A physical therapist, Nowak said she was working on an MBA when SSM launched Project Beacon and she got involved. She was trained as a product specialist for the EHR, developed by Epic Systems Corp., but last fall was promoted to be the onsite project manager of the EHR installation at St. Joseph Hospital West. One of Nowaks duties was to oversee training more than 600 hospital employees from St. Joseph both at the Lake St. Louis hospital and at a sister facility in Kirkwood, Mo.
Nowak stood up, walked over for a second to a bank of mark-and-wipe boards covering one wall and quickly came back to her table. Wed met yesterday, but Nowak had been seated at a table in the surgeons conference room and what wasnt noticeable then was obvious now. She was standing, now, and a baby bump protruded noticeably between the sides of her red vest. She was in her eighth month, Nowak volunteered.
So, Youll be delivering two babies soon, I said. She laughed. Nowak said shed been at the hospital since 9 a.m., the seriousness returning to her face.
Hows it going? I asked.
Well make it work, she said.
Hine was standing nearby. I commented on the obviousthe room was almost fulladding that I had no idea it took so many people to get a system like this up and running. Hine said some of the folks were there, helping out from 332-bed St. Marys Hospital in Madison, Wis., which would have its own EHR go-live in May. If we were just bringing up this hospital, this would be overkill, Hine said.
The nice thing about Epic is its fully integrated and configurable, Hine said. And thats the challenge with Epic; its almost universally configurable.
Hine said he came to SSM after working as a consultant with other products as well as Epic. In his experience, he said, oftentimes IT failures are blamed on the vendors by leaders who want to scapegoat their own or their organizations shortcomings. Dealing with configuration, it forces you to bring up processes that might be broken and were just buried. It forces you to bring them back up, and if its a dysfunctional organization, then it is difficult to deal with, he said.
I asked, Have there been any configuration issues at St. Joseph Hospital West that have presented problems like that?
I know they have gone back and forth on how to document patient histories, Hine said. There is a nurse part of it and a doctor part of it. Now you have shared tools. I know they had to deal with that.
Hine also talked about the obvious differences in ages of the people in the room. He said, having worked with Epic before, he felt obliged to warn his SSM colleagues that the software vendor would field a young crew at installations, but that they shouldnt worry. Theyd be capable. Hine said its easy to tell without knowing who the Epic installers in the room were and who the hospital system workers were. The ones with gray hair, he said, were with SSM.
Epics Dan Sullivan, who could pass for a youth group leader at a church camp, is the implementation manager for Project Beacon at SSM. Sullivan said he has been with Epic for nine years. The opening to needle was irresistible.
How old were you when you started? Twelve? I asked.
Sullivan, who said hed been heavily involved in six to eight previous installations, had heard it before.
Im over 30 now, so my baby face is starting to become an advantage, Sullivan said. I think the most interesting dynamic is seeing the culture of the organization accept and embrace the implementation because its really different than changing technology. Its embracing a different way of taking care of patients.
Sullivan explained that the EHRs will be working off regional databases and regional versions of the software, what he called instances.
We have an instance in St. Louis, and there is an instance in Wisconsin, he said. In St. Louis, all six hospitals will be logging into an instance of the application. In Wisconsin, there they will have Madison and (77-bed St. Clare Hospital in) Baraboo and the Dean physician organization. (The Dean Health System, an integrated delivery system, is affiliated with St. Marys Hospital in Madison. SSM has a minority ownership interest in Dean and has several joint ventures with the largely physician-owned organization.)
I spotted Pat Komoroski, president of St. Joseph Hospital West, in the war room about a half-hour before midnight. Komoroski came to St. Joseph in 2000 as chief operating officer and was promoted to president in 2005. Earlier that evening, shed been to a ball hosted by a group of local mayors. Most of the preceding week, Komoroski had been in Baraboo as part of an executive exchange with Sandy Anderson, president of St. Clare Hospital.
Shes going live (with an EHR) in October, Komoroski said. I was very anxious to get back. I didnt want to miss the go-live.
If there were any doubts in Komoroskis mind about the looming conversion to an EHR, it didnt show. She was bubbling and lavished praise on the install team. She singled out physicians Richard Vaughn, vice president of medical affairs at SSM; Michael Handler, medical director and chief medical officer at St. Joseph; and James Hinrichs, the hospitals medical director for infectious disease control, for leading the medical staff.
I think its so important to have a physician-champion, she said. To get physicians to go through 8½ hours of training, they really stepped up.
Someone handed me a 16-ounce plastic cup with about an inch of white sparkling grape juice in it as everyone turned toward a backward countdown clock that earlier in the evening had been moved into the war room from the hospital cafeteria where it had been placed initially eight months ago.
