PAGE 1

On the Same Page An Epic Newsletter May 26, 2011 So said Dawn Grinenko, M D assistant professor of m edicine and d irector of the hospitalist service at Shands at UF, upon admitting what turned out to be the first Shands patient using the Epic electronic medical record system. Epic went live at the Shands at UF, Shands Vista and Shands Rehab hospitals at 7 :20 a.m. on May 14. (At Shands Jacksonville, Epic will go live in September .) Job 1 for UF&Shands is to ensure safe, high quality care for our patients. The very first action item in the quality component of our strategic planning process was the decision to imple ment an electronic medical record, or EMR, across ambulatory and hospi tal care, and across our Gainesville and Jacksonville campuses The decision to proceed a $100 million commitment over five years was approved by the Shands Board in Gainesville and Jacksonville in September 2009; Epic was chosen as the vendor in Novem ber 2009; Kari Cassel was recruited as the UF&Shands CIO in December 2 009 ; and the inpatient Epic installation began in January 2010. Now, after an extraordinary effort touching virtually every clinical faculty member, resident, student and staff member, and working at lightning speed by th e standards of most EMR installations, inpatient Epic has been successfully launched. Some of us remember a time before the World Wide Web. Before personal computers, laptops, cell phones and iPads. Before word processi ng and electronic spreadsheets. Before Google, Facebook and Twitter. Before PubMed, WebMD and UpToDate. Before cally in our times to the Industrial Revolution before us. But where has this technology been in our health care system? Up until a few years ago, the average supermarket with bar coding, supply chain management and store cards that tracked your purchas es offices and hospitals, where you had to write out the same demographic, insurance and journey that begins with the electronic recording of health information but leads to higher quality care, better health outcomes, improved education and training, and improved knowledge about care processes and outcomes that, in turn, leads to further enhancements of disease preve ntion, diagnosis and treatment.

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Part of our early success with inpatient Epic on the Gainesville campus is a consequence of the lessons already learned in implementing Epic at our ambulatory faculty practice sites. (In Jacksonville, the faculty practice had previously implemented an electronic medical record, which will transition to Epic in 2012.) By the time May 14 th rolled around, Epic had already been i mplemented at more than 26 UF Physicians practice sites and at Shands HomeCare, with more than 2,000 active users. In addition, almost all UFP providers have begun electronic prescribing, and the Epic MyChart patient portal pilot has successfully linked al most 1,500 patients to the practice in a secure online format, where they communicate with the practice team, request appointments and receive test and X ray results from their physicians. So, when the go live date for inpatient Epic arr ived, attendings an d resident physicians were already facile with navigating Epic and entering data in the EMR, allowing the team to focus training on those aspects of Epic that differe d between the outpatient and inpatient environment s That said, on the first morning there were still some snags to be resolved around device connectivity (e.g., the ability to see imaging studies or fetal monitoring str ips online ) and order entry (which worked for attendings b ut not for residents). M any issu es have arisen large and small: O n the first day, there were more than 9 00 calls to the "command center" for help. With greater experience, the number of calls has waned, but we want to encourage more inquiries, pushing us to create the best system possible for our pat ients. Indeed, a wonderful thing has transpired ov er the past week. In each department, there has been a buzz of activity around the nuances of taking care of patients using Epic. There were few regrets about how the system couldn't do certain things, a nd little yearning for paper and pen; rather, there has been small group learning in real time the way the medical educators say it's supposed to happen and email shout outs to others for help with using Epic as applied to specific type s of patients an d circumstances Solutions appear, often due to the ingenuity of another member of the department figuring out how to deal with a similar problem. The solution is communicated, and then goes viral. I'm sure that the above description doesn't fit everyone 's experience, and that I will hear from those with specific problems that have been particularly intractable but the energy and spirit that I have observed from so many, whose clear goal is to figure out ways to make Epic work on behalf of improved patie nt care, is clearly palpable. Epic support s our quality goals in patient care, improves our research capabilities and overall operational performance, and will be embedded in our educational curricula for our students. As stated by Donald Novak, M.D., professor of pediatrics and the physician liaison whose herculean efforts with faculty and staff have contributed greatly to our overall success: term payoff is going to be very big improved patient care, i mproved patient safety and improved access to records for patient care and research T he beauty of this is that what we will achieve in enhancing patient safety will also create tremendous efficiencies for the health care system which will find their way back to the patient. But in the short term, we have just reached the We are focused on getting people comfortable with the

