Primary care migration to integrated electronic health record standardizes workflow for optimal care

As primary care practices within The Medical Group of Christiana Care migrate to PowerChart over the next several months, they are doing more than simply piloting an integrated electronic health record (EHR) that syncs ambulatory charts with inpatient, emergency and lab notes.

Along with colleagues in cardiology and vascular services who began piloting the improved system from a specialty perspective in December 2016, the primary care group is also helping to standardize workflow for optimal care across the health system.

Christiana Care physicians have documented electronically for several years, yet inpatient and ambulatory records were captured on separate platforms requiring primary care providers and specialists to toggle between records for complete information on their patients.

Now with the global move toward “one patient, one chart,” providers on the hospital side will have ready access to clinical interactions and be better able to understand events leading to a patient’s presentation in the emergency department or inpatient stay. Those on the ambulatory side will be up-to-date about care provided in-house.

“An integrated record helps us achieve mutual goals of reducing readmissions and making sure we have good handoffs of care,” said Sri Donepudi, M.D., MMM, FAAFP, associate chief medical information officer, who has informatics responsibility for the PowerChart ambulatory technology initiative.

Dr. Donepudi said the integration and the collaboration it involves will be a huge benefit for both patients and providers as it lays the foundation to leverage the tools of clinical decision-making for current and future population-health goals.

Innovative thinking, transformational practice

Primary care physician David Driban, M.D., and his team at Christiana Care’s New Castle Family Medicine office led the primary care migration to the integrated PowerChart record in October. The Medical Group’s two New Jersey based practices, the Carney’s Point and Woodstown centers, joined the pilot in November. By the end of 2017, all of Christiana Care’s primary care practices will move to PowerChart. The rest of the health system’s specialty practices will migrate to the integrated record in 2018.

Dr. Driban, who is medical director of informatics for primary care and behavioral health and clinical leader of the Primary Care Council, said the integration puts inpatient and ambulatory providers on the same page and demonstrates Christiana Care’s commitment to innovative thinking, transformational practice and more unified patient care.

Thanks to integrated PowerChart documentation, Dr. Driban said his primary care colleagues will find that notes are generated in real time and completed faster than in Centricity. Primary care providers will also appreciate the easier access to information pertaining to transitions of care, he said, including emergency department and medical aid unit notes, hospital discharge summaries and notes from specialty partners.

“All of the information we need is now forward-facing in our office notes at the time of patient visit,” he said. “If we see a patient who had labs done earlier that same day, the results are already in the chart for our review. It is clearly easier and nicer to have all of the information in one location and no longer have to jump from system to system,” he said.

Leveraging IT to improve workflows in patient care

Changing the way an office performs daily tasks is never without growing pains. Learning a new EHR requires clinical providers and administrative staff to navigate new software and adjust to new reporting processes. It also has the potential to change workflow, subtly or significantly, in ways designed to reduce unnecessary variation among practices to increase quality across the board.

Roger Kerzner, M.D., FACC, a cardiologist whose practice migrated to the integrated EHR last summer, said the heart and vascular pilot helped the rollout team understand the system and improve training, and identified ways to standardize workflow across primary care and specialty practices to increase the ability to improve outcomes.

“This ambulatory PowerChart initiative is more than just an information technology project,” said Dr. Kerzner, who is also associate service line physician leader for Primary Care & Community Medicine, clinical director for specialty services for The Medical Group of Christiana Care and a team leader on the PowerChart ambulatory project. “It’s an opportunity to use Cerner as a process tool to standardize our workflows to reduce unnecessary variability and increase quality. Ultimately it will help us to provide better care because it allows us to know more and do better.

“We knew what questions to ask about workflow because our experience with the heart and vascular specialty rollout allowed us to develop a better product. Now we are seeing the fruits of that work in New Castle, and we are learning even more before the ‘big bang’ of bringing on all primary care practices in December.”

To prepare for the primary care go-live from the clinical side, the New Castle team appropriately altered schedules to allow more time for each patient to avoid backlogs and wait times. Thanks to significant IT support, both onsite and via the command center, the New Castle practice quickly acclimated to the new system and was back to pre-implementation patient volume within a few weeks.

“We have already seen major improvements in some of our workflows,” Dr. Driban said.

Dr. Kerzner said the benefits of the new system will only grow as primary care and more specialty practices are brought online throughout the coming year.

“It’s a better system — a better electronic health record — in terms of population health capabilities and the way data is presented,” said Dr. Kerzner. “As with any change, there will be a bit of pain when practices start using it, but once they learn the new system, they will see that it is better organized. The disjointed nature of ambulatory care goes away now that we are moving to one patient, one chart.”

Down the road, he said, the Cerner platform will allow for a unified patient portal and the ability for patients to self-schedule. The greatest impact of the integrated record, though, he said, will be the ability to look at populations of patients to proactively identify opportunities to address gaps and optimize care.

Caring for the care team

Dr. Driban described the support provided by Christiana Care’s IT and Cerner support teams for the go-live as “phenomenal, grade A and first class,” adding that the analysts and consultants were courteous and professional and made the New Castle team feel “really comfortable as we learned the new platform.”

Not only was the implementation support team ready to address technical questions as the New Castle team transitioned to PowerChart, Dr. Driban said that The Medical Group demonstrated their commitment to supporting his staff — to caring for the care team — through the transition, as well.

Mini massages, food deliveries and even a visit by a PAWS for People pet therapy team provided encouragement and helped lessen the stress that accompanies a change in routine, especially for those on the first wave of such a massive integration.

“We felt very supported,” Dr. Driban said. “Yes, there were mild pain points, but on day one of the primary care go-live at New Castle, we were able to see that ‘one patient, one chart’ was going to be a better system. We have already seen the benefits at New Castle. If this makes us more efficient, if it makes us better providers of health care to our patients, that is what this is all about.”