May 1, 2019

Brain Rothman, MD, and Jonathan Wanderer, MD, MPhil, will present during the Expert Group Meetings (XGM) Epic from Monday, April 29 to Friday, May 10.

Rothman’s Presentation

Rothman’s presentation is titled “Periop Flightboards in Every OR.” The presentation demonstrates Vanderbilt’s successful OR Flightboard implementation using Epic Monitor across more than 90 OR locations. “This was a ‘big bang’ implementation. At that time, I don’t believe the Epic flight board had been implemented simultaneously in that many locations,” said Rothman. “Our implementation wasn’t perfect at first, but we got it to work seamlessly in a reasonable amount of time.”

“Our teams prepared extremely well for the implementation,” Rothman explained, “and there is only so much that can be done before you just have to turn the system on. It is the team’s response after the system is turned on that matters. Our build team went above and beyond.”

OR Flightboards positively impact patient care and contribute to patient safety throughout the intraoperative period. The presentation will discuss how this tool improves care team work flows, patient safety, and the necessary build for a successful implementation. The presentation focuses on the real-time electronic timeout feature, in particular, that electronically supports required pre-incision timeouts to improve patient safety and decrease the likelihood of wrong surgeries.

Rothman explained that VUMC worked with Epic to get an electronic timeout with a design element that helped implement it. Electronic timeout is the right thing to do in a perioperative space, and Epic provides a tool to do that. The World Health Organization (WHO) has said that timeouts before surgery are important.

“We partner with Epic,” he said. “They do site visits where they come to our office.” VUMC and Epic collaborated to have Saga, VUMC’s website, work together with Haiku, a mobile application. Another thing they have worked on with Epic has been document mass transfer protocols. 
 
Wanderer’s Presentation

Wanderer’s presentation at XGM, titled “Procedure Path and Enhanced Recovery After Surgery: A Path to Opioid-Free Anesthesia,” describes the tooling  that VUMC has put together to support our enhanced recovery after surgery protocols. “This is helping with reduction in length of stay, reduction of intraoperative opioids, and reduction of opioids prescribed at discharge,”Wanderer said. He explained that the most engaging presentations demonstrate novel use of Epic’s functionality as well as share the results that have been obtained with the help of those tools.

In keeping with that approach, he will also discuss VUMC’s enhanced recovery after surgery implementation and results. The Department of Anesthesiology’s Perioperative Consult Service team provides regional anesthesia and/or multimodal analgesia for patients prior to certain procedures and input on medical management, from decision to operate through discharge. “We developed robust informatics support for that service in our legacy system, and then I invested time before Epic Go Live rebuilding that function in our eStar system,” he said.

“I became certified as a physician builder and learned system architecture to create tools within eStar that provide services to the perioperative consult service team and regional anesthesia team.”

A lot of complex configuration is possible within Epic, and Wanderer will be showing off tools within Epic that made the perioperative configuration possible. Epic’s tools can be used in different ways at different institutions. “We are able to learn from other institutions and share what we’ve learned at XGM so we can make our respective electronic health records function better.” Wanderer also leads VUMC’s Physician Builder Program and serves on Epic’s Anesthesia Specialty Steering Board, where he provides feedback on new features under development, highlighting areas for improvement.

Summary

Rothman said that working with Epic on special projects reflects the innovative culture of VUMC.

According to Wanderer, “VUMC is unique because the institution has really committed to involving clinicians with system design and optimization. “We have support from Dr. Balser for growing our physician builder program which, in the long run, will help us optimize our eStar system across all of our clinical programs.”

Anesthesiology Department Chair Warren Sandberg, MD, PhD, said it is truly amazing to see how much the Epic implementation at VUMC has changed and improved over the past year, due to the hard work of numerous people like Rothman and Wanderer. “Epic is so important to the quality of care here at VUMC, and they continue to lead developments that lock in the quality of care we expect.”