project fusion overvie · project fusion overview research readiness owners: sharon finlay, uohi...

Project Fusion Overview

Research Readiness Owners: Sharon Finlay, UOHI and Nancy Camack, OHRI

October 31, 2018

Go-Live June 2019

Presentation Objectives:

1. Discuss the rational and timelines for Project Fusion implementation and training

2. Describe the “wins” for Clinical Research

3. Demonstrate examples of changes in Clinical Research Documentation

Neither Sharon Finlay nor Nancy Camack have conflicts to declare

Why are we embarking on Project Fusion? • One patient, one record, across a continuum of care !

• Health-care providers within this digital network will have real-time access to common medical information, allowing them to make timely, informed decisions based on the most comprehensive patient data.

• Six health-care organizations involved in the ATLAS ALLIANCE:• TOH• The Ottawa Hospital Family Health Team• UOHI• Hawkesbury General Hospital• Renfrew Victoria Hospital• St. Francis Memorial Hospital (Barry’s Bay)

• ATLAS ALLIANCE partners share the values of respect, quality and collaboration and believe Project Fusion will help deliver our goals of • world-class care • exceptional service• acting with the compassion we want for our loved ones

We are here

June 1, 2019

• Credentialed Trainers - 6 month commitment, 6 weeks training beginning Jan 21st

• Specialists Training Specialists (STS) - recruited. Training Jan 22-24

• Super-Users – in progress to determine #s – training over 3 wks. Mar 4th - Mar 24st

• Physician & End-User Training – 8 weeks – Mar 25th - May 19th

• Refresher Training - 2 weeks - May 20th – May 31th

• At-the-Elbow Support ~ 2months - June 1st - Aug 1st

Training Roles/ Timelines:

Tools and Information on Project Fusion WebsiteINFO: Check out Project Fusion website icon on your TOH desktop TOOLS:

http://www.ottawahospital.on.ca/en/project-fusion

Password: fusion

INFO: Newsletters, Fact Sheets

Fact Sheets on Epic Features• Clinical System Design• Pathways and Order Sets • Documentation Made Easy (SmartTools)

What have you heard about Epic? Use our Myth Busting tool on the Project Fusion website to find out what is accurate or submit your own concern

http://www.ottawahospital.on.ca/en/project-fusion

userweb.epic.com

Everything Epic

Documentation

Report Repository

Released Metrics

Online Learning

“Training home” or training.epic.com

Everything Epic

Documentation

Report Repository

Released Metrics

Online Learning

What is “In Basket”? Secure closed messaging system

▪Maintains patient confidentiality

▪User and system generated messages

▪NOT e-mail!

▪Task-based▪Messages are grouped by message type (workflow or type of task)

▪Ex. Reviewing results, telephone messaging, ADT notifications

▪Work is not new or extra▪Replacement of similar paper workflows

• Every user will have an In Basket

• In Basket messages can be sent to:

▪ Individuals

▪ Groups (pools)

Who uses In Basket?

Example: Open Encounter Messages

MyChart

Big Wins✓ Ability to send questionnaires to patient and integrate answers into patient chart✓ Ability for patient to update allergy, medication and health issues✓ Ability for patients to see past and upcoming appointments✓ MyChart on phone will get fast pass email notifications of open slots/cancellations ✓ Pilot – patient self-scheduling – Weight Management Clinic✓ Patient ability to communicate with billing offices to address questions✓ Ability for patients to pay bills with credit card via MyChart✓ One MyChart for all Alliance Sites

Shared Patient Record

Organizational Drivers for Research Functionality

1. Alert clinical staff to patients’ participation in studies and provide study information2. Research staff contact information available3. Easily accessible and better quality health data for research4. Notifications to study coordinators when research participants visit the Emergency

Department / Admitted (adverse event reporting)5. Centralize/standardize research participant scheduling6. Improve tracking and regulatory compliant documentation7. Improve recruitment strategies8. Improved registration and billing processes Organizational

Drivers

Definitions –Key Performance Indicators

• Identified by Epic community members

• Measure profitability and quality of care over time

KPIs are metrics

• Demonstrate areas where your customer is currently strong

• Find opportunities for improvement

KPIs help run the business

• Establish pre-live baselines for at least one KPI per application

• Readiness leads monitor KPIs on their dashboards

KPIs are a part of Good Install

Research KPIs

% of patients providing permission for research contact

# of patients on clinical trials

Epic Changes How Clinical Research Trials are Managed

1. Communication: about research participation between clinicians and researchers via the Health Record

2. Engagement: assessing study feasibility; screening patients for eligibility; study recruitment and enrollment

3. Study Conduct: scheduling research visits, ordering research tests or interventions; documenting medical oversight for Health Canada; access to the health record for clinical research staff

4. Accounting: billing for research-related activities

5. Data Use: data abstraction & analysis; reporting of study metrics

Epic will impact the following research activities:

Before Epic After Epic

• Must access multiple data sources to assess study feasibility and reliance on the clinical team to remember and mention study eligibility to patients.

