This Week Health

Solution Showcase: A Story of an Epic Implementation, a Brand New Hospital, and a New EHR

May 17, 2023: Straight from HIMSS, Kat Hasanovic, Senior Director, Clinical EHR Applications at Baptist Health shares the story of their big Epic implementation, implementing the EHR, how DrFirst aided in their journey, and more. What was the process of implementing the new EHR system, including the challenges faced and how they were overcome? How did they decide on DrFirst as a solution, and what were the criteria they used to evaluate different vendors? What was the impact of the solution on patient safety, clinician satisfaction, and overall quality of care? And, looking back, what would they have done differently in the implementation process, and what lessons did they learn that could be useful for others going through a similar project?

Key Points:

  • EHR implementation challenges
  • Medication data consolidation
  • Artificial intelligence solutions for data cleaning
  • Stakeholder collaboration and input
  • Testing and validation processes

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Transcript

This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.

Today on This Week Health.

so you're talking millions of medication, SIGs that needed discrete elements, discrete places where clinicians can see that and pull that and leverage that data.  

 All right. Here we are from Chicago Hymns 2023, and we're gonna do a solution showcase. We've been doing interviews in action, but solution showcase. Kat, thank you for being a part of it. Kat Hasanovic? Yes. With Baptist Health out of Jacksonville. Yes. And you're sitting in for Stacy, who is not here.

So, last minute, fill in. Last minute fill in. But you know, this is a, this is a solution that you are very familiar with, that you were a part of bringing in. So we're gonna be talking a little bit about Dr. First and I, I think the best place to always, to start with these is what's the problem you were trying

to solve?

Sure, sure. So at Baptist Health, we recently went live with a new EHR system, CL system-wide EHR system. We consolidated multiple EHRs. Oh, you did? Yeah. You did that big epic implementation. Yes. We had a big Epic Big Bang implementation. And so one of our problems was that we have, of course, six hospitals.

I'm including a children's hospital. We have three free-standing emergency departments as well as an outpatient oncology clinic Baptist Anderson. And so, and of course over 200 points of care. That's a beautiful building, by the way. Yes. We love Baptist Anderson. I keep going on Tanya. Sorry. No, this is perfect.

No. All right. So you had, so we had to consolidate Yeah. Was our issue and so. Therefore,

how many EHRs are you consolidating from?

Oh gosh, a plethora. Because you have to remember, we have over 200 points of care. That includes outpatient primary care offices. It includes our MD Anderson, all of our hospitals, so multiple points of contact, and they were all on disparate different EHR systems.

Now, we had our main ehr, which at the time was Cerner, but of course we had all of these multiple points of entries where everyone had a different ehr. And so the issue that we were having was. Consolidation of medications. So, you know, if you're a patient and you're being seen at one of these points of entries and the EHRs don't talk, so now you're, you're relying on the patient being the historian, and then you're also relying on clinicians to manually transcribe this information, which could lead to era, which, you know, that's a big patient safety dissatisfier.

So we needed something. To clean that data for us to give us some tangible data so that way our clinicians had something that they trusted and they knew this information is correct.

Yeah. When we're doing these migrations, we're, a lot of times we talk about the Pammy data. Yes. And the m is medications.

Medications. And bringing that medication data together is a challenge. Talk a little bit about that challenge. Yes. I mean, because it's, It's not all input the same. It's not

all, no. And then you have to think about free text, right? So, so there may be free text information that needs to be cleaned. And so we leverage DR first and their artificial intelligence solution to do that for us.

And so you're talking millions of medication, SIGs that needed discrete elements, discrete places where clinicians can see that and pull that and leverage that data.

So this is it's interesting as a solution, I'm thinking. If you're doing a big EHR implementation, it makes sense. If you're doing a m and a, it probably makes sense as well, anytime you're moving that data and have to normalize that data.

Yes. So you identified a problem. Mm-hmm. Talk about the process of examining solutions, looking at different solutions and how you evaluated solutions at Baptist.

So we collaborated with, you know, key stakeholder. So we input is important, you know, people have to trust what we're doing.

And so, and to do that you bring your folks to the table and, and you discuss it. And you know, Dr. Johnston, you know, she's very well known, very resourceful, and I think she looked at a couple of other vendors and Dr. First just met the need.

