The pandemic has forced all healthcare professionals to act quickly and modify workflows, and hospital EHR leaders are no exception.
Here, five executives who lead their hospitals' Epic electronic medical record programs share key strategies on successfully optimizing operations during an emergency and discuss how they have maintained success during the pandemic:
Editor's note: Responses have been lightly edited for clarity and length.
Kim Mendez, EdD, RN, chief information officer, NYC Health + Hospitals: From an information technology viewpoint, key strategies which supported optimization of operations during the acute response to COVID-19 included the following: real-time access to evolving clinical and operational data to support critical decision-making; special IT task force groups to be at the ready to intake, prioritize and implement rapid changes to EMR and other applications as well as direct technology deployment to support clinical needs and efficiency; employ streamlined and virtual processes to onboard and provide just-in-time training of temporary supplemental staff; ensure infrastructure capacity and flexibility to support increased telecommuting, inpatient and ambulatory virtual care options and virtual avenues for patient-to-family communication; maintain comprehensive and proactive communication, both
internally and externally, to maintain awareness, transparency and trust; provide continual monitoring to ensure IT environments remain safe, secure and reliable; maintain an appetite for innovation and creativity; and learn from each experience and have an active process for continual improvement.
The ability to leverage an enterprisewide electronic medical record was instrumental to our COVID-19 response. Thanks to this unified system, we maintained a real-time window into our patient-bed capacity and ability to meet surge demand in a strategic and coordinated way. Having an enterprisewide EMR also allowed us to quickly expand our acute care bed capacity by over 90 percent, as well as bring onboard and connect temporary alternate care and field sites, eliminating the need for downtime and/or paper documentation options.
The alternate care and field sites gained access to our EMR using secure remote access technology via virtual desktop infrastructure, providing ease and flexibility of use. We developed new special task force groups to rapidly respond to COVID-19-related high-priority clinical and operational demands while maintaining core review standards and governance. Additionally, having a well-implemented, enterprise EMR allowed ease in onboarding and training over 8,000 new supplemental staff members and supported integration of essential biomedical devices to enhance centralized patient monitoring. The enterprise embraced new and current Epic EMR functionality and modules to increase virtual care options (e.g. Epic MyChart) and reduce barriers to care by use of Epic Care Everywhere to query and access patient records from multiple other NYC health systems to ensure safe, quality patient care.
Janet Thompson, executive director of information systems application services, Prisma Health (Columbia, S.C.): Prisma Health's alignment around a common goal and investing in the creation and maintenance of a robust emergency management response team, that includes all necessary resources, is key to timely responsiveness in the event of an emergency and particularly a health pandemic. It is vital that all key resources are evaluated and included. In today's acute, post-acute and ambulatory environments, information technology participation is key. The use of our enterprise EMR, Epic, means that [IT services] resources are part of the team to assist in implementing emergency support functions. Everything from setting up drive-thru and community testing locations, to lab interfaces, department build, billing and documentation changes cannot happen without the appropriate ITS resources. It is pivotal to have clinical knowledge within the ITS environment that understands workflows and terminology and can articulate the needs to the appropriate ITS resources. ITS must remain available and responsive to urgent and emergent needs that sometimes don't fit in with our normal business processes.
Prisma Health's keys to the success of ITS and our Epic program during the past several months rested with both ITS and operations. Our ITS input was successful because of an ITS leadership decision to have a single point-person to participate in incident command and coordinate and track any necessary ITS responses. In our case, because of the scope of our geography, we had that singular point of contact in each of our two incident command centers. Each ITS representative also had clinical experience, which adds another layer to our successful response.
We were not allowed the leisure of project planning and normal ITS timelines but still maintained the quality work that we always do. A perfect example of that was our virtual visit implementations. We had a timeline and already had pilots underway but were able to turn it around in days, not months, and provide the remote contact we needed to continue patient care. We leveraged our Epic MyChart platform for that and many other means of patient communication and outreach.
Bobbie Byrne, MD, chief information officer, Advocate Aurora Health (Downers Grove, Ill., and Milwaukee): I think the most important thing was that we took really good leaders and gave them new COVID-related responsibilities that might not have been part of their day jobs — such as surge planning, mobile testing, etc. These leaders are able to quickly identify everything that needs to be done and pull together all the different teams to accomplish the goal. Partnering these leaders with excellent communication processes enabled the organization to move quickly and in unison. We had a "source of truth" COVID site for all announcements, policies and communications. There were routine, appropriate and targeted communications to different groups in the organization. Our daily cadence of short, frequent meetings with clear accountability resolved issues very quickly and disseminated information effectively.
