Admission Discharge and Transfer (ADT) stands for the admission, discharge, bed control and long-term reports.
The ambulatory rollout began with Locust Pediatrics in June 2010, followed by other ambulatory departments. Akron Children’s Hospital Pediatrics offices are scheduled to go-live in 2013.
Applications refer to different modules of software in Epic that perform specific functions. For example, the Cadence application contains all the ambulatory scheduling workflows, ASAP covers emergency department workflows, and Radiant enables users to perform workflows related to radiology.
Application testing refers to testing all the modules within Epic. Testing is done to make sure the processes and workflows contained within it work as designed to enable staff to use them to do their jobs. Teams use scripts, or scenarios, such as admitting a patient or scheduling a patient, to make sure the applications perform properly. Application testing is the first stage of testing. (See Integration Testing below.)
At-elbow support is individual help in using Epic provided by Super Users at go-live and in the weeks following go-live.
Basic PC skills
Everyone will need basic computer skills - how to use a keyboard and a mouse - to access Epic. The Medical Library has two computers that have the typing tutorial Mavis Beacon on them. You must use the Mavis Beacon book in conjunction with the computer program. Medical Library staff can assist you during normal operating hours, which are listed outside the Medical Library. Additionally, the Mavis Beacon program is available at retail stores.
Clinical documentation refers to the electronic capture of clinical notes and flowsheets; patient assessments; and clinical information such as medication administration records in Epic.
CPOE stands for computerized physician order entry, which allows providers to manage and communicate orders.
Credentialed trainers will serve as Epic experts in their assigned application. After receiving specialized training at Akron Children's and becoming credentialed for Epic training, they will conduct end-user classroom training.
On June 1, we will integrate devices in critical care areas and the PACU with Epic - allowing clinical information to flow automatically into the electronic medical record. Examples are ventilators, anesthesia machines, and cardiac monitors.
Discovery is the process of collecting information (orders, pathways, and workflows, etc) to assist the Epic design and customer teams in understanding how a hospital department is currently delivering patient care.
Dragon Medical Enterprise Edition (Dragon)
Dragon is a voice-recognition software that helps providers navigate and dictate information directly into a patient's electronic record. We are investigating the implementation of Dragon. We are investigating the implementation of Dragon.
A dress rehearsal provides an opportunity for a department to do a "dry run" of a typical patient encounter using Epic for the first time. This allows the care team to have a first-hand experience prior to go-live.
EHR – Electronic Health Record
An Electronic Health Record (EHR) is a longitudinal electronic record of patient health information generated by one or more encounters in any care-delivery setting. Included in this information are patient demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data, and radiology reports. The EHR automates and streamlines the clinician's workflow. The EHR has the ability to generate a complete record of a clinical patient encounter (as well as supporting other care-related activities directly or indirectly via interface) including evidence-based decision support, quality management, and outcomes reporting.
While key tasks leading up to a successful activation of Epic are crucial (building, testing, training), a pivotal series of activities occur after the June 1 activation. We call it, “optimization.”
All of these optimization activities will be deployed and periodically enhanced in order to drive-up our EHR adoption.
eMAR stands for electronic medication administration record, which monitors and documents the administration of medications.
Enterprise-wide refers to all Akron Children’s Hospital facilities and strategic operations at the Akron campus, Beeghly campus, specialty and ambulatory clinics and Akron Children’s Hospital Pediatrics (ACHP) offices. It also includes our satellite locations where we operate and provide services, including:
Epic Systems Corp.
Epic Systems Corp. is a company based in Verona, Wis., that makes software for mid-size and large medical groups, hospitals, and integrated health care organizations – working with customers that include community hospitals, academic facilities, children's organizations, safety net providers, and multi-hospital systems. Epic Systems Corp. supplies the software that provides the foundation for Epic.
Go-Live – the start date chosen for Epic database system to be used in a department. Epic is scheduled to go-live in inpatient areas on June 1, 2012.
HIM – Health Information Management
Health information management (HIM) is the practice of maintenance and care of health records by traditional (paper-based) and electronic means in hospitals, physician's office clinics, health departments, health insurance companies, and other facilities that provide health care or maintenance of health records. With the widespread computerization of health records and other information sources, including hospital administration functions and health and human resources information, health informatics and health information technology are being increasingly utilized in information management practices in the health care sector.
The Implementation Plan is an itemized, electronic program that includes thousands of steps (by responsible person) required to deploy the Epic EHR along with the estimated number of months it will consume. Note that we are implanting Epic across several broad stages, of which each stage has its own Implementation Plan.
