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
