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Apotti Programme Deployment of Epic in the Helsinki Area 2016–2020

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Apotti Programme Deployment of Epic in the Helsinki Area 2016–2020 Apotti Programme Deployment of Epic in Helsinki Area 2016–2020 How to work with customizing a shared EMR for different specialties? How to organize the work getting clinicians in front ? How was the experience so far with EPIC ? Helsinki and Uusimaa Hospital District Apotti area covers • 30 hospitals, including University hospital group (Helsinki University Hospital) • 40 public health stations • 50 social service offices • 1,6 million citizens Denmark: The Health Platform • Two regions – 2.5 million citizens • 12 hospitals • 44,000 employees in the region will be using the system • 46 municipalities can (at least in part) be linked up to the system • 400 persons involved in the project organisation • No social or home care included Eastern Denmark Background: Social and Healthcare in Finland • Healthcare and social care services • Healthcare expenditure: 20 billion a year (9.5 % of GNP) • Private healthcare service providers’ combined turnover: 3.5 billion a year • Social care expenditure: 66 billion (32 % of GNP) • Proportion of social care expenditure related to old age: 38 % • Role of private sector providers is set to increase • Challenges • Aging population • Chronic diseases • Almost 100 % Electronic Medical Record coverage Epic Systems’ EHR software, the core of Apotti, is in use in some of the world’s top-ranking health care establishments • Over 3 million users • Over 45 million client portal users • Over 360 organizations, including Kaiser Permanente, Mayo Clinic, Johns Hopkins • The best content is incorporated into the Epic system and shared and updated with the system to all users → The best practices in the world can be easily adopted Key facts about Apotti Programme Apotti’s main objective is to establish one regionally integrated client and patient IT-system for social and health care Apotti reforms Social and Health Care: Medication Process before Apotti = Information does not move, need for double documentation Effica Social services (nursing home) Effica Health center Pegasos GE Clinisoft Pegasos Uranus Uranus Emergency Lab WebLab Radu Agfa Pacs X-ray GE CA Anesthesia Operating room GE Opera Intensive care GE Clinisoft Inpatient ward Uranus Medication after Apotti go-live Medication check point Changing color in the line describe that the medication is changed. Social admin Health center HUHD ED HusLab HUHD General Imaging Anesthesia Operating room Intensive care Bedded unit The Scope • Specialized Care, Primary Care, Oral Health Care • Elderly Care, Home Care and other Social Care Services • Most of the Epic applications – clinical and administrative • A lot of Finland specific functionality developed by Epic according to the agreement • Integration to national health archive KANTA and Prescription Center • Finland specific coding and reporting • Integrations to around 60 other systems • My Chart client portal Key Facts about Apotti May 2012: Program starts as a common project owned by Uusimaa Hospital Area and 5 municipalities Fall 2013 to fall 2015: Procurement and product evaluation period • Over 600 social, health and ICT professionals take part in the procurement process March 2016: 65 Apotti Associates (Physicians, Nurses and Social workers) start their work April 2016: Contract between Apotti and Epic signed • Value 384 million euros over 10 years August 2016: Implementation begins September 2016: Contract for infra services signed with Fujitsu November 2018: First parts of system go live Latest news: • Over 400 employees working within the Apotti Company • Apotti associated professional network consists of over 500 professionals • Total number of end users is about 40 000 Implementation time lines 2018 2019 2020 November May November January May October HUS PEIJAS VANTAA: VANTAA: HUS: HUS: HELSINKI most of oral healthcare, Hyvinkää, Meilahti hospitals, KIRKKONUMMI 2 000 users healthcare, substance abuse Lohja, Porvoo, Skin and Allergy KAUNIAINEN family services services, Jorvi, Raasepori, Hospital, TUUSULA and services for services for the Gynaecology Töölö Hospital, KERAVA the elderly disabled, and obstetrics, Surgical Hospital, employment HUH Psychiatry HUS units of the 15 000 users 2300 users services Malmi, Laakso, Aurora and family law 9 400 users and Herttoniemi matters hospitals, HUS Medical Imaging 700 users 12 500–15 000 users ONGOING SERVICE / PRODUCTION / FURTHER DEVELOPMENT Areas of operational change Structured Guiding workflows Utilisation of Electronic Harmonized documentation →Client and patient knowledge services practices safety How to organize the work getting clinicians in front ? What did the clinicians do in Apotti? • Workflows: How do clinicians work in Finland? • Content: How can we help clinicians do their work more safely and effeciently? What kind of order sets, note templates and reports do they need? • Training material and acutal training • Testing • Integrations: Where in the workflow do the clinicians need the data from different intergrated systems? • COMMUNICATION • OPERATIONAL READINESS How are clinicians involved? 