Epic is one of the largest and most respected Electronic Health Records (EHR) companies in the country. Some of the nation's largest and most prestigious hospitals and health systems use Epic's EHR system. In total, Epic has 297 customers, and 70 percent of HIMSS Analytics Stage 7 hospitals use the Epic Care EHR system. The use of design thinking and agile innovation radically transformed Physical Therapy clinical care with the largest and metrically most successful EHR overhaul in Stanford Healthcare Ambulatory history.
An EPIC problem: Physical Therapy Context
Stanford Healthcare’s Dr. Bill Seringer, Physical Therapist and Clinical Supervisor, Outpatient Orthopedics and Sports Medicine, saw a need for an upgrade to the Epic documentation system. The observed problem existed, not only within Epic at a structural level, but at almost every major institution in the country: allied health gets lumped into the nursing profession. Considering Physical Therapy (PT) is one of the most regulated allied health professions, it provides different documentation challenges compared to nursing within the hospital system, yet no efficient large scale EHR system was available.
The documentation system currently implemented in the outpatient Physical Therapy department was costing Stanford Healthcare millions of dollars each year as a result of lost clinician productivity and documentation that was inconsistent with regulatory and compliance standards. This is why Dr. Seringer, DPT, SCS, OCS, CSCS, and his (*Physical Therapy) team, including Manager of Ambulatory Implementation, Rajesh Anbumozhi, and Matt Caudle, Ambulatory Analyst, introduced an innovative concept to the Epic Stanford team, an agile development strategy, to develop a project which would end up becoming the gold standard for rehabilitation documentation systems around the country by August 2016.
“They [Stanford EPIC team] told me over and over again, it couldn’t be done. I kept pushing back, showing the EPIC team that it could be done and that it had been done before. All the aspects I wanted incorporated into the new design had been accomplished in other templates Epic had created for other healthcare professions. I just needed those pieces to effectively work together for my Rehabilitation team.” - Dr. Seringer
Meeting (Physical Therapy) User Needs
Dr. Seringer’s focus on the end user experience stemmed from his own experience, as a practicing therapist, with countless hours of documentation under his belt, he understood the importance of an intuitive and efficient documentation system which would allow the clinician to concentrate his/her energy on providing the best possible clinical care and not on regulatory matters. This clinical insight is what lead the team down the agile development path, spending time testing and retesting the users,an integral step that many EHR companies are missing.
“We did test and retest the user experience, but I think it’s more of the intensity with which the user experience was tested. We needed every aspect of the template to be connected and seamlessly integrated. We looked at fonts, colors, outline, and most importantly, that the user had everything they needed at just the right time. We wanted the system to look gorgeous and connect with the users in ways they didn’t necessarily know was happening but felt.” - Dr. Seringer
Utilizing design thinking, Dr. Seringer and his team spent 3 years evaluating and dissecting current rehabilitation EHR systems, meticulously designing back end work-flows, meeting with EPIC design teams, and re-iterating the agile design experience repeatedly: planning, analyzing, designing, building, testing, integrating, and reviewing. Dr. Seringer and his team were so confident in their design that for the 1st time in the Stanford EPIC teams’ history, there was no clinician schedule reduction during a “go live” (roll out). The team relied on the fact that the new documentation template was going to be so intuitive that full schedules could be maintained. The team was right. The “go live” roll out on August 29th, 2016 had a few expected technical issues, but all were resolved within the first week. On Dec 3rd 2016 the new EPIC design was launched at Stanford Health Care’s 2nd satellite clinic in Portola Valley, CA, and like the first roll out, it went off without a hitch.
What was the result of this bold undertaking? An orthopedic rehabilitation documentation system with an impeccable end user experience, which, via the trickle down effect, is drastically improving patient centered care. The expectation after a 1-year post “go-live” is a full ROI of principal investment and to increase revenue by approximately $500-$1M per year in cost savings and productivity. Now clinicians are able to utilize upgraded standardized workflows and better data (note) capture system designs, providing improved data integrity, increased communication between healthcare practitioners, and ultimately allowing for better decision-making and improved quality of patient care. Beyond the cost savings and an improved clinical experience, clinicians have had up to a 20% improvement in documentation efficiency, thereby decreasing the amount of time clinicians spend documenting at the end of day.
“This new template should be the gold standard of rehabilitation documentation systems.” -Dr. James Zachazewsi, DPT, Clinical Director, MGH PT/OT Department, Partner’s Healthcare
As an orthopedic physical therapy resident at Stanford Healthcare, I have enjoyed using the new documentation system and process. Stanford’s innovative culture, multifaceted treatment approaches, and improved documentation system is the reason why every physical therapist should aspire to work here.
*Members of the Stanford Healthcare Physical Therapy team working on the EHR innovation project included:Tiffany Asp, DPT, OCS; Ricky Yu, DPT,OCS
