Freed Associates

Bringing Physicians On Board With EPIC – Introducing a New Electronic Health Record Program

Introducing a new Electronic Health Record (EHR) program into the patient care environment is complex and highly disruptive for all caregivers. Anyone who has gone through an EHR implementation or optimization understands the challenges involved. Physicians not only have to adjust to the transition from paper and verbal orders to electronic reporting, they have to learn a brand new system to do it. They have to modify their daily workflows to comply with their organization’s policies and simultaneously address the requirements involved in achieving Meaningful Use stages. Not surprisingly, most physicians groups need help navigating the extensive changes required.

When John Muir Health was ready to invest in a new EHR, they hired Freed Associates to help them maximize the value of their investment.

“We had resistance from all directions,” said Dr. Kate Bennett, the Chief Medical Information Officer (CMIO) of JMH. “But Freed came up with solutions that encouraged buy-in and kept the transition moving forward.”

Bringing disparate groups and systems together

John Muir Health is a leader in health care in the San Francisco Bay Area, with two of the largest medical centers in Contra Costa County and a number of primary care and outpatient services throughout the community. Before their EHR implementation project began, ambulatory care, emergency room, and acute care physicians were utilizing different paper, electronic, or hybrid systems for maintaining patient health information. In order to share data efficiently and ensure seamless communication across the entire continuum of care, they needed a single, system-wide, standardized EHR system. They chose Epic Systems.

Freed Associates was tasked with helping John Muir Health engage, prepare, and support physicians through the go-live and beyond. Their first task challenge was to ensure that physicians from all departments were involved in the design, validation, and build of the new system. The doctors’ participation would maximize buy-in alignment, and standardization of the EHR across the health system.

According to Dr. Bennett, “Because of the size of our health system and the various ages and backgrounds of our caregivers, we were experiencing a range of opposition to the transition, despite the fact we had a general agreement that electronic records and computerized physician order entry (CPOE) would provide a more engaging patient experience and better health outcomes. ”

Many of the challenges John Muir Health confronted were unique; but others may be familiar to larger health care organizations facing similar transitions:

  • Disparate systems from department to department
  • A lack of standardization across the campuses
  • Demand for data conversion, which was technically difficult
  • Resistance of certain older physicians
  • Resistance from one medical group that was already entrenched in an electronic system
  • Resistance to participation in build and training activities. Some felt they already knew Epic and did not need extensive training on the new system.
  • Moving to an entirely new workflow for some who were used to paper forms and having nurses filling in the blanks

Effective work-streams, team building and communication promote buy-in

Freed worked with Dr. Bennett and other key doctors at John Muir Health to build the team infrastructure and the multiple work-streams required to support EHR implementation. They developed a governance structure for the EHR, drafted a request for proposal (RFP) process for vendor selection for go-live support, developed order sets to save physicians time and improve processes of care, created a physician communication strategy, developed a campaign to register caregivers for training, designed templates for EHR note-taking, and designed and implemented various key applications, workflows, and policies. In order to meet organizational goals and promote education and program acceptance, Freed forged collaborative relationships with physician champions, EHR application teams, communication managers, training managers, operational readiness owners, physician analysts, EHR leadership, and Information Technology (IT) leadership.

Provider outreach was critical to support change management and facilitate a smoother transition. In addition to working with their physician champions to troubleshoot and resolve issues, they helped develop multiple forums for other physicians to provide input, ask questions, and test-drive the new system. They supported a large team of at-the-elbow support resources and provided 24/7 physician support coverage in the Command Center. After go-live, they developed cross-functional focus groups to quickly address opportunities for improvement specific to core service line workflow and functionality.

A win for John Muir Health

“After over two years of strategic planning and program development, we have successfully deployed Epic to over 1,000 physicians across both outpatient and hospital locations,” said Dr. Bennett. “We now have an integrated EHR system that provides the best options for doctors, patients and John Muir Health as a whole.” With Freed Associates’ help, John Muir Health was able to:

  • Recruit and orient over 100 Physicians Super Users to champion the program
  • Validate the content of over 300 order sets
  • Design and validate over 150 note templates
  • Achieve over 90% computerized physician order entry (CPOE) in week one of go-live

Today, optimization and process improvement is ongoing as John Muir Health works to deploy the program to additional community physicians.