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Colin Ward (Host):  Dean Kamen, the inventor of the Segway Personal Transportation Vehicle once said, “Every once in a while, a new technology, an old problem and a big idea turn into an innovation.”

Today, on the University of Maryland Upper Chesapeake Hero Podcast, we will discuss the final preparations for the implementation of the innovative electronic medical record system called Epic. Good afternoon, I’m Colin Ward, Vice President of Population Health. And I’m pleased to be joined by Dr. Fermin Barrueto, the Chief Medical Officer and Dr. Muhammad Jokhadar, the Chief Medical Information Officer for University of Maryland Upper Chesapeake Health. Gentlemen, thanks for joining me. Dr. Jokhadar, let’s begin with you. You’ve really been deep down in this process over the last probably more than a year I would guess at this point. So, deploying a medical record system, it’s a challenge, it’s complex just for its scale and its complexity; how much has Upper Chesapeake really partnered with the University of Maryland Medical System to try and make this an easy process?

Muhammad Jokhadar, MD (Guest):  Thanks Colin. To be exact, it’s been actually 15 months since we started the journey.

Host:  Only feels like 12.

Dr. Jokhadar:  Yes it does. Yes it does. So, it’s been a journey to say the least. We’ve been able to partner with our IT folks down at University and we’ve had many interactions with them; clinical leaders, IT support, and all the staff including also some of the providers that had like Dr. Abraham from Emergency Room and Dr. Osler from Anesthesia. So, there has been a lot of work that went into this and we’re counting on this paying off at Go Live.

Host:  And these are folks who have been through this many times before.

Dr. Jokhadar:  That’s correct. So, the benefit that we’re actually getting from this partnership, the University of Maryland has done this implementation at many other hospitals within UMs before. The most recent was Shore and Shaw’s Regional end of 2018.

Host:  All right Dr. Barrueto, you have gone through many different training modules over the last couple of weeks here. So, clinically speaking, what benefit do you think the providers and the patients will reap from this new system?

Fermin Barrueto, MD (Guest):  Well let’s start with the providers. I went through several training sessions. I think I’ve seen everything from smiles to laughter to tears. You got a little bit of everything. Change is always hard and when you’re going through a whole new electronic medical record, it has been a huge lift and I’ve been very appreciative of Dr. Jokhadar’s leadership. There is a net gain which I’m very, very pleased to see come closer every single day. First is for the patients. Imagine your most complex patient like a congestive heart failure patient. They have work that was done in outpatient facilities. They have work that was done in imaging. The admissions that were done in previous years. catheterizations, going on and on. Those studies, that load of work will now be coordinated in a way that really hasn’t been seen before. And I’m very excited to see how our patients are going to benefit, how that will improve our efficiency, decrease redundant testing. I think this is a real net gain to our patients.

And then we have clinical decision support. Everything from helping the Emergency Department begin to categorize acute patients that require hospitalization to those that actually can be discharged is going to be an incredible gain for our physicians. It helps apply evidence based medicine practices to real time clinical care. And I think it’s something to be very excited about.

Host:  And so that means at the time that you are in front of that patient and you are zeroing in on what the specific diagnosis is, you’ll have prompts that pop out of the system to sort of guide you through testing options, treatment options, those kinds of things?

Dr. Barrueto:  I would say one of the examples I would like to give is actually chest pain patients. Where we would be able to categorize those chest pain patients with the heart score, an evidence based clinical tool that will pop up as you finish your documentation and give you the score and tell you, this is a low acuity, or moderate or high risk patient and provide you guidance on whether or not that patient actually needs hospitalization and concurrent risk for an adverse cardiac event.

Host:  Great, okay. Now about a year ago, the mere mention of Epic would elicit some groans from our caregivers and that’s really not the case so much anymore despite a couple of tears here and there as Dr. Barrueto just mentioned in the training. So, Dr. Jokhadar, what kind of feedback are you getting from the team once they’ve already been through the training and been exposed to the system?

