1. Engaging Bedside Nurses in the EHR Change Request Process
Jacquel J. McDonald, MSN, RN-BC; Kimberly C. Burress, MIS, BSN, RN-BC
Children’s Hospital of Philadelphia
Epic Change Request Process
Requestor enters tickets
Prioritized
Scored
In Queue
ENCC consults/gathers requirements
ENCC validates
Change goes to production
Methods/Design
Background
The department of nursing had an established process for responding to electronic health record (EHR ) change requests and well as requests for new functionality.
Once a request was submitted a single analyst reviewed each change request, met with requestors to understand the rationale for submission, and defined the business and build requirements for each request.
The analyst then reviewed the requests with the Epic Nursing Clinical Champions (ENCC), eight practicing bedside nurses with clinical and EHR documentation expertise.
The ENCCs’ input often yielded significant workflow and build questions that created a cyclical process of the analyst meeting with requestors and the ENCC team until the final design requirements were finalized.
Approved changes are communicated to clinical stakeholders and put into the production system on a monthly basis.
The analyst as the single point of contact and the cyclical request processing methodology caused delays in ticket submission to completion rates and significant requestor dissatisfaction.
ENCC model change initiated
September 22, 2016
Tickets submitted by requestors entered into the nursing change request queue
A follow up is sent to requestors soliciting detailed change request information.
Change requests are prioritized based on the following weighted criteria:
Quality effectiveness
Work Effort
Financial Impact
Clinician and patient scope
Productivity
Patient safety
Based on the prioritized rankings and a “gut check”, lead nursing informaticists and the analyst review each request in the queue and assign tickets to the Epic Nursing Clinical Champions.
ENCCs meet with requestors to assess the business need, develop clinical workflows and document build requirements.
Build requirements are reviewed with the analyst who is now singularly focused on EHR build.
Once the changes are entered in the test system, the ENCCs and requestors validate the workflow.
Validated changes are communicated to clinical end users and are put into the production system on a monthly basis.
Purpose
EHR change process and perceived the Epic Nursing Clinical Champions as barriers to change.
Goals of the Project:
10% increase in nursing satisfaction with the epic change request process.
10% decrease in ticket initiation to completion rates
Discussion &
Implications for Nursing Practice
Initial outcomes indicate faster response time to nursing requests for EHR documentation changes
Clinical and Epic expertise have been attributed to these improvements.
The ENCCs have partnered with IS team members to perform biweekly Epic and technology rounds.
Together they address Epic concerns and immediately resolve many technology issues.
The program has been highly successful and is expanding to meet unit requests for increased support.
The ENCC team is expanded from 8 nurses to 12 to provide enhanced support Epic development and unit level support.
Results
30% Reduction in ticket submission to implementation time.
13% Reduction in “average time ticket held in queue.”
User Satisfaction Results:
11% Increase in nurses comfort with contacting an ENCC for Epic assistance
3% Increase in nurses satisfaction regarding communication of monthly Epic changes
5% Increase in nurses satisfaction regarding “time of contact from an ENCC/NI team member after ticket submission.