Bringing Epic EHR to the Post-Acute Space at Spaulding

April 13, 2016 - The vision for a learning health system put forth by federal officials includes connecting all parts of the care continuum, connecting both the acute and post-acute settings. Much of the challenge realizing this goal centers of standing up health IT infrastructure in clinical environments where the benefits of EHR incentive payments and the like were not available.

Spaulding Rehabilitation Network in Massachusetts is currently preparing to join its fellow hospitals in the Partners HealthCare system in a significant health IT endeavor, an Epic implementation that will put all these clinical sites on a common platform and enable EHR integration and health information exchange.

"We're in a time of major transformation," Spaulding CIO John Campbell, CHCIO, recently told EHRIntelligence.com. "The Partners HealthCare system is in the middle of their Epic implementation. The Brigham family and our home care organization went live last May. Mass. General and that whole family are going live in a matter of days. When Mass. General has gone live, 85 percent of the Partners implementation will be done. Then we get to the Spaulding sites."

For Spaulding more so than its partners at MGH or Brigham and Women's Hospital, this upcoming Epic implementation will be particularly special in giving the post-acute (or non-acute) care network the opportunity to have an Epic EHR solution tailored to its unique needs.

"Epic will be transformational for us because we have a lot of challenges in our current IT footprint," Campbell maintains. "A patient gets transferred to us from one of our acute hospitals and they are on a different EMR,  and even in this world of technology  very often the patient arrives in the bed with a stack of paper. We might be able to go to some portal and get a snapshot of the patient, but it is really not the full medical record."

Despite being part of the Partners health system, patient information does not currently move smoothly between its various hospitals, defying assumptions that integrated health systems have resolved issues surrounding EHR interoperability.

"In many ways, even though we're within the same system, a patient who comes to us from a hospital within our own system we may not have better information or a better picture of that patient than if they came from Beth Israel or another hospital outside our system," Campbell adds.

With the Epic implementation already touching parts of Partners (this interview occurred days before MGH and Brigham and Women's went live), the benefits of a common, integrated EHR platform are already providing a glimpse into Spaulding's future.

"It's phenomenal," says Campbell. "We're already seeing that in our home care division where patients who move from Brigham to Partners home care — the availability of information, access to the complete record, communication that it enables between upstream providers and downstream providers."

Spaulding's Epic implementation will also signal an important moment for post-acute care settings as it pertains to working with EHR vendors and their products.

"The commitment has really been there from Epic to work with us and other systems around the country to build solutions for the non-acute space, which is really kind of a seed change in the industry," Campbell observes. "Until recently very few of the big EMR vendors have really been paying attention to the non-acute space. They are also working on solutions for the skilled nursing space and the inpatient rehab space. We have already implemented their home care module, which is a good module and we're working with them to make it great."

In total, the Spaulding EHR implementation will span five different hospitals and last between 12 and 15 months. And work is already well underway in terms of preparations for 2017, much of it in collaboration with Epic developers.

"They have already developed a module for long-term acute care and we will implement that," Campbell reveals. "That module will be in place at Partners by the time we go live at our long-term acute hospital — Spaulding Cambridge — in April of 2017."

Alongside its collaborations with Epic, Spaulding is working with Partners to ensure a successful go-live, including the use of one project management office during the post-acute care network's multi-year buildup to 2017.

Fortunately for Spaulding, the network has enjoyed the backing of its parent system.

"At the Partners system level there is an acknowledgment that non-acute is critical and important," says Campbell.

Additionally, Spaulding's own leadership ensures that the post-acute care network has a strong and respected voice at the Partners table.

"We also have a very strong CEO within the Spaulding network, David Storto," Campbell notes. "He's a strong advocate for making sure we are appropriately represented at the Partners level, whatever the initiative or strategy or forum is. Sometimes those invitations come to us naturally because they should and sometimes David has to push to make sure they happen. In the end, we always have a seat at the table."

The remaining 15 percent of work that remains for the Partners Epic implementation is crucial to Spaulding's success in ensuring high-quality care for its patients across the entire care continuum and certainly carries more weight for the network itself.