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April 10, 2024: In this engaging episode from VIVE 2024 in Los Angeles, we delve into the transformative journey of Baptist Health Jacksonville under the leadership of Stacey Johnston, Chief Application Officer, and their remarkable achievement of a ten-star EPIC implementation. The conversation also focuses on the clinician experience, specifically medication reconciliation (MedRec) challenges, as Colin Banas, Chief Medical Officer with DrFirst, outlines the persistent hurdles despite advancements in interoperability and digitization. How can the gaps in medication history be filled, and what solutions can address the semantic interoperability problem to prevent manual data transcription errors? This episode not only sheds light on the complexities of healthcare IT implementations and optimizations but also presents innovative solutions to longstanding challenges in clinical workflows.

Key Points:

  • Ten-Star EPIC Implementation Success
  • Post-Live Optimization Strategies
  • Medication Reconciliation Challenges
  • Improving Medication History Accuracy
  • AI-Driven Process Enhancements

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

My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week Health, where we are dedicated to transforming healthcare one connection at a time.

Now, let's jump right into the episode.

β€Š Alright, here we are from VIVE 2024 in L. A. We have Stacey Johnston, Chief Application πŸ“ Officer with Baptist Jacksonville. And we'll come back to you in a minute.

Collin Banas, Chief Medical Officer with DrFirst. We're gonna talk medical reconciliation. We're gonna talk a lot of different things. Stacey, first of all, congratulations. Ten πŸ“ stars on the EPIC implementation. Yeah. You're still standing, you look healthy, πŸ“ and

that's an amazing accomplishment. How did you guys accomplish that?

So, honestly, I couldn't have done it without the team that we had. We just built a rockstar team. Everyone from our application analysts to the directors we brought in. And then we had a significant amount of operational involvement.

We had over 1100 team members participate in the workgroups, participate in the build. 300 positions were part, partaking in the build. They participated in all the workgroups. So we had a significant amount of operational involvement and just this, it was great collaboration across IT, revenue cycle, clinical operations, and just, just everyone came together to build the system.

How did you get that, I think is what people want to know, it's like, I think it's unheard of to go ten stars that quickly.

I just, I think it was again, just making sure people knew the why, why is this important, why should you participate. And there's an ongoing joke that if I ask you to do something, it's pretty hard to resist.

And so, anyway, so I've been pretty lucky in having people sign up and participate in the build. And even post live, calling upon people to help with the post live optimization and saying, let's get together, let's figure out, where you need improvement.

Yeah, and

I don't want to picture that it's easy, because even post live now, you probably have a fair amount of optimization to do and things to clean up,

I would imagine.

Yeah, absolutely. I mean, it's just every day we meet with the end users and say what are you struggling with? I have incorporated some rounding into the application analyst team and we round with clinical informatics, training, and the clinical folks and so we, the application analysts are going and they're meeting at the bedside and meeting with the physicians and the nurses and the pharmacists and I think that's really helped understand what the actual workflows are and then that way.


so we're going to talk the clinician experience today. Specifically, we're going to talk about MedRec. Colin, I want to come to you and talk about the problem set. What kind of problem are we trying to solve for the clinician in making their life a little easier? Yeah,

20 years later, we're still talking about MedRec conciliation, which is crazy.

So, we still haven't gotten it right because it's a complex problem. I usually distill it down into two big buckets as to why MedRec is so complicated still. One Despite years of interoperability and digitization, we still don't have all the records. We still don't have, there's still gaps in the medication history that we receive on behalf of our patients.

So, how can we fill those gaps? And a lot of times it's phone calls and extra interviews and things like that. Because not all of the pharmacies are connected, not all of that data is flowing. The second problem is that even when we get that data, access to that data coming into our system, we still as an industry have a semantic interoperability problem.

The data isn't always usable right off the bat. So that means someone is going to have to take that data and manually transcribe it back into the system. And so, two things, lack of data or missing pieces of data, and then having to re input this data manually is a recipe for disaster, really. MedRec is so important because when you get it wrong, people get hurt.

Barnard. Yeah. And we're going to do a first on the show. We're actually going to do a demo for those who aren't aware. I'm going to get to do the first play by play. I'm going to be Jim Nance here, and Collin's going to describe it. But Stacey, I'm going to come to you first. Sure. What what kind of problems specifically do you look to DrFirst to solve for your clinicians?

Yeah, so when we first started engaging with DrFirst, it was actually in our Cerner days. And what we were finding was the first point that Dr. Banas was describing. We couldn't find all of the medications in the medication history. So when we were sending out these queries to your big pharmacies, your Walgreens, your CVS.

