It’s Not About The Box Improving Care at Group Health with People, Process and Technology

November 30, 2006

EpicCare Inpatient : Kaiser Permanente South Sacramento

Filed under: Informatics Team — admin @ 5:20 am

I was honored this week to visit the Kaiser Permanente South Sacramento Medical Center, where EpicCare Inpatient has been installed, and computerized physician order entry has been operational since September 5, 2006. South Sacramento is one of two hospitals in the Kaiser Permanente system to implement CPOE.

Three months since go-live might seem like a long time compared to the rollout of the Ambulatory product, but it is not in the inpatient realm. All of us are familiar with the complex care coordination that comes with a hospital stay. None of us at Group Health are familiar with coordinating that with a single clinical information system like EpicCare. I didn’t visit because Group Health is looking to buy or install the inpatient product, though Kaiser’s experience will offer us a glimpse of how coordinated care can happen in a fully interoperable system.

I spent time in the Emergency room, the Intensive Care Unit, and at a lunch and learn with their HealthConnect (aka EpicCare) implementation team and practicing care providers.

There is something to be said about being able to admit a patient and retrieve their outpatient medication list and allergies seamlessly from the outpatient setting and transfer that information back into it. Same goes for being able to manage the inpatient side of the EMR equation at the pace you want and for the members you serve – this is not something we have the ability to do except in partnership with our contracted hospitals.

November 29, 2006

Is Overlake Hospital installing EpicCare?

Filed under: Information continuity — admin @ 10:36 am

The answer to that question is an unqualified “no.”

It is in Group Health and Overlake’s mutual interest for an Epic install not to happen at this time or as part of the opening of the Bellevue Specialty Center. We’ve thought about this question a lot, and come to this conclusion. There are several reasons for this:

First, there are few (I actually know of one) models of the type of arrangement this would entail – a hospital install of EpicCare tied to another organization’s ambulatory installation. The place where this is happening is in Colorado in affiliation with Kaiser Permanente. Kaiser Permanente is hosting that installation on its servers. My understanding is that they are not yet live with computerized physician order entry (I will talk about Inpatient CPOE tomorrow, when I discuss my visit to South Sacramento).

Second, Overlake does not have the expertise or infrastructure to do an EpicCare hospital build at this time. Their information technology group is quite nimble and enterprising; however, it is small (much smaller than Group Health’s), and they have a relatively full plate, which includes installing a brand new PACS system. Group Health’s team will be engaged in replacing Last Word with Epic Scheduling and Billing, and completing our PACS install. We’ll have a very busy (and exciting!) 2007 in Informatics.

Third, Group Health and Overlake Hospital leadership are engaged on many levels, from the most basic to the very complex, to ensure an excellent care experience for our members. Our experience to date tells us that technology should be implemented in support of, not in advance of collaborations like this.

These factors support our current strategy, which is to interface with existing clinical systems. The Overlake IT team has good experience with work, as does ours. This approach has the highest likelihood of supporting information continuity when our Bellevue Specialty Center opens. This has been well described on this blog, and presented to our East King Leadership Team. We are beginning the due diligence process and are prioritizing Overlake interfaces as #1 in our interfacing work. This means that we’ll ask people who request interfaces to internal or external systems to hang on to those until we achieve success with Overlake systems. It takes approximately 3 months per interface of development and testing. It’s an intensive process.

Speaking of EpicCare Inpatient, I was honored to visit one of Kaiser Permanente’s first full install of the system in South Sacramento. I’ll post information about that experience tomorrow.

November 28, 2006

Upgrade News

Filed under: Improvement News — admin @ 10:40 am

Work on this years upgrade to the Epic production environment is now in full swing.  This upgrade consists of several hundred ‘default’ changes to the look and function of the system and is primarily not  a set of ‘enhancements’, which are changes based on specific user requests.  There are some places where we do have choices as to how these default changes work and  a group of the clinical informatics team and providers are looking at each one.  We have created dynamic demonstrations of the most critical upgrade items and screenshots of the remainder.  I was very excited that so many people wanted to take an early peek at the new fancy changes to the system and I am sorry there was not a bigger conference room to hold the entire gang. Joy Ferkovich will hold a separate optional showing of some of the new functions on December 13 at the ACC between 1:30 and 3:30pm to show a quick review of the most critical functions.

The communication and education materials are being developed as we review each of the upgrade items. The material will come in many forms based onimportance and complexity. The major changes will have live demonstrations and the less critical will be a set of screen shots with clear explanation. Appreciating that weall learn best in different ways, the new features will be demonstrated with slide presentations  in the medical centers and there will be on-line resources as well.  CIS specialists will be the go-to folks when they are on site. Lastly, in December, we will have a daily snippet of the top 25 changes, sort of a ‘twelve days of Christmas’ sort of thing on the Blog to enhance your general holidaycheer.  Feel free to post your comments or share your excitement.




November 27, 2006

Alert fatigue, real or perceived?

Filed under: Technical Issues — admin @ 5:48 am

There is a nice discussion about it on the Informatics Wiki. Click here to go to it, and feel free to come back here and post your thoughts.

November 22, 2006

Allergy section in ED/UC Navigator fixed

Filed under: Safety — admin @ 6:06 am
Allergies in Navigator

The Group Health Epic team has received a fix for the “Allergies” section of the visit navigator in the Emergency Room module. We received an alert from Epic systems recently indicating that under certain circumstances, the complete allergy list might not show in this specific navigator section. We solved the problem temporarily by adding a new section that was less functional, but showed all of the information.

The fix has been applied, and this additional section will now be removed.

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