PAGE 3

Veronica Carr, R.N., M.S.N., a nursing information services coordinator, says Epic will improve communications immensely a floor in the hospital, we have to start all over collecting data we get their weights again, we ask them about thei r medications, personal/family health histories and Ms. m sorry, but we h we are finally Instead we will be able to look at the record and be able to talk about their history, name their medicatio ns, confirm whether the patient is still using the medication and ask if they are taking anything new. It demonstrates to the patient that we are informed, and we will be. I think Epic is going to dramatically improve our customer service and improve patie nt Jeremy Archer, M.D., a p ediatric c ardiology f ellow with the Congenital Heart Center, first learned the Epic system while he was a pediatric resident at the University of Vermont He says the challenges of learning a new system gradually give w ay to the realization that it is a valuable tool. outpatient settings is very powerful. I particularly like the ability to create templates which standardize the information that caregivers col lect Dr. Archer says It helps remind you to do everything necessary for a complete an d thorough patient interaction. At first, the several month s people get used to wo rking with it and increasingly appreciate the ben efits. But for the new people entering our health care system, it wi ll be the standard approach. A new group of residents will be c oming in July, and they will be the ones who will t ake to Epic most easily a nd probably wind up as Likewise, Barbara McNamee, M.B.A., a director in the department of surgery, knows from experience the power of an electronic medical record implementations at my previous institution, I was eager to start the process at UF as I culture change our department admittedly had mixed feelings of enthusiasm and tr epidation, but as the opportunities for standardizing patient care, eliminating redundancy and ensuring billing compliance became evident, trepidation waned and enthusiasm increased. Our department is committed to real izing the full potential of Epic and i s aligning resources to ensure continued success in each phase of An important goal for UF&Shands is to improve the university's ability to do science, to make discoveries, to publish results and to translate those results into improved c are and improved health through the Clinical and Translational Science Institute. Epic will also add value to that effort. strides we hope to make in advancing clinical and translational research at U Nelson, M.D., director of the UF CTSI int egrated data

PAGE 4

repository project and universal informed consent for all patients will allow us to harness the collective power of our clinical data to improve the health of our communities. In the future, with more data available, we can more rapidly transform scientific discoveries into Dr. Marvin Dewar has been the architect of the Epic installation in the UF physician practices. He comments: "I t is great to have the continuum of care data available for everyone in one place from initial patient inf ormation collected in the ambulatory visit, to admission information, to discharge information. Having a truly interdisciplinary record where ever y clinician can see what any other clinician has done and not duplicate work or tests is helping us to deliver safer, more effective clinical care." Dr. Juan Vilaro, c hief r esident in Internal Medicine said : I t's going much more smoothly than we had expected. We believe it's better for our patients and it makes us so much more effective as residents. And it's great to finally see emergency, outpatient and inpatient information all in one place! I'm looking forward to being a fellow here a nd making this system work for me." Installation of Epic has been coordinated under the watchful eye of Kari Cassel, UF&Shands CIO. She summarizes it this way: "Going from paper to electronic is one of the largest and most important changes that can occur in a clinical organizat ion. An EMR positions an organization for the future. The systems are far from perfect and today we must adapt our processes to work with the system. Over time, we will adapt the system to our workflow. Our goal is to embed EMR tech nology in our health care delivery and our healt h sciences education curricula so that EMR becomes core to how all of our health care providers deliver care. The EMR will provide us with the tools necessary to improve continuously Soon after Epic went l ive, Epic on the iPad using a fre e Citrix ap p was discovered Presto a fully functional hand held version of Epic! Although a view only version of Epic for the iPad was in the works as a future element of the Epic roll out, news of the fully functional Citrix app spread like wildfire, and hijacked the original plan. Soon, iPads appeared everywhere and the IT team ensured that they were registered and secure. Now, a l l of a patient s health information is in the palm of a hand. William Riffee, Ph.D., d ean of the College of Pharmacy and well known technophile, Forward Together David S. Guzick, M D Ph D Senior Vice President, Health Affairs President, UF&Shands Health System


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On the Same Page


An Epic Newsletter

May 26, 2011


"I just admitted a patient using Epic, and it was beautiful."

So said Dawn Grinenko, M.D., assistant professor of medicine and director of the
hospitalist service at Shands at UF, upon admitting what turned out to be the first Shands
patient using the Epic electronic medical record system.

Epic went live at the Shands at UF, Shands Vista and Shands Rehab hospitals at 7:20
a.m. on May 14. (At Shands Jacksonville, Epic will go live in September.)