• Tools to support study feasibility and eligibility assessments all within Epic.

• Difficult to coordinate a patient's research visit with their clinical visit.

• Research visits can be transparently coordinated with any clinical visit.

• The research team finds out about emergency room visits or hospital admissions from the participant after the fact.

• Research staff will automatically be notified of emergency or urgent clinical events.

• There is no way to track progress in recruitment and consenting process and communicate

• Easy, transparent tracking of patient recruitment and consenting process.

Before Epic After Epic

• It is unclear if a presenting patient is on a research study, what type of study, or who is leading the study.

• A clear icon indicates which patients are associated with research studies and provides information about the studies.

• It is hard to identify patients who may be eligible for a particular research study.

• Tools to automatically identify patients eligible for a study and invite their participation.

• Clinical data is stored in multiple formats and in various systems, making it difficult to use for research.

• Access to clinical data in one electronic system with consistent data architecture.

• Charges to research studies for hospital services are difficult to track and reconcile manually.

• Clinical services for per-patient research costs are charged directly to the study account with easy reporting at the study, department and institutional level about research participation rates and fee schedules.

• All INTERVENTIONAL Studies & all studies with “billing risk” (using service departments) MUSTbe registered in Epic by completing a Research Administrative Record

• Other prospective studies MAY be registered• For related benefits such as recruitment tools, scheduling visits, notifications, etc.

• Retrospective studies should not be registered• No benefit and no need to have a record of study in the chart• No patient involvement/no contraindication for enrollment in other studies

• Recruited patients are “associated” with the Research Administrative Record

• Research staff will document in the research section of the patient record

• Patient-study associations, study status and research related visits to be done by research team

IMPORTANT POINTS

IMPORTANT POINTS

• Pre-consent:

• Identified

• Interested

• Waiting for consent

• Active:

• Consented – in screening

• Enrolled

• Randomized

• On Follow-up

• Inactive:

• Declined

• Completed

• Ineligible – did not meet criteria

• Screen Failure – consented, not eligible

• Withdrawn – patient decision

• Withdrawn – Investigator decision

• Long-term follow-up

• Lost to follow-up

Three groupings for Study Status – MUST be updated immediately following any changes

Research Administrative Record

Click Additional Info

Additional info report

Click Adverse Events link

Enter Adverse Events Info

Patients on Insomnia Study report

Cogito Tools Self-service physician and research tool

Reporting Workbench

Radar

Benchmarking

3rd Party BI (Crystal)

3rd Party BI (Universes)

SlicerDicer

Cubes (Billing, BPA)

Cogito Tools - Takeaways

1. Dashboards will be the main point of entry for users

2. More specialized tools tend to be for certain users

3. Drive adoption of SlicerDicer - will be the future of Epic reporting

• Driving consistencies:

• Research documentation within the patient record in all divisions, clinics, wards

• Research staff throughout the institutions consistently documenting in the research section of the record

• Research section of the patient record is redacted from release of information requests

• Permission To Contact registration clerk process– visible in patient record header

• *NEW* - Circle of Care documentation by SmartText – routed to clerk; this will improve PTC metrics

• Patient record flagged as Research Active; Clinicians can see the research summary and key contacts

• Adverse events recorded within the research section of the patient record

• Regulatory compliant documentation

• MD confirmation of eligibility/ MD evidence of reviewing test results, NCS/CS, no more printing/signing of results; assigning causality to AEs within Epic

• Visibility on patient scheduling and can book “research only” visits

• Study Monitor access to Epic (and potentially remote monitoring)

• No more requisitions and signing of printed results! Paper replaced by Epic In Basket communication with individuals or groups

The ‘WINS’ for Research…

• Patient engagement – recruitment strategies with My Chart; Patient can view their results in My Chart

• Real time recruitment and study status reports

• Test ordered for research purposes routed to research billing or standard of care when applicable

• Monthly invoicing of lab work

• Lab results reported within the patient record, with exception for blinded or sensitive results

