Preparation for Partners eCare (PeC) has been underway since 2012—from the evaluation of the finalist systems to the Epic kickoff in early 2013 to the Epic Enterprise Premiere last December and the hundreds of nurses, physicians, clinical, IT and administrative staff working collaboratively with colleagues from across Partners HealthCare as subject matter experts (SMEs) on the design and “build.” Our path to implementation has been progressive and culminates on May 30 when PeC goes live for the first time.
For the next two months, thousands of employees throughout BWH are participating in training and preparation that includes several hundred staff being trained as super-users throughout Patient Care Services (PCS) to support their colleagues throughout implementation. Although a great deal of work is required for a change of this magnitude, staff are looking past the initial anxieties about go-live and focusing on the improvements PeC will bring.
What are staff most looking forward to regarding PeC implementation? The answers vary—better coordination, streamlined processes, improved efficiency and communication—all of which will help us provide even better care. Heart & Science rounded up thoughts from several Nursing and PCS areas about their unique PeC journeys and what they are most looking forward to.
As RN care coordinators prepare to start their work each day, they use about 14 different computer applications. Each morning, they print a list of assigned patients on their units, identify the newly admitted patients and review whether patients have insurance, and if so, what type. Depending on the patient’s particular needs, different systems are used, including Interqual (for appropriateness of admission), PEPL, LACE (for predicting risk for readmission) and 4Next (to identify agencies for post-admission care close to the patients’ home) to name a few.
With PeC, all systems will be interconnected and work will be directed within a work list that Care Coordination will create. Using a “Case Manager Navigator,” all applications are linked, so logging into 14 applications and remembering different passwords will be a thing of the past.
“We will have a streamlined system of handoffs instead of having to search through multiple sites,” said Christine Dutkiewicz, MSN, RN, CCM, Care Coordination nursing director. “Care Coordination staff are excited about PeC and how it will allow us more time to be with our patients and families rather than logging into so many applications to complete our work.”
For high-risk primary care patients in the ambulatory setting, the integrated Care Management Program (iCMP) built a customized system in PeC. Ambulatory Care Coordination Nurse Director Lisa Wichmann, MS, RN, notes: “It will be wonderful to have only one patient record in which to document, so everyone can see and read what the iCMP team does in order to coordinate care for our sickest or highest-risk ambulatory patients.”
“The PeC journey for the Department of Rehabilitation Services has been a tale of two (or more) different experiences,” said Director of Rehabilitation Services Linda Arslanian, PT, DPT, MS. That’s because the department includes physical therapy, occupational therapy, speech and language pathology and orthopedic technology, and provides these services to inpatient units, three ambulatory clinics and as subcontracted services to other ambulatory clinics. Inpatient therapists participated in the PeC clinical documentation build and found that it was a great opportunity to markedly improve their current tools for documentation and patient management, especially because Epic didn’t come with any rehab-specific content or functionality. This created a strong sense of ownership. Now, super-users have created their own users’ manual to help facilitate the learning of their colleagues. “More critically, there is a strong sense that Epic will be a great improvement in work responsibilities, particularly because the system is the product of their considerable contributions during build and validation,” said Arslanian.
The experience of ambulatory therapists has been quite different. They are currently using a comprehensive software program that was explicitly designed for physical and occupational therapy. It is a fully integrated clinical documentation program that includes patient management functionality, billing compliance and robust clinical and operational analytics. Super-users brought their knowledge of the current system to enhance the quality and thoroughness of the clinical content and patient management functionality built into Epic. Arslanian noted: “As with inpatient therapists, there is a strong sense of ownership of the build and genuine optimism that this change will be positive and well worth the effort they have given to date.”
The advantage of the interpreter system in PeC is multifold. It will improve communication among the interpreter team, as well as between providers and interpreters. PeC will also allow Interpreter Services to quickly identify high-volume areas and respond rapidly through teamwork. More information about the Interpreter Services Tracking System (ISTS), a web-based program that allows providers to place same day interpreter requests, and simple user instructions will soon be available. “One thing is for sure; all the effort, time invested and hard work will pay off at the end,” said Sigfredo Salguero, operations manager for Interpreter Services. “We are confident that Epic and the new Interpreter Services Tracking System will be a total success.”
