To provide high-quality patient care, physicians and other clinicians need quick and easy access to patient records. Yet many health systems struggle to deliver comprehensive information in a consistent format precisely when it’s needed most – at the point of care.

THE PROBLEM

Baptist Health, which serves the Jacksonville, Florida, community through a wide-reaching healthcare network consisting of six hospitals and more than 200 specialty physician and primary care practices, was like many others in that it was using different electronic health record systems for its hospitals, ambulatory clinics and other care settings.

Unfortunately, these disparate systems didn’t communicate with each other.

As a result, clinicians were unable to see their patients’ full medication histories. Clinicians were relying on patients as the source of truth, which required them to manually enter data into the local EHR every time a patient presented at a different Baptist Health facility. The medication reconciliation process was not only inefficient but also prone to error.

"To solve these problems and ensure we provide our clinicians with robust data to make the best care decisions, our health system set a goal to eliminate disparate systems and consolidate patient data in a single, enterprise-wide Epic EHR," said Dr. Stacey Johnston, vice president, chief application officer and Epic program executive at Baptist Health.

The goals for the project included:

• Improve patient care by seamlessly sharing health information across all practice venues.
• Improve operational efficiency by spending less time transcribing medication data, making phone calls, or otherwise tracking down medication details for each patient.
• Improve ability to make evidence-based decisions as an organization by making all data points available in one platform. Without this, it would remain extremely difficult to analyze data on a large scale, since reporting structures are not the same between EHR platforms.

PROPOSAL

"We planned an Epic implementation for five existing hospitals and one new hospital, three free-standing emergency departments, our outpatient oncology clinic, and more than 200 points of care," Johnston explained. "As part of the project, we needed to consolidate millions of medications, clean up prescription instructions (known as “sigs”), and ensure free text was entered into discrete fields in the new EHR. After researching a few vendors, we chose DrFirst’s MedHx because its AI normalizes the data for us.

"MedHx delivers six months of medication data from pharmacy benefit managers, EHRs, pharmacy fill data and payer records," she continued. "Its artificial intelligence uses clinical and statistical context to clean and structure medication history data, to prevent missing information, while avoiding manual entry."

"After our EHR consolidation and the addition of an AI-powered medication history solution, we can provide better care for our patients, while giving our clinicians robust data at their fingertips to make the best care decisions."

Dr. Stacey Johnston, Baptist Health

It normalizes sig information into consistent terms, translates national drug codes between different databases, safely infers missing information, and processes free text so it pre-populates into discrete fields. It also enables staff to convert continuity of care documents from the legacy EHR systems into Epic.

"The AI-powered medication history solution improves the amount and quality of medication information available directly in the clinical workflow to do an effective medication reconciliation," Johnston noted. "That’s critical when patients arrive in the emergency department unable to communicate, and is essential to preventing inaccuracies reported by patients and families.

"It can also help streamline the admissions and discharge processes and avoid errors in medication reconciliation during level-of-care transfers," she added.

MEETING THE CHALLENGE

Baptist Health's clinical applications team worked with multiple stakeholders throughout the organization to test, validate and ensure physicians and other clinicians could access consolidated medication data in real time.

"Beginning in early 2020, and continuing until our official project kickoff in October 2020, we worked with more than 170 clinic partners who were running a plethora of different EHR platforms, to show the benefits of consolidation and get their buy-in," Johnston recalled. "Next, we worked with inpatient units to understand and document legacy workflows for medication history and medication reconciliation so we could ensure the new EHR configurations would accommodate workflows for all practice areas.

"We then worked closely with Epic and DrFirst to build, implement and test the new EHR system and medication history tools in partnership with our operations team," she continued. "After implementation, we rolled out a training program on the new medication history tools and workflows, and ensured the appropriate people had security access."

RESULTS

When medication records are imported into an EHR system, sigs arrive as unstructured free text, often with missing pieces of information and using a variety of terms for the same instructions (for example, “by mouth” versus “orally”).

MedHx uses AI to decipher clinical language and interpret missing clinical details that are implied, but not present.

"Consider a prescription for a Lisinopril 10mg tablet (a medication to treat high blood pressure), including the instruction 'tk 1xD,'" Johnston explained. "The AI not only interprets the clinical intent, but also sees that for this medication, a route of 'oral' can be safely inferred.

"Since our Epic go-live on July 30, 2022, our health system has converted more than 7,352,000 medication sigs without clinician intervention using MedHx," she continued. "A subset of these conversions had no sig provided in third-party data, and the sig was inferred by the technology."

Another subset had a sig available, but only in free text form, and Epic converted these to a discretely defined sig in the database. Prior to the EHR consolidation and integration of MedHx, clinicians would have been responsible for manually converting all 7,352,000 sigs. By avoiding this conversion, Baptist Health has saved critical time for its clinicians and reduced the likelihood of transcription errors.

"We also identified more than 3,000 additional high-risk medications from more than 1,700 unique patient medication profiles that would not have been identified by legacy EHR systems," Johnston said. "Awareness of these medications improves patient safety and informs better prescribing and medication management by our clinicians.

"We also enabled our medication history technicians to perform teleconsultation and efficiently perform medication histories," she added.

ADVICE FOR OTHERS

"Sharing high-quality data across your health system is vital to your EHR’s ability to trigger critical safety checks, such as drug interactions and allergy alerts, which can help reduce adverse drug events," Johnston said. "Seamless data-sharing also gives your clinicians access to all medication information that was documented during any encounter with your health system so they can make evidence-based decisions and provide the best possible patient care.

"After our EHR consolidation and the addition of an AI-powered medication history solution, we can provide better care for our patients, while giving our clinicians robust data at their fingertips to make the best care decisions," she continued.

Another important goal was to give patients access to their health information and medication records from any web browser – not only from Baptist Health but also from other health systems running the same EHR.

"This will be increasingly important moving forward as new regulations ensure patients’ right to their medical records," she concluded.

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