We’ve decided to dedicate the entirety of this month’s newsletter to an Epic update. This will include examples of great collaboration, some big decisions made, and some upcoming decisions to be discussed.

Cultural transformation

  • Provider documentation – providers and our compliance and billing departments are collaborating to improve documentation quality and efficiency, reduce clinician burnout, and at the same time adhere to regulations. We hope to make our notes, shorter, easier to read, and more complete.
  • CDS – a newly formed clinical decision support committee, representing many areas of the organization, is taking ownership of decisions that will affect the quality and safety of our practice. This includes asking tough questions about what clinical alerts will be turned on and also committing to regular review of those alerts. We will use standard Epic dashboards to monitor alerting.
  • Expanding responsibility – the Practice Workgroup is transforming expectations, policies, and trust in order to increase the ability of all clinicians to work to the fullest extent of their licensure. These decisions included allowing nurses and medical assistants to pend medication and lab orders, and also to remove expired medications from the home medication list. Our new problem list policy expands the list of those clinicians who can contribute to maintaining an active and accurate patient problem list. Each of these will help promote greater collaboration and team-based care.

Big decisions being made

  • Voice Recognition – in order to improve documentation turnaround time and provider efficiency, we have decided to purchase an enterprise license from our new voice recognition vendor, M*Modal. This vendor recommendation was made by providers, for providers. We will use M*Modal on tethered microphones and on smart phones. Transcription-based dictation will remain available for operative note documentation and for those few sites that may not have ability to use an online voice recognition system. We’re still discussing how this may (or not) apply to areas like radiology and pathology.
  • Discharge medication list – we are currently in discussions with Med Action Plan, with the hope of using this software for our discharge medication list. This will provide a patient-friendly medication list at discharge from all venues of care at Seattle Children’s, with the goal of improving medication understanding.
  • MyChart – a fully functioning patient and family portal was identified as a key feature of our new EHR. Several workgroups and councils, representing patients, families, nurses, revenue cycle, compliance and physicians/APPs have worked hard to deliver on that goal. A recent decision has set a high bar, with agreement to use Open Notes for all but the most sensitive areas, to release all labs after 24 hours unless marked as sensitive, and to release all radiology reports after 72 hours. This achieves a balance between empowering and informing patients while maintaining the ability of clinicians to provide education, counseling, and context. This new MyChart portal content, in addition to other features such as video/photo upload, portal messaging, and selective portal-based appointment scheduling are dramatic advancements for all involved.

Upcoming discussions and decisions

  • Mobility – One of the guiding principles of this project is to use mobile wherever possible. Over the next month, our strategy of how we use the various Epic mobile tools including Haiku, Canto, and Rover will be decided. This includes how and where we will deploy a BYOD (bring your own device) strategy and where devices will be supplied.
  • Clinic intake – our Ambulatory Advisory Council is working hard with our IT team and with Epic to design a more efficient system for getting patients checked in and taking a medication history. The goal is to reduce time for the patients and families and make their experience more seamless while simultaneously improving efficiency for the clinical team.

Remember…go live is May 30, 2020!