The chanting of the numbers began at 13. Cheers started after one, and everyone held up their cups for a toast. There were a few short speeches, some awards were handed out to project leaders and then, not much else happened. Many people went back to their computer screens to monitor the systems activities.
Komoroski introduced me to Hinrichs, who volunteered to take me on a tour of the wards to see firsthand how the system performed in production mode.
As a champion of the EHR project, Hinrichs said everyone was upfront with physicians that the system probably would slow them down initially but, in time, their workflow would get faster.
We really tried to emphasize patient safety and the reduction in mistakes, Hinrichs said. The goal was to have 270 physicians trained on the EHR system and about 200 had completed training at go-live. Hinrichs conceded that asking physicians to give up 8½ hours of their time without compensation to take computer training is a big bite.
We are giving continuing medical education," he said. Its a little bit of a carrot. Thats about all we have.
One guy said he wasnt going to do it; he (said he) was going to resign in August, Hinrichs said. A couple of people said they would admit fewer patients (but) they came around. So, all told so far, we lost one of the 270.
We met Sara Polston, a nurse working the 7 p.m. to 7 a.m. shift on a combined medical ward with oncology and surgical overflow. Thirty-four patients were on the ward. Polston said she was caring for five of them. She had checked to make sure all of her patients were on the EHR and got all my flow sheets and documentation Im going to be using she said. Now, Im going through my (e)MAR. There was one discrepancy on a medication that was on hold.
Learning the new system, was kind of a shocka lot to take inbut now weve had all the training putting it with real, live patients, it kind of makes sense, she said. I think once I get used to it, it will be easier. Im still kind of slow.
Debbie Hoffman is the clinical director of the medical unit where Polston works. A superuser, she underwent about 45 hours of training, but the hard part for Hoffman with the EHR project wasnt learning the software. For me, it was staffing, having enough nurses on the floor and getting them to classes, Hoffman said. I have 63 employees under me. To get them all trained and get them on the floor, thats probably my biggest challenge.
I think once we have it up and running, say a month down the road, it will save time, Hoffman said. When you bring people up from the ER, we wont have to question patients over and over. The information will be right there. Bar coding, thats a new change. Thats a whole new process for us. We have (bar code) scanners in every room. That (information) flows right to it.
Hoffman said shes not worried about concerns that the system will reduce physician/nurse communications, because when physicians come on the floor, nurses habitually update them on their patients. Its going to be when the doctor writes an order at the office or at home, the nurse is going to have to rely on their computers to see when a new order comes in, Hoffman said. There is a flag that tells you there is a new order.
Leaving the ward, I spotted a man in a red vest writing up an error report for the go-live. It was for a PC malfunction. If you only have one computer on the floor that doesnt turn on, you have to say thats pretty good, the technician said.
On Sunday afternoon, Nowak ran a meeting, updating about a dozen leaders of the install team on progress and problems so far.
We did experience some challenges, not with respect to Epic, but with respect to normal patient flows, and the nurses getting acquainted with how to practice in a new environment, Nowak said.
Two physicians came on rounding this morning, Vaughn said. "They were very comfortable using the chart and were able to document on their patients. But they werent frequent admitters, Vaughn said, so they missed getting their logins in advance, which caused some delay in getting them onto the system.
Vaughn also mentioned problems with getting the correct home medications of some patients discharged that morning.
Nowak said shed received a report from the emergency department, which they started using a different physician order-entry system at go-live.
They were having some difficulty finding the appropriate medication orders with the appropriate frequencies as default settings, Nowak said.
Vaughn explained the emergency department, the only part of the hospital to go live with CPOE, ended up with the standard order sets designed for ambulatory care. The emergency department physicians, he said, were understandably uncomfortable.
But Vaughn said, for the most part, physicians took the change in stride and are considering moving up the scheduled April 27 go-live date for CPOE for the rest of the hospital.
Hinrichs predicted the doctors will soon want to customize the system for their notes.
I left St. Joseph Hospital West Sunday afternoon with the impression that, despite the inevitable glitches, the first go-live of an EHR of Project Beacon at SSM was a success.
Brian Piper, communications specialist for SSM, reported in an e-mail that from midnight Sunday through 7 p.m. Mondaythe first 43 hours of the go-livethe support center received 507 calls from users, an average of about a little more than 11 per hour. Meanwhile, four SSM St. Charles Clinic Medical Group physician offices in communities near Lake St. Louis have started using the ambulatory-care version of the EHR.
The goal, Piper said, was to have 110 physicians in 15 SSM office practices using the system by year-end and five hospitals, two in Wisconsin and three in the St. Louis area, would be up and running as well.
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