Clinicians help drive electronic medical records system

Tyler Gluckman, M.D., FACC

Medical director, clinical excellence, Providence Heart and Vascular Institute
Cardiologist, Providence St. Vincent Heart Clinic-Cardiology
Clinical champion, Epic implementation

Among all the advantages an electronic health records system provides – connected patient care, consistent quality standards, greater efficiencies – Providence’s Epic implementation offers yet another: Clinicians are helping to decide what content is built into the system.

This collaboration between medicine and software is vitally important if we’re to make the best use of this important technology. At Providence, 32 clinical advancement teams, or CATs, drawn from various medical specialties are contributing to the system’s design.

The heart and vascular CAT members include cardiologists, surgeons, an electrophysiologist, critical care nurses, cath lab managers, pharmacists and others to offer broad representation. The team’s charge is to review and standarize order sets for electronic order entry. These “SmartSets” cover everything from pre- and post-procedural care to admissions for major cardiovascular disorders, such as heart failure, acute coronary syndrome or atrial fibrillation.

Epic also introduces the concept of a shared chart that will better connect the inpatient and ambulatory care settings. This connectivity will help reduce unnecessary testing and improve patient and provider communication, particulary when patients are moved into and out of the hospital. Finally, patient records will be easily accessed across multiple health systems, since Kaiser Permanente, Legacy Health and Oregon Health & Science University already are using Epic.

The heart and vascular CAT, which has met every two weeks since April 2011, places an emphasis on evidence-based guidelines. It also works by an 80-20 rule; that is, the content must apply to at least 80 percent of patients, but not necessarily to all patients.

Clinicians also provided significant input into Providence’s inpatient and outpatient pharmacy system, helping to develop a single medication formulary that will improve quality while lowering costs.

Other quality initiatives include:

  • Creating best-practice alerts to ensure that patients are given appropriate risk-reducing medications
  • Creating an appropriate-use algorithm for nuclear stress myocardial perfusion imaging to reduce unnecessary testing
  • Identifying patients at higher risk for rehospitalization for certain cardiovascular conditions, such as heart failure

Providence St. Vincent Medical Center is scheduled to “go live” with Epic in April 2012, followed by Providence Portland Medical Center and Providence Milwaukie Hospital in June. In the meantime, the heart and vascular CAT will begin focusing on Epic’s cardiology-specific application – Cardiant – which will help to standardize procedure documentation, improve scheduling and workflow, and simplify reporting into national registries.

Transitioning to integrated electronic health records is an important and welcome milestone. Not only will it improve how we practice medicine, it will ensure that our patients get the best care we can provide.