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Bill Klaproth (Host):  The move to Epic is on. So, what does Epic look like from a provider point of view? Let’s find out with Dr. Muhammad Jokhadar, Chief Medical Informatics Officer and Dr. Joel Klein, interim Senior Vice President and Chief Information Officer, both from the University of Maryland Medical System.

This is the Hero Podcast from UM Upper Chesapeake Health. I’m Bill Klaproth. Dr. Klein, let’s start with you. So, what is the “why” around Epic portfolio?

Joel Klein, MD (Guest):  Yeah, so thank you so much for having us on this podcast. The short answer to that question is it’s the best electronic health record system in the world. Epic has been the market leader in the United States for much of the last decade, taking market share from pretty much every one of their other competitors in both the inpatient and outpatient space. And in the last few years, in just about every continent, there’s health systems who have operated very differently from us, but nonetheless, have found that Epic’s flexibility, power and clinician focus really makes sense for essentially the same job that they are trying to do there.

Our organization chose Epic about 10 to 15 years ago. And it’s funny, you think about all the decisions that you make as an individual or for your organization a decade or more ago and how many of those turned out to be the right one. And I really have to take my hat off to all the people, many of whom are no longer with UMS anymore but who made that decision ten years ago or about fifteen years ago to go with Epic.

I’m a practicing emergency physician. I work at Baltimore Washington Medical Center which is one of our medical systems. The hospital is just south of Baltimore. It’s very similar to Upper Chesapeake in terms of acuity and patient types and distributions. I work about once a week in our emergency department there and I’ve been an Epic user since we went live in 2012. And I can tell you that what I need as a doctor is, I need to be able to quickly synthesize all of the available data on a patient and put it together so that I can in my mind, know what am I dealing with here. And I have to do that multiple times an hour for patients whose complexity varies from a sprained ankle to a cardiac transplant patient who has been in and out of three different ICUs over the last year. And I’ve got to figure that out in a very short amount of time so that I can spend more of my time at the bedside talking to patients, talking to their families rather than playing with the computer.

And I can tell you, it works really, really well. It takes some time to get to use it and we’ll talk more about that later in the hour. And it takes some adjusting to get comfortable with it, but as an everyday user of this thing; it’s a world class system.

Host:  Absolutely. Very, very powerful and Dr. Jokhadar, your thoughts on the “why” around Epic portfolio.

Muhammad Jokhadar, MD (Guest):  Yeah, I want to second Joel’s comments that I really applaud those people who made the decision to choose Epic as the system platform for our shared HER. So, in addition to being a really robust and powerful system, I want to share that Epic is ranked highest for provider satisfaction worldwide, not just in the United States. I want to also mention that locally with that decision to go for one patient one record one UMS. So, locally at Upper Chesapeake, we actually use three different EHR systems. One for in patient called Meditech, one for our employed outpatient providers called NexGen and another one at the Kaufman Cancer Center. So, our transition to Epic for all these three different care settings can break these siloes and allow providers to have the full picture of what’s going on with those patients, regardless of where the care was delivered.

And one thing I want to mention that’s a piece of functionality from Epic is something called Care Everywhere that I don’t just have visibility of patient records within University of Maryland Medical System Hospitals, but I also have the visibility of those records at any Epic hospital in Maryland or even nationwide as well.

Host:  Right. Well that makes sense. And Dr. Klein, let’s turn back to you. Can you point out Epic benefits for health systems and particularly physicians and providers?

Dr. Klein:  Yeah so, I’ll actually start with the feature that Muhammad just raised Care Everywhere. So, a few months ago, so my community hospital is near BWI airport down in Glen Burnie, just south of Baltimore. And so we get a ton of patients who are diverted off of flights that have to stop and land because a patient is having some kind of a medical problem. And a lot of those are actually from outside the country because we are on the East coast and flights that are travelling from Europe to the interior of the country will often stop at our place just because geographically it makes a lot of sense.

So, I had a patient who was on a medical diversion. It was a flight going to Europe and it was someone who was coming from Cleveland. Cleveland Clinic is a Epic hospital. And it was a very complicated patient who had – it was a whole wound issue and they started having a fever and not feeling well on-board the aircraft and so they – given on how long the flight was, they just diverted and landed and brought the patient into our ER. So, I had the whole patient’s record right in front of me. Because we can see the record from every other Epic hospital. And I could tell exactly who I needed to call. It was if they were the hospital across town. Even though they were all the way across the country.

And from that patient’s point of view; we were miracle workers. Because they figured they were going to a strange place where they were going to have to explain this whole complicated story from the beginning and – which of course would increase the chances that we would make a decision about their health and their trip and am I sick or not that was just wrong because we weren’t familiar with the story and didnt talk to the actual people who knew the patient best.