Job 1 for UF&Shands is to ensure safe, high-quality care for our patients. The very first
action item in the quality component of our strategic planning process was the decision to
implement an electronic medical record, or EMR, across ambulatory and hospital care,
and across our Gainesville and Jacksonville campuses. The decision to proceed a
$100 million commitment over five years was approved by the Shands Board in
Gainesville and Jacksonville in September 2009; Epic was chosen as the vendor in
November 2009; Kari Cassel was recruited as the UF&Shands CIO in December 2009;
and the inpatient Epic installation began in January 2010.

Now, after an extraordinary effort touching virtually every clinical faculty member,
resident, student and staff member, and working at lightning speed by the standards of
most EMR installations, inpatient Epic has been successfully launched.

Some of us remember a time before the World Wide Web. Before personal computers,
laptops, cell phones and iPads. Before word processing and electronic spreadsheets.
Before Google, Facebook and Twitter. Before PubMed, WebMD and UpToDate. Before
retail shopping, ticket ordering and "research" on just about anything online anytime,
anywhere. It's been an amazing journey, equivalent historically in our times to the
Industrial Revolution before us.

But where has this technology been in our health care system? Up until a few years ago,
the average supermarket with bar coding, supply chain management and store cards
that tracked your purchases had more information technology than most physicians'
offices and hospitals, where you had to write out the same demographic, insurance and
medical history information over and over. Now that's changing; we are embarking on a
journey that begins with the electronic recording of health information but leads to higher-
quality care, better health outcomes, improved education and training, and improved
knowledge about care processes and outcomes that, in turn, leads to further
enhancements of disease prevention, diagnosis and treatment.









Part of our early success with inpatient Epic on the Gainesville campus is a consequence
of the lessons already learned in implementing Epic at our ambulatory faculty practice
sites. (In Jacksonville, the faculty practice had previously implemented an electronic
medical record, which will transition to Epic in 2012.) By the time May 14th rolled around,
Epic had already been implemented at more than 26 UF Physicians practice sites and at
Shands HomeCare, with more than 2,000 active users. In addition, almost all UFP
providers have begun electronic prescribing, and the Epic MyChart patient portal pilot has
successfully linked almost 1,500 patients to the practice in a secure online format, where
they communicate with the practice team, request appointments and receive test and X-
ray results from their physicians. So, when the go-live date for inpatient Epic arrived,
attending and resident physicians were already facile with navigating Epic and entering
data in the EMR, allowing the team to focus training on those aspects of Epic that differed
between the outpatient and inpatient environments.

That said, on the first morning there were still some snags to be resolved around device
connectivity (e.g., the ability to see imaging studies or fetal monitoring strips online) and
order entry (which worked for attending but not for residents). Many issues have arisen,
large and small: On the first day, there were more than 900 calls to the "command
center" for help. With greater experience, the number of calls has waned, but we want to
encourage more inquiries, pushing us to create the best system possible for our patients.

Indeed, a wonderful thing has transpired over the past week. In each department, there
has been a buzz of activity around the nuances of taking care of patients using Epic.
There were few regrets about how the system couldn't do certain things, and little
yearning for paper and pen; rather, there has been small group learning in real time -
the way the medical educators say it's supposed to happen and email shout-outs to
others for help with using Epic as applied to specific types of patients and circumstances.
Solutions appear, often due to the ingenuity of another member of the department
figuring out how to deal with a similar problem. The solution is communicated, and then
goes viral.

I'm sure that the above description doesn't fit everyone's experience, and that I will hear
from those with specific problems that have been particularly intractable, but the energy
and spirit that I have observed from so many, whose clear goal is to figure out ways to
make Epic work on behalf of improved patient care, is clearly palpable.

Epic supports our quality goals in patient care, improves our research capabilities and
overall operational performance, and will be embedded in our educational curricula for
our students. As stated by Donald Novak, M.D., professor of pediatrics and the physician
liaison whose herculean efforts with faculty and staff have contributed greatly to our
overall success: "Everyone realizes the long-term payoff is going to be very big -
improved patient care, improved patient safety and improved access to records for
patient care and research. The beauty of this is that what we will achieve in enhancing
patient safety will also create tremendous efficiencies for the health care system, which
will find their way back to the patient. But in the short-term, we have just reached the
mountain, which is 'Go Live.' We are focused on getting people comfortable with the









system and informing them about what is going to happen next."