We were getting back a certain percentage of our queries, but we were finding that the smaller mom and pop shops some of the DoD pharmacies weren't on this network. And so we had, there could be some important medications that were prescribed at these other pharmacies, and we were not able to pull that into the medication history.

And so I engaged with DrFirst to say, Hey we are Looking to expand our query search. And so, we started to actually look at building it into Cerner, but we thought, you know what, let's, we're moving to Epic, let's focus on our Epic implementation. And really, what can we do with the Epic implementation?

And I want to take medication history to the next step. So then we also realized the gap in the workflow was this manual process. And that these they're called SIGs in the pharmacy world, but these SIGs are going and coming. It was coming back from the pharmacy and it would say one tablet twice daily for 30 days.

Right? but a lot of times that information was coming back the semantics wasn't mapping directly. And so you'd actually have to do manual entry and type in one tablet twice daily for 30 days. And so that was having to fall on our nurses and our pharmacy techs that do the medication history in the inpatient space.

So we have So they were actually doing the manual entry. Yes, so they were literally typing in one tablet. Well, or clicking on the box. Dropdowns. Yeah, like the little discrete. Sometimes

dropdowns take longer than just typing it in.

Yes, exactly. So they were doing the dropdowns, and so, so a lot of manual entry.

A lot of clicks happening, and so I thought, let's go live with not just the additional search queries, but let's go live with the, that AI component. And so, we call it smart processor. So basically, it lets you It helps to pull in these additional queries from all these other external sources, but then it maps it into these discrete fields.

it actually, sometimes there's fields that are blank. So if it's saying one tablet and it's phrased daily, they might not fill in a quantity of 30 tabs, but you can infer that, or, 60 tabs. But you can infer that in that one month period of time, it should be 60 tablets.

And so the smart processor does that in five minutes. And it actually maps it to these discrete fields. So it fills in the one tablet twice daily with 60 tabs so that the nurses or pharmacy techs aren't having to do that manual entry. Plus that additional search to these other external pharmacies, these mom and pop shops and the Department of Defense pharmacies.

And so we have we did some studies that at the 7th month bill, we did some studies with DrFirst. We had found out in that 7 months, we had received We received an additional 23, 000 medications that would not have been inputted into our system without DrFirst. And we did a time and motion study and it saved us 7 million clicks.

So, 7 million clicks received in 7 months after GoLive of time saved for our nurses.

So, we're going to demonstrate that. So, a lot of people, you walk by these booths and it's AI, I mean, everywhere is AI. We're actually going to demonstrate it. So, I'm looking forward to this. Colin? Take it away.

Here we are from beautiful L. A. and, Yeah,

so this is actually a a mock up game that really, within one minute, I can explain the power of the doctor first. Not only the additional data, but actually the ability to turn that data into structure and semantically interoperable. So, we call it Med Entry Dash.

And here's what Stacy's referring to. PhormTech is getting access to external data, but needs to put it back into the system prior to MedRec. So, we have three meds I'm gonna add So, it's saying, one, take one to two taps by mouth four times daily as needed, but none of that data flowed into the fields.

So, I'm the farm tech, I gotta type all of this back in, or I gotta drop down. So,

β€Š Capsule, MyMouth, Daily, SecondDrug, One, Patch, I gotta remember that's transdermal, and every 72 hours, Submit. So for those three drugs it took me almost a minute, 28 clicks. And we didn't even count, oh it was 28 clicks. 28 clicks and 5 keystrokes for me having to input. So with clinical grade AI in our fusion platform in Epic, this becomes lightning fast.

So, if you see that right there, it all populated. And I think these are little yellow yield signs that we're getting rid of. So, looks good. All I'm doing is verifying before I commit it to the database.

And even with me talking it was probably a sub 10 seconds if I hadn't given you the play by play. But, see, just for three meds I've saved almost a minute. I've saved, 75 percent of the keystrokes as well. So, I've given the clinician more data, but I've made that data usable.

And so that's time, that's energy, that's cognitive load that they're getting back. So, here are my questions. What πŸ“ were the numbers you saved πŸ“ in 7 months? 7 million. 7 million clicks. That's amazing. How are you getting the additional information from the DoD and these smaller pharmacies? Yeah, so the power of the additional data is that I think every one does. On the show, the listeners of the show is probably familiar with the external medication history feed that's typically available through someone like SureScripts.