It's interesting cuz when you're talking medications, like we were just trying to put our medications in the portal and.

Every time we went to a different physician group to say, Hey, here's what it looks like. They'd say, you can't do that. You can't do that. You can't do that. Right. So there was probably a lot of oversight on this and a lot of testing on this specific project.

Absolutely. So this had to include multiple application team members, multiple stakeholders.

You have to test, you have to validate, you have to be sure. Cuz at the end of the day, there's a patient at the end of that data. Another important aspect also is not only for the clinicians and physicians to have access to that data in real time, all consolidated. It's also the patient, because when we moved to Epic, that gave the patient in their hand from any web, web browser to be able to see their history, their medication data.

So you have to remember, they didn't have that before because we had our main EHR that our inpatient hospitals were utilizing, and then we had our different EHRs at our different locations. Our outpatient locations. And so as a patient, you didn't have that one source of truth. And now we do. And thanks to Dr.

First, we have that one source of truth that our patients can also leverage.

Did, did that create a huge med?

Absolutely. Absolutely. And we still have some challenges today, right? Because you know, there's always challenges. There's always challenges today. But you know, medvac across the industry is challenging for all health.

Systems. I would welcome if there's a health system that has a down pat, please see me if they have it down pat.

No, but I'm picturing, you have these silos of medications, these different EHRs. Yes. And then you go to bring 'em together. How do you handle the, the discrepancies between them?

Well, that's what we count on Dr. First for that is, that was a part of the solution is to make sure that they gathered all the data. Especially the free text elements and, and making sure that every point of care, every medication sig, every full sig was consolidated. And our medication techs and our, our nurses and our physicians, they trust that data and they know that we, we have implemented, you know, one top of the line.

Yeah. And I think one of the things that's important for people to realize is as we're doing this med rack, we're not throwing away, oh, this is the data and we're throwing this other stuff away. We're always keeping that lineage of the data. Yeah. So we can go back and, and you know, because we still, as much as we're talking about AI here right?

We still want the nurse and the clinician and, and you know, whoever the primary care doctor to look at it and have a conversation.

Oh, absolutely. I am a nurse by trade, and so I completely understand the importance of making sure that you validate, validate, validate. It's not just relying on the computer, it's also having that conversation with your patient.

And, and leveraging that information.

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now, back to the show.

So talk to me about the implementation. I mean, was this just part of a massive other project that was going on and what did it take to stand up Dr. First and, and what did the initial steps look like?

Well, we knew that going in, that we were going to have a challenge, right?

Because we're consolidating, we are moving to one single platform. So we knew we were gonna have a challenge.

A challenge amongst challenge

amongst many challenges, right? And so as we were implementing Epic, we knew that we had to have a solution. We knew something had to be done. And so it was kind of a project within a project, right?

And so we started our implementation with Epic back in the fall of 2020. And as we started building and as we started looking at those legacy workflows, cause remember, We had to look at legacy workflows from different aspects, different points of entry. And so that took, it's a team of people and it also took collaboration with our clinicians and with our stakeholders because like I said previously, you have to have buy-in from them.

You cannot just implement without having buy-in from your stakeholders. They have to know and be at the table and trust the information and trust the process. And to do that, they have to partner with them. And that's what we did.

So, As you were testing, was it nurses and clinicians doing the testing?

Nursing, nurses, MAs. We have medication technicians. We have pharmacists. Pharmacists, we have doctors. Everyone. It's everyone at the table. Everyone who has a stake in the game. Everyone who could do medication reconciliation.

So Big bang. Big bang. So you said it was six at a children's hospital.

Well,

let me tell you our story.

So Baptist Health, of course, we have six hospitals now. At the beginning of the project, we had five hospitals. So we had five hospitals and four, three standing emergency departments. And so having a Big bang, epic go live, that just wasn't good enough for us. And so six months after our big Bang go live system-wide with Epic.

And this is acute care. And outpatient. Okay. And primary care and ambulatory clinics and our cancer center. So your entire medical, all your medical groups, entire thing, everything. And six months later, which kids you're gonna do it, you might as well, might as well do it. And six months later we opened a new hospital.

And so we, we like, like from the gra, like bills round up, we had four freestanding emergency departments. And so we went live with Epic in July. And in December we decided that we were gonna open up Baptist Clay, which started as a freestanding emergency department. The construction was ready, December came, and we said, you know what?

