Does Paul Simon Work in Healthcare?

After I died and the makeup had dried

I thought it was odd there was no sign of God

Then a voice from above sugarcoated with love

Said, "Let us begin"

You got to fill out a form first

And then you wait in the line

You got to fill out a form first

And then you wait in the line

Just to glimpse the divine

What'cha think about that?

Well, it seems like our fate

To suffer and wait for the knowledge we seek

It's all His design

No one cuts in the line

No one here likes a sneak

You got to fill out a form first

And then you wait in the line

You got to fill out a form first

And then you wait in the line

-Paul Simon, The Afterlife

Nobody ever accused hospitals of making paperwork easy. I thought of that when I first heard the Paul Simon song excerpted above: We have plenty of rules, forms, and such to give to our patients, and we’re not very good at sharing the information across departmental lines; never mind about making the information portable to or from other providers. At our management retreat in the last week of July, one of our physicians was explaining this in concrete terms when he discussed how many times a patient has to answer the question, “Do you have any allergies?” After being asked a fourth time, one of his patients simply told one of our staff, “none.” This is a high-risk omission from the medical record.

Vision for healthcare information

What would our world look like if we were able to communicate repetitive, but critical, information like allergies and medication lists across the various sites and times of care? What if the information gleaned in the doctors’ offices was immediately available 24/7 in the Emergency Department and outpatient rehabilitation? How can we avoid faxing certifications to doctors and repeatedly checking that they get faxed back to us? How would outcomes change if licensed staff could see literature on best practices for rare conditions by links that are available as they write their plans of care? How would we do all of that?

The answer lies in finding software that distributes information to users in various settings in useful ways, and that can be used in doctors’ offices, clinics, labs, therapy sites and hospitals. It would require software that is designed to solve the documentation specifications in each unique setting. It would be software that doesn’t create redundancies.

It’s quite a challenge to do all of that when you consider all of the ever-changing differences in clinical and compliance needs in each of the many departments and settings that this software would have to serve. Simply said, it is a mind-boggling task to develop such a universal platform for an electronic medical record. Plus the software would need to address security requirements and the need for seamless integration with business functions, quality reporting, and so forth.

The Asante Plan

EPIC is the name of that software solution. We are embarking on the installation/implementation of EPIC at this moment; you might have noticed the Human Resources postings for approximately 60 positions for analysts or trainers for the software. You will soon see teams’ working in empty rooms on the 6th floor until their new space is ready at Black Oak. Once the analysts and trainers are working by early next year, this project will become much more visible to us. We will bring it live in about 18 months. The rollout will happen at the same time for both hospitals, without a “pilot” unit. However, some physician offices will adopt the system before the inpatient hospitals do, and some ambulatory services will implement after the inpatient hospitals do. (It’s undecided right now where exactly Rehab will fit into that timeline.) On “D-Day” Soarian will be turned off (along with our dozens of piggy-backed systems, including SpectraSoft and our own Rehab documentation templates) and EPIC will be turned on.

The Rehab Plan

Depending on your perspective, the good (or bad) news about this software is that it comes with “off the shelf” modules that have been developed, tested, used and refined at the many other facilities—many of them top-ranked hospital systems—that have gone before us. So we won’t be spending much time developing electronic versions of our existing forms or converting our template forms into EPIC unless we can demonstrate a clear benefit to do so.

But we will be spending a lot of time training with and adapting to what are essentially best practices from other facilities. I have not seen the forms yet, but I have been told that EPIC uses many innovative input methods, including iPads and iPhones. Our days of faxing certifications to physicians will (mostly) end, as will the scanning of charts and replication of information. Many other hospitals in Oregon already do or soon will use this system. (Providence will be installing EPIC at about the same time as we will be.) Transmission of images, medical records and diagnostic tests between providers is very easily accomplished within the design of EPIC even if they are not in the same network. Patients will even be able to download their medical records to their home computers or access their information from an iPhone app.

Prepare for the new world of information!

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Here is a link to the Mail Tribune's coverage of this implementation.