Dashboards: Where We've Been and Where We're Going (166372999)
Where we were, where we're going: Beacon Oncology Lessons Learned Minnesota Epic User Group 2010.
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Where we were, where Where we were, where we're going: Beacon we're going: Beacon Oncology Lessons Oncology Lessons Learned Learned Minnesota Epic Minnesota Epic User Group 2010 User Group 2010
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Transcript of Where we were, where we're going: Beacon Oncology Lessons Learned Minnesota Epic User Group 2010.
Where we were, where Where we were, where we're going: Beacon we're going: Beacon
Oncology Lessons LearnedOncology Lessons Learned
Minnesota Epic User Minnesota Epic User Group 2010Group 2010
North Memorial HospitalNorth Memorial HospitalMinneapolis, MNMinneapolis, MN
Cancer Clinic OverviewCancer Clinic Overview
Provides comprehensive cancer care for a variety Provides comprehensive cancer care for a variety of oncologic conditionsof oncologic conditionsLocated in the same building as the imaging, Located in the same building as the imaging, radiology, and patient education departmentsradiology, and patient education departments9500 chemo visits per year (approximately 25/day)9500 chemo visits per year (approximately 25/day)11000 non-chemo visits per year11000 non-chemo visits per yearInternal and external research programsInternal and external research programsGenetic counseling services/programGenetic counseling services/program
Implementation PhaseImplementation Phase
August 2007, implement practice management suite August 2007, implement practice management suite of epic products (Prelude/Cadence/PB)of epic products (Prelude/Cadence/PB)July 2008: Medical Assistants, Nurses, Physicians, July 2008: Medical Assistants, Nurses, Physicians, entered allergies, home medications, vitals, notesentered allergies, home medications, vitals, notesDec 2008: Project Team-Pharmacists and Dec 2008: Project Team-Pharmacists and Oncologists backloaded treatment plansOncologists backloaded treatment plansJan 2009: CPOE for in-clinic preformed procedures, Jan 2009: CPOE for in-clinic preformed procedures, labs, and Beacon orderslabs, and Beacon ordersMarch 2009: Beacon orders in the HospitalMarch 2009: Beacon orders in the HospitalMay 2009, upgraded to Epic Spring08May 2009, upgraded to Epic Spring08
Protocol StructureProtocol Structure
Take Home MedicationsTake Home Medications
LabsLabs
Treatment ConditionsTreatment Conditions
Nursing CommunicationNursing Communication
Pre-ChemotherapyPre-Chemotherapy
ChemotherapyChemotherapy
Intrathecal ChemotherapyIntrathecal Chemotherapy
Post-ChemotherapyPost-Chemotherapy
Lessons learned & OptimizationLessons learned & Optimization
Scope DocumentationScope Documentation Project Team StructureProject Team Structure Plan for ongoing "at the elbow" supportPlan for ongoing "at the elbow" support Complexity and time for order entryComplexity and time for order entry Comprehensive reportsComprehensive reports Data/Documenation across encountersData/Documenation across encounters Inpatient vs In-Clinic (outpatient) Inpatient vs In-Clinic (outpatient)
The St. Cloud Hospital The St. Cloud Hospital CentraCare Health System CentraCare Health System
St Cloud, MNSt Cloud, MN
Coborn Cancer CenterCoborn Cancer CenterOutpatient Cancer and Infusion Center Outpatient Cancer and Infusion Center 4 Medical Oncologists, 2 Radiation 4 Medical Oncologists, 2 Radiation Oncologists,1 Physician’s Assistant and 1 Oncologists,1 Physician’s Assistant and 1 Nurse PractitionerNurse Practitioner14 Nurses, 3 Pharmacists and 4 Pharmacy 14 Nurses, 3 Pharmacists and 4 Pharmacy Technicians Staffed DailyTechnicians Staffed DailyAverage 54 pts/day (43 Cancer Pts, 11 Average 54 pts/day (43 Cancer Pts, 11 Infusion Pts)Infusion Pts)PICC/Port Lab draws-average 20 per dayPICC/Port Lab draws-average 20 per day18,880 patient visits last fiscal year18,880 patient visits last fiscal year
Partial to Full Beacon Partial to Full Beacon Implementation Implementation
February 2007February 2007: Pharmacist Order Entry for : Pharmacist Order Entry for Beacon Protocols containing Meds Only Beacon Protocols containing Meds Only (including research studies). (including research studies). RNs had to work with both paper and EpicRNs had to work with both paper and EpicIn Epic, RNs entered Allergies, Home Meds, In Epic, RNs entered Allergies, Home Meds, Height/Weight and documented on eMAR to Height/Weight and documented on eMAR to drop charges upon administration.drop charges upon administration.October 2008October 2008: CPOE for Beacon Protocols.: CPOE for Beacon Protocols.Communication (provider and nursing) along Communication (provider and nursing) along with take home meds were added.with take home meds were added.
Protocol StructureProtocol StructureOncologist Provider CommunicationOncologist Provider Communication
Verification Order (Inpt, Outpt, Research)Verification Order (Inpt, Outpt, Research)
Take home meds Take home meds
Treatment conditionsTreatment conditions
Line care (Flush bags, Heparin, etc)Line care (Flush bags, Heparin, etc)
Pre-treatsPre-treats
Chemotherapy/BiotherapyChemotherapy/Biotherapy
Nursing CommunicationNursing Communication
Order Conversion Order Conversion
About 300 paper orders to convert prior to About 300 paper orders to convert prior to partial implementation (Feb 07).partial implementation (Feb 07).
It took pharmacists a total of 42 hours (8.4 It took pharmacists a total of 42 hours (8.4 minutes/plan) to convert all paper orders. (Over minutes/plan) to convert all paper orders. (Over twice as long as Epic’s Estimate)twice as long as Epic’s Estimate)
Build fixes were done on-the-fly during Build fixes were done on-the-fly during pharmacist order conversion.pharmacist order conversion.
Conversion Stages: Week 1 orders, then Week Conversion Stages: Week 1 orders, then Week 2 orders, then all others.2 orders, then all others.
Post Go-Live FindingsPost Go-Live FindingsGet RPh (and MDs) involved early in validation Get RPh (and MDs) involved early in validation which will help increase speed during order which will help increase speed during order conversion.conversion.Partial implementation- Issues were resolved Partial implementation- Issues were resolved prior to CPOE, but pharmacists overwrote Epic prior to CPOE, but pharmacists overwrote Epic calculations (mg/m2) in order to match the calculations (mg/m2) in order to match the paper orders. (Lost the mg/m2 ordered in Epic)paper orders. (Lost the mg/m2 ordered in Epic)RN’s had to work in paper and Epic world RN’s had to work in paper and Epic world (some duplication of documentation).(some duplication of documentation).Imaging and Labs are still in question.Imaging and Labs are still in question.
Q & AQ & A