Dr. Jokhadar:  Mostly positive. A provider who has gone through training and personalization and really got a chance to use Epic Playground to test the environment and really mimic the workflow that they currently do in their EMR, have been very excited to actually get Epic and really leverage all the tools that Epic will bring. I have to mention there is also a lot of anxiety that we built a lot of muscle memories already with using our current EMR and now we’re moving to a brand new EMR that there are functionalities that we have to discover, there are new muscle memories as I said that we have to build, so I don’t want to sugar coat it. it will be – the transition will be hard but we’re doing everything we can to actually provide that support to all providers.

Host:  And there is one bit of benefit is that we have people that are working in our organization now that have previously been Epic users and have been exposed to the system, so it’s not like everybody is coming in from ground zero.

Dr. Jokhadar:  And that is correct.

Host:  Okay. So there’s been a lot of readiness activities, dress rehearsals, sometimes they’re referred to over the past few weeks so any advice you would give our caregivers to be focused on in the remaining few weeks before Go Live?

Dr. Jokhadar:  So I mentioned Playground and really, I cannot highlight that enough. That access to Playground and –

Host:  Tell us what is Playground.

Dr. Jokhadar:  So, Playground is a test environment of Epic that has the same set of patients that providers have used during their training where they can go in there and try to mimic any task, they currently do in EMR. So, on the inpatient side, what I’ve been telling providers, if you just put an order for a particular medication or a complex procedure; try to take a few minutes to go to Epic Playground and try to replicate that work so come Go Live, you’re not really surprised or trying to figure out how am I going to do that in Epic. But this is an environment that was set up specifically for this reason. And it gets updated every night, so you’ll start fresh every single morning. So, you are not going to break the system is what I keep telling providers. Just do whatever you want to do there, test it out, stretch the limits and see what happens.

Host:  So there’s no harm, no foul there.

Dr. Jokhadar:  Correct.

Host:  Okay now from an efficiency standpoint, so we’ve heard about clinically there’s pick up here in terms of continuity of care, in terms of the heart score as you mentioned Dr. Barrueto, from an efficiency standpoint, are there components of an Epic Go Live, an Epic system deployment that will really help our teams be more efficient in picking up either components of care that could be better done or perhaps avoided all together? What components of the Epic system make us more efficient?

Dr. Barrueto:  So, I’ll start, and I think Dr. Jokhadar will follow up with a few things. But I think the first thing is to understand that of course, there will some inherent slowing down from the OR to the ambulatory services and outpatient practices but once everybody starts picking up the muscle memory, everybody starts learning their way around the electronic medical record; you start getting back to baseline. I think where we actually start to see some of these efficiencies is when you are using those skills from personalization labs. It’s when we actually start using the data that we find within Epic, specifically being able to mine our own patient data so that we can improve on ordering, bringing in certain patients; I think will both be able to improve on efficiency and quality of care based on the tools that we have within Epic.

Dr. Jokhadar:  To add to that, I couldn’t agree more. But to also add to that, right now we look for information several other ways. We try to get records from outpatient providers. We try to get records from other UMs facilities. All that loss of efficiency for our providers trying to have the full picture for our patients will be at their fingertips. In addition to that, Crisp will be integrated right within Epic. Right now we hear from a lot of providers that I keep forgetting my password, I can’t maintain several log ins, now with this -

Host:  Crisp is the stat health information exchange; it has data from other hospitals.

Dr. Jokhadar:  That is correct. Thanks for clarifying. So, that will be embedded right within Epic, so providers don’t have to go outside Epic to find that information and one of the byproducts of us migrating into Epic is the implementation of a single sign on with tap and go using our badges. So, another complaint that we usually hear from providers is as I’m moving from one computer to the other, I keep having to log in and log out. Now this is all going to be saved with just a tap of a badge that will get you right within Epic.

Host:  So, this is that sort of frictionless idea that Amazon has made famous here.

Dr. Jokhadar:  Absolutely.

