting key go-live metrics to monitor successes and highlight opportunities across Ballad Health. Contact Josh Metcalf if you have any questions.

ARC insight – Access & revenue cycle

Throughout the Big Bang implementation, there has been unwavering adherence to the B-Epic Guiding Principles:
• Patients are our number one priority
• We are all accountable for the project’s success
• Use Epic system design
• Standardize workflow and content
• Work as one Ballad Health team

During the final weeks leading up to and during the Big Bang project going live, the Access and Revenue Cycle scope had several events that showcased each and every one of the guiding principles.
• Over 15,000 appointments from multiple legacy applications were converted to Epic. Ensuring that this was “invisible” to patients required participation and contribution from operations and multiple IT application teams and training.
• Patient cutover was the epitome of teamwork and collaboration, with patient safety as the top priority.
• Charge conversion of over $38 million also required significant contribution from non-revenue cycle teams to prevent any impacts to the patient experience.
• Revenue integrity and go-live issue resolution has been another shining example of working as one Ballad Health team and embracing the idea that we’re all accountable for the project’s success.

Thank you to everyone across Ballad Health for your dedication and contribution to the success of the Big Bang implementation!

Vital signs – Clinical team members

Your team worked hard behind the scenes to be ready for Oct. 1. Team members have attended countless meetings across all disciplines and participated in important events to be ready for the October Go-Live! Appointments and cases were converted over the Sept. 12-13 weekend. The Patient Safety Surveillance Dashboard was demoed at the Sept. 22 Clinical
Readiness Team meeting, and a tip sheet on how to get to the metrics was shared. The last readiness event started on Tuesday, Sept. 29, and finished late Wednesday, Sept. 30. A representative group of nurses from every go-live facility participated in the clinical cutover data entry activity and entered clinical data for 700+ patients. On Wednesday, Sept. 30, 70+ nurses continued this activity and entered active non-medication orders, height/weight/allergies and home medications for all in-house patients. Pharmacists entered and verified all active medication orders. Infection Prevention entered the infection status on all admitted patients. All this was in preparation for the official Oct. 1 go-live.
• The lab departments have the ability to move specimens between labs and facilities. • “Case Request” enhances communication between clinics and Surgical Services. Schedule Explorer allows the clinic staff to view employed providers’ OR cases and office visits in one location.
• Inpatient Medication Reconciliation History from SureScripts was implemented across all facilities.
• Imaging Services has one integrated chart and streamlined workflows in Epic across all facilities. Imaging third-party systems are integrated with Epic with the ability to view images from a link in the patient chart.
Imaging hospital charging is centralized in Epic. Mammography Coordinator Dashboards streamline tracking. Specimen collection workflow ensures specimens are collected on a timely basis and increases communication between lab and imaging. The IR narrator allows for a one-stop shop for all procedural log documentation increasing clinician efficiency and accuracy.
• Integration between Cardiology and third-party systems is working successfully (CPACS – Excelera, McKesson, syngo Dynamic; hemodynamic systems – Sensis, Mac-Lab and ECG management – Cardio Server). Supply
usage interface automatically documents inventory from Sensis into Epic. NI procedural charges (professional and technical) trigger automatically based on interfaced results. Cardiology nurses have streamlined sedation
documentation for TEEs/Cardioversions.
• Team members and providers are able to see how all facilities are achieving patient safety metrics by reviewing the Patient Safety Dashboard. Congratulations to all the go-live facilities for achieving target levels for L&D Essential Delivery Documentation and Medication Order Verification for Routine and High Priority Medications within the first five days. Franklin Woods Community Hospital, Indian Path Community Hospital, Johnston Memorial Hospital and Norton Community Hospital had 100% L&D Essential Delivery Documentation by the fourth day!
• Departmental and hospital leadership have access to dashboards highlighting key go-live metrics to monitor successes and highlight opportunities across Ballad Health. Contact Josh Metcalf if you have any questions.

