As electronic health records (EHRs) have become increasingly prevalent in the U.S., specialized implementation teams throughout the industry have become more efficient at EHR installation. Best practices and lessons learned are passed from one implementation to the next making a complicated technological process routine. Except for Cardiology.
Most healthcare systems have multiple Cardiology groups operating on different legacy systems, in diverse community settings, with different documenting and imaging technology. Typically, these disparate groups utilize unique standard practices and technologies, within the same system, to do the same work. Bringing these groups together on a single platform utilizing Epic’s Cupid for documentation, imaging, and ordering, labs, and tests take a tremendous amount of change and transformation and have proven problematic to master. However, steps can be taken to mitigate complications. Consider the following five factors to assist with your Cupid installation:
The most important prerequisite for any Cupid installation is to establish a strong governance structure and designate a Cardiology leader that operates across the enterprise to lead and support all end users, especially physicians, to resolve conflict and ambiguity. Appointing a leader helps break down the silos within the organization, so you don’t have variations within the practice.
As a best practice, physician leaders in each key functional area (Cardiology, Cardiothoracic Surgery, and Vascular Medicine) should serve as the champion for implementation across both inpatient and outpatient settings. It’s critical a recognized leader in each area be the champion for gaining consensus for decisions about workflow and configuration within the EHR and coordinating with the other physician leaders. This allows for standardized build and configuration, as well as best practice standards of care throughout the organization.
It is critical to configure Cupid around evidence-based practices to provide a standardized approach that meets clinical standards of care. This method allows clinicians to learn the technology and required institutional standards for documentation during implementation. This applies to every facet of Cardiology – Nuclear, Echocardiography, Electrophysiology, Interventional Cardiology, General Cardiology, Cardiothoracic Medicine, Vascular Medicine (Non-Invasive and Invasive). If each subset has a recognized and supportive leader to coordinate standards for documentation and acquire consensus for configuration, the organizational outcomes will be vastly improved.
Almost universally, Cardiologists are accustomed to meeting once a week in the main hospital for a Cardiac Catheterization Conference. The best way to train Cardiologists is to leverage regular conference meetings where physician leaders outline desired standards for documentation and provide multiple scenario walkthroughs in Epic.
These meetings provide opportunities for open interaction, free flow of questions, hands-on experience, and even discussion on how to customize when appropriate. Clinicians discuss cases freely and talk about how to manage patients best. It’s an excellent opportunity to integrate workflow and evidence-based medicine with Epic before an engaged audience.
Much of Cardiology is based on required imaging for structured documentation for reporting. Typically, the provider must exit Epic and work in another system with a different look and feel, then return to Epic. This is incredibly inefficient and often limits what can be seen within the technology. Adding to the inefficiency, imaging systems are typically only available in the hospital, not in ambulatory setting.
This has been a constant problem for Cardiology modules and workflows in EHRs. The best practice I adopted was to embed the imaging within the EHR seamlessly; physicians don’t know they’re viewing the image in another application. This allows them view, read and report capabilities within the EHR – all in one place, all at the same time.
Embedding imaging within the EHR also allows providers to view imaging remotely, which provides faster resolution and better patient care. (Most technology only provides viewing from where the study was performed, which can delay results and care for the patient.)
One of the many challenges organizations face is valid workflow testing – from appointment through billing. It is a common implementation mistake to leave workflow as a manual process in favor of automation during optimization.
The benefit of the Cardiology workflow is that it lends itself well to automation. Testing is aligned to ordering and billing with little variation so that the workflow can be embedded seamlessly. Automation ensures things are correctly ordered and billed properly according to the test type, decreasing the probability of human error.
Embedding the workflow within the EHR also has positive downstream effects. Doing all the work in one place – reading tests in the EHR – automatically sends the bill for that test, which improves compliance and faster throughput for charge capture. With a separate system, custom configuration and integration would need to be established so charge capture could flow from one system to the next, increasing the possibility of error.
Each of these factors, when done properly, can increase provider buy-in and happiness which leads to a more productive practice. It’s not enough just to implement Cupid; a thoughtful implementation that is simple and seamless for physicians, administrators and, ultimately, patients, is a win for everyone.
Optimum Healthcare IT has many years of experience implementing Cupid within Epic and understands the nuances around Cardiology and the needs of physicians. Dr. Michael Hyder has extensive experience implementing these services and advising CMIOs and Cardiology leaders to build these systems. We can help you formulate a strategic plan specific to your Cupid implementation.
Installing Cupid the right way is a strategic move that can benefit your healthcare system, and we can help you navigate those waters and facilitate your implementation. Taking these steps when implementing Cupid can save money by removing legacy systems and promoting work in Epic, which you’ve already paid for. The increased efficiency saves time and generates additional revenue.
The result is happy doctors and happy patients. For Optimum Healthcare IT and our clients, better solutions equal better patient care.
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