7 Phases for Successful Epic Beaker Project Planning

7 Phases for Successful Epic Beaker Project Planning

Spring has arrived and for many laboratories that means planning is underway for new LIS projects. If a roll out of a new LIS system is something your team is tackling, here is an outline of 7 project phases our Beaker certified staff of licensed Medical Technologists (MT) believe to be critical parts of a successful plan.  Following all the steps and phases will help you achieve your goal, ensure the needs of your lab are met, and ensure patient safety.

1: Planning – Application Coordinator and Application Manager have onsite visit from Epic team to evaluate the lab department.

Key points: Make sure all software and technical aspects of the lab are included:  Blood Bank, Anatomic Pathology, Laboratory Automation System, and Analyzer Instruments.

2: Installation – Shell System is installed as a Basic Foundation System including build of all lab tests.

Key point: Your lab team can provide a complete list of all order codes and tests available, including all reference lab tests.  This will help you to avoid delays and manually needing to build them later on.

3: Validation – Usually a 3 month time period consisting of site visits to go through lab workflow and determine customization requirements.

Key point:  Ensure Subject Matter Experts (SME) from each department are included for decision making. 

ü  Clerical/Billing

ü  Chemistry

ü  Specimen Processing

ü  Hematology

ü  Microbiology

ü  Blood Bank

ü  Urinalysis

ü  Pathology

 4: BuildBeaker Build occurs in a 3-4 month period concurrent with all other system builds.

Key Point: Many detailed build items occur during this phase.  Some items will be completed by IT personnel and other by laboratory assigned resources.  Experience and clinical knowledge are critical at this step.  Include your Beaker Certified MT or MLT in all aspects of the build, their clinical knowledge is invaluable to completing a full lab build and have it done right prior to the MRT testing period. 

·   Order Codes and Test Codes – Only the initial build is done via export/import functionality so be sure to assign each department SME their section to validate.

§  Facility Structure Build – The full lab and department outline will be detailed here. Include your specimen routing logic, auto cancel rule, and worklists for bench development.

§  Instruments – All analyzer setup occurs here and mapping may be completed by an IT resource, but a MT or MLT should review and sign-off on all data.  Laboratory staff should determine if processing rules will be written in the middleware selected or built in the application.

§  QC Build – A Unity Real Time external product or Beaker internal QC functions can be used for this build, but a department SME should work to develop the scheduled QC runs and alerts within system.

§  Security Build (outside Epic Beaker Module) –Having a certified resource assigned to build all lab users, allows control as to which lab facilities your end users will have access to.

§  Charge Build (outside Epic Beaker Module) – Laboratory build of CPT per order code or result code. Be sure to include a billing specialist to complete this build.  (BCS has developed a detailed billing testing plan that can be incorporated in your system validation to monitor accuracy.)

§  Patient Reports & Labels – Extra time and attention should be dedicated to make sure all CLIA and CAP reporting features are included for proper specimen or patient identification prior to reporting. 

§  Reference Lab Interface – Completed primarily by using translation tables which may be managed by the IT department. Again, include your specimen processing specialist for review and sign off of actual naming mapping and specimen mapping.

§  Custom Management Report Writing – This can be a very technical skill but laboratory personal need to provide the guidance on what they need to capture. 

§  Outreach EMR Interfaces – All outreach systems need to be validated against the new LIS Order and Test build to ensure translation tables are built with the new codes.

5: Testing (Mapped Record Testing) – Internal MRT process within Beaker. Each Order code is ordered and downloaded to the analyzers. Review results returned to ensure each posts to the representative result code. Include MRT to Reference Lab interface and EMR Interfaces.

Key Point:  MRT testing does not cover all CAP mandated checks to ensure laboratory results are complete and compliant.   Work with your project manager to add extra steps in your project plan that check for the following CAP regulations:

ü  Patient Name & Unique Identifier

ü  Name & Address of Testing Lab

ü  Name of Test Performed

ü  Test Report Date

ü  Physician of Record or Ordering Person

ü  Test Results Including Units & Interpretation (if applicable)

*If applicable/appropriate: Specimen Source, Specimen Comments, Date/Time of Specimen Collection, Time of Release of Report, Reference Ranges

6: Training – Workflows are developed by the Instructional Designer to train internal staff.

Key Point:  Include audit tracking to ensure all staff completes training and are signed off as compliant. Strong SOPs will help ensure processes are followed, and new personnel are trained properly.

7: Data Conversion – At this point, your old LIS is able to be exported and imported to Beaker for reference.  There is no limit to the amount of data that can be imported.

Key Point:  Have MT involved in linking each test/result from the old system to the new Beaker code.

After completing these 7 project phases, it’s time to take a deep breath and realize that your lab has gone live with Epic. Congratulations!  Our team has worked through these phases numerous times with Epic and Beaker, as well as with Epic and other Laboratory Systems, having seen firsthand how good planning and qualified resources can impact not only the build, but reduce the risk of retests and lost revenue. Carefully executing these 7 phases will help your new system work for your lab and your patients. Please call us for more information or help with any part of your project.  We’d love to help!