Each staged Implementation Plan contains logical groupings of major activities that culminate in a significant milestone. Each phase contains numerous overlapping tasks and activities. The completion of a particular phase, as identified by the final achieved milestone, normally a formally signoff, enables the team to move forward into the next logical phase of the project. The phases are:
Because we have such a large degree of applications that need to be replaced, we decided to divide our project into a multi-year endeavor, containing groupings of applications. Our stages are as follows:
After confirmation that Epic software works as it's supposed to through application testing, integrated testing begins to ensure that Epic will communicate properly with existing systems at Akron Children’s.
Information Technology Steering Committee (ITSC)
The ITSC is an interdisciplinary group of executive-level representatives from key divisions and departments. ITSC meets monthly to deliberate and decide a variety of IT-related tactical and strategic matters. Topics range from deciding upon procurement and deployment guidelines to final decisions about how budgeted IT funds will be spent – and most anything in-between. In summary, the ITSC is the guiding entity that maneuvers through key IT-related decisions.
Interdepartmental Transformation Team (ITT)
Leaders from across Akron Children’s Hospital were selected to form the ITT, an oversight committee responsible for providing direction and oversight for all Epic activities, enforcing Epic as change management and acting as sponsors and advocates of Epic.
Meaningful use is a government incentive program run by the Centers for Medicare & Medicaid Services (CMS) to reward investment in electronic health records. CMS has developed a set of objectives (such as maintaining a medication list for each patient or providing patients with electronic copies of their records) and quality measures (such as appropriate management of patients with diabetes) to guide adoption of electronic health records. To receive meaningful use incentives, providers and hospitals need to demonstrate meeting these set of objectives and quality measures.
Medical informaticists are clinicians engaged in all aspects of understanding and promoting effective organization, analysis, management, and use of clinical information in Epic.
The Model System is a starter-set that Epic Systems Corporation delivers to new customers. It contains their latest software release, pre-configured content such as order sets, templates, decision support knowledge, as well configuration tools and a library of standard reports. The starter-set assembles years of experience into a “best practices” deliverable on day-one. Because of this, we have moved more rapidly through implementation as compared to other EHR software suppliers.
The playground is an environment containing fictitious patient information that enables users to become familiar with Epic and practice their skills. The playground will be made available to users after they receive their Epic usernames and passwords.
Practice management includes the processes of scheduling, admission-registration, hospital and professional billing, discharge, and transfer.
After training in Epic, all users will demonstrate proficiency in using Epic to do their jobs before receiving a log-in and password to the system.
The term "readiness" refers to two different aspects of the implementation:
Ready users are employees and providers who have both the will and the skill to be able to use Epic effectively and efficiently to do their jobs.
Scanning refers to the process of turning paper medical records into an electronic format for viewing and archiving in Epic.
Scope refers to departments, processes, and systems that will be included in Epic.
Scope of practice
Scope of practice defines the procedures, actions, and processes that can be performed by licensed or certified staff members in Epic - by law for specific education and experience, and demonstrated competency. Future users of Epic will perform work at the highest level authorized by their licensure or certification as defined by scope of practice standards.
Single Billing Office (SBO)
Akron Children’s will be using Single Billing Office through Epic which will allow us to integrate professional and hospital billing in a single system.
Subject Matter Expert (SME - pronounced "smee")
SMEs are employees with expertise in a specific area. SMEs inform all aspects of Epic's development by reviewing and validating Epic System Corp.'s Model System; providing input about workflow design, system configuration, interface functionality, training, go-live, etc.; and serve as liaisons/advocates with eventual Epic users.
In preparation for go-live, the sneak peek will take participants through realistic patient care scenarios to validate Epic workflows across the care continuum. Integrated workflows will be shown in Epic to test that system design and build are aligned and directionally correct. Subject matter experts, Super Users, and others will validate that key decisions have been incorporated successfully. The objective is to verify that integrated aspects of the system build can perform cohesively and that data can flow from one setting to another appropriately in a representative patient care scenario.
Super users are eventual Epic end users who are respected by peers and trained to: assist in adoption pre-go-live, support peers during training, provide dedicated support to peers at go-live, serve as ongoing "go-to" people for peers, and act as liaisons to the Epic team.
Test scenarios, or sets of instructions performed in Epic, such as transferring a patient or issuing a refund, are tested individually to ensure that they function properly on their own. Individual application modules in Epic are made up of dozens of test scripts.
Validation sessions are held to examine workflows in Epic’s Model System to ensure that staff will be able to use all the workflows incorporated into Epic to perform their jobs. Validation sessions allow staff to focus future time and resources on only those points that need further analysis.
A workflow in Epic walks a user through the steps needed to do their job. Epic started with workflows offered in Epic's Model System, asked hundreds staff members to validate the workflows, and then modified them to accommodate the way we work at Akron Children’s.
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