• Lab samples with PHI labels are permitted

• Barcode verification reduces errors, improves safety

• Device integration – Welch Allyn vital sign monitors

• Portable Workstations On Wheels (WoW) for timely documentation

• Cogito reporting tools – more specialized dashboards; SlicerDicer – investigate hunches

• All access to PHI is audited

• Revenue cycle – responsible management of our finances

The ‘WINS’ for Research, cont’d…

• Check out the Project Fusion information on your desktop

• Go to EpicUserWeb, check out training videos and GALAXY/Cogito/SlicerDicer

• Research staff to mentor investigators with the documentation practice changes

• Workflow walkthrough

• Plan for operational changes of workflow within your team – start thinking about it early!

• Ordering in advance for investigator sign-off – orders are “pended”, not visible or ‘actionable’, until signed off by study MD

• Patient engagement – recruitment strategies with myChart – REB correspondence

• Policy and procedure changes to reflect change from Oacis and access to Epic

• Monitoring workflows during and after go-live

• Transitioning desktop PCs to laptops

• Attend Project Fusion monthly research presentations on Workflow Changes

Things to do and think about…..

The Big Wins: EPIC options accepted and

included in our system buildDeferred:

Options not ready by go-live

Access Team Workstream

Prelude Cadence

eReferral Grand Central

Portering EVS

Identity ManagementHealth Information Management

Scanning Transcription

Voice Recognition Welcome Kiosk

Cadence & Referrals

Big Wins✓ Electronic referral intake/triage/tracking✓ Patient appointment schedules visible across Alliance✓ Providers (especially therapies) able to self-schedule easily✓ Many new features for scheduling provides improved efficiency for booking✓ Electronic appointment requests through referrals/orders✓ Rescheduling of clinics and move of appointments between providers much easier✓ Booking joint appointments with multiple providers/resources possible/easier than current systems✓ Snapboards provide clinics with ability to view entire clinic schedule in one view ✓ Cancellation lists and FASTPASS MyChart option helps to ensure clinic is more fully booked with less effort✓ RECALL feature to manage bookings when templates are not available provides both efficiency for

maintaining a list and ensures appointment requests are not lost✓ MyChart for appointment notifications and questionnaires✓ Template build and maintenance much easier

Deferred▪ Patient Self-Scheduling pilot only –

broader use is deferred

Scheduling for patients

Ambulatory Team Workstream

My Chart

Core Ambulatory

Healthy Planet

Bones

Beacon

Research

Specialty Core

EpicCare Link

Kaleidoscope

Phoenix

Wisdom

Beacon

Big Wins✓ OPIS will be decommissioned✓ Epic will replace BPM functionality✓ Epic to MOSAIQ interface is working✓ ESAS questionnaires will be completed in MyChart from Epic*✓ Oncology treatment will be accessible to any care provider at TOH and Alliance✓ Lifetime dose calculation will be more accurate as it will be automatically calculated

within Epic✓ Radiation Oncology (First in Canada)✓ Bone Marrow Transplant (First in Canada)

Oncology Information System

Deferred▪ Nothing – all wins!

Research

Big Wins✓ Research visibility - increased visibility of research in

general and specifically research at the patient level ✓ All research related information will now be in the patient

chart✓ Department/Procedures – Bringing CIU and lab draws into

Epic (patient safety)✓ Billing – Research billing standardization✓ Recruiting – study feasibility and reporting✓ Recruitment Best Practice Advisory

Deferred▪ IRIS interface ▪ Geovisualization

Inpatient Team Workstream

Clinical Documentation Orders

Pathways ASAP

Care Everywhere Willow

Rover

Infection Control

Inpatient EMR

Inbox

Handover

Specialty Team Workstream

Optime Anesthesia

Cupid Hybrid

Procedures Supplies/Materials Management

Radiant

Cupid

Big Wins✓ Structured reporting for Stress/Cath/EP✓ Unified reading worklist✓ Easy charge capture workflow✓ Seamless results routing out of Epic vs. having to do it from each ancillary system✓ Statistics/Dashboards – this is common to all applications

Cardiovascular Information System

Deferred▪ Online Cath-PCI registry reporting

Billing Team Workstream

Hospital Billing Professional Billing

Claims & Remittance Facility Structure

Charge Master Files

The Success of this Project and the Safety of Our Patients / Study

Participants Depends on Your Diligence to Ensure You are

Appropriately Trained!

Taking the Temperature: Emoji survey of how you’re feeling about this project

Overwhelmed!

