The Epic Roll Out: BWHers Share Successes, Challenges of New System
Since Partners eCare went live four months ago, staff across BWH, BWFH and Dana-Farber/Brigham and Women’s Cancer Center (DF/BWCC) have been diligently learning and adapting to the new system, adjusting their workflows and working with colleagues to troubleshoot issues. Over the next five years, the PeC will integrate all clinical, administrative and revenue systems across into one comprehensive system, improving the way BWHC delivers care to patients across the hospitals and distributed campus.
CRN talked to several BWHers about improvements, growing pains and overall impressions of the new system so far. Here is what a few had to say:
Hospitalist Rob Boxer, MD, PhD, Director of BWH’s General Medicine Service
“Given the amount of change providers have absorbed, things overall have gone really well. People are getting used to the new system and becoming more efficient with it. Some areas already recognize Partners eCare as a clear improvement from old systems, especially the ability to access and receive information in a timely fashion.
“I’ve been hearing about the place where providers are most struggling with the transition, which has been medication reconciliation on admission and discharge. Orders are now written with a particular phase of a patient’s care in mind and reviewed and ordered at different stages. Providers didn’t have to do this prior to Epic implementation and are getting used to it; there have been fewer concerns over time.
“There are also pockets of concern related to certain workflows. Some of the homegrown systems that were custom-fit to our needs and adapted over the years are certainly missed, but Epic is working to fix our issues and has been open to where the gaps are. Additional tip sheets are being developed on how to best use the new system, and sessions with frontline providers are identifying root causes in workflows leading to patient medication errors. Committees are working to understand how much of our challenges are due to people getting used to a new system, which is natural, as opposed to areas where Epic needs to update or change the system.
“Providers recognizing areas of concern in their workflows can submit tickets to the Help Desk to alert the Partners eCare team of the issue. If the issue relates to patient care, it will be resolved right away. “Larger system-build issues go to a committee to review the root cause of the problem and determine options for changes to the system. Shelly Anderson, vice president of Strategy Implementation, is organizing different workgroups to focus on different key areas—lab orders, radiology, IP workflows, ambulatory workflows—to identify and prioritize the work that needs to be done.
“Overall, this has been a hard period of transition, as we’ve identified the gaps and problems with initial implementation, but we are adapting and can see that there is great opportunity to make our workflows more efficient and to be able to provide the highest-quality care for our patients using the new tool. Anytime I talk to someone about Partners eCare, he or she says, ‘I miss this aspect [of an old system], but overall, I think the new system will be better.”
Theresa Stone, Research Billing Compliance Manager
“The Epic research functionality allows for increased transparency and the ability to provide better and more streamlined care, both in terms of patients’ usual clinical care and their research-related care as subjects in clinical trials. With the ability to enroll patients as subjects and link their research-related ordered or scheduled services, all clinical staff are able to see these different layers of care. In addition, we have a more robust method of ensuring research billing compliance.
“Study coordinators and department administrators have told me that they feel they can track things better. For example, after working out some of the kinks, Epic has been hugely beneficial to them in placing lab orders because they are getting the lab results more quickly. For patients in that area, it’s a huge improvement.
“It’s been challenging for many folks with varying degrees of frustrations; there have been some issues to work out that we didn’t anticipate with regard to weaving research activity into clinical activity. But truly, there have been much success and support for this functionality within our research community.”
Matthew Carty, MD, Plastic and Reconstructive Surgeon
“I think that given the scope of transition required and the fact that it affects outpatient and inpatient areas at BWH and BWFH at the same time, implementation has gone surprisingly well. With an undertaking of this size and magnitude, there are always unanticipated issues, and this was no exception; however, for the most part, people have transitioned well over the span of one to two months. BWFH’s ORs are running pretty much as they were prior to Epic implementation, and BWH ORs are getting closer to pre-implementation turnover time, which are successes.
“The biggest challenge for most people has been figuring out how Epic alters their individual workflows. One thing that could have been done on a subspecialty basis prior to implementation were walkthroughs of exactly what would change in the clinic, pre-op, OR and post-op areas. Epic has a huge spectrum of capabilities, and a lot of what we were exposed to before implementation was the bells and whistles—things we might not be using on daily basis. We are learning all of the daily processes and changes on the ground through real-time training now.
“Any thoughtful consideration of Epic needs to be done in the context of what came before it; BICS and LMR were cutting-edge at the time they were developed and rolled out, but they were not necessarily easy or seamless systems in their own right—people just got used to them, as we will with Epic. “Traditionally every year there’s a cycle of people learning the system for the first time—our residents, which is about 10 percent of our community. Now, 100 percent of staff is learning the system, but all-in-all, Epic is a better system, and I believe we’ll have more and more appreciation for it as time goes by.”
Diane Miller, RN, Emergency Department Clinical Nurse Educator
“There are 144 nurses in the ED, and they have all really stepped up to the plate. The morning we went live, a major trauma patient came in, and nurses jumped right onto the Trauma Navigator and documented the case in real-time; that was a huge accomplishment. There was a big crowd huddled around one computer; everyone wanted to learn the process. We had lots of help from super-users and our Partners eCare partners to help us in documenting trauma right off the bat.
“Now, we’re problem-solving when nurses have trouble with their workflows. We’re looking at revising tip sheets and connecting with Epic to resolve some of the issues. There are parts of Epic that fit really well with our workflows and parts where we stumble a bit, and that’s when we hear from staff.
“Our department has embraced Epic and done well with it. There have been challenges, such as being slowed down at triage. We are still working through those processes, and Janet Gorman, RN, BSN, MM [Emergency Medicine nurse director] has been instrumental in helping us work through that.
“In the ED, nurses and staff have really put their best foot forward.”