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For members of the Texas Children's Hospital medical staff
Creating a paperless trail, transforming health care
By Robert W. Warren, M.D., Ph.D., M.P.H.
In 2010, Texas Children’s will become one of the first children’s hospitals in the country to have a fully integrated electronic medical record (EMR). When complete, this multi-year project we’ve named IRIS will impact medical staff, patients, referring providers and nurses in nearly every interaction they have with us.
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IRIS implementation plans
Patient lists (floor census) and results
viewing will go live in April 2008. Physician training will begin in early 2008. Ambulatory and Inpatient documentation
and orders will go live 2008-2010.
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The conversion from paper records to electronic records at Texas Children’s began in 2006, with the goal of improving patient care through enhanced access to information, legibility, clinical decision support and integration across virtually all aspects of clinical care in Texas Children’s Pediatric Associates practices and at the main Texas Children’s campus and health centers. The Epic products being implemented include an integrated set of business and clinical applications that manage all aspects of outpatient and inpatient care.
The following update looks at the work that’s being done on Texas Children’s system wide integrated electronic medical record and what lies ahead.
IRIS project update
IRIS, which stands for Integrated Record Information System, began with a two-year detailed evaluation of application vendors. More
than 1,300 Texas Children’s and TCPA employees and medical staff attended demos held on the main campus. Four site visits included five medical staff and four registered nurses. Epic far outdistanced all competitors in national and Texas Children’s ratings. Texas Children’s signed a contract with Epic in May 2006, with an approximate budget of $60 million for the life of the project.
Training began in July 2006, and to date more than 40 Texas Children’s/TCPA personnel are certified in specific Epic applications. IRIS teams are in place, with 148 employees on the project, including a 17-member physician council. Members are Drs. Greg Buffone, David Butler, David Coats, Jan Drutz, Mark Farrior, Cary Fernandes, George Ferry, Carol Green, Juan Juarez, Curt Kennedy, Mona McPherson, Paul Minifee, Brigitta Mueller, David Nelson, Marianna Sockrider, Steve Stayer, Mark Ward and me. Since July, the council has had training at Epic in Wisconsin, and been meeting approximately twice monthly. The specific responsibilities of the Physician Council are:
Define physician implementation of IRIS, including content, process and timeline. Support the integration of medical information into a single system. Evaluate the priority of project requests in the legacy systems. Consider integration of ancillary systems. Consider EMR infrastructure issues. Participate in interdisciplinary work teams to define, build and validate clinical systems and processes. Advise and participate in Physician training efforts.
IRIS officially kicked off in September 2006. Our IRIS project is comprised of several tracks that will occur in phases through fiscal year 2010. We recently passed the halfway point of the first track, which is the Foundation track. The Epic “Foundation” applications will replace Oacis, IDX (the “revenue cycle” software, including patient registration and scheduling), IDXRAD (diagnostic imaging scheduling and reporting, but not PACS) and EMSTAT (the electronic “roster”). Physicians will be using Epic first mid next year to review results.
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The conversion from paper records to electronic records at Texas Children’s began in 2006, with the goal of providing readable information that is available real time to staff and clinicians involved in patient care in Texas Children’s Pediatric Associates practices and at the main Texas Children’s campus and health centers.
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Our IRIS teams, led by Director of Enterprise Systems Valerie Bergeron, recently conducted a thorough review of the IRIS project scope, plan and timeline, resources, vendor applications, our IRIS communication plan, project budget and the training plan. I am pleased to report that many project successes were identified, such as the commitment by IRIS team members, our strong partnership with Epic, the progress of the Foundation track, and the active involvement and commitment by project leaders and physicians.
This review also pointed to the need to reschedule the “official” start of the Ambulatory and Inpatient tracks, which were scheduled to kick off in early April. The new schedule will result in a 90-day delay and is necessary to ensure completion of all project preparation work and all the staff Epic certification training. It will also give the Foundation track team added time to focus on staffing and training needs and completion of the DBVs (design-build-validate process) – all key to the work ahead. BUT because of anticipated resulting efficiencies of process going forward, the goal remains an unchanged overall project completion deadline of January 2010.
Elements of implementation
Implementing IRIS throughout our entire organization involves the following five key elements:
Design-build-validate (DBV) sessions: Members from the appropriate Epic application teams, Epic advisors, nurse and physician champions participate. System build: System build is done after the DBVs by Epic-certified Texas Children’s/TCPA application coordinators and analysts. Validation: The system build validation is reviewed by all members who attend the DBVs, as well as the appropriate advisory councils (ppt). Training: Physicians and other users will get intensive Epic training appropriate to their role and needs within 60 days of the go-live date. Training will be provided on the Texas Children’s campus, as well as regional locations for TCPA and the health centers. Go-live support: More than 100 Texas Children’s/TCPA staff support and 30 Epic staff support will be available to physicians and staff.
In addition, the IRIS project will use the following processes to optimize the Epic system and track project success:
Process optimization review and training post go live Texas Children’s system and project audit Epic system and project audit Texas Children’s/TCPA-established clinical and business metrics such as time from order to lab draw, time from order to first antibiotic dose given, medication errors, physician satisfaction, family satisfaction, clinic research publications, dictation costs, overall bill denial rate and other business measures
As our EMR implementation continues, the IRIS Executive Steering Team, which includes Drs. Ralph Feigin, Ann Stark, Joan Shook and me, will be providing oversight. In addition, the Medical Staff Medical Executive Committee (MEC) began bimonthly reviews of IRIS with its March 2007 meeting. As we go forward, MEC will be reviewing progress and providing advice about implementation, and also making policy surrounding the new comprehensive electronic medical record, studying such issues as the necessity of training, requirement for use, and validating its clinical decision support mechanisms.
As we go forward, we welcome your feedback. We know that as IRIS evolves, understanding how all its pieces will fit together and affect your work may be a challenge. Moreover, we need your commitment to help us build it so it fits your practice requirements. Please contact me at 832-824-3830 or by e-mail with any comments or questions. I look forward to hearing from you.
Robert W. Warren, M.D. Ph.D., M.P.H. is Medical director of Information Services at TCH, Medical Staff Department Head of Ambulatory Services, and Chief of the Rheumatology Service. He also is associate professor, Department of Pediatrics, at Baylor College of Medicine.
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