650 Subject Matter Experts Line of business Experts of different disciplines management in organisations 65 Apotti Associates = Nurses, Physicians & Social Workers working at Apotti Ltd. Decisions on the Regular meetings with workflows and contents Broad understanding of the the leaders of their of the system workflows and strategies in their departments respective departments Team around a Each Apotti Associate belongs to an system application application team How did Apotti involve Clinicians? Epic has a standard way of doing it: Direction / Review, Build, and Approve workflows Adoption Review, Build, and Approve “common” Core content for all specialties ACDC Review, Build, and Approve content needed (Apotti Content Design for different specialties Conferences) Problems in Denmark and in Finland ”The most important decisions are done when you know the least about how the system works” ”We did not understand what we were deciding...” FOUNDATION – CORE – CONTENT BUILD ACDC (Foundation) Apotti-Core- Apartments After ACDC Workgroups 15 ACDC GROUPS 1 Anesthesia 13 specialties group 2 Abdominal Care Primary care 3 Cardiac/Pulmonology Social care 4 Emergency 5 Head and Neck Centre 6 Inflammation 7 Intensive Care 8 Internal Medicine & Extended Care 9 Obgyn 10 Oncology 11 Orthopedics 12 Pediatrics 13 Primary Care 14 Psychiatry 15 Social Care Abdominal Care service line in HUH ONE ACDC-GROUP Endocrinology and Parenchymal Diseases CAN HAVE MULTIPLE Hepatic and Transplantation Surgery SPECIALTIES Nephrology Gastroenterology Gastrointestinal Surgery Urology Vascular Surgery Vantaan Go Live (11.5.2019) timeline 16.4. 28.3. 27.4. Go Live dress Cutover New Epic rehearsal training version 11.5. at 04:00 12.4. 25.4. Apotti GO Live in Vantaa 1.4. Cutover 23.4. Cutover Primary Care and Social Care GLRA 1 training GLRA 2Kick Off March April May June 4.–11.5. 11.3.–3.5. Health Care End user training Pre Go Live 29.4.–11.5. 12.3.–11.4. Soc Care Pre Go Live Super user training 25.3.–24.5. Data conversion 20.3.–7.5. 8.–11.5. 11.5. → GL2 Log-in labs Cutover Intermediate workflows 1.4.–30.4. Manual conversion training and Kick offs 28.3.–5.4. Building of 8.4.–16.6. schedules for Manual conversions end users 8.4.–6.5. 6.–31.5. 1.–19.6. Support models in place Hyper care (extensive support) Support continues 25.3.–19.6. Go Live organization in place and working How was the experience so far with EPIC ? How did we succeed? Greatest challenges during the build period • Epic is used to working in silos/applications, but health care is an integrated process • Medication goes from outpatient to inpatient to home care etc • Scheduling, coding, billing and reporting is part of every process and cannot be separated from clinical work • Epic is very configurable –sometimes even too configurable… • US Health Care workflows are not the same as Finland workflows • Terminology and translation is hard and ”wrong” or ”new” terms can cause problems • Focus on core workflows and do optimization after clinicians know what they need Greatest challenges today (6 months after Go Live1) Medication: Patient transfer: • Difficulties with integrations and workflows • New and complicated workflows with the national Prescription Center, both when the patient is moving between technical issues and slow workflows different levels of care (ED to ward, • Unsatisfactory configuration due to lack of ward to operation theatre etc) time and lack of co-operation between • Apotti should have followed Epic`s different teams inside Apotti guiding on how to support change • Easy to customize -> 76 different views and management, but did not because of lists in different parts of the system lack of resources and time • Inpatient and outpatient medication lists do • Insufficient end user training with not communicate as clinicians are used to incomplete system • A lot of improvement still needed Greatest challenges today (6 months after Go Live1) InBasket: Code capture: • Professionals were not used to checking results through “email-like” InBasket. • Registering administrative codes for • Technical issues with results routing billing, databases and more takes a • Not enough change management before Go Live lot of clicks • Inadequate end-user training → No clear understanding of the overall effect to daily work • Codes for are missing and end up in error work queues Ordering: • Code capturing needs to be intuitive • Computerized Physician Order Entry (CPOE) – and easy good or bad? • Epic Order Sets, Note templates and Favourites • Hard stops? utilization is not on satisfactory level • Personalization not on satisfactory level • Secretary workflows are unclear • Who does what? Valley of death Wrap up • Change management • Strong local clinical leadership • Ability to make fast decisions and document them • A certain level of detailed knowledge about the system is necessary .
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