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![Page 1: Epic Update: The Minnesota Epic User’s Group Advance Care Planning Project Sharing the Experience: Honoring Choices Minnesota Conference July 19, 2012.](https://reader030.fdocuments.in/reader030/viewer/2022032605/56649e7c5503460f94b7ec2c/html5/thumbnails/1.jpg)
Epic Update: The Minnesota Epic User’s Group Advance Care
Planning Project
Sharing the Experience:
Honoring Choices Minnesota Conference
July 19, 2012
Minneapolis, Minnesota
Jonathan R. Sande, MD
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Objectives
• Introduce Epic/Minnesota Epic Users Group (MN EUG)• Review fundamentals of Advance Care Planning (ACP)• Discuss MN EUG ACP efforts since June, 2011• Summarize current situation regarding Epic/ACP• Discussion
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Epic and MN EUG
• Epic• MN EUG
– Allina– Altrua– Centracare– Essentia Health– Fairview University – Health Partners– Hennepin County Medical Center– North Memorial– Park Nicollet– Sanford
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Fundamentals, Advance Care Planning
• Definition of ACP
– “an organized process of communication to help individuals understand, reflect upon, and discuss goals of care for future healthcare decisions in the context of their values and beliefs” (p. 14).
– Hammes, BJ and Briggs, L., “Building a Systems Approach to Advance Care Planning.” (Gundersen Lutheran Medical Foundation, Inc.,: LaCrosse, WI, 2012).
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Fundamentals, Advance Care Planning
• Based on “Five Promises” (p. 29)
– “We will initiate the conversation…”– “We will provide assistance…”– “We will make sure plans are clear…”– “We will maintain and retrieve these plans…”– “We will appropriately follow these plans…”
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Fundamentals, Advance Care Planning
• Three basic requirements
– Leadership (commitment of both senior leadership and leadership specific to ACP program)
– “Hardwire” ACP into the healthcare system’s procedures, expectations, quality improvement, and mission
– Dedicate the necessary human/financial resources
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Fundamentals, Advance Care Planning
• Four key elements– Systems design (documents, storage/retrieval, ACP
team and ease of referrals…)– ACP facilitation (ongoing hardwired dynamic process,
with coordinated teams of trained facilitators at different stages [steps]…)
– Community education/engagement (including all healthcare organizations, religious institutions, attorneys…)
– Quality improvement (standing QI team with commitment to ongoing data collection/analysis and dynamic [responsive] policies/procedures…)
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MN EUG ACP Efforts
• “Hot Topic” Session, June 2011– Panel discussion: HCM, HCMC, Health Partners, Allina
• Session summary: Epic suboptimal for ACP– No consistent place for code status, advance directives, living
wills, advance care planning– No central template; different cumbersome and time consuming
work-arounds at MN EUG institutions– Inpatient vs outpatient issues– ACP issues not a priority at Epic, nor at MN EUG institutions…– Negative impacts on patient care, especially compared to what
seems possible…
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MN EUG ACP Efforts
• Approved by MN EUG Board in September, 2011– Form working group with representatives from all
members– Develop core ACP template; all MN EUG institutions to
have identical (and transferable) solutions– Core template to be based on “wish list,” and work at
Allina over 18+ months by Sandra Schellinger and colleagues
– MN EUG to use this initiative to “encourage” Epic to share this work with others
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EMR “Wish List”/Design Principles
• ACP documentation in one location and consistently documented across continuum
• ACP documentation is first thing all caregivers see in chart • Information displayed is most current version• Discrete data fields required for high priority items• Links included for scanned documents • Display most important documents first• Activation of power of attorney when patient deemed incapable• Ability to aggregate advance directive data • Revisions to advance directive tab • ACP review with decision tree • Linking of discussions to process
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MN EUG ACP Efforts
• Since June 2011 “Hot Topic” session…– Late summer, 2011
• Allina/Gundersen/HCM/Essentia conference call; “Gundersen solution”
– September, 2011• Presentation at Epic Verona
– December 2011 Epic response– January 2012 conference call
• Epic/HCM/Allina/Essentia/others– Spring 2012 collaborations– May 2012 Epic proposal
• Monthly national conference call re Epic/ACP
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MN EUG ACP Efforts
• Questions to Epic: • Timeline for fully functional ACP Epic product?
• Is “Gundersen solution” compatible with future Epic products?
• Answers:– No firm timeline; “committed to looking at it” in 2014 release
– “Gundersen solution” is NOT incompatible with the 2012 release, but whatever shape Epic development takes “it won’t be in the format of encounter level flowsheets... If customers use [Gundersen’s approach] they will run the risk of having a large project on their hands to convert the flowsheet data into whatever format we eventually end up using…”
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MN EUG ACP Efforts
• June 18, 2012 MN EUG ACP Working Group meeting:
– Common shareable solution within MN EUG
– Collaborate with Epic and others nationally
– Have useable Epic/ACP product as soon as possible
• MN EUG ACP Working Group Agenda
• Define key ACP terms
• Identify “essential elements” of ACP template
• Identify key data points
• Determine how best to capture/measure
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MN EUG ACP “Essential Elements”
• ACP functionality in one standardized location• ACP functionality portal accessible through first screen shot• ACP functionality accessible/functional throughout care continuum • Hyperlinks for all scanned documents• Assure that all information displayed is most current, with older
information available• Discrete data fields required for high priority items• Most important information displayed first• …