Problem List Engagement During an Expanse Implementation

When:  Nov 18, 2020 from 01:00 PM to 02:00 PM (ET)
Associated with  Inspire Demo

Presenter:  Dr. Priscilla Frase
Organization:  Ozarks Medical Center, West Plains, Missouri

This presentation will review Ozarks Medical Center's approach to problem list engagement during Expanse implementation. With Expanse and the new-for-us concept of a shared medical record across all care areas, engaging providers in problem list governance and active management became a priority. Our experience through this endeavor and the educational approach we took with the remainder of the medical staff before, during and after go-live will be reviewed. Hear our highs and lows, what we did well and what we wish we had done differently.

Presenter:  Dr. Priscilla Frase
Organization:  Ozarks Medical Center, West Plains, Missouri

This presentation will review Ozarks Medical Center's (OMC) approach to problem list engagement during Expanse implementation. OMC is an independent, not-for-profit, 114-bed hospital with nine primary care clinics and 15 specialty clinics in West Plains, Missouri.

Prior to Expanse, our organization had multiple EMRs with disparate, cluttered problem lists and little to no established problem list governance. With Expanse and the new-for-us concept of a shared medical record across all care areas, engaging providers in problem list governance and active management became a priority for our organization. We chose not to convert any historical information, on the clinical side, beyond laboratory data, opting instead to start with a clean slate.

Our Physician Advisory Committee (PAC) embarked on the arduous task of becoming knowledgeable enough about problem list and other functionality in Expanse to be able to make informed decisions regarding policy development. We utilized the materials provided by MEDITECH for this process, in addition to many hours of discussion and brain-storming over the course of a year. OMC's PAC team managed to come to an agreement with general problem list approach involving not only primary care providers and hospitalists, but also specialists, surgeons, psychiatry, ED and Urgent Care. Further, we made the bold-for-us decisions to limit nursing involvement in problem and history lists to the ability to add pending diagnoses only and to require problem reconciliation at discharge for acute patients.

Our experience through this endeavor and the educational approach we took with the remainder of the medical staff before, during and after go-live will be reviewed. Hear our highs and lows, what we did well and what we wish we had done differently. You will also learn how it all turned out in the end, including comparisons of before and after problem lists from real patient examples. This session will provide a basic overview of problem list functionality in Expanse compared to our legacy systems. With our last EMR implementation, it only took about three months for our problem lists to become unmanageable. Was the investment in time devoted to problem list engagement during the implementation phase of Expanse worth it?  You will have to join us to find out. Our Expanse Go-Live date was 01/01/2020.

Priscilla FraseDr. Frase is hospitalist and CMIO at Ozarks Medical Center in West Plains, MO. She previously worked as hospitalist and CPOE physician educator through an HCA-affiliated hospital in Tennessee. Dr. Frase received her medical degree and completed her residency in Internal Medicine and Pediatrics at the University of Tennessee Health Science Center. She has used MEDITECH at every stop along her professional journey.

Learner objectives:

  • Identify several approaches to engaging providers in discussion of organizational problem list governance, including review of current problem list state, discussion of historical background for problem lists (apart from EMRs) and demonstration of significantly changed problem list functionality in Expanse.
  • Appreciate the pros and cons of 1) not converting problem lists during new EMR implementation, 2) the approach we took to patient care with an essentially blank medical record at go-live and 3) problem list management settings we chose to institute.
  • Describe the benefits, or lack thereof, of focusing a large amount of CMIO & PAC implementation time on problem list management.

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