BWH nurses Chantal Cayo (at left) and Katie Labella go through an Epic tutorial with Sam Sanni, of health care solutions company HCTec.

This is the first in a series of stories that BWH Bulletin will feature in the coming months about Partners eCare implementation.

Since Partners eCare went live just over four months ago, staff across BWH, BWFH and Dana-Farber/Brigham and Women’s Cancer Center (DF/BWCC) have been diligently learning and adapting to the new system, adjusting their workflows and troubleshooting issues with colleagues. During the next five years, the new system will integrate all clinical, administrative and revenue systems across Partners into one comprehensive system, improving the way BWHC delivers care to patients across the hospitals and distributed campus.

BWH Bulletin talked to several BWHers about improvements, growing pains and overall impressions of the new system so far. Here is what a few of them had to say:

Rob Boxer, MD, PhD, Hospitalist, Director of BWH’s General Medicine Service

“Given the amount of change providers have absorbed, things overall have gone really well. People are getting used to the new system and becoming more efficient with it. Some areas already recognize Partners eCare as a clear improvement from old systems, especially the ability to access and receive information in a timely fashion.

“I’ve been hearing about the place where providers are most struggling with the transition, which has been medication reconciliation on admission and discharge. Orders are now written with a particular phase of a patient’s care in mind and reviewed and ordered at different stages. Providers didn’t have to do this prior to Epic implementation and are getting used to it; there have been fewer concerns over time.

“There are also pockets of concern related to certain workflows. Some of the homegrown systems that were custom-fit to our needs and adapted over the years are certainly missed, but Epic is working to fix our issues and has been open to where the gaps are. Additional tip sheets are being developed on how to best use the new system, and sessions with frontline providers are identifying root causes related to workflow issues. Committees are working to understand how much of our challenges are due to people getting used to a new system, which is natural, as opposed to areas where Epic needs to update or change the system.

“Providers recognizing areas of concern in their workflows can submit tickets to the Help Desk to alert the Partners eCare team of the issue. If the issue relates to patient care, it will be resolved right away. Larger system-build issues go to a committee to review the root cause of the problem and determine options for changes to the system. Shelly Anderson [vice president of Strategy Implementation] is organizing different workgroups to focus on key areas—lab orders, radiology, IP workflows, ambulatory workflows—to identify and prioritize the work that needs to be done.

“Overall, this has been a hard period of transition, as we’ve identified the gaps and problems with initial implementation, but we are adapting and can see that there is great opportunity to make our workflows more efficient and to be able to provide the highest-quality care for our patients using the new tool. Anytime I talk to someone about Partners eCare, he or she says, ‘I miss this aspect [of an old system], but overall, I think the new system will be better.”

Theresa Stone, Research Billing Compliance Manager

“The Epic research functionality allows for increased transparency and the ability to provide better and more streamlined care, both in terms of patients’ usual clinical care and their research-related care as subjects in clinical trials. With the ability to enroll patients as subjects and link their research-related ordered or scheduled services, all clinical staff are able to see these different layers of care. In addition, we have a more robust method of ensuring research billing compliance.

“Study coordinators and department administrators have told me that they feel they can track things better. For example, after working out some of the kinks, Epic has been hugely beneficial to them in placing lab orders because they are getting the lab results more quickly. For patients in that area, it’s a huge improvement.

“It’s been challenging for many folks with varying degrees of frustrations; there have been some issues to work out that we didn’t anticipate with regard to weaving research activity into clinical activity. But truly, there has been much success and support for this functionality within our research community.”

Diane Miller, RN, Emergency Department Clinical Nurse Educator

“There are 144 nurses in the ED, and they have all really stepped up to the plate. The morning we went live, a major trauma patient came in, and nurses jumped right onto the Trauma Navigator and documented the case in real-time; that was a huge accomplishment. There was a big crowd huddled around one computer; everyone wanted to learn the process. We had lots of help with super-users and our Partners eCare partners to help us in documenting trauma right off the bat.

“Now, we’re problem-solving when nurses have trouble with their workflows. We’re looking at revising tip sheets and connecting with Epic to resolve some of the issues. There are parts of Epic that fit really well with our workflows and parts where we stumble a bit, and that’s when we hear from staff.

“Our department has embraced Epic and done well with it. There have been challenges, such as being slowed down at triage. We are still working through those processes, and Janet Gorman, RN, BSN, MM [Emergency Medicine nurse director] has been instrumental in helping us work through that.

“In the ED, nurses and all staff have put their best foot forward.”