We were able to pull together many different data sources very quickly in order to get a picture of the COVID situation. This included information from four different EMRs, supply chain data, lab data, and equipment and bed utilization data across 27 hospitals and hundreds of ambulatory locations. We were then able to take this data and apply predictive models to enable forward-looking capacity planning for COVID surges.
We were in the middle of our Epic implementation in Illinois when COVID hit, so we delayed our planned June go-live, which is now rescheduled for October. The experience of managing through COVID on multiple EMRs reinforced our commitment to the single patient record. We used Epic tools heavily: for alerting for patients at risk, for ease in ordering tests and treatment, and for data analysis and aggregations. We especially used some of the Epic front-end data exploration tools like Slicer-Dicer to identify early trends and patterns. This kind of "at your fingertips" data exploration was invaluable as the activity of the virus was unfolding rapidly.
Sherry Buxton, BSN, RN, chief surgical services officer and Epic program executive, Orlando (Fla.) Health: For our Epic implementation, the importance of continuing with our workflow was essential to staying on track with our timeline. We were in the beginning of the integrated testing phase when the pandemic started. That was especially challenging as the whole team had to transition to working virtually from home, including the testing teams. This was done in an innovative and transformational manner where the team members pivoted from traditional on-site, in-person collaborative integrated testing methodologies and processes to working virtually and not missing a beat. And as a matter of fact, the teams' adoption of the virtual methodology and tools improved productivity and testing outcomes. This pleasantly surprised everyone, including our seasoned Epic and Accenture partners.
In addition to the implementation of the virtual testing programs, we also pivoted to redesigning an extensive training plan that was in the final stages of development for training more than 30,000 team members and physicians. This is now solidly in place to deliver a hybrid model for planned go-live training that starts later this year. Instrumental to both the training and the testing pivots is the use of the Microsoft Teams capabilities. We quickly adapted and optimized the use of this tool that has enabled us to stay in touch with operations and collaborate with other members of our implementation teams across Orlando Health, Epic and Accenture as needed throughout these challenging times.
Darby Dennis, RN, vice president of clinical systems and informatics, Houston Methodist: Our key strategies during the first wave of the pandemic focused on patient and staff safety. We increased virtual solutions to patients and clinicians and provided mobile tools to critical staff. This helped us focus on the best approaches for optimizing care.
We rapidly deployed enhancements to support workflow efficiencies for clinicians that also kept them safe. For example, we went from approximately 100 video visits per month to 10,000 video visits per week via MyChart. The need for virtual appointments with patients helped with rapid adoption and protected both our patients and staff. We also expanded video capabilities with inpatient virtual rounding for physicians, which minimized exposure to COVID. Our virtual intensive care unit initiative was accelerated and expanded, allowing remote monitoring for our sickest patients.
We were able to streamline clinical documentation tools within Epic to help clinicians quickly document assessments and care. We also updated Epic to make it easy for our clinicians to find critical information on COVID and non-COVID patients. Nurses and IT partnered to create disaster documentation tools, which optimized capturing key COVID information and provided a framework for daily post-pandemic documentation optimization. Epic order sets were quickly modified to meet the unique COVID needs, and new order sets that hadn't existed pre-COVID were rapidly deployed.
We also escalated and expanded the rollout of mobile tools across our system. We created virtual training and support models, which streamlined the rollout across all eight campuses while minimizing exposure to IT staff. We expedited our launch of Epic Rover. We turned on the Secure Chat feature within Epic so our clinicians and physicians could communicate better with each other. We are now sharing more than 30,000 chats per week.
Additionally, we expanded our Epic reporting and BI offerings by creating and rapidly deploying multiple dashboards to executives and clinicians to support decision-making and track our COVID patients more effectively. This included functionality to automate infection status when COVID tests are ordered; those with positive results are automatically flagged. We did a rapid implementation of some infection control module features including contact trace features.This provides summaries of patients, clinicians and other staff who came in contact with an infected patient or caregiver to quickly identify those who were exposed.
Epic new hire training classes were quickly converted into virtual learning events. In addition, fast-track float training was created to quickly educate floating to new assignments.