And so, that’s not just true across the country. There are lots of health systems locally, Hopkins, Condell,  Mercy, GBMC, just to name a few that are on Epic and we can see – it looks like their chart is part of our chart. And on top of that, we are doing work to integrate the VA records so that Veterans Administration Care can all be seen in our chart. That’s a big deal in our area given how close we are to DC and just how many military installations there are around here. And we’re doing work over the next couple of years that will let us see Department of Defense records. So, for patients who are still active duty.

And this all sounds like a little small corner of Epic but it’s kind of indicative of the power and reach of a system that’s as mature as Epic. So, whether we’re talking about making order sets or making it possible for you to save text that you use in a note all the time or quickly get to discharge instructions that you want a patient to have using language that you’ve thought about and how you want to describe a patient should advance their diet or change their dressing or whatever it is. There are so many parts of
Epic that are so mature at this point because their customer base is so big. I feel as a physician, that I’m using a high end tool. I don’t feel like this is something that’s being held up by a dozen people at my own shop. I feel like this is something that has been refined over the years to the point that this is the tool that I really prefer to use to take care of people.

Host:  Well it’s very easy to see. And Dr. Jokhadar how about you, your thoughts on the benefits for health systems and physicians?

Dr. Jokhadar:  I agree. Actually, I want to highlight something for physicians and what we hear frequently nationwide about providers’ concerns regarding impact of EHRs on provider burnout. And Epic is doing a lot of work to actually address it. We are not there; we have not arrived yet but we’re definitely on the right path. So, one thing we frequently hear from physicians that when we ask them what drives your success in an HER. Number one we hear is personalization, i.e., do my work different than the physician next to me or the provider next to me. So I want to be able to customize how I look for certain elements of data, I order certain stuff in a certain sequence. So I want to be able to dictate that. And Epic actually will give that to some extent to providers.

The other piece that we hear from providers frequently is mobility. I want to be able to do certain tasks from my phone or from a tablet. And also Epic provides that. Again, it’s a journey. It’s not the perfect solution but it is a pretty well thought out and designed solution as well. So, the other piece also for providers is how well and how proficient they are in using Epic. So, part of the training probably should touch on that later on. But I want to highlight personalization and also a program that Epic has called Power User physician program where Epic as a company offers these classes to providers to teach them short cuts and ways to improve their workflow and to customize the system to their needs.

So, I think the transition is not going to be easy. It’s a brand new system for a lot of providers but if they invest the time in it, they will be better off, and they will enjoy using this system.

Host:  Yeah, it really is a very powerful system but like most things, you only get out of it what you put into it. so, Dr. Klein can you stress the importance of engagement in the preparation, the training and implementation of Epic?

Dr. Klein:  Yeah. So, this is absolutely critical. So, everything that we’ve said is true as far as what using Epic is like at a steady state. But there’s no getting around the fact that to get to that steady state, you got to go through the go live, you got to go through the transition. And I think as physicians, we’ve all been through those kinds of things in our careers, not just IT changes but the transition that you make in your training from medical school through residency through the transition of your first job where you really start working without that safety net. And I think what we’ve all learned is that you get perspective on managing yourself through transitions and we start to get really good at figuring out well what do we need to know for the test. What do we need to know to survive on that rotation? Where’s the good coffee shop? What time should I get there to do rounds? All of those practical kinds of things that make the transition survivable and ease your way into this new world.

And that’s exactly the same kind of thing that this is. So, we’ll have later in the year, and as the project starts to get closer to our go live; we’ll start to talk to our medical staff about what training looks like. And of course, we’ll be doing this for the whole hospital, not just the medical staff. And so, that involves a combination of things that we’ll want you to look at and study before the second phase which is classroom training. So, we bring you in. We have our staff, it’s actually staff that we train at your hospital to do this who eventually become super users. We have them walk you through the system, front to back and show you all the parts of the system that you are going to need to note to use the system effectively.

And we actually spent a whole bunch of time tailoring that training to who you are as a provider. So, if you’re a family practice provider; you’re going to need to understand if your practice is just in the outpatient space, how to take care of patients in the ambulatory world. If you also see patients in the hospital; then you are going to need to know that part of Epic. You are going to need to know how to find patients and read inpatient stuff and read PT/OT consults and order things and manage complex live orders in the hospital. It’s a very different set of tools that you are going to need to be familiar with.

If you’re an anesthesiologist, the tools change again. If you’re a surgeon; you’re going to need to understand how to manage orders in different phases whether we are talking preop, or intra-op; it’s a layer of complexity that doesn’t exist for other kinds of providers. And so really, your training curriculum, the program that we map out for you is custom fit to who you are as a provider.

But after that formal training; there’s actually that final critical part and that’s what we call familiarity. You’re going to need to take the time and again, we’ll talk you through how this works but you’re going to need to take the time to really get to know Epic. And the more you do that prior to go live; the more you think about well all right, how are my partners and I going to divide up the patients, for real on day one? What’s that going to feel like? Are we going to have a patient list, are we going to use the official attending of record, are we going to use a different tool in Epic to subdivide them? What if one of our partners is slow and we need to pick up the slack? How are we going to know that without calling each other?