And that's a lot of financial claims transactions. That's PBM data, adjudicated claims, etc. The problem is a lot of times people use cash, they use coupons, they go in and pick these drugs up at places that might not participate as robustly, and that data is missing. DrFirst has been e prescribing for e prescribing space for almost 25 years.

Over those two decades, we've made a lot of progress. A lot of relationships with a lot of pharmacies, a lot of pharmacy dispense software systems. So, actually, one of the first things we do when we go live with a partner is we find out where are all your prescriptions going? give us an outbound query, six months worth of scripts so I can tell what your providers are sending those scripts.

And then we cross reference that against the database of these connections to these local mom and pop pharmacy dispense systems and we start flipping switches. We say, oh, bring that, start bringing that data. If we don't have the connection. The addiction will actually go out and try to make the connection on behalf of the hospital or health system.

The pharmacy, like, it's no charge to anyone involved. The pharmacies love it because they're getting fewer phone calls to clarify things, and the health systems love it because they're getting more data. So we're taking a traditional medication history feed, and we're augmenting all of these other sources on top of it.

So that's why I can feel confident saying we have the most robust medication history in the industry. The word augmenting I think is the key. This is why I think the clinicians like it. it's coming alongside a clinician and making it more effective. I heard Satya Nidala πŸ“ at Microsoft talking about this and he said, the perfect machine is one πŸ“ that comes alongside us and helps us, doesn't take πŸ“ our role , but it just helps us.

And taking away 7 million clicks, πŸ“ I'd imagine they're pretty happy with that. Yeah, and it's like they almost don't know it. But if I put those clicks back, I'm sure they'd be, I'd be getting a phone call from them. So, a lot of what we do in IT is really behind the scenes and, we went live with this and so it's hard for them to really know what we're doing for them.

But on the physician side, in the ambulatory space, we did go live without the SmartRenewal. πŸ“ And we were getting calls from docs and saying, it's really hard to refill prescriptions right now. We are having to do all these manual entries. So, of course, I called DrFirst and said, okay, what can you help us with?

And they said, well, we actually have a new product. Would you be interested in working with us and develop, coming together? And I said, of course, sign me up. So we actually are live on SmartRenewal and it's doing the same thing. So all these fields are being filled in and so without the SmartRenewal, we were at about 60 percent of the fields being filled in from this external history.

We are now at 95 percent of all fields being filled in for our physicians, so they are the ones that are definitely feeling it. Like, they can see the difference of before and after. DrFirst coming in and afterwards. And so, I mean, are they calling me and thanking me? Probably not, but I think, they are definitely, the time back and the time saved.

So I'm not getting any calls anymore about how long it takes for them to do a refold request. IT is the best supporting actor, but πŸ“ yeah, I would imagine it will show up in the overall physician satisfaction scores at the end of the year.

They'll say this has gotten a lot better. Right. And so we do so at Baptist, as I mentioned, we do some very integrated rounds. But we have also been going out and doing listening sessions led by physicians. So, the CMO is there, the VPMA is there, I'm there, the CMIO is there.

So, we have all these physicians going out to physician groups, both employed and not employed. And the ongoing joke is that they thought ethic would be a major topic of conversation. And so I've been Kind of sitting in the corner just listening and and so again, it's where we were a year ago post live and where we are now, the physicians love it and they love Epic and they really feel like we've been trying to bring in the right partners, we've been trying to use AI, we've been trying to really optimize the system as best as possible to make that end user experience as much, as integrated and as easy as possible.

Last word goes to you, Colin. We talked a lot about EPIC. Yeah. I assume this can be utilized in the other platforms. Let's not forget there are other platforms. Yeah, no this same technology we are, one of the key things is that this is native. That's why users don't necessarily recognize that some external force is improving things.

It's all under the covers, but we do this in EPIC, we do it in Cerner, Meditech all scripts. And of course DrFirst has integrated lots of their technology in multiple EHRs, not just the So we actually have plays and integrations in over 270 different EHRs. Wow. Did you know there's 270 different EHRs?

I'm learning that right now. Isn't that crazy? I did because in Southern California I had to connect to like, it felt like all of them. Yeah. It's like every physician practice had their own. Well I want to thank you Stacey. Great job. Thank you. And great job the team at Baptist Jacksonville. And Collin, always a pleasure.

Yep. man.

Thanks for listening . If you found value, share it with a peer. It's a great chance to discuss and in some cases start a mentoring relationship. One way you can support the show is to subscribe and leave us a rating. it if you could do that.

thanks for listening. That's all for now..

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