Getting Along Epically

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Symbiotic relationship allows ambulatory nurses to redefine role

A transition as major as the enterprise-wide rollout of the Epic electronic medical record system brings with it a host of expected changes to workflows, protocols, and many other procedural details. What was unexpected—though not at all unwelcome—was how much the first phase of implementation would lead ambulatory nurses to redefine their role in delivering quality care.

For several months starting in April, Epic was introduced in over 600 ambulatory care settings throughout Johns Hopkins Medicine and at inpatient settings in Howard County General Hospital and Sibley Memorial Hospital. Nursing played a key role in that process, beginning with the additions of Renay Tyler, DNP, RN, ACNP, and Bryan Barshick, RN, MS, to the implementation planning team. Nurses reviewed workflows and served as conveners and intermediaries to ensure that all points of view—from patient to physician—were heard and addressed. When the time came to recruit and train “superusers” to guide colleagues through the transition period, “Nurses really saw the need and stepped up to take a role,” says Barshick, Ambulatory Clinical Informatics Program coordinator. Good teams found ways to get even better.

“It’s changing how we operate in ambulatory nursing,” says Barshick. “As we’re learning to use the system correctly and to adapt to changing procedures and rules, it’s making us rethink and re-examine how we’re going about taking care of patients, how to ensure billing compliance, how to enhance processes to provide doctor and clinician support.”

Epic allows nurses to be identified in patient records as schedulable resources, something that has created a shift in nurses’ self-perception. Now, with patients specifically scheduled to see them, and the resulting accuracy in documentation of services, Tyler observes that “it’s not only increased transparency, it’s allowed nurses to define their role more clearly and encouraged them to see themselves as providers of care. I think nursing was really ready for that.”

But nursing also plays critical parts in the ongoing optimization of Epic. “It’s come to light how much we need to create protocols for ancillary services like radiology and phlebotomy, and that’s an area where nurses are a valuable resource,” notes Tyler, director of nursing for Ambulatory Care. “It has exposed some incredible assessment skills on their part. They know these specialties so well that they can think like a physician and see the most logical way to establish protocols.”

An added bonus is that ambulatory nurses are exceeding expectations on meeting so-called Meaningful Use measures that bring federal dollars to their clinics. The money is an incentive for using technology and better tracking to improve patient care. “Nurses need to wear many hats in ambulatory these days,” says Tyler. “They are the arbiters of getting the job done.”

Photography by Chris Hartlove

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