CASE STUDY 01
Epic Beacon Oncology Implementation
Strategizing, supporting and training for the transition from paper to electronic record keeping.
• Electronic Health Records
• Process Improvement
This client is an established oncology and research institute that recently affiliated with a large metropolitan health system. Prior to the project with The Robertson Group (TRG), the client’s medication use process (medication order entry, pharmacist dose calculation and order verification, medication administration documentation by nursing) operated almost entirely on paper. The larger organization which the client had established an affiliation with is an Epic® customer and recently completed a successful implementation of their own. As a result of the partnership with the larger organization, the client was able to adopt the larger organization’s electronic health record (EHR) and thereby overhaul own their medication use process, specifically by leveraging the Beacon oncology module of Epic®.
- Serve as a content expert and primary liaison between technical teams and client pharmacy operations
- Provide deliverables necessary to reach implementation milestones –specifically by:
- Drafting electronic order specifications for research medications,
- Validating Beacon protocols from a pharmacy operations perspective, and
- Facilitating group validation (consisting of research coordinators, nurses, physician
principal investigators, and technical teams) of Beacon protocols
- Mediate discussion between client and parent organization regarding differences in clinical practice and facilitated resolution
- Plan, coordinate, and implement paper-to-electronic protocol conversion prior to Beacon go-live
- Provide at-the-elbow go-live support
- Provide recommendations for process improvement regarding new research protocol or amendment build requests
- Train pharmacy users to the work described above (drafting research medication specifications, validating protocols, and facilitating group validation)
TRG worked closely with pharmacy, nursing, physician, and project staff members on both the parent organization and the affiliate for a successful implementation and adoption of a new medication use system.
CASE STUDY 02
Medication Management Assessment and Remediation
Streamlining pharmacy operations from build to charging in Electronic Health Records.
• Medication Management Assessment
• Medical Oncology
Client: A large, private, independent, non-profit healthcare organization with more than 200 physicians in 30+ specialties at 22 patient care facilities. Epic Ambulatory, Epic Beacon and Epic Willow Inpatient implemented.
Review and provide recommendations for medication build and charging in the Electronic Health Record in preparation for implementation of Charge on Administration (COA) functionality.
Assist pharmacy operations in review of existing medication build, especially as related to equivalencies, standardized doses, and other charge related build.
Preparation of spreadsheet for import with appropriate updates to pertinent items within the medication record.
Medication List (EFY) was not updated regularly and therefore was incomplete. In order to provide a complete list of medication records (ERX) for review, a recent inventory report and an extract of all ERX records used in Beacon protocols were reviewed and missing ERX records were added to review document for pharmacy operations.
Existing ERX records did not consistently include information regarding equivalencies, concentration, or dose rounding. Developed a simplified spreadsheet for pharmacy operations to review and provide appropriate information.
When charging, the exact NDC and vial size used to prepare the mixture needed to be identified. Proposed implementation of Dispense Prep functionality or use of pharmacist verification process including special workflow to include all clinically pertinent dosing information for nursing.
CASE STUDY 03
USP <800> Operations Readiness Project
Enabling a nonprofit regional health system to accelerate and complete key compliance planning activities.
• Electronic Health Records
• Operations Readiness
• USP <800>
USP General Chapter <800> Hazardous Drugs – Handling in Healthcare Settings (USP <800>) set new standards for safe handling of hazardous drugs (HDs) to minimize the risk of exposure to healthcare personnel, patients, and the environment. USP <800> is far-reaching in scope, applying to all healthcare
personnel who receive, prepare, administer, transport or otherwise come in contact with hazardous drugs and all the environments in which they are handled. In the case of this health care organization (HCO), the standards affect thousands of healthcare personnel and patients at seven acute care facilities and tens of ambulatory clinics.
A few years before the standards were scheduled to go into effect, an informal workgroup of HCO stakeholders formed to identify potentially non-compliant aspects of the organization’s operations. Approximately seven months before the deadline, this workgroup identified the need to accelerate their work, and the organization engaged TRG to help drive the effort to completion.
The TRG team, comprising project manager and subject matter experts in USP <800> and pharmacy informatics, embedded itself within the existing workgroup to leverage the group’s existing organizational relationships and knowledge. The TRG team provided process structure and subject matter expertise that enabled the workgroup to quickly produce a “compliance roadmap” comprising two documents: an analysis that identified standards-related operational gaps, and a set of prioritized recommendations for how to close those gaps.
These documents enabled the HCO to move into implementation planning knowing that it was focused on the most important compliance risks. They also demonstrated to regulators (who might visit during compliance implementation) that the HCO was committed to meeting the new standards.
TRG has been contracted to support the implementation planning efforts as a second phase of this effort.