MU drives clinical transformation at Emory Clinic

Meeting Meaningful Use (MU) requirements and a desire to improve patient experiences drove practice transformation and standardization at the Emory Clinic, said its CMO and Chief Quality Officer Penny Z. Castellano, MD, during a Dec. 11 webinar hosted by the Institute for Health Technology Transformation.

Emory Clinic, based in Atlanta, is the ambulatory arm of the Emory University Healthcare system. It houses approximately 1,400 providers, employs an additional 2,500 to 3,000 staff members, operates across 37 physical locations with 82 front desks and serves approximately 3 million patients per year.

During a recent annual meeting of the organization’s executives, they realized they could encounter difficulty meeting the requirements of MU, if not during Stage 1, then possibly during Stage 2 or Stage 3. Although an interactive EHR system was implemented in 2005, providers were using few of its functionalities and workflow was still modeled on paper-based processes of the past. They decided it was time to “break the paper-based workflow and leverage the EHR and all the tools it gave us,” according to Castellano. 

Emory’s leadership were also aware that many patients felt as if there were a disconnect from from one Emory location to the others and from one Emory specialty to the others. Few standardized operating procedures existed. “We would have described ourselves as a collection of providers working alone together,” Castellano said. “And we were astonished by how much energy we spent doing that on a daily basis.”

Emory entered an organization-wide effort to better integrate EHRs into daily workflow and to standardize practices from site to site and specialty to specialty, an initiative that would improve patient experiences and prevent Emory from having to redesign workflow in the later stages of MU.

Their first step was to partner the IT department with the clinical operations department. The collaborative identified  several areas where standardization could occur. These areas included patient intakes, bring patients to exam rooms, discharging patients and post-discharge follow-ups. With this information in mind, leadership spent time developing specific goals for the organization and assessed, based in part on MU requirements where changes would need to be made in each physical location and each specialty.

“We started out spending more time than we normally would have with our future vision,” Castellano said. Then, once a specific vision had been drawn up, “we felt like we were in a position to create new best practices for our EHR tools and to make sure that we tied all of that back to improvements in patient satisfaction and attaining MU.”

After completing a two-month workflow analysis and survey of provider and patient experiences, communicating potential changes to employees and allowing them an opportunity to provide feedback was the next step. Various mediums including newsletters, a website and flashcards were used to communicate changes. This prepared providers for training and to go live with new workflows, which consisted of classroom training and provider shadowing.

“We got somewhat worried about ability to execute changes because we have so many practice types,” Castellano said. Realizing that early on was key for Emory. It allowed the organization to develop specific plans for change and to implement them accordingly. “We wanted to make it easy to do the right thing and difficult to do the wrong thing.”