CHEO expands use of Epic to improve safety, quality

OTTAWA – When Allerject – a commonly prescribed epinephrine injector used for the emergency treatment of patients with severe allergic reactions – was recalled in October 2015, the Children’s Hospital of Eastern Ontario (CHEO) used its Epic health information system to do several things not possible before.

It could run a report of how many Allerject scripts were written and notify providers; create a system alert to prevent providers from submitting future orders, with a link to the Health Canada recall notice online; and recommend a substitute.

This is just one example of how CHEO is using Epic to introduce key clinical improvements across the hospital.

CHEO is fast-tracking its Epic implementation to realize system-wide benefits like this as soon as possible.

“Epic represents a fundamental change in how we communicate and how we deliver care,” said Tammy DeGiovanni, Director of Ambulatory Care at CHEO. “It offers continuous quality improvement and that’s how we’ve chosen to implement it.”

Before the end of 2017, CHEO will expand its current use of Epic from ambulatory care, admission/registration, and its main lab and genetics program throughout the hospital to include emergency, inpatient documentation and ordering, the medical day unit, pharmacy, radiology and oncology.

CHEO is also leveraging the Epic Haiku/Canto apps to go mobile.

CHEO is the first Canadian hospital to achieve HIMSS EMRAM Stage 6 in ambulatory care and within the next two years, CHEO plans to be one of the first Canadian hospitals to achieve HIMSS Stage 7 throughout its organization.

So far, CHEO has implemented Epic across 44 services, including 80 separate clinics with more than 900 physicians and staff.

Dr. Jim King, Medical Director of Informatics at CHEO, noted, “Most CHEO physicians are already using Epic in outpatient clinics and, while there is a steep learning curve and working with the system takes effort, they are eager to use Epic in all aspects of care.”

As its use spreads throughout the hospital, clinicians are finding it easier to coordinate their care across multiple disciplines.

Epic is also helping CHEO meet the changing expectations of a digital generation. Patients and families expect seamless access to personalized health information and services, realized through one single electronic health record per patient. For those with complex medical histories whose paper charts can number multiple volumes, an EHR means their full story is at the fingertips of each member of their care team and they no longer need to repeat their story or wait for physical charts to follow them from clinic to clinic.

It means real-time information sharing between clinics. “I think my favourite thing about Epic is that the chart’s always available,” said pediatric ENT specialist Dr. Matthew Bromwich. “That’s a game changer in that you can always make decisions, whether you’re on the floor or in clinic or in emergency, based on the most up-to-date information.”

Starting in April 2016, CHEO also began offering instant, ‘view-only’ access to Epic MyChart – a secure, online portal that gives patients, parents or legal guardians access to parts of their medical record. MyChart also provides the information they need to keep on top of appointments, make decisions and be true partners in care.

CHEO also offers ‘interactive’ MyChart access in its diabetes, ENT and endocrinology clinics to allow two-way communication between clinicians, patients and families. During the next two years, CHEO will gradually expand interactive MyChart access to other areas of the hospital.

CHEO was one of the first hospitals to use Epic, back in 1993, for patient scheduling, registration and hospital billing. It has been an early innovator and investor in electronic health records because it believes in the value information systems bring to patients, the hospital and the health system as a whole.

“We chose Epic as our electronic health record because it frees us up to focus on our passion, which is caring for kids, not searching for information,” said Alex Munter, president and CEO of CHEO. “It will mean that all patient information is in one place and readily accessible as a patient moves through the hospital.”

As CHEO physicians and staff become proficient with Epic, they’re seeing the impact of what it can do. “Epic provides us with timely, evidence-based information that we are already using across the hospital to identify trends, find issues and continuously improve care,” said Mari Teitelbaum, vice-president of technology and chief information officer at CHEO. “It’s also helping us tackle challenges such as a growing patient population, increasing patient complexity and the need for more efficient and effective care.”

Better data has enabled CHEO to more quickly and accurately track and assess the nature and quality of its care.

Since CHEO started implementing Epic in its outpatient clinics in October 2013, physicians and staff have seen 78,269 patients and documented 421,196 clinical encounters. This preliminary snapshot – made possible through its use of Epic – reveals that CHEO provides over 40 percent of its patient care closer to home through phone calls (33 percent), prescription refills, etc. About one-quarter of all outpatients now receive an after-visit summary documenting the outcome of their clinic visit.

Staff and physicians across the hospital are learning to use this data to analyze and streamline their clinic workflows. Orthopedic physicians, for example, have used Epic data to help revamp their schedules, smooth volumes and decrease appointment time for families.

And Epic referral management has enabled CHEO to track, measure, report on – and reduce – initial consult wait times for new outpatients. Referrals are triaged when received and referring providers notified of patient referral status.

Maureen van Dreumel is a communications advisor for strategic initiatives at the Children’s Hospital of Eastern Ontario. Canada Health Infoway has supported CHEO’s efforts to implement Epic since the project’s inception.