Columbia University Medical Center

EpicTogether Direction Sessions Q&A With Dr. Rachel Lewis

We sat down with Rachel Lewis, MD, FAAP, associate chief medical informatics officer of ColumbiaDoctors, to talk about Direction sessions, the latest stage of the EpicTogether project that will give project stakeholders their very first look at future workflows for the enterprise. Dr. Lewis is an assistant professor of pediatrics at CUMC, and in addition to daily patient care activities, she has dedicated the last decade to optimizing EHR adoption and utilization.

What’s happening now on the EpicTogether project?

Our efforts are now focused on conducting a series of Direction sessions, which begin in June. They’re intended to help us address issues that are at a higher level of complexity with the goal to directly improve the difficult situations we face as clinicians. We are also gathering detailed information from a wide variety of clinical specialties to start designing specific content for each area.  Epic’s team understands that big medical centers like ours do really complicated things — like multidisciplinary visits that involve a patient meeting six doctors and nurses and do several tests in one day. Making a day like that happen has a lot of moving parts, and when we are dealing with doctors who don’t work in the same subspecialty, it can be hard to pull together.

What will be happening at Direction sessions?

Team members from around Columbia, Weill Cornell Medicine (WCM), and NewYork-Presbyterian (NYP) have been hand selected to represent their areas of specialty. These team members are called SMEs, short for subject matter experts. Earlier this year, the SMEs filled out groundwork questionnaires. All of that data was read in detail, and is being layered on top of the Epic Foundation System as well as the Epic system already in place at WCM to develop comprehensive workflows that will become part of our joint iteration of Epic. The workflows our SMEs will be seeing will take into consideration all of this work and data.

At the sessions, the team from Epic will demonstrate each workflow and ask SMEs, “here is the way we propose to handle this workflow or trouble spot, what do you think?” The SMEs’ feedback will be coming from people with all different sorts of expertise, from the schedulers, front desk staff, billers, advanced practice providers, and physicians from each specialty. Their job is to say yes or no, and then each decision is recorded. This is going to be a highly organized process, and it will be an incredibly valuable use of our SME’s time.

Does this mean that the next iteration of workflows will be final?

No. I want to emphasize that this is not our only chance to get it right — this is an opportunity for Epic to leverage everything they have learned about us, and to take all of the learning that has been put into building the Epic Foundation System, as well as the system at WCM. All of this is intended to help us build a system that benefits all of us and will help us to deal with the messy parts of our current EMR. We will have multiple opportunities to review the workflows before they are finalized, but this is our first opportunity to get the kinks out of the system.

In your role as associate CMIO, how are you working with your counterparts at NYP and WCM?

I came on board as assistant CMIO in January, so I was very involved in the groundwork process. It’s been really great — I didn’t anticipate how well-integrated a process it was going to be. In general, doctors from different hospitals don’t always talk to each other very much, and medical schools and hospitals don’t always talk to each other very well, but this has been really different. We’re talking on WebEx meetings, meeting in person, and on emails with people from Columbia, WCM, and NYP. This is my 19th year at Columbia, and I have talked to more doctors outside Columbia proper in the last five months than I have in the entire time I have been here. It’s very cool.

This project is really helping to break down silos, because collaboration breeds more collaboration, not just on the physical level. It’s a type of integration we’ve never seen before and it bodes well for patients who will be coming to see us in the future. We’re seeing a group effort among office managers, finance staff, billing coders, floor managers, nurses, all of whom work in their own areas and wouldn’t ordinarily have reason to speak to one another. This has never existed before — surgeons from different schools and campuses are going to meetings together because of Epic and now they’re talking to each other — it’s unprecedented. What I didn’t see coming in all of this is the extraordinary level of cooperation. This is going to make medical care in New York better. All of us are going to do better work on every level.

What concerns are you hearing from our doctors at Columbia?

Well, doctors don’t always like change. I’ve heard some say “Now you are asking us to change, even though we finally got it right,” with CROWN, and they are concerned that their unique workflows and designs will not be captured by the new system. I just spent a few days at Epic, and this system is more flexible and adaptable. It puts more power at an individual physician and administrator level.  You can change what you see in Epic more so than you can in CROWN. The Epic system will look more like what users see in web-based systems that they use in the rest of their lives.

I don’t want to sugarcoat this: It will require a little homework, and users will have to learn a new system, and there’s no getting around that. There will be a learning curve, and it’s still an electronic medical record, but it will be much more nimble than what we now use. Once you get through the training and the pain that comes with that, there is more horsepower in Epic. The coolest thing I saw was that Epic allows a custom dashboard at any level of the organization, so you can evaluate performance at the provider level, month over month — operating times, length of stays — you don’t have to ask for a report, it’s there in realtime. The training I had showed me how to personalize Epic, so my confidence in being able to make it look the way I want it to is pretty high.

How is the tripartite CMIO group working to address doctors’ concerns?

There are many frustrations that clinicians have with our current EMR situation, but training and support are key concerns. We are looking ahead to training to make it really efficient and to provide the necessary support, before go-live, during and afterward. The team will offer a wide variety of training options, with very brief four-hour training sessions, personalization labs, and an Epic playground so users can go play online and make Epic more customized. During the go-live there will be plenty of on-the-ground staff, and Epic has gone live with organizations of tens of thousands, so they have the machinery in place to make this happen. They know how many of us there are.

In addition, there will be many types of trainers, both specialty-specific and general use. We will also offer at-elbow help during and after go-live, and we have something now that we did not have for the CROWN implementation — a big EpicTogether infrastructure — so people who are doing that work for us now belong here and they are not leaving. Our own people are being trained now so our analysts and IT support will be more robust. We are preparing ourselves better.