Last week, I wrote about the value of site visits as a way to learn from others. Fresh off the annual Epic User Group Meeting (UGM), I’ll call it a site visit on steroids. There are over 10,000 attendees, 100’s of educational sessions presented by users, 
direct access to Epic staff, and plenty of networking time; you see what I mean?
This was the first year it made sense to invite my executive colleagues from UMHS to attend. Our core Electronic Health Record is now in place, our executives need to look to the future: what else is possible with the product we already have, what new functionality is planned for future upgrades, and what other Epic users are doing.
Three UMHS executives answered my call and they were glad they did: the Hospitals and Health Centers CEO, and the executive directors of the children and women’s hospital and the adult hospital. We will debrief as a group soon about what they saw and heard, and to explore what functionality we should prioritize next. It’s no surprise there is great interest in operational dashboards. We will figure out what we can develop with the tools we already have.
Our UMHS team showed up ready to learn, and to teach. We led five education sessions on topics that included e-prescribing for controlled substances, pharmacy documentation, self-developed patient education tools, registries, and our integrated build approach.
I’m an extrovert and an extreme networker; I think UGM is very valuable. I catch up with colleagues who have solved problems we’re having, implemented modules we haven’t, or are struggling with the same issues. We have a lot of experience, so I freely offer advice to my colleagues.
There are the open, honest CIO roundtable discussions with Epic leadership. We challenge Epic when they say something is easy to implement and takes only limited time and resources. We ask Epic to share best practices they’ve seen to give us all a running start on something new.
At a joint CEO-CIO session with Epic CEO, Judy Faulkner, we were asked to give feedback on licensing approaches for affiliates, we examined what is in our best interest. In the CIO advisory council with Epic president, Carl Dvorak, he asked us to consider changes to the upgrade schedule. We discussed the impacts on the timelines and work effort to get new functionality sooner. As customers, we need to be willing to participate in advisory councils to help shape product futures.
And then there is the up close and personal time you get with UMHS colleagues as you travel together: sharing a meal, sharing rides, sitting together at a session. It’s an invaluable chance to get to better know the people you work with.
Last but not least, one of the favorite sessions – Cool Stuff Ahead. This is where Carl and a team of Epic experts tell us about what’s coming in future releases: improvements for patient engagement, population health, real-time location systems (RTLS) integration, capacity management, mobility, research, and more.
Health care organizations are making significant investments in their EHR. It is worth our time and energy to attend user group meetings such as this, learn from our colleagues, engage with vendor experts and help shape our future – all with the goal of improving health care for the patients and families we serve.
Fadi Islim on said:
• Electronic health records (EHRs) have numerous benefits, but are also besieged with risks.
• Health care leaders must analyze potential risks throughout all EHR stages.
• Lessons learned from an EHR implementation may assist nurse leaders in avoiding disputes and risk.
• Strategies for reducing risk, liability, and ultimately litigation associated with EHR implementation are discussed.
In May 2012, a moderate-sized hospital in Southern California launched its first EHR. Prior to the EHR build, an organizational needs assessment was conducted by the project lead. Needs were assessed by interviewing key nursing and executive leaders within the medical center. The needs of the organization, relative to implementing an electronic health record, were categorized into three main areas;
(a) Additional resources, both human and financial;
(b) Physician buy-in (the hospital has a large number of older physicians, many expressed their reluctance with converting to the EHR); and
(c) Nurse collaboration during the system build and implementation/ training phases.
To address the top three identified needs, the organization judiciously monitored their financial budgets. The information technology team secured system office support for additional money with well-documented justifications. During the build phase, the implementation was pushed back 3 weeks to allow for more testing. The additional money needed was sought and approved. The physician champion worked diligently to establish buy-in with the medical staff. He partnered with the chief of staff to share the benefits of the EHR with the medical group. While there was certainly a strong effort, 2 months post-launch meaningful use requirements were not being met for physician documentation of patient problem lists. This is an issue other hospitals have faced; 16% of hospitals with new EHRs have also reported this as a barrier to achieving meaningful use (Jha et al., 2011). To date the hospital is still unable to gain compliance with this physician documentation and CMS incentive dollars are unlikely. The nurse engagement for the EHR remained strong; however, the availability of extra nurses to provide system training proved to be an overwhelming challenge. While most nurses were excellent trainers, a significant number were not skilled educators and communicators, and some simply did not acquire the expert knowledge of the system. Two months into the operations phase, numerous programming errors were discovered. Clinical documentation designed with the intent of meeting quality standards lacked critical data fields. Nursing leaders discovered there was no capability for registered nurses to co-sign licensed vocational nurses, no ability for nurses to document telephone orders, and clinical information needed to meet CMS core measure requirements was nonexistent. The system was designed in a way that did not support the nursing administrative documentation policies. To further complicate matters, nurses and physicians were unable to navigate through the record efficiently. In the end, the EHR placed the organization at risk. Pertinent clinical documentation was omitted, such as patient discharge instructions, lab value reference ranges, respiratory therapy treatment notes, anticoagulation titrations, and nursing end-of-shift documentation. The information that was captured was difficult to retrieve due to the lack of adequate training and system design. The EHR did not read like a traditional medical record. Information retrieval was not intuitive and required multiple navigation points across several screens. The numerous clinical documentation errors required the risk manager to be involved. To mitigate the risks, the information technology department arranged for weekly meetings to discuss needed HER changes and the prioritization of each change. This level of risk required immediate action. While the risk manager and others were involved, there was no recognized need to involve the hospital’s counsel. The organization was confident the programming issues could be resolved within 1month’s time. Proposed alternative solutions were to document on paper all EHR documentation with missing fields, or continue all documentation in the EHR to maintain consistency with newly implemented processes. The decision was made to resume paper documentation where necessary to meet regulatory and accreditation requirements. The omissions in the EHR record were concerning for several reasons: (a] The Joint Commission was expected to survey the hospital soon; (b) quality scores were falling significantly below standards, and (c] potential claims against the hospital would be hard to defend with missing clinical information.
Conclusion
Modern EHR systems are excellent tools, but one cannot lose sight of their potential hazards. The HER has created a new liability risk for health care organizations and providers. Patient harm can result in medical malpractice claims stemming from EHR inefficiencies and errors. Organizations and providers can face legal fines and lawsuits for privacy breaches with the EHR. Organizations must be aware of the variety of potential perils to mitigate risk and patient harm.
References
Houston-Raasikh, C. (2014). What the Others Haven’t Told You: Lessons Learned To Avoid Disputes and Risks in EHR Implementation. Nursing Economic$, 32(2), 101-103
Rodney Nelson on said:
Sue,
Thank you for the recap of the Epic UGM. I like the recap of the highlights. This discussion gives me another perspective on the value of user group meetings or just getting out to network with other groups of people within UMHS and campus.
Thank you!
Rodney
Sue Schade on said:
Rodney, networking in any forum is a good thing!