AAAEM RETREAT

APRIL 8, 2014

Tammi Miller

Administrator, Information Systems and Technology

Johns Hopkins Emergency Medicine

The EMR Experience

Applications,

Challenges,

Successes &

Lessons Learned

JHH JHBMC HCGH Suburban JHCP

Patient Portal

Health

Information

Exchange

(CRISP)

Registration/

SchedulingEpic

MEDITECH, Epic,

GE (IDX)MEDITECH MCKESSON GE (IDX)

ADT Keane MEDITECH MEDITECH MCKESSON

N/A

Inpatient EMR Eclipsys MEDITECH MEDITECH MCKESSON

Ambulatory EMR Eclipsys (limited) MEDITECH/LSSMEDITECH/LSS

(limited)

GE (Centricity

EMR)

GE (Centricity

EMR)

Specialties Varied Varied Varied Varied N/A

EPR2020 Enterprise clinical data and document repository

Hospital Billing Keane MEDITECH MEDITECH MCKESSON N/A

Professional Billing GE (IDX) GE (IDX) GE (IDX) GE (IDX) GE (IDX)

STATE OF SYSTEMS IN 2010

ANALYZE & EXPLORE

Money

Timeline

Preferences

Culture Change

Implementing Epic requires

significant organizational

transformation. It is critical

that Johns Hopkins Medicine

be ready to embrace the

cultural change that an

integrated solution requires

driven by active, ongoing

senior operational and

clinical leadership

involvement.

JHH JHBMC HCGH Suburban JHCP

Patient Portal Epic

Registration/

SchedulingEpic

Health

Information

Exchange

(CRISP), EPR2020

and Epic

ADT Epic

Inpatient EMR Epic

Ambulatory EMR Epic

Specialties Epic with some exceptions

Hospital Billing Epic

Professional Billing Epic

FUTURE STATE OF SYSTEMS

THE JOHNS HOPKINS GO-LIVE PLAN April 2013

Ambulatory Sites

Johns Hopkins Community Physician Sites

JHH Adult and Pediatric Emergency Departments registration only

Replaced Epic 99 with Epic Prelude

June 2013

Sibley Memorial Hospital and Howard County General Hospital ‘Big Bang’

July 2014

Suburban Hospital ‘Big Bang’

August 2014

The Johns Hopkins Hospital Adult and Pediatric Emergency Departments ASAP

Future 2015/2016

Johns Hopkins Bayview Medical Center ‘Big Bang’

The John Hopkins Hospital (all other inpatient)

ASAP TEAM

Tammi Miller

Peter Hill, MD

Pat Zeller

Gary Dunn, RN

Neesha Patel, RN

Vince Collins

Marc Johnston

Christine Trotta, RN

Monica Datta, RN

Erin Powell

Matt Loftus

6

JHM Enterprise ASAP Business Owner

JHM Enterprise ASAP Physician Champion

Epic Ancillary Manager

ASAP Team Lead

ASAP Application Coordinator III

ASAP Application Coordinator I

ASAP Instructional Designer

ASAP Credentialed Trainer

ASAP Credentialed Trainer

Verona ASAP Implementation Services

Verona ASAP Implementation Services

LEADING UP TO GO-LIVE

Emergency Medicine Council (Fall 2011) Includes Physician, Mid-Level, Nursing, Registration and

Billing Leadership or Designee

Includes other disciplines, such as Radiology, Pathology, Pharmacy, Compliance, Internal Audit

Meets every Monday afternoon for 3 hours

Demonstations

Validation Sessions (review workflows and functionality within Epic)

LEADING UP TO GO-LIVE

COMMUNICATE

LEADING UP TO GO-LIVE

COMMUNICATE

LEADING UP TO GO-LIVE

COMMUNICATE

GO-LIVE ISSUES (ANTICIPATED)

Unclear workflows are unmasked

Admissions process (patient movement)

In-basket functionality

Radiology discrepancy notification

Facility Charge Calculator

Outstanding questions going into go-live

No time for integrated workflow testing

Test workflow assumptions

Test the use of Epic in the workflow

Training affected by all of the above11

GO-LIVE ISSUES (UNANTICIPATED)

Go-live support for Inpatient/Admitting

Physicians in the Emergency Department

We were not prepared to provide support to

others outside of ASAP

Admitting Physicians

Detailed at the elbow support

Help with admission navigator

Communication and documentation

Workflow

12

CLASSIFICATION OF GO-LIVE ISSUES

Access

Integration

Interface

Workflow

Orders

Content

Training

13

KPI - STATS

Metrics CY12 Average June 1 - 10, 2013

LWBS 0.21% 0.52%

Arrival to Room (min) 0:09 0:18

Arrival to Provider (min) 0:16 0:44

ED Decision to Admit to Inpatient Bed 2:05 2:26

Overall Average LOS N/A 3:02

Admitted Avg LOS 4:57 5:53

Discharged Avg LOS 2:22 3:02

Sibley Memorial Hospital Emergency Department

As of June 12, 2013

14

Metrics CY12 Average June 1 - 10, 2013LWBS *includes Peds 3.52% 8.08%

Arrival to Room 1:09 2:00

Arrival to Provider 3:03 2:52

ED Decision to Admit to Inpatient Bed 3:22 5:19

Overall Average LOS 4:48 7:28

Admitted Avg LOS 5:33 12:19

Discharged Avg LOS 4:36 6:45

Howard County General Hospital Adult Emergency

CHALLENGES & LESSONS LEARNED

Go-Live at two hospitals, in two states on the same day

Difficult to provide desired level of support to three EDs

at the same time at two different hospitals

similarities and differences

Implementation of Change Control

Consensus for most changes

Decisions about harmonization vs. divergence

Communication and education of changes

Difficult on the fly and at the pace we were going

Difficult to balance command center attention

To the clinicians on the ground

To the work that needs to get done

15

CHALLENGES & LESSONS LEARNED

Patient Identification

Increased size of patient database, resulted in more

misidentified patients

Registrars became even more important

Some potential solutions

Retrained staff on searching in Epic

Exploring Patient Photos

Kiosks for Self Registration

Merging of Patient Records

CHALLENGES & LESSONS LEARNED

Reporting

Harmonizing

Time

Adjusting to Change/Old Habits

Multiple sites with different starting points

Downtime Planning (BCA)

Policies and Procedures

QUESTIONS?

COMMENTS? FURTHER

DISCUSSION