One of Nordic's strengths is the diverse blend of consultant experiences. This mixture of Epic, IT, and clinical backgrounds brings unique perspectives that result in fresh approaches to solving health IT's biggest challenges. In today's conversation, Nordic Practice Director Lauren Griessmeyer talks with Senior Nordic Consultant Karen Hahn about some of the trickier parts of Meaningful Use. As a nurse with 15 years of experience, Karen has great insights on what areas can be challenges and offers possible approaches for overcoming those challenges.
Topics covered in this conversation:
- Quick baseline information on EH and EP
- Patient engagement strategies and tools on the inpatient side
- Barriers to Meaningful Use on the inpatient side
- Tricky regulations successfully incorporated into workflows
- Keeping MU projects on time and on budget
- Governance structure for MU projects
- Challenges with Stage 2 and transition of care
- Planning for Stage 3 – e-prescribe (Note: While recorded before the final ruling, the discussion is still relevant.)
- Improved patient outcomes as a result of Meaningful Use
- Clinician engagement – strategies
Do you have questions about your Epic implementation, optimization, working with affiliates (including mergers or acquired organizations), or managed services?
Time: 14 minutes, 11 seconds
Lauren Griessmeyer: Hi. I'm Lauren Griessmeyer. I'm the Willow and Beaker practice director at Nordic. I'm here today with Karen Hahn, who is one of our consultants out in California. Karen, why don't you tell us a little bit about your background?
Karen Hahn: Well, I've been a nurse for 15 years now. I started off as a clinician in a med/surg/tele unit and quickly got absorbed into the clinical informatics role in the hospital side. Then, my organization decided to embark on an electronic health record project. I quickly became a part of that and was ClinDoc certified in 2006 with Epic and then worked on various implementations, probably about ten or 11 with that same client.
Karen: At different hospitals.
Lauren: A number of roll outs.
Karen: Small, large, teaching hospitals, across the board.
Lauren: You've seen it with ClinDoc.
Karen: I have, yeah. In 2011, decided to become a consultant and see some other organizations, loved it. Quickly took roles related to Meaningful Use. I've been doing the EH side of Meaningful Use at a couple of institutions now.
Lauren: What does EH stand for, for the newbies that we have there, so it's a Meaningful Use conversation.
Karen: Eligible Hospital is also known as EH. Meaningful Use has two sides of the coin. EP for Eligible Providers is more of the ambulatory clinical side. EH is more the hospital or large institution side of Meaningful Use.
Lauren: Does that dovetail with the community access hospital or are those two separate buckets?
Karen: They're two separate buckets but depending on how they're build is, they could be wrapped up into the eligible hospital side. That's always something that organizations need to keep in mind ...
Lauren: As they're doing their project.
Karen: Correct. Correct.
Lauren: Got you.
Karen: I've been at this client now since October (2014). I was brought in as the Clindoc stork and ASAP team lead, but also responsible for the eligible hospital build and configuration for Meaningful Use.
Lauren: That sounds like a pretty full plate.
Karen: It very much is. Some days, it's a balancing act. I work with a lot of great people on multiple teams. Then, also, I get to deal with eligible professional side too, a little bit. It's a nice crossover between the teams.
Lauren: Cool. Can you talk to me a little bit about some of the patient engagement strategies that you're using on the inpatient side and some of the tools you use to accomplish patient engagement?
Karen: Sure thing. One of the main strategies that eligible hospitals really take into consideration and use heavily is the after visit summary. When a patient is discharged from the hospital, they get a summary of their care while they were in this hospital. The after visit summary is also available in the MyChart application so that the patient, when they get home, can also access that information electronically through MyChart so they don't have to rely on that piece of paper or what happens if I spill my coffee on it.
They can always get to it electronically. It has a lot of great information for the patient. Follow up appointments, it has follow up, see your PCP in two weeks or maybe some wound care instructions. That's really one of the main strategies the EH side uses for patient engagement for Meaningful Use.
Lauren: Is that one of the main tools you also see for transitions of care when somebody's going from a hospital to an outpatient recovery scenario?
Karen: Yes, absolutely. We can give an after visit summary to those different levels of care, the different facilities that the patient may be going to next. We also have a tool called "Care Everywhere" in Epic that allows those facilities to actually enter a patient's record and see what happened during the course of the stay. A couple of different ways that we can provide communication so that level of care stays pretty standard for the patient.
Lauren: We've talked a little bit about some of the tools that you can use on the inpatient for patient engagement for Meaningful Use. Let's talk a little bit about some of the barriers you run into during a Meaningful Use project on the inpatient side.
Karen: I think one of the major drawbacks to Meaningful Use is sometimes CMS makes regulations and maybe doesn't take the considerations of a workflow in mind so they, of course, publish all these standards. It's really up to the organization to fit them into their standard workflows for the clinicians. That's probably one of the biggest areas I see organizations struggle with is getting those standards into their workflow so that it's intuitive and it's part of their daily workflow.
Lauren: Can you give me some examples of particularly tricky regulations that you've seen organizations incorporate into a workflow successfully?