There’s a lot of little practical things like that and if you start to think those things through as you approach the go live as opposed to running around trying to figure it out that week of the go live; that’s going to ease that transition. And again, all of us as providers, we know what this is. Because we’ve been through transitions like this in our careers like I said before. And so, it’s really remembering what that’s like, accessing those skills that maybe we haven’t used in a long time in adaptability and managing through change. And that’s really what it is. It’s always a challenge to get through change. But at the end of the day a year from the go live; it’s going to be a distant memory and your focus will be more on okay what else can I do to get out of this tool. What else can I get? What other value can I extract from this tool? How can I go even faster than I’m already going?

So, it will be a distant memory once you get past it. but you got to get past it.

Host:  Absolutely. And good point about familiarity as well. And Dr. Jokhadar your thoughts about preparation, training and implementation.

Dr. Jokhadar:  As Joel was saying, this is crucial, and we really cannot stress it enough how important can it be. The commitment to the classes that when providers sign up for a class, taking everything in and then the personalization, coming back and learning how to navigate and thinking of those specific things as Joel was saying. The other piece of this beyond training and personalization, we are actually slated to go live on March 15, 2020. And this is going to be a big bang. We are going to go live at University of Maryland Upper Chesapeake Medical Center, Hartford Memorial Hospital. So, both hospitals. We are also going to go live with Epic at the Kaufman Cancer Center using a module there called Beckon and also in the ambulatory practices for our employed providers.

So, this will be a big bang for the entire Upper Chesapeake System and during the first couple of weeks of go live; we will have help and available support team trying to help providers and clinicians and nurses and all team members with that initial shock. You learn everything you need to learn, you personalize and then come go live, you turn the computer on, and you stare at the screen and say what did they tell me I need to do. All this anxiety will kick in, so we are going to have people around to tell you remember during training this is what they told you to do. It’s like oh yeah, yeah, yeah, it’s all coming back to me and help those providers and clinicians and team members use the system and get the most our of it.

So, our team members and providers are not going to be alone. They are going to have plenty of help during go live time for a period of a couple of weeks after.

Host:  Which is really comforting to know as you get to know any new system. So, as we wrap this up, I’m going to ask you each the same question. Dr. Klein, we’re going to start with you. Any other information or data you’d like to share to this audience of colleagues?

Dr. Klein:  I think the biggest thing is that putting a new EMR system into a hospital no matter what it is, and no matter what the hospital is; it’s like a marriage. So, it’s a partnership between the team of people that’s executing the change and the people who are experiencing the change. And like any marriage; it’s a beautiful thing when two people are able, or two groups are able to work together to achieve a shared common outcome that is very important to the organization. But there’s always bumps. There’s always little challenges, sometimes even big challenges because every hospital is different. The culture an even every unit is different and there’s always things we didn’t think of and always little challenges that pop up before, during and after the go live.

And like any marriage, what you do is you manage through it. You start with the shared vision that we’re going to get through this together and we’re going to help each other, and we’ll figure it out and with that kind of bedrock under you; it’s a lot easier to say okay well how can we compromise. How can we make this work? How can we make an adjustment here? How can we change the workflow there? And it’s never easy. No marriage is easy. But the great thing is that on the other side of that, you sort of look back and say heh, this was worth it. This really made sense. I’m really able to give care for the patients who are expecting that of me really not just effectively but comprehensively in a way that I never really could do with such a more limited view and window into my patients’ data. So it’s keeping perspective as we make our way through the project.

Host:  Really good point and I like how you said that like any marriage you manage through it. so, I guess if this medicine thing doesn’t work out Dr. Klein, there’s marriage counseling that could be in the cards.

Dr. Klein:  I can hear my wife laughing.

Host:  Great answer and Dr. Jokhadar I’m going to ask you the same question. Any other data or information you’d like to share to your audience of colleagues?

Dr. Jokhadar:  Sure. One frequent question I hear from out providers is what’s going to happen to the data? Do I have to live in two systems, the Legacy system that we had and Epic as well for the historic information and clinical data? So, we’re fortunate that our colleagues at University and colleagues here have thought about this and for the last four years, we’ve been sharing reports, radiology reports and clinical notes from Meditech our current EHR system in the hospital to Epic. So, that information will be readily available at go live if any of those patients happen to come back to the hospital.

Also, for the last 18 or so months, also we have been sharing lab values and lab data as well. We’re trying to figure out how that’s going to look like also for our outpatient providers, but we want to assure them that we are going to do everything in our power to do our share or the bargain and as Dr. Klein was saying, it’s a marriage so we’ll need to do our part as those providers do theirs as well.

Host:  Great point and great information. Dr. Klein and Dr. Jokhadar thank you for your time today.

Dr. Klein:  Our pleasure.

Dr. Jokhadar:  Thank you Bill.

Host:  This is the Hero Podcast from UM Upper Chesapeake Health, a podcast for internal communications. Please visit www.umuch.org/epic to learn more and check back for our next episode soon. And thanks for listening.