Host:  Okay. Now Dr. Jokhadar, I want you to take us behind the scenes here a little bit because you’ve been really well versed in this over the last 15 months. But probably not many people know that we have been sending information from our current EMR systems to Epic charts for going back a couple of years. So, what has that process been like and what kind of benefit will that bring to our patients and caregivers?

Dr. Jokhadar:  Excellent question. And I keep getting that question almost on a daily basis. What’s going to happen to the data that we put together in our previous EMR? I’ll speak about the inpatient process for now. So, we are currently on Meditech platform and for the last four years, we’ve been feeding all reports, and dictations from providers so history and physicals, discharge summaries, consultations, from Meditech to Epic. So, that’s all going to be available to our providers right away as we Go Live in Epic. For labs, we’ve been feeding lab data for the last two years as well. And usually that by itself is plenty from a clinician’s perspective.

On the outpatient side, we’re also leveraging what we call a CCD extracting problem list, medication list, allergies from our NextGen platform that will be readily available for our providers as they turn on the system and start seeing the very first patient in Epic.

Host:  And that data is important. You need to look at the historical information for patients to see if they are improving or not. So, to just flip a switch and not be able to view that data may be not so helpful for clinicians.

Dr. Jokhadar:  That is correct.

Host:  Okay. So, let me ask you both then, what has surprised you? We’re closer and closer and sometimes there’s excitement as kids do on Christmas Eve, they’re very excited for what’s under the tree the next day. So, what surprised you as we get closer to that Go Live date about how the organization has come together, how the system has come together for Upper Chesapeake?

Dr. Barrueto:  Well I think I’m going to bring up one moment when we had a demo with the orthopedic group and these guys are high volume, require high efficiency and during the demo, you started seeing the light bulbs go off, one after another, after another and they started to say, you know what, we really can do this. We can get it done and we can maintain the efficiency and the quality of care that they expect. And I enjoyed seeing them as well as the OR really begin to what was considered an insurmountable task really begin to tackle and dismantle the problem and start coming up with a solution. So, I’ve been very pleased in seeing all of these people come together, but particularly, those two moments I’ve really enjoyed.

Host:  And for Dr. Jokhadar, what do you think you’re looking most forward to seeing here over the next couple of weeks as we convert from this idea of being an Epic hospital to actually deploying the system?

Dr. Jokhadar:  I can’t wait to see how our providers are going to be leveraging all the tools that are going to be available to them and how the support is going to pan out for our providers and all team members in general.

Host:  All right gentlemen, over the last year, on this podcast, we’ve heard from local Epic experts that work here at Upper Chesapeake. We’ve had many stakeholders from the UMs IT team, but you two are going to have the final word prior to our Epic Go Live. So, what message do you want our team members to hear before we flip the switch on March 15^th?

Dr. Jokhadar:  Well, I’m going to say you’re not – we are all in this together. We are going to have a lot of support for our providers and team members. It won’t be easy. Transitioning is going to be a bit hard but we’re doing everything we can to make it the least painful for our providers as much as we can.

Host:  And for you Dr. Barrueto?

Dr. Barrueto:  So, first, I want to say that one of the best moves we’ve made right out of the gate is hiring our CMIO to be able to head this project and make this a complete success. I’ve seen us take on H1N1. We did 2011 Meditech V6 and I can’t wait to see how this group comes together during this time when we’ve had so much turmoil leading up to it to be so resilient to be able to make this a complete success. I’m looking forward to coming out the other side and having a nice tall drink.

Host:  I think we’re all looking forward to that.

Dr. Jokhadar:  I’ll have two.

Host:  And of course, that very important hire that you were describing is our Chief Medical Information Officer is none other than Dr. Jokhadar. So, thank you Dr. Jokhadar for all the work that you’ve done here. I echo Dr. Barrueto’s sentiments here. And thank you both Dr. Barrueto and Dr. Jokhadar. Good luck with the implementation and obviously, improving the care that we provide our community. You’ve been listening to the University of Maryland Upper Chesapeake Hero Podcast.