(480) 346-7011   www.bcsolutionsrfn.com

Addressing EHR Rollout Problems

EHR rolloutsTo say that there are certain people in the medical industry that are resistant to change, especially when it comes to technology, may be an understatement. But with new regulations and rules coming our way, many hospitals, doctors offices, and providers have been forced to upgrade and embrace new technology or pay the penalty. In addition to avoiding penalties, there are also cash incentives available to practices that upgrade to and meaningfully use electronic health records (EHRs). But are these incentives actually causing problems with EHR rollouts?

Let’s take, for example, a recent case that occurred at the Athens Regional Health System in Georgia in which the CEO resigned after an aggressive and rushed EHR rollout. Staff and clinician’s basically came to a ‘no confidence’ vote for the CEO after the rollout created medication errors, scheduling problems, misplaced orders, and general disorganization. Management then turned and placed the blame squarely on the their own IT department for not following proper decision making channels.

In another example, a Maine Medical Center is claiming their EHR rollout is partially to blame for a $13.4 million operating loss. Nurses cited a lack of training and stated they were unaware that they were responsible for charging patients for procedures and that they weren’t even trained on how to charge with the new system. Therefore the blame was on the company that installed the system, according to the medical center.

So as in any instance where things go wrong the question is always, who’s to blame? Is it the CEO who aggressively tries to implement new procedures trying to take advantage of cash incentives? Is it the staff that are resistant to change and fail to apply themselves during training? Is it the IT company that installs the system and is responsible for training team leaders and employees on how to use the new system?

In a large amount of these cases, the blame seems to go in a circle. The staff blames management, management blames IT, IT blames the staff. In the end, everyone is affected from the hospital or medical center losing money down to the patients who don’t receive the proper care.

But if we step back and look at the big picture, the truth is that everyone is partially to blame and everyone is responsible for righting the ship. Technology rollouts are not something anyone should take lightly and preparation is key to make sure everything goes smoothly. All the decision channels should be determined before an IT company even starts to implement changes.

While we have highlighted some of the problems with EHR rollouts, there have certainly been a number of success stories. Many providers have successfully implemented new systems and are benefiting from quicker access to patient data, easier methods of sharing information, and better ways to track costs and bill patients.

Delays in new regulations are giving providers more time to make changes and providers would be wise to take advantage of the extra time. Additional training for employees and better testing of systems before they are set in place can help insure a smooth EHR rollout and ultimately help provide better care for patients.

Understanding Meaningful Use

For those outside the health care industry, you may not be familiar with the term ‘meaningful use’ in conjunction with health care. According to www.cms.gov, “Meaningful Use is a a set of criteria for the use of EHR (Electronic Health Record) systems to improve patient care by health care providers”. The end goals of meaningful use include improved population health, coordination of care, improved safety, and patient engagement. In an effort to motivate providers to implement meaningful use, incentives were established by the HITECH (Health Information Technology for Economic and Clinical Health) Act for adopting Meaningful Use criteria starting in 2012, with the possibility of penalties for failure to achieve the standards by 2015.

So, in more basic terms, in order to receive incentives and avoid penalties, provider must prove they are “meaningfully using” their EHR technology by meeting certain thresholds established by the Centers for Medicare and Medicade Services (CMS).

But meeting this criteria is no easy task. The program includes three stages providers must complete in order to receive their incentives, each with increasing requirements. To begin, providers have to meet requirements for a 90-day period in their first year, then meet Stage 1 requirements for the full second year. Starting in 2014, they can move on to Stage 2 requirements which must be met for two full years. Stage 3 will start in 2016. Whether you participate for a fiscal or calendar year depends on the type of provider you are.

While the participation is challenging, the rewards are significant. As of Feb. 2014, CMS says it has distributed more than $19 billion dollars in reimbursement incentives. Over 440,000 providers are participating with approximately %88 receiving incentive payments.

The program is on track to achieving its goals, according to recent surveys. There has been significant increase in the use of EHR systems by office-based physicians, with nearly 80% of offices using some sort of EHR system in 2013 according to a National Ambulatory Medical Care Survey. But most importantly, over 78% of respondents said that EHRs “overall, enhanced patient care” was a clinical benefit to increased use EHR systems.

For more information on the requirements of the meaningful use program, we encourage you to visit http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Meaningful_Use.html.

Will EHRs Curb Demand for Physicians?

Technological advances have had obvious impact on many industries, and the health care industry is no exception. But recently researchers have begun speculating that the implementation of EHRs (electronic health records) and other digital tools is going to greatly influence the way health care is delivered and possibly decrease the need for office visits and physicians in general, according to a recent article at http://www.healthcareitnews.com/.

Consumers have been using the internet and smart phones to manage their health for some time now. But now that more than 70 percent of office-based physicians are making use of electronic health records, offices are becoming much more efficient and allowing doctors to increase their patient base by an estimated four to nine percent. Obviously this is going to affect the demand for more physicians.

Other IT aspects, such as ‘e-referrals’, tele-medicine, and secure remote doctor/patient digital communication, could further reduce the need for physicians, and give greater roles to nurse practitioners and physician assistants.

The study suggests that effects of advancing health care IT will be profound and far-reaching, and that it is likely that the most interaction between the patient and doctors office will be digitally communicated. While some may see this as distressing, it’s more than likely going to help with predicted future doctor shortages, as long both doctors and patients are willing to adopt comprehensive e-health and IT more widely.

If you have questions about your practice’s health care IT system, please contact BC Solutions. We offer consultative services to insure your EHRs and EMRs are consistent, communicative, and compliant.