Karen: One of the main themes with Meaningful Use is getting those providers to enter a problem list or keeping that problem list accurate and up-to-date. A lot of facilities struggle with getting physicians onboard with just entering a simple problem. They come in for maybe a chief complaint and then getting that attending provider to really update the patient's problem list so that it really accurately reflects why the patient's here.
I've seen some organizations develop best practice advisories to help physicians, as more reminders. Just, "Hey, update that problem list. Review it for accuracy." That's probably one of the ways that I've seen organizations succeed in meeting that one particular measure related to the problem list.
Lauren: You've been involved in a number of Meaningful Use projects. You've had some involvement of actually doing the project planning as well. Can you talk a little bit about the strategies that you've used to keep these Meaningful Use projects on time, on budget, and successful?
Karen: Sure. I've seen organizations succeed when they have a group that's designed with multiple applications involved and committed to getting the work done. The resources have to be planned and accounted for. There has to be clear guidelines on when timelines need to be completed. It's also important to have a government structure made up of clinicians, partly, that understand their current workflows as well as that are empowered to make decisions.
Lauren: About what the future state's going to look like?
Karen: Right. Maybe a change in the workflow. Should we do it this way or this way? Really having a strong commitment from leadership with that governance group to give them the authority and the autonomy to make decisions is one of the areas that I think facilities struggle with a lot, but I've seen organizations succeed if they do have that really strong governance group that can make those kinds of decisions.
Lauren: I think that the project that you're currently on is working on Stage 2? Is that correct?
Karen: They are on Stage 2. They're reporting on Stage 2 currently. They're in planning stages for Stage 3.
Lauren: That's pretty exciting.
Karen: It is.
Lauren: Can you talk a little bit about the trickiest piece for Stage 2 that you have run into currently, just on the inpatient side?
Karen: I think transitions of care is always the area that a lot of facilities struggle with. I know just meeting some of the thresholds is difficult.
Lauren: Can you talk a little bit about why that's so hard? I mean, is it the workflow? Is it the technology? Is it a combination of both?
Karen: Yeah, I think it's a combination of both. You've involving clinicians that have to enter certain things in the record as well as getting the system to set up configuration behind-the-scenes that sends a summary of care, for example, to a PCP. Having all of those pieces work together as well as provider records all have to be configured and when you have a lot of providers that you have to touch each one. It gets cumbersome and time consuming. I think that scenario a lot of facilities struggle with and especially the client I'm at right now.
Lauren: Just because of the number of working pieces.
Karen: It's complex, for sure.
Lauren: Okay. As you are ramping up for Stage 3 and you're thinking through the guidelines that have recently been published and are commenting back on them, what are the areas that you are really focusing on and putting some real thought around, "How are we going to manage to do this piece?"
Karen: Sure. For the EH side, there's a couple of areas from my current client that we're really starting to put some thought into and that one is e-prescribe. My current client does not use the e-prescribing functionality on the hospital side. They use it on the EP side. That's going to be a big change for the users, not only in their workflow, but we also have some technical build behind the scenes that has to occur.
Lauren: We've talked a bit about the tools that you guys have been using to achieve some of the goals of Meaningful Use, but one of the big goals of Meaningful Use we haven't talked about yet are improved patient outcomes. Let's talk a little bit about the improved patient outcomes that you've seen as a result from Meaningful Use.
Karen: Really, the outcome is pretty much a standard of care that benefits the patient. The patient is ultimately the reason why we're doing all of this.
Karen: I've seen really good outcomes when the clinician is provided a clinical decision support tool at the time of order entry, for example. The patient's on a particular medication and the physician or provider is prompted to order a platelet count, for example.
Lauren: It's like a safety check.
Karen: Right. Again, the electronic health record can provide a lot of different tools that benefit the patient ultimately. I've seen some documentation prompts that a nurse can use. For example, we just built a best practice advisory for the nurse who put on sequential compression stockings if the patient had an order and hadn't been documented on. We just built a BPA to help the nurse. She probably already has put the device on the patient but just a reminder to document that in the record. All of that care, ultimately, benefits the patient in the end.
Lauren: We've talked about Meaningful Use. We've talked about improved patient outcomes. Let's talk a little bit about clinician engagement. That can sometimes be a little bit of a tricky topic, as you've been talking about a lot of the tools there are set up to increased documentation are not going to take the place of clinical decision-making. It's just more a reminder to put that information into the system. What strategies have you guys used to increase the use of the system tools and increase clinician's satisfaction and engagement with the system?
Karen: We've used a couple of different strategies. Everything from getting the clinicians engaged in the workflow up front, where they think the best place in their normal documentation would be, which flow sheet do they want to document that in. Everywhere from that initial clinician involvement to the reporting end. At the end of the whole workflow, we want to see maybe where the workflow didn't work out quite so well. Epic has some really good tools for showing where those pieces of the workflow maybe broke down. Getting those clinicians to really see those trends and run those reports routinely helps them become engaged and involved in getting perhaps better numbers and better outcomes.
Lauren: Get involved a little bit with the system optimization, which is a buzzword that you're hearing a lot within the Epic space.