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What Epic Means to Me: Domain Group Lead

What Epic Means to Me: Domain Group Lead 2019-02-27T06:56:48-07:00

Bebs Navarro, RN, MHA
DPH Title: Director, Emergency Department, ZSFG
Domain Group: Emergency Services (including Psych Emergency Services subgroup)

Q: What does a Domain Group do?
Bebs: A Domain Group oversees all aspects of Epic readiness within a particular department, from build and policy making, to closing gaps and following up with other departments. It is a very focused group that looks at all readiness for that specific domain, ensuring that the department is aligned with the timeline of the organization to be ready to go live with Epic.

Q: Why do we need this other role on top of everything we already have? (SMEs, etc.)?
Bebs: What I really like about it is our weekly meetings, where we focus on closure of gaps, help eliminate barriers, and connect with resources. Everyone is very accountable. When we put a gap up on the wall to discuss it, we know right away who is in charge of it, who is accountable. It helps keep us focused and on task. The Domain Group is a highly functioning group to get us ready for Epic go live and ensure that all of the areas that need to be ready are being touched and helped, and that we provide the support they need. It’s not an easy task, but I think we are nailing it.

Q: What do you think will be the biggest benefit of SFDPH having a system-wide EHR?  How do you anticipate that Epic will impact our patient care?
Bebs: Everybody is excited about the integration; it will be the most incredible thing that will happen. The patients within our network are using all different departments depending on what type of care they are seeking. With people coming into ED, we will be able to see what’s going on with their Primary Care visits. Then when they go back to see their Primary Care provider, that provider will then be able to see what happened in the ED. There will be improved communication among health care providers for the care of that patient.

Q: What advice to you have for other DPH staff members to be successful going through the implementation?
Bebs: Spend a lot of time in the playground environment, and during go-live ask your Super Users for help! In my previous campuses, that practice in the playground really helped a lot of people.  Shadow charting will also be very helpful to our staff (see “What is Shadow Charting?” below to learn more).

Q: In one word, how would you describe how you feel about SFDPH implementing Epic?
Bebs: Excited! I’ve worked with Epic before, so it’s hard for me right now to use our existing tools because they don’t provide what we need. Epic has been very valuable to me in my work before, so I’m very excited it’s finally here! I can’t wait, actually!

Diane Lovko-Premeau
DPH Role: Director for Health Information Services
Domain Group: Health Information Management

Q: What does a Domain Group do?
Diane: From the formation, the goal was to bring together the leaders that support whatever it is that the domain is talking about. For HIM, we have someone who attends from Behavioral Health and Ambulatory Care clinics, and from Laguna Honda and ZSFG. As we are investigating topics, we invite people who are more at the user level in that particular zone. That provides us with an opportunity to not only understand the workflow that we will be adopting within Epic, but also an opportunity to understand within ourselves what things are going to need to change. It is a good strategy – as opposed to people making decisions in silos, or the build team getting five different answers to questions that don’t look alike. It builds a level of consensus.

Q: What do you think will be the biggest benefit of SFDPH having a system-wide EHR?  How do you anticipate that Epic will impact our patient care?
Diane: The number one benefit is of course for our patients. Today we have so many disparate systems, and the patient is left to be the historian and translate their information from one episode of care to another. This often isn’t their strength, and they may assume that we know information that we don’t. Medications, major surgeries and other afflictions would be beneficial for another health care provider to know about. It will be a lot more efficient for our patient population, and in the long-run we will have better and safer care, and hopefully reduce some costs of duplicating care by having standardization.

Q: What do you think will be our biggest challenges as we go through implementation?
Diane: I fear that people will think that Epic is going to solve everything, and then they will be disappointed. There are extremely high expectations that many years of challenges – such as retrieving data or having patient care information translate across the continuum – will suddenly be gone. And there’s a sense that if we did our job well setting Epic up, then we can flip the switch and it’ll solve everything. It doesn’t work that way – people still have to put the data in the right places, they still have to develop reports in the right way/time. I don’t want peoples’ expectations to be so high that they will think we failed if it isn’t so easy. It takes time.

Q: How do you think we should manage the change involved?
Diane: Within HIM we have been doing for a year what I refer to as Incremental Moments of Change. We have gone through all of the job functions and workflows at ZSFG, and and analyzed them pre- and post-Epic. This helped us identify incremental pieces of change we can do now so that staff are already adopting a new workflow. That way, when Epic gets here it’ll be more about learning Epic and not a new workflow. We have been able to accomplish that in most key locations, allowing the staff here to already have the opportunity to become accustomed to change. The questioning process is human nature – we’ve had to work through that. Once someone does something the first couple of times, then it becomes the norm. We’ve had some design sessions with staff so they can see current and future flow charts and have been able to contribute to the process.

Q: In one word, how would you describe how you feel about SFDPH implementing Epic?
Diane: Excited. But that’s me – I try to tell my staff that since this is my 4th EHR implementation, it’ll be like going on a trip with someone who has already been there. Those of us who have done it before know the places not to go, what to focus our energy on to make it easier, and how to have a better experience. I’m excited because I feel like throughout this process, I’m able to give others the guidance about what we need to do. For them it’s been a big sense of trust, and they know that we are in it together and in it to win it.

Barbara Haller, MD, PhD
DPH Role: Clinical Pathologist and Director of the UCSF Clinical Laboratory at ZSFG
Domain Group: Laboratory

Q: What is the benefit of having a Domain Group process set up for our implementation?
Barbara: It has allowed us to use these focus groups to address common issues as well as specific challenges involved in the implementation of Epic for the individual laboratories. Through our Domain meetings we have had help identifying other domains that we need to work with to address common problems.

Q: What do you think will be the biggest benefit of SFDPH having a system-wide EHR?  How do you anticipate that Epic will impact our patient care?
Barbara: It will be a tremendous advantage to have one EMR for inpatient and outpatient locations. Because the current state of communication within our healthcare system involves so many different computer medical records, we often cannot see clinic notes on patients, so it is difficult to interpret lab results or make recommendations for further testing. Trying to reach providers to get the needed information is very challenging. So, improving the communication between providers and even other healthcare systems will greatly improve our ability to take care of our patients!

Q: What do you perceive as being your fellow staff members’ view or opinion on how Epic will impact their jobs?
Barbara: I think providers are very optimistic about changing to Epic. For the laboratories in our Domain, there will be some changes in workflow processes that will be challenging, but I think we laboratorians are always interested in learning about new instruments and computer programs.

Q: What do you think will be our biggest challenges as we go through implementation?
Barbara: The biggest challenge, especially for the clinical services and outpatient clinics, will be adapting to the changes that Epic is bringing with new workflows, new ways to document patient care, and learning to efficiently use this new computer EMR! Other challenges will be taking care of current patients while asking services to release staff to become Super Users with extra training as well as training a huge number of staff on Epic!

Q: In one word, how would you describe how you feel about SFDPH implementing Epic?
Barbara: Optimistic

DPH Domain Group Leads