Let's just do it. Merry Christmas, Jacksonville. Here's your new hospital.

Merry, Merry Christmas team.

It was great. It was great. It was the right thing to do for the community.

Yeah, it's so talk to me now. So the Big Bang which is, which is pretty amazing. So it all goes into place now. Typically when you do an EHR implementation of that scale.

Mm-hmm. The first couple of months are a challenge. Sure. Now, the nice thing for you guys is you're not early adopters by any stretch, and so you had a lot of help. I mean, they're, I, I know a Baptist out of Kentucky send some people down to work with your team. I mean, you guys had a epic now has a community of people that sort of swarms around and helps.

Yes. But what, what are some of the challenges you found specifically around the medications and the migration? Like post GoLive? I

think post goli, some of the challenges were the fact that this is new to everyone, right?

Right. So it's new work. You moved, moved all the cheeses,

moved all the cheese, new workflows for everyone.

And also remember, Not every partner that we work with is under the back of umbrella. And so when you have different practices that are governed by different bodies, that becomes a challenge. But communication is the key and buy-in is the key. Correct? Definitely the

key, it's a, the each R implementation's always comes down to a, a handful of things.

I mean, we can get the build pretty close now, but the education, yes. And. You know, and some people are like, how hard can it be? I, you know, I don't need to go to the trade. But the education and then the customization Yes. Of the environment and and every time we do these or I've been a part of these, it's the doctors who are the last to customize are the loudest Until you go, do you realize you could do this?

And they go, oh, well that's a lot easier. Year. Absolutely,

yes it is. And then you have to remember that there are other epic shops in Jacksonville and so you have those practicing clinicians who work at other health systems in town. And so they think that they know Epic because they already utilize it somewhere else, but they have to realize that to build the workflow, this is our epic.

Right. It's really

interesting. Yep. Talk about steady state. So, oh my gosh, you're. Three or four months past your go-live. So you're steady state now. What is the, what is the Doctor first implementation? I mean, does it take a lot of maintenance and a lot of oversight or is it just sort of running in the background?

It's

running in the background and so I think, you know, with Doctor First, we have a great partnership with them and so we're constantly collaborating with them on other projects. And so it's right in the background, it's doing what it does, and we just have to monitor, validate, monitor. Make sure that things are what we call high and tight in the nursing world.

You know, make sure everything's high and tight and just keep that constant line of communication if we're in that partnership.

And I, I think the last question talk about we have a lot of pharmacy partners in the community. How does Dr. First either, you know, assist or help with, with the communication and the flow

of the medications out to those partners. Sure.

So remember we had to convert millions of medication. Six, right? So you may have a patient that's on, you know, a certain medication, you know, certain 30, you know, b i d for 30 days, you know, 60 pills or what have you. You have to remember, because now we're all leveraged, we're on the same platform, and Doc Dr.

Versus helped us to clean that data. Our pharmacy partners out in the community. Now they are only working with the one EHR system. The one system is electronically prescribing and sending to those different pharmacies. So Walgreens now knows Baptist Health has leveraged. We're on Epic now. So now they don't have prescriptions coming from them, from Baptist Health, from Allscripts perhaps cuz that was one of the EHR vendors and our primary care offices.

So now everyone is comfortable and satisfied with the fact that this patient information has been convert. It's been converted. It's been measured. It's been leveraged, and it's one source of truth now, and it's trusted.

Fantastic. Kat, I wanna thank you for your time. Thank you. Take care.

I love the chance to have these conversations. I think If I were a CIO today, I would have every team member listen to a show like this one. I believe it's conference level value every week. If you wanna support this week health, tell someone about our channels that would really benefit us. We have a mission of getting our content into as many hands as possible, and if you're listening to it, hopefully you find value and if you could tell somebody else about it, it helps us to achieve our mission. We have two channels. We have the conference channel, which you're listening. And this week, health Newsroom. Check them out today. You can find them wherever you listen to podcasts. Apple, Google, overcast. You get the picture. We are everywhere. We wanna thank our keynote partners, CDW, Rubrik, Sectra and Trellix, who invest in 📍 our mission to develop the next generation of health leaders. Thanks for listening. That's all for now.

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