The Evolution of Epic.
When Epic launched at Houston Methodist in March 2016, excitement and focus was centered around our commitment to patient safety and leading medicine. Epic helped us move away from multiple systems and old, paper-based processes for documentation and patient record-keeping. Epic was envisioned as a tool to connect our patients and their loved ones with our care teams, while also promoting unparalleled safety, quality, service and innovation. Over time, Epic has continued to grow and improve, and it maintains a firm handle on our early vision.
“When we launched Epic, much of the talk centered on capturing a more accurate snapshot of each patient’s complete story,” said Vicki Brownewell, RN, Houston Methodist West chief nursing officer. “Fast-forward to today, and we’re still focused on our patients, while also looking to maximize clinician efficiency, so they can focus more on what they do best — patient care.”
Safety. Integrating tools with Epic to promote patient safety.
The growth of Epic has seen the adoption of numerous clinical efficiencies, but more significant are the various improvements that have mitigated risks and ensured greater patient safety. Through several integrations with other tools, we’ve made the delivery of care a more seamless and automated process that also reduces those risks.
Two systemwide Epic integration efforts that are enhancing patient safety, while also reducing documentation demands on clinicians, include bar code specimen scanning and IV pumps. Bar code scanners can quickly capture specimen collections and record medication administrations with a simple point-and-shoot. The details are then automatically fed into a patient’s chart in Epic.
Similarly, IV pump integration has successfully launched at more than half of HM campuses, the most recent being at Houston Methodist Willowbrook in May, and the remaining expected to be completed by 2023. This integration provides more detailed, precise and accurate documentation when managing complex IV infusions, which helps to ensure patient safety. It’s also proven to be valuable when recording infusion start and stop times and verifying infusion flow rates.
“Epic has always been about doing things safer, faster and more efficiently,” said Dr. Nicholas Desai, Houston Methodist Sugar Land chief medical and quality officer. “For every step forward, we take careful consideration of the patient experience and their safety. New tools and improved integrations may be highly effective, but first and foremost, they must always be safe for our patients.”
Quality. Using data to better plan and understand our patients.
As a record-keeping system, Epic is full of useful data. Every patient, every diagnosis, every lab and test result can be broken down and evaluated based on any number of social and demographic factors. But the goal is to find more effective ways to analyze the information and make it more meaningful for the patient experience and their care.
“We want our providers and clinicians to focus on their patients, and let the technology sit in the background as a support tool, not a burden,” said Dr. Jordan Dale, HM chief medical information officer. “When we’re working optimally, clinical information flows in and out of Epic effortlessly. We’re quickly able to evaluate our patients’ needs, communicate with peers and deliver the quality patient care that’s synonymous with Houston Methodist.”
Today, managers and leaders can use various reports and dashboards to help them understand different trends, like ED admissions, unit head counts and patient transfers, which can help predict future trends and help them plan staffing and resources accordingly.
During the pandemic, daily reports were used to determine when and where additional ventilators, PPE and even float nurses may be needed. HM leaders utilized a variety of data, including daily patient census reports, to build predictive models around bed capacity and expected hospitalizations. These reports would later be used to forecast future demand for equipment and staffing.
“As COVID-19 hospitalizations accelerated through our hospitals, we quickly recognized the need for quality metrics to evaluate what was happening and plan appropriately,” said Belimat “Billy” Askary, HM director for clinical outcomes and service line analytics. “Our executive dashboards were invaluable to paint the picture of what was happening at Houston Methodist and across the broader Houston community. They were used by our leaders, and even government officials, to make plans and advise others on the best ways to protect ourselves.”
Researchers also use our data to help understand community health care trends. Comparing treatment and results with different populations can offer providers guidance on managing the care of other patients, based on similarities they share with those in the community. And ultimately, this use of data can help drive better patient care and improved long-term outcomes.
Service. Creating efficiencies that return our focus to patient care.
With Epic as the cornerstone, we continue to plug in tools that make things easier for clinicians and staff. Secure Chat, for example, added an instant messaging feature, like Microsoft Teams, right in Epic for clinicians and staff to safely discuss patient-related issues. These chats can also be included in the patient record. As we look to the future, there are more opportunities for seamless connections to on-call scheduling, which will allow messages to be routed to others when providers aren’t available.
In today’s health care environment, clinicians can’t be tethered to a laptop or workstation. Through mobile technologies like Haiku (for iPhones) and Canto (for iPads), more than 3,000 providers can now review patient charts, add clinical notes, prescribe medications and place orders on the go. And with “Hey, Epic!” they can use simple voice commands that the device hears and quickly provides access to patient details, open communication tools or complete order entry.
Chief nursing officers (CNOs) and local program directors of informatics are also spearheading a systemwide initiative to provide greater efficiencies in nursing. Opportunities to streamline flowsheets, navigators and workflows are being identified to shift the focus on documentation and paperwork back to our patients. In addition, acuity tools, which measure the intensity of nursing care needed by patients, are being evaluated to help managers balance staffing assignments accordingly.
“We want our nurses and clinicians focused on patient care, plain and simple,” said Sarah Fleming, MBA, BSN, RN, Houston Methodist The Woodlands associate chief nursing officer. “Unfortunately, with all the documentation and additional demands placed on nurses, there aren’t enough hours in the day to do everything they’re asked to do. The CNOs and system leadership are committed to making efficiency improvements that return that focus back to our patients.”
Innovation. Keeping our patients at the center of everything we do.
In the more than six years since Epic launched, we’ve kept a watchful eye on technologies that will enhance the patient experience. Many improvements include positive changes for MyChart, our patient portal, including enhanced admissions and check-in processes and the ability to complete most forms before arriving. In addition, many of the efficiencies that focus on our clinical teams and staff are designed to provide more time to focus on our patients.
The development and improvement of Epic is a continual process. Major system upgrades are added twice a year, with the next Epic Update planned for Sunday, Aug. 14. Starting Monday, July 25, Update Companions will be available to review major changes for each role.
As the health care landscape continues to evolve, we’re committed to continuously finding ways to make Epic even better, for our providers, clinicians and staff and, most importantly, our patients who are at the center of everything we do.