The 20 owned and 13 affiliated hospitals of SSM Health across Missouri, Illinois, Oklahoma and Wisconsin for years have used the Epic electronic health record system, along with 185 clinics and more than 1,500 employed physicians.
But SSM Health has had three different Epic systems--one serving Wisconsin, one serving SSM Health Saint Louis University Hospital and a tri-state regional platform serving Missouri, Illinois and Oklahoma. Now, SSM Health will consolidate onto a single Epic system running across the entire enterprise.
“The goal is to develop a single simplified and more efficient platform that will standardize and streamline internal workflows for Epic users,” says Philip Loftus, senior vice president and chief information officer. “The unified system will also reduce the cost and duplication associated with maintaining multiple separate systems, while enhancing the patient experience through better data coordination and sharing of information.”
In early 2016, SSM Health decided that consolidation of Epic on one platform had to be driven by clinicians, so two workshops were established with 800 clinicians looking for the best way to bring the disparate segments together, and to standardize clinical best practices using an evidence-based approach where possible.
The tri-state region is the largest, so the project started there with the goal of being live this July, followed by Saint Louis University Hospital in early 2018 and Wisconsin by the end of 2018. Protocols will be standardized for a variety of processes covering surgery, admission workflow, transfers, discharges, overall emergency department workflow, OB workflow, behavioral health, clinic workflow, and referrals and authorizations, according to Theresa Eckman, interim vice president of IT and EHR.
As SSM Health moves forward in the process, it also has identified past deficiencies to correct them. The organization realized that the disparate groups had used separate versions of Epic for 10 years and served their regional needs, Loftus explains. “If Wisconsin improved its ED system, it didn’t typically discuss it with other regions, so the workshops for the first time brought clinicians together to find common, simplified best practices. For the first time, we were looking at the EHR from a system level—not just a regional level—together with new systemwide governance.”
The work continues, with Epic helping SSM Health implement enhancements while at the same time being able to do so with fewer customizations, Eckman said. With its vast experience, the vendor has identified best practices as it did deployments in recent years.
Revamping order sets was another part of the initiative, says Loftus. Between the three disparate systems, SSM Health has more than 4,500 order sets, and it plans to pair that down to a standard set of about 2,000.
Next up is tackling the hundreds of infusion pumps across the organization and the 11 different ways that pumps are operated. Now, there will be standardized adult and pediatric pump processes. The standardization process will continue with standard drug formularies across hospitals, including changes to meet business related market needs.
SSM Health leaders also have aligned with clinicians to improve workflow on patient history questionnaires, which had many questions that did not provide value, so the questions will be cut in half with a focus on capturing the right information. “SSM Health was historically a holding company of autonomous entities,” Loftus explains. “Going forward, we want to run the business on a small number of highly standardized business processes and information systems. Part of the move to an integrated delivery network is clinical workflow governed by standard evidence or consensus-based best practices.”
Other streamlining and transparency initiatives include moving six different Epic development teams into one team, which Eckman leads. In addition, SSM Health plans to reduce five data centers to two, saving millions of dollars, and is proposing to adopt Open Notes in the MyChart personal health record to enable patients to view providers’ clinical notes of an appointment to improve transparency and foster patients and providers working together to manage health.
The evolution of databases in recent years has played a large role in the services that SSM Health now can offer, CIO Loftus contends. “Five years ago, there was a limit on the power of databases. Now, we can put an entire patient database in one environment for a regionally based healthcare system. There also are many more tools to move the data around. There will likely be more regional systems doing what we are doing.”
A single Epic system will improve workflow and documentation processes for physicians and other clinicians, reduce complexity, minimize errors and even save some money, says Richard Vaughn, MD, system vice president and chief medical information officer.
With two different Epic systems being used in the St. Louis region that includes parts of Missouri, Illinois and Oklahoma, physicians have experienced considerable double-entry into EHRs. For instance, there is a lot of patient overlap in St. Louis, where 40 percent of patients have charts in both EHRs. “We’ve done a good job getting information across, but it has not been ideal,” Vaughn acknowledges. “We are looking forward to having a single record so physicians won’t have to log into two systems.”
Another benefit: Building a reminder or order set currently needs to be done twice because of the two different types of EHRs used in the St. Louis region. Along with a single EHR serving all of SSM Health will come standardized processes for reminder or order sets to have a single system with little or no variations.
For example, SSM Health has an initiative to decrease the number of pills prescribed to patients for pain relief. SSM Health wants to reduce the pills prescribed after procedures to just the amount that’s needed by the patient. Right now, with three different EHRs, that means three order sets have to be checked by physicians when making a change to a prescription. With standard and evidence-based prescribing practices and one EHR, a physician will only need to make a single change on an order set.
And where there were three different approaches to documenting quality across SSM Health, there now will be one standard. Further, EHR maintenance fees will go down, as will the current rate of other EHR fees being paid, Vaughn notes. “The real efficiency is when we optimize the EHR, we’ll only have to do it once.”
Having one platform for its EHR is expected to support knowledge sharing, executives believe. For example, best practices at SSM Health facilities in St. Louis, Oklahoma, Missouri, Illinois and Wisconsin, haven’t been passed on to the other regions. With a single electronic health record, if Wisconsin finds a way to get bladder catheters out quicker, that procedure can be put in the EHR for other physicians to use. “We have an opportunity as we build a single EHR to build in best practices, and after a while physicians will see the practices as the easiest way to get the job done,” Vaughn says. One best practice, for instance, will enable SSM facilities to connect to vaccine registries one time through one EHR.
But the big gain for SSM Health is how a single enterprise electronic health record will ease the move to population health management and the financial risks that come with value-based care. Enterprise data in the EHR will give a more complete look at patient populations, segmenting patients into risk levels and focusing on those with the most intensive needs.
“Our analytics, reports and data will be more standardized and built one time,” Vaughn explains. “Data will be more reliable, help deliver better care and show employers and insurers that we are providing the best possible care. It is easier to show results when data comes from one EHR rather than mashing three different reporting systems. The more standard data you have will give you more reliable outcomes.”
Better and more reliable outcomes also will be supported via a single enterprise patient portal that will enable patients to upload data in their own devices to the single portal. This will give patients one place to access their data, but also help clinicians in their population health efforts by showing which patients are engaged in their care and which are not, enabling identification of patients who may be slipping into trouble. Physicians, Vaughn says, will have the information to know if patients have been taking their medications on schedule, and to know those whose weight has recently gone up, which could indicate emerging personal or medical issues.
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