Shands Jacksonville Begins its Epic Journey

Saturday, January 21, 2012. Shands Jacksonville goes live on Epic. A spectacular success.

In the May 26, 2011 edition of On the Same Page, I wrote similar words about the Epic electronic medical record (EMR) launch in Gainesville. Since then, however, there has been a period of significant growing pains associated with implementation of EMR—disruptions of work-flow in many areas, and a list of errors and incompatibilities. Thanks to the commitment of the UF&Shands faculty and staff in Gainesville to de-bug the EMR and enhance its functionality, the list of issues and problems involving Epic has been shortened. Acceptance is growing that the EMR is here to stay, and that we are on the right track.

Shands Jacksonville has clearly been on the right track from the beginning. SJAX prepared diligently; while we expected the launch of the Epic Electronic Medical Record, Emergency Department, Pharmacy and L&D systems to be a success, the go-live experience exceeded those expectations greatly. In fact, the project leaders from EPIC remarked that this was one of the most successful implementations they had ever seen. Faculty and staff were excited about Epic and made sure that they were well-trained; by the time of the launch, they were very engaged and calm. Two weeks later, problems and issues are few and staff members continue to be very positive.

According to CIO Kari Cassel, Jacksonville’s go-live success is attributable to many things, including application of “lessons learned” in Gainesville. There was close collaboration between the two sites, which minimized unique requirements for the system and fostered an excellent training program. But the most important reason for this success is that “SJAX leadership ensured that the project was staffed appropriately from an IT, physician and staff perspective, that any roadblocks were removed and that all Jacksonville faculty and staff understood how important the project was to their future.”

I asked Jim Burkhart, CEO of SJAX, “What were the keys to your success?” “Extensive planning, system-wide teamwork, physician and clinician leadership, effective training, and hard work were key,” he said. “Greg Miller [SJAX senior-vice president, hospital operations] was instrumental to our success through his effective coordination and direction of the hospital’s project plan. Dr. Joseph Tepas was the key to our physician efforts; he held regular Clinical Champions meetings to ensure that physicians were involved throughout the process. Mary Parry provided a similar key role for nursing.”

Dr. Tepas, professor of surgery and pediatrics, comments that “the incredible commitment of virtually every member of the Shands Jacksonville community to embrace this process, to recognize that it is indeed the path to even better patient care,and to accept that this new tool required learning new skills, was the major factor that drove success.” He emphasized the importance of staging resident “Epic Wars” in the Jacksonville simulation laboratory, which “was invaluable in assessing provider capability, confirming training effectiveness, and in defining areas of potential concern before the actual event.” Lessons learned from the simulation lab directed useful changes in Epic implementation prior to go-live.

Don Novak, M.D., professor of pediatrics, has been the individual in Gainesville who is accomplishing the herculean task of solving Epic problems related to physician implementation, and developing innovative Epic solutions for the future. His is a unique perspective: “I was present for the first day of the Jacksonville go-live, and spent my time walking throughout the hospital lending help. Issues encountered were minor, and physicians and staff were engaged and anxious to make the new system work. Problems that did occur were handled efficiently by a staff that had alreadyexperienced a go-live, and really knew how to quickly fix things that broke. Training for the Jax go-live was excellent, due to the efforts of the Shands Jax leadership and the input of SUF personnel working in concert with their counterparts in Jax. Finally, the product used for the Jax go-live was a far different one than that used for the SUF golive. We live with Epic now day in and day out, and the changes have been incremental. But the input of faculty, housestaff and nursing staff in Gainesville, with the strong help of Shands IT, has produced a product that was more intuitive, and with far fewer “bugs” than experienced during the SUF go-live. Finally, Jacksonville physicians and leadership learned from the Shands UF experiences over the past nine months. They knew what to expect and where the pitfalls might be. And, they did a terrific job managing it. We have already learned lessons from Jacksonville, and they from us. As an example, significant improvements in the chart review section of Epic inpatient will go into effect next week, the culmination of several months of work. Jacksonville will benefit from these changes. Conversely, we have taken a novel treatment team approach developed by Jacksonville, and will install it at SUF within the next month.”

We must all remember that implementation of electronic medical records is not an “IT project”; it is a process of clinical transformation. Implementing Epic is a journey — we will always have things to add and improve but we have now taken crucial steps forward to improve patient care at UF&Shands in both Gainesville and Jacksonville. We can now share patient records electronically between SJAX and SUF, and soon we will be able to share with other Florida hospitals and clinics. We can now begin to add SJAX clinical data to SUF data in populating our Academic Health Center Integrated Data Repository, and begin using these data for quality improvement and research.

I want to convey special recognition for Kari Cassel, UF&Shands CIO, and the entire Academic Health Center IT team. With a very short timeline, Kari expertly guided an extraordinarily complex process of Epic implementation in Gainesville, and then, without missing a beat, applied lessons learned and led an even more successful launch in Jacksonville. We are all indebted to Kari for her tireless devotion and commitment to these projects, which continues every day. Kari is an IT professional who understands that IT serves as a catalyst for improved patient care, research and education, and she is genuinely devoted to these missions.

In addition to IT, several other groups deserve special mention. The communications team, led by Dan Leveton, spent many long hours into the night providing great support to the launch, as did Facilities, Dietary, Environmental Services and Security.

Jim Burkhart sums it up nicely: “The enthusiasm of the physicians, nurses, pharmacists and other clinicians continues to be contagious throughout the campus. It is so exciting and rewarding to hear them talk in the hallways about how Epic improves their ability to provide high-quality patient care. While we continue to make enhancements to the system, the entire organization is bubbling with enthusiasm. It is truly an exciting time for UF&Shands Jacksonville.”

Forward Together,

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