Epic veteran updates

Order set alignment is complete with 100% of the aligned order sets in production. The remaining Ballad Health sites completed all readiness events and are live as of Oct. 1. Ballad Health is now “One Patient, One Record.” With the October go-live, new features and functionality were added.
• Glucommander Order Sets have been added across all facilities. An embedded BPA on the Post-Op to Floor Navigator notifies providers of a patient with irregular glucose.
• Added neurologist reading tools for EEGs.
• Flowsheets were updated, and the ABC flowsheet was added for the new Falls policy.
• LPN cosign functionality was added.
• A Comments column has been added for all ED tracking boards.
• Family Notifications was implemented for Surgical Services. Schedule Explorer allows the clinic staff to view employed providers’ OR cases and office visits in one location. Nursing Cutover Team entering Ht/Wt/Allergies and Home Medications.
• Inpatient Medication Reconciliation History from SureScripts was implemented across all facilities.
• Mammography Coordinator Dashboards streamline tracking. Specimen collection workflow ensures specimens are collected on a timely basis and increases communication between lab and imaging. The IR narrator allows for a one-stop shop for all procedural log documentation increasing clinician efficiency and accuracy.
• Integration between cardiology and third-party systems is working successfully (CPACS – Excelera, McKesson, syngo Dynamic; hemodynamic systems – Sensis, Mac-Lab and ECG management – Cardio Server). Supply usage interface automatically documents inventory from Sensis into Epic. NI procedural charges (professional and technical) trigger automatically based on interfaced results. Cardiology nurses have streamlined sedation documentation for TEEs/Cardioversions.
• Team members and providers are able to see how all facilities are achieving Patient Safety metrics by reviewing the Patient Safety Dashboard.
• Departmental and hospital leadership have access to dashboards highlighting key go-live metrics to monitor successes and highlight opportunities across Ballad Health. Contact Josh Metcalf if you have any questions.

All aboard! – Education & training

Your Epic “Big Bang” training ride has reached its destination. The train ride went up and down, around curves and hit a few bumps every now and then, but WE DID IT! On Oct. 1, your training ticket was pushed as completed and the big day came and went. Ballad Health survived a massive training event through a pandemic. Ballad Health’s Epic training team would like to express our sincere gratitude and appreciation to everyone’s dedication as you attended numerous training events. A big thank-you goes out to managers who loaned us team members from operations to become Credentialed Trainers and assist in training our team members. Thank you to providers who stepped up and trained their peers
in their specialties. And we could not have done this if leaders and team members across the system and committee had not pulled together to support the Epic EHR implementation. We are a family, and families pull
together during challenges.

From July through the end of September, Ballad Health’s Epic educators trained over 6,000 providers and team members. As with any change, emotions ran high at times and fatigue set in, but because everyone pulled together to make this implementation a success, we were a success.

The next Epic implementation train is about to pull out of the station. But for now, be on the lookout for Epic EHR updates via “tip sheets” and other forms of communication. Seek out your unit/department Super Users and ask them what’s new with Epic or what changes you should be aware of. If there are needed optimization changes, be sure to communicate them to a member of the SLDS committees.

Most importantly, we’ve been extremely proud and honored to have served each of you on this project.

Super Users’ spot

Super Users, now that the Epic EHR has been implemented, you need to activate those strong communication skills. Team members and providers will need you to be approachable, outgoing and enthusiastic, even when they’ve asked you the same question ten times. Show them you understand and appreciate their clinical workflows and that you’re there to help support them as they adopt the Epic EHR into their daily workflows. Let your teams know we’re all learning and that you’re there to help them remain competent in their Ballad Health Epic EHR skills. Share with your teams that you were selected as a Super User because of your problem-solving skills, and that you’re open and adaptable to change.

Epic fun fact

Approximately 190 million patients across the globe currently have a record in Epic’s EHR system. Epic’s software is used in a variety of clinical settings, including community hospitals, retail clinics, rehabilitation centers, academic medical centers and independent practices. Patients can access the software from their homes and their mobile devices.

Epic expose’

Marvin Eichorn, Chief Administrative Officer, Epic Executive Sponsor

Q: In a nutshell, what are your responsibilities in your role as Epic Executive Sponsor?
A: My responsibilities are to provide overall oversight and support to our operations and finance teams, the IT department, Epic, Impact Advisors, and our many consultants that are engaged on the Epic project. In addition, I have an accountability to Alan and the Ballad Health Board to ensure that we stay on time and within our budget.

Q: How do you think Ballad Health team members have grown from the experience of implementing the Epic system?
A: Epic is the most advanced integrated EHR and financial system in the U.S. Our Ballad Health team has benefited from the discipline Epic instilled in us to follow their direction and guidance 100% of the time in order to have the most successful implementation of Epic.

Q: This project has been three years in the making. What have you learned by sponsoring a project of this magnitude?
A: A lot can happen over a three-year period and did on this project. Thankfully, one of the first things we did was to adopt five guiding principles, which have guided us through the last three years. One of the guiding principles that stood out to me was for operations to own the Epic
implementation – our operations team not only owned it but excelled at it.

Q: What is the one thing you’re most proud of with regards to the Ballad Health Epic implementation?
A: I believe having all of our hospitals and physician practices on Epic will be one of the greatest things Ballad Health could do to improve the quality of care for our region. Just to be involved with a project of this magnitude has been one of the most humbling and exciting experiences of my life. Our team members and physicians have done a remarkable job to make this happen.

Questions about Epic? Email bEpic@balladhealth.org.