Veronica Carr, R.N., M.S.N., a nursing information services coordinator, says Epic will
improve communications immensely. "Today, when a patient comes to the emergency
department, their information doesn't easily move along with them. If they are admitted to
a floor in the hospital, we have to start all over collecting data we get their weights
again, we ask them about their medications, personal/family health histories and
allergies," Ms. Carr says. "With all the areas of the hospital or clinic the patient travels
through, I've heard patients say, 'I've already answered that question six times.' The
clinician must say, 'I am sorry, but we have to ask you again.' With Epic we are finally
going to a place where we don't have to ask patients the same things over and over.
Instead we will be able to look at the record and be able to talk about their history, name
their medications, confirm whether the patient is still using the medication and ask if they
are taking anything new. It demonstrates to the patient that we are informed, and we will
be. I think Epic is going to dramatically improve our customer service and improve patient
safety."

Jeremy Archer, M.D., a pediatric cardiology fellow with the Congenital Heart Center, first
learned the Epic system while he was a pediatric resident at the University of Vermont.
He says the challenges of learning a new system gradually give way to the realization
that it is a valuable tool. "Having all of a patient's data in one system in inpatient and
outpatient settings is very powerful. I particularly like the ability to create templates which
standardize the information that caregivers collect," Dr. Archer says. "It helps remind you
to do everything necessary for a complete and thorough patient interaction. At first, the
system can be challenging, but it's always challenging to learn a new system. After
several months, people get used to working with it and increasingly appreciate the
benefits. But for the new people entering our health-care system, it will be the standard
approach. A new group of residents will be coming in July, and they will be the ones who
will take to Epic most easily and probably wind up as the best at using it."

Likewise, Barbara McNamee, M.B.A., a director in the department of surgery, knows from
experience the power of an electronic medical record. "Having participated in Epic
implementations at my previous institution, I was eager to start the process at UF as I
had seen firsthand the benefits of the program," Ms. McNamee says. "Embarking on this
culture change, our department admittedly had mixed feelings of enthusiasm and
trepidation, but as the opportunities for standardizing patient care, eliminating
redundancy and ensuring billing compliance became evident, trepidation waned and
enthusiasm increased. Our department is committed to realizing the full potential of Epic
and is aligning resources to ensure continued success in each phase of implementation."

An important goal for UF&Shands is to improve the university's ability to do science, to
make discoveries, to publish results and to translate those results into improved care and
improved health through the Clinical and Translational Science Institute. Epic will also
add value to that effort. "The launch of Epic is a precursor to many of the giant strides we
hope to make in advancing clinical and translational research at UF&Shands," said David
Nelson, M.D., director of the UF CTSI. "The combination of EPIC, the integrated data









repository project and universal informed consent for all patients will allow us to harness
the collective power of our clinical data to improve the health of our communities. In the
future, with more data available, we can more rapidly transform scientific discoveries into
medical advances."

Dr. Marvin Dewar has been the architect of the Epic installation in the UF physician
practices. He comments: "It is great to have the continuum of care data available for
everyone in one place from initial patient information collected in the ambulatory visit,
to admission information, to discharge information. Having a truly interdisciplinary record
where every clinician can see what any other clinician has done and not duplicate work or
tests is helping us to deliver safer, more effective clinical care."

Dr. Juan Vilaro, chief resident in Internal Medicine, said: "It's going much more smoothly
than we had expected. We believe it's better for our patients and it makes us so much
more effective as residents. And it's great to finally see emergency, outpatient and
inpatient information all in one place! I'm looking forward to being a fellow here and
making this system work for me."

Installation of Epic has been coordinated under the watchful eye of Kari Cassel,
UF&Shands CIO. She summarizes it this way: "Going from paper to electronic is one of
the largest and most important changes that can occur in a clinical organization. An EMR
positions an organization for the future. The systems are far from perfect and today we
must adapt our processes to work with the system. Over time, we will adapt the system to
our workflow. Our goal is to embed EMR technology in our health care delivery and our
health sciences education curricula so that EMR becomes core to how all of our health
care providers deliver care. The EMR will provide us with the tools necessary to improve
continuously."

Soon after Epic went live, Epic on the iPad using a free Citrix app was discovered.
Presto a fully functional hand-held version of Epic! Although a view-only version of
Epic for the iPad was in the works as a future element of the Epic roll-out, news of the
fully functional Citrix app spread like wildfire, and hijacked the original plan. Soon, iPads
appeared everywhere and the IT team ensured that they were registered and secure.
Now, all of a patient's health information is in the palm of a hand. William Riffee, Ph.D.,
dean of the College of Pharmacy and well-known technophile, put it succinctly: "How cool
is that?"

Forward Together,


David S. Guzick, M.D., Ph.D.
Senior Vice President, Health Affairs
President, UF&Shands Health System




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