EPIC Ambulatory UpdateEPIC Ambulatory Update

November 29th, 2006Pete Newcomer & Alev Wilk

Guests: Deb Boushea, Betsy Trowbridge, Laurence Williams

Learning ObjectivesLearning Objectives

Epic Highlights & TimelinePatient/Provider Room ArrangementProductivity Data before & after Epic

ImplementationEpic Software Future UpdatesResident Clinic WorkflowQ&A with Guest Speakers

Project Highlights so farProject Highlights so far

UWMF continues to “roll out” EPIC at new clinics in our system.

Preparation/planning for UWHC sites continues. Interface concerns between and EPIC scheduling and A2K scheduling software have slowed preparations some.

EPIC TimelineEPIC Timeline

EPIC will be installed as the EMR for both inpatient and outpatient sites over next 4 years.

The EPIC project is being coordinated between the UWMF sites and the UWHC sites in an integrated fashion.

Specific TimelinesSpecific Timelines

EPIC Ambulatory will be rolled out in the Primary Care sites throughout 2007 for UWMF-working on rollout schedule for UWHC clinics

EPICRx Inpatient (the pharmacy program should replace our current system by end of 2007)

Specialty clinics will start EpicCare by end of 2007 and continue implementation for the next couple years in a rolling fashion.

EPIC inpatient will start with flowsheets and rounds report by early 2008 and be completed by 2009.

Current Timeline for UWHC Current Timeline for UWHC Internal Medicine sitesInternal Medicine sites

We now have a firm date for the Epic Cadence/Prelude go live at West: itwill be 2nd floor on 2/27, followed by floors 1 and 3 on March 20. (This is the registration and scheduling software)

The “Go Live’ for AB will be a month or two later assuming everything goes well.

CD and EF (the clinic formerly known as Women’s Health) will be next –schedule coming soon.

Room Arrangement Room Arrangement

Working effectively with EPIC and the patient will involve rearranging the exam rooms to be more conducive to the patient interview.

Examples are in J3/1 at the Hospital and on the second floor in A/B.

3 styles are currently being considered.

Today’s Examining Room

COMPUTERDOOR

Tomorrow’s Examining Room

ComputerPatient

Doc/NP

Door

Sink

Angled Toward Patient (ATP) option

Computer On Wheels option (COW)

Standard (SAS) option

Epic’s Effect of ProductivityEpic’s Effect of Productivity

One of our concerns with the EPIC EMR implementation is the effect on physician productivity.

In May of 2006 the first UWMF internal medicine clinic went “live”.

This event has given us the ability to more closely evaluate what is likely to happen in UWHC internal medicine clinics in 2007.

The following slide shows 10 providers at 20 S. Park and the average RVU/Hour worked before and after the “go live” date.

RVU's per Available Hour

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Oct-05 Nov-05 Dec-05 Jan-06 Feb-06 Mar-06 Apr-06 May-06 Jun-06 Jul-06 Aug-06

RVU

/Ava

ilabl

e H

our

Productivity continued.Productivity continued.

The prior slide showed significant variability among providers as regards RVU/hour worked.

The current trend after the “go live” appears to be more neutral than in prior implementations.

The following slide shows the entire group of physicians average RVU/hour worked over that time period.

Effect on Productivity at 20 S. Effect on Productivity at 20 S. ParkPark

20 S Park Internal Medicine

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Oct-05

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What’s New in Spring ‘06 What’s New in Spring ‘06 Upgrades.Upgrades.

Improved color schemes to make text easier to read.

Snapshot page with a summary of patient’s clinical data.

Charting tools such as point and click; documenting the physical exam and ROS.

Resident Clinic WorkflowResident Clinic Workflow

Residents will have access to EPIC EMR, their clinic schedule, patient data & documentation.

They will see and evaluate their patient.They will present to you and describe an

assessment and plan.They will complete a progress note and

place orders, ie labs, radiology, injections.

Resident Clinic WorkflowResident Clinic Workflow(our recommendations)(our recommendations)

Resident documentation will be limited to smartsets and tools, as well as free typing.

We believe staff should have the ability and responsibility to close the encounter (sign the chart) once resident documentation and patient care is complete.– This allows for accurate documentation &

patient care.– This allows for accurate billing.

Resident Clinic WorkflowResident Clinic Workflow(our recommendations)(our recommendations)

Residents will not close the encounterAdvantages

– All work and documentation is completed that day.– No wait-time for reviewing and correcting resident

dictations.– Residents are well-versed in this type of

documentation.Disadvantages

– Staff need to take more time reviewing resident documentation during or after clinic hours.

Q and A Q and A

Recent implementation at 20 S. ParkLaurence Williams, Betsy Trowbridge, and

Deb Boushea will be open to questions.