Stacey Johnston, M.D., vice president and chief application officer at five-hospital Baptist Health in Jacksonville, Fla., recently spoke with Healthcare Innovation about some of the benefits the health system has seen since an enterprise-wide transition to Epic that went live in July 2022.
“With the disparate systems we had previously, we realized we could not see the whole patient journey, and medication history was one of the things that was impacted,” Johnston said.
In the ambulatory setting, Baptist used Touchworks and in the inpatient setting they used Cerner. The medication data did not flow well from one to the other, she said. “We had a lot of issues with medication reconciliation. What we ended up doing is relying on Surescripts data, which was sometimes leaving us with incomplete medication history,” she said. “In the inpatient space, what would happen is every 30 days, they would essentially wipe the medication record clean. Every time a patient got admitted, they had to basically start over with a clean slate, a brand-new medication list.”
Once they consolidated EHRs, they began applying an artificial intelligence solution from DrFirst to the process of migrating medication history data in order to get more complete patient records. The DrFirst solution automated the pharmacy data transmission that previously a pharmacy med/rec team or the nurses would have to enter manually. “We have an artificial intelligence solution for reviewing the free text, which would have previously required manual entry. That free text can now be read by the artificial intelligence solution, and then entered into the EHR’s discrete fields,” Johnston said, which has led to time savings and workflow efficiencies.
There are other ways the consolidation helps provide a more complete picture of patient data, Johnston said. “We are a clinically integrated network, and a majority of our CIN providers are on non-Baptist EMRs,” she said. “We are pulling in all of this data from disparate systems. We have had a data and analytics platform that is able to pull that data together for some of our analytics and value-based care, but it doesn't necessarily cross back into the systems that we are using when we see the patient. I'm a hospitalist by background, so if I discharge a patient from the hospital, my discharge summary would create an ADT feed notification for Touchworks, but they would not actually receive that discharge summary unless they logged into Cerner, and vice versa. I would not receive the last primary care notes. I was sometimes left inferring from previous admissions, and I was missing that primary care component. So the quality of care was definitely not what it could be having these disparate systems and that was definitely one of the key reasons we decided to move toward an integrated system.”
Bringing over the data
One significant challenge was initially porting over years of data from the previous EHR systems into Epic. “I didn't realize how big of a challenge it would be,” Johnston said. “We brought in three years of data. A lot of it, though, was PDFs, and they just get dumped into the media file in Epic and that is kind of messy to sort through. We've spent a lot of time and effort in cleaning up and re-labeling it,” she explained. “We brought in an external company to do this work for us. But anytime you have manual entry, there could be transcription errors. Had I known that there were some artificial intelligence solutions out there to do some of this, we probably would have gone that route. But you know, we are interested in partnering with AI partners to look at the PAMI (problems, allergies, medications, immunizations) reconciliation data ongoing, because every time we get a new patient, we still have to do this PAMI reconciliation, so it is going to be an ongoing effort. There's definitely a use case for artificial intelligence to help with this.”
Preparing for the transition
Johnston described working with clinicians on planning for the transition to the new EHR. “It was an interesting big bang implementation. We went live with all the acute care facilities — and the clinics, labs, pharmacy —everything all at once,” she recalled. That required a great deal of training and planning. “We held over 5,500 in-person classes, for every specialty from patient access to physicians, and then we had to bring in additional outside at-the-elbow support during the transition.”
For the most part, people were really excited about this move, she said. “Some physicians, in particular, thought it was going to be a panacea,” Johnston added, “but what we found was that there are still some gaps. Primarily what we're struggling with now is moving from a previous workflow to a new workflow, and making sure that people receive consistent training, and understand and adopt the new workflows. But the desire to move to this integrated platform was always there.”
The transition process involved having more than 1,100 people participating in workgroups, and over 300 physicians building the system. “That is nearly 10 percent of our organization participating, which I think is one of our crowning achievements,” Johnston said. “I also think having a physician lead the implementation was probably one of the reasons we've had a lot of great engagement. I'm still seeing patients. I can explain the need for integration, the need for their involvement.”
Patient portal improvements
Johnston said unifying on a patient portal has been a significant benefit for patient engagement. “We had a patient portal that was a third-party tool that worked with Cerner and Touchworks, but because it was a third-party tool, it required additional integration and maintenance, and sometimes it didn’t have information that the patients were hoping for, so our portal usage was about 10 percent,” she said. “Our goal for patient portal usage in Epic was 30 percent after three months and 50 percent after 12 months. We got 30 percent after about a month and a half, and 50 percent in about six months. We have turned on essentially all of the features and functionality — from being able to pay your bills to some direct appointment scheduling. We are really embracing the ability of the patients to take the information in their portal and use that to their advantage to become an advocate for their own care. Our new patient education system is fully integrated into our EMR, so we are turning on as many of the tools as we can in MyChart, which I think has driven our adoption.”
Baptist had a lot of clinical decision support alerts built out in Cerner. They had to start over in Epic. “We deliberately tried going with Epic’s foundational best practice advisories,” Johnston said. “We had an average of 147 alerts per each admitted inpatient. That is way too many alerts.” They have made a concerted effort to cut down on alerts based on ones that are overridden the most often. “We are now at about 95 alerts per admitted patient. That is still not where we want to be, but we are definitely moving in the right direction.”