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Lean implementation of electronic health records (EHR).

211 Background: The Palo Alto Medical Foundation (PAMF), an integrated multispecialty physician group and one of five regions of Sutter Health in Northern California, is converting from an electronic chemotherapy ordering and administration system, Intellidose, to Epic Beacon to achieve full EHR integration. As chemotherapy workflows are complex with multiple interactions between providers and high potential for patient harm, we adopted a novel approach of incorporating Lean process improvement principles in advance of our Beacon deployment to improve the design of our software build and increase operational safety and efficiency.


METHODS
Two multi-disciplinary teams including oncologists, pharmacists, nurses, administrative and technical support staff were deployed; a Sutter Beacon team responsible for technical design and build of the Sutter Beacon standard and a second PAMF team to evaluate workflow variation among PAMF chemotherapy infusion centers, identify best practices, engage the Sutter Beacon Build team around system design and institute rapid cycle process improvement in partnership with the PAMF Lean Promotion Office.


RESULTS
Visio maps of current state workflows were constructed to reflect oncologist, pharmacy and nursing workflows from medication ordering to chemotherapy administration and billing submission. Two Rapid Process Improvement Workshops designed future state workflows and identified key areas requiring re-engineering. Lean rapid cycle improvement strategies will be leveraged to improve clinical workflows prior to Beacon implementation. To support the 40% of infusion treatments that are for non-oncology patients, a second process was designed as an important patient safety initiative to avoid discordant nursing administration workflows.


CONCLUSIONS
Successful design, build and implementation of EHR require achieving consensus-driven work processes that maximize patient safety, eliminate workflow redundancies and maximizes the value-added component. It requires coordination between the EHR technical build team who design the system and the implementation team who integrate it with re-engineered workflows. Lean methodology provides the conceptual framework to achieve a successful EHR deployment.