Epic to Pilot Decision Support Tools Using Real World Data | So Good News


In a recent wide-ranging interview Healthcare innovations, Johnston Thayer, MBA, RN, Epic’s director of clinical informatics and population health, described a new tool the company is preparing to test, called Best Care. point of care for clinicians using real-time data on similar patients.

Thayer, who has experience as an emergency room nurse, said she is interested in using genomics, machine learning and population health tools to transform healthcare delivery. He said health systems are getting better at using population health tools, such as overlaying data to see how many diabetes patients are late for foot exams or regular screenings. In the past, identifying these patients would have required a lot of time to review your entire chart. Using the tools in Epic, he says, you can automatically identify all patients, automate follow-up and make sure patients come to those visits. “All kinds of populations have a whole set of tools to do this kind of work,” he said.

Now, Epic is starting to use its huge data set. Cosmos combines data from more than 160 million patients, representing billions of clinical data points, and creates a platform where personalized data is available for research.

The new Best Care tool offers patients the ability to see similar treatments and outcomes for patients, Thayer explained. “Let’s say I’m a doctor and I have a new hypertensive patient named Charlie who has just been diagnosed and we’re considering prescribing him a new medication,” he said. “Even though I’m very knowledgeable and aware of all the current literature on hypertension and treatment options, it’s unlikely that I would have read anything relevant to patients like Charlie, given his age, his co-morbidities, his past medical history. treatment activities and other factors that make it unique. Best Care allows me to see some information from Cosmos about how patients like Charlie have been treated in the past and whether the patient’s blood pressure was successfully lowered. to what extent, so it really empowers physicians, as they make decisions at the point of care, for them to have access to real data.”

Thayer said Epic will be rolling this out in a very safe and methodical manner. “We’re running a pilot within a year where this information will initially be available on the Cosmos portal, but the goal is for the information to be embedded directly into the workflow. We’re starting with the hypertensive use case as an initial pilot concept, but then we plan to work with the Epic organizations and some of the experts in different fields to define their use cases as we continue. after that.”

Another new way the company is using Cosmos features is a project called “Lookalike” that Epic will release in November. If a doctor has a patient with a rare disease or a special group of symptoms that the doctor has not worked with before, the program will focus on all Cosmos patients and identify similar patients. In this case, the goal is to identify providers who have seen similar patients so the patient can contact them, talk to them, have a “roadside consultation” and ask them questions about how they treated that patient and some. there were results. “We see this as an opportunity to improve and increase collaboration on an unprecedented scale,” Thayer said, “to determine who treated the patient I’m seeing today.” There were no such tools before. We are very excited to see it come out and see how it will begin to change the way doctors can work together.”

I asked Thayer if Epic has any mechanisms to share and disseminate best practices or innovations among health system customers, other than the annual user group meeting.

“Absolutely,” he said. “When we see an organization doing really interesting things that can be measured and replicated at other sites, we write what’s called a ‘clinical program,’ where they describe how they did it, what results they saw, the tools that enabled it at Epic.” , training, change management”.

As I reviewed the agenda for the upcoming AMIA meeting, I mentioned that I saw a session on health systems building a culture of EHR builders/developers among their clinicians. I asked him how Epic is encouraging this phenomenon.

“We have a program that helps train medical builders and we also have clinical builders depending on the type of area you work in and your background, but their goal is really for you to learn more.” We have the nuanced tools available at Epic to tailor to your specialty.” He said there are special cases where providers like to document certain routes. Instead of asking the IT team to create a new form, clinicians learn how to do it. “KLAS, which measures user satisfaction with EHRs, was able to show that the presence of physician builders embedded in the specialty actually affects user satisfaction in the field.”

One of Thayer’s responsibilities is strategic planning for research and development, which he says is very rewarding.

“We’re working with the development teams to look at what we need to do next and what will have the biggest impact for our community,” he said. Artificial intelligence and ambient voice are two examples. “Both are big areas for us. Recently, we’ve been working on developing new tools for several of our predictive models. I was specifically involved in working with the sepsis algorithm and how to use tools like this. AI is still relatively new to healthcare, and having a platform to actually use this information and make decisions based on some of the data we collect is still a challenge for many groups. It was really fun to help build the framework to do that. Surround sound is an area of ​​interest for many groups. When we imagine the future of healthcare, most people think about the ability to simply have a conversation with a patient and automatically capture that conversation, turn it into something structured and meaningful, and really reduce some of the manual input of information. system”.

I asked Thayer if part of the decision-making process involved figuring out what Epic wanted to build in-house and integrate with outside vendors.

“Obviously we want to partner with others that we’re working with. For example, externally, we work with voice providers who have developed platforms and programs for real natural language processing, rather than our own,” he said. “There are also areas where we are working with some of them, but we understand that we will never be able to work with all of them. The AI ​​space is a good example. We have our own models and algorithms that we develop in-house at Epic, but there are many opportunities in the space. We have a set of tools for embedding algorithms directly into Epic, the same way our tools are embedded. The goal is that you can use the best of what’s out there and still have a unified experience for your providers and clinicians.”

Thayer regularly works closely with clinical informatics teams, consulting on implementations with health systems. I asked him if he saw the roles and relationships between IT executives and operations managers evolving.

“It’s absolutely evolving,” he said. “As you know, computer science is relatively new in the grand scheme of things, especially in some management positions. For some time, there has been an artificial boundary between the operations side under the CIO and the informatics or IT side, and there hasn’t been much alignment, especially from a strategy perspective. Within groups, they often functioned as independent organizations with their own plans and goals. But recently we’ve seen more and more cases where they fit together as part of an overall organization. So now it’s very common for the CIO to report directly to the CFO on the operations side, or at least have a dotted line, so they’re included on the business and operations side, just like on the informatics and IT side. .”

I asked if the Epic App Orchard was starting to allow third-party developers to make additional enhancements or add-ons to Epic, rather than having to build everything in-house.

He said the tools in App Orchard can range from small changes or specific use cases to larger tools designed to impact the broader organization. “It’s just providing APIs as a way to send data from Epic and rewrite the data as needed to create that integrated experience, so doctors, nurses and others don’t feel the need to go to some.” it is a separate portal to find the details,” he said. “Workflow is very important and asking a doctor to refer to an external portal and compare it to what they’re seeing in the system is a really difficult thing for them to do. Instead, bringing it all together allows for a much more integrated and seamless experience. We see both of these groups creating offerings that they want to sell, but we have access to health systems as they update and create their own development. They can make it available on the app market for free sharing or as a way to cover some of the costs of developing that tool.

In addition to working with informatics leaders in health systems going live at Epic, Thayer consults with teams in the go-live process as they work to manage change and create governance structures for decision-making. I asked him how the pandemic has affected the process for organizations that want to switch to Epic but are operating in emergency mode.

“I don’t know the exact numbers, but we had a lot of bands that, even with everything going on, went live on time, which required a lot of pivoting and a lot of flexibility,” he said. “But we have great teams and we work with great organizations, so for the most part we’ve still been able to go live on time. Of course there are exceptions, but this involved figuring a lot of things out as we went along.”


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