For the Nutrition and Wellness Service, one of the biggest changes is in coordination of care. Currently, many patients see multiple providers within Partners and across institutions. “We look forward to working more closely and seamlessly with these providers, including primary care physicians, medical specialties, social workers, speech-language pathologists, rehabilitation services and psychologists,” said Kate Sweeney, MS, RD, LDN. “In doing so, we’ll continue providing the best and most appropriate care for our patients.”
Staff are also looking forward to the ease and standardization of documentation among nutritionists. “We’ll be better able to track lifestyle changes, such as if a patient eats more vegetables or exercises more frequently,” said Sweeney. “These changes often occur before a patient’s weight or A1c level changes, so tracking these changes and reminding patients of their successes can provide the necessary motivation to keep up the hard work.”
This enhanced coordination of care and ability to track behavior changes will aid in improving wellness among the patient population nutritionists care for.
Caring & Healing Modalities
Nursing’s Caring & Healing Modalities team has been busy working with PeC experts over the past year to see how the new electronic medical record can improve the process of bringing integrative care modalities to our patients and their families. “To illustrate the benefits, we need only look at the BWH Reiki Volunteer Program, which has provided approximately 35,000 free Reiki sessions to patients, families and staff over the past five years,” said Pat Reilly, MSN, RN, program director. “With PeC, any member of the care team will be able to electronically enter a consult for a patient Reiki request through a very simple process.”
The request would appear on the work list of the Reiki coordinator, enabling him to deploy volunteers effectively, track program volume and growth, and evaluate the demand for these services.
PeC will also improve the way Reiki sessions are documented in a patient’s medical record. Currently, nurses document in their progress notes when patients receive Reiki and their response to treatments. With PeC, nurses will be able to document more easily and efficiently on the flow sheet utilizing dropdowns.
Two BWH social workers have prior experience using Epic and are enthusiastic about the implementation at the Brigham. “We want to reassure all of our colleagues that this transition will bring improvements to patient care,” said Amanda Roche, MSW, LICSW, and Torey Stronell, MSW, LCSW. “Epic is a user-friendly and intuitive system that streamlines and optimizes workflow. Mastering Epic may take some time, but once we feel comfortable, we will appreciate the benefits of transitioning to PeC.”
Social workers have been meeting monthly for more than a year to prepare for go-live. PeC will offer customized social work notes according to service and a different model for psychosocial assessment. “The transition to PeC is viewed as a positive change for our department because it will streamline the way we care for patients and families,” Roche and Stronell added. “We are eagerly anticipating our Epic trainings this spring and are looking forward to the go-live date!”
In preparing for PeC, Chaplaincy Services examined past and current practices to consider how the same needs could be met more efficiently. “We set priorities on the types of data and reports we would need to accomplish our work,” said Chaplain Brian J. Conley. “We considered our relationships to the interdisciplinary team and what sort of information from a patient’s religious, social and cultural background would be most helpful to share with interdisciplinary staff. Perhaps most importantly, we considered our dreams for the future.”
Chaplains also recognized the need to participate in research studies to examine and document the effectiveness of their services and considered how to organize data to facilitate this. “We began to consider how we might best meet the religious and spiritual needs of an increasingly spiritually diverse population of patients, family and staff,” said Conley. “The directors of the Chaplaincy departments across the Partners systems then met to discuss the wide variety of chaplaincy models in use and develop a unified chaplaincy component for PeC. We are excited that all of Partners will be using the same system.”
Christine Dutkiewicz, Lisa Wichmann, Linda Arslanian, Yilu Ma, Kate Sweeney, Teresa Buchanan, Amanda Roche, Torey Stronell, Brian Conley and Kathleen Gallivan contributed to this story.