Cool with it!Not supportive!

Cautiously Engaged

Thank you!

The following slides provide additional information on some of the other modules in clinical areas.

Prelude

Big Wins✓ Standardized registration flow✓ More comprehensive insurance

capture

Registration


Welcome Kiosk

Big Wins✓ All sites will leverage or pilot at go-live✓ Check-in feature enabled✓ Health Card Scan to bring up patient

Patient Kiosk

Deferred▪ Paper Scanning▪ Patient Photo▪ Questionnaire completion▪ Map for wayfinding▪ Patient Self-Updating of Demographics

MyChart

Deferred▪ MyChart Bedside▪ Patient Self-Scheduling beyond Pilot▪ Patient Communication with Clinical Teams▪ Patient MyConditions▪ Patient requested ROI▪ Functionality loss with EPIC MyChart: patients cannot provide proxy access, requires hospital intervention▪ Functionality Change: cannot withhold operative notes as is done today▪ Personal health device integration▪ SMS Push Notifications▪ Refill requests

Shared Patient Record

Kaleidoscope

Big Wins✓ Increased data-capture and ease of tracking data in Epic - greater than what is possible with paper✓ Positive for patient outcomes and research✓ Scheduling/Booking efficiencies could be transformative for such a heavy volume referral/outpatient

area✓ As charges are captured during documentation, the ophthalmology group will be able to take advantage

of a file transfer to their existing billing system – interest in joining full PB post-live

Deferred▪ ADT/Order integration with Synergy

Ophthalmology Information System

Bones

Big Wins✓ Comprehensive view of patient means not having to

consult multiple systems (SMS and Oacis) to get complete view of history

✓ Although Orthopedics is highly paper-based, there are many tools in the Bones module to help increase efficiency (e.g., Express Lanes, procedural documentation)• One action: procedural documentation orders a medication,

marks it as administered, starts visit note and drops charges

✓ Charge capture workflow will enhance the documentation provided to billers • Will help to expedite billing as the billers will have all they

need out of the reconciliation report

Deferred▪ For go-live, only a small subset of

the Patient Reported Outcome questionnaires will be implemented in Epic, remainder deferred to optimization

Orthopedics

Phoenix

Big Wins✓ ABO Timeout functionality is being implemented. Will allow greater safety and compliance (Health Canada)

for transplant surgeries and is a net-new practice for TOH/UOHI. ✓ 2 BPAs have been approved for implementation, in relation to transplant:

1. immunosuppressant transplant drug warnings will populate to warn clinicians that they are potentially discontinuing a drug necessary to maintain the health of the transplant organ of their patient. This will put the health of the transplant patient as paramount and reduce risk of potentially damaging the organ unnecessarily.

2. when a patient expires at TOH, the correct pop-ups will remind clinicians and nursing staff of the triggers necessary to place the call to TGLN for potential organ donation based on identified patient factors.

✓ In-scope reporting opportunities for go-live are going to transform their capabilities and is a huge gain for both heart and kidney groups

✓ Trending with transplant populations will allow for easier and more relevant clinical decisions to be realized in a time sensitive manner and is a net gain to improved patient care

Transplant Information System


Infection Control

Big Wins✓ Currently the main workflow for gathering information is all paper-based. With Epic, all information will be

online and fully integrated✓ Additional reporting and tracking tools from Epic - MRSA, VRE, CPE, ESBL (all related to organism

identification)✓ Trend on patients based on lab values (without a case being created). Currently a case must be created in

order to run any kind of trend/report✓ Trace a patient, room, or caregiver✓ Follow cases through (incomplete cases are easily accessible)


Radiant

Big Wins✓ Compared to current state, much easier access to all patient information✓ Will be documenting contrast in the patient MAR with Radiant✓ CareSelect decision support will facilitate selecting the most appropriate test for select modalities✓ Breast Imaging module, inclusive of lesion tracking✓ Breast-specific history✓ MyChart✓ Questionnaires✓ Consistent workflow across partner sites

Radiology Information System


Resolute – Hospital Billing

Big Wins✓ Faster and more accurate charge generation ✓ All information available from one system ✓ Departmental involvement with charge capture and revenues ✓ More reporting availability as well as up-to-date dashboards

of activity ✓ Detailed cost tracking available✓ Dramatically decreased manual data entry

Enterprise Revenue Suite

Deferred▪ Credit Card Integration

project fusion overvie · project fusion overview research readiness owners: sharon finlay, uohi...

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