A typical hospital EHR project can take at least a year. A team at health IT giant Epic has been able to stand up technology at field hospitals in COVID hot spots in a matter of days.
In all, the Wisconsin-based EHR vendor has helped to bring online 440 alternative care facilities to help expand hospital capacity throughout the country in the past four weeks. Epic has worked with 175 health systems, public health authorities and state and local governments to add up to 80,000 beds nationwide.
The key is to get creative, Epic executive Nick Frenzer told FierceHealthcare.
"Speed is an obvious factor. So we have to say: 'What exactly do we need to provide care in this instance and as quickly and safely as possible?' We have to throw out the window any assumptions about what processes need to happen and look at what is the critical path to set up a tent hospital in 10 days."
Some of those beds are in use, such as the Javits Center in New York City, which was stood up in record time with the capacity for 2,500 beds. Other facilities set up in hotels and athletic stadiums are ready and waiting in case there is a surge, Frenzer said.
New healthcare facilities are also being set up in Chicago, Boston, Atlanta, Dallas, and St. Louis. Epic is helping increase capacity at a health systems’ request, adding beds in existing hospital areas, and at the state’s request, creating new hospitals in alternative facilities selected by state officials.
How they did it
The company started by setting up a field hospital's electronic health record system using the customer's base implementation of the Epic EHR. For example, when setting up the field hospital at the Javits Center, Epic connected with NYC Health + Hospitals' EHR system. Clinicians also use Epic’s interoperability platform, Care Everywhere, to access patient’s information from different health systems.
"We try to make it as 'plug and play' as possible," Frenzer said.
Epic is providing the software, staff, and strategy for these projects at no cost. It partnered with tech giant Apple to provide some of the hardware that was needed for clinical staff such as laptops and iPads.
"We try to do as much as possible with mobile devices. We get a laptop and 30 phones and we can make that work," Frenzer said, adding they stood up special workflows and streamlined processes for clinicians. "We want to ensure that IT does not impede providing patient care."
Some temporary hospitals also feature other standard equipment for patient care, including mobile diagnostic imaging machines, pharmacies and lab equipment,
He has worked at Epic for six years, leading implementation service project teams of 40-126 staff on multiple enterprise EHR projects.
There are now 400 Epic staff working on these rapid expansion projects.
"Eight weeks ago, I wouldn’t have believed you if you told me I'd be working on this," Frenzer said. "This is an opportunity to help improve healthcare tangibly and we all have a sense of mission and purpose. It's been a tough time, but it’s been inspiring what we’ve been able to accomplish. I’m proud to have been a part of it."
Health systems are faced with an influx of patients and, at the same time, many hospitals are sending IT executive teams to the frontlines of patient care. Health systems are looking for guidance on developing a strategy for adding capacity, Frenzer said.
"Some hospitals are expanding into lunchrooms and converting rehab units to ICUs. Some states and public health departments are working with health systems to set up healthcare facilities in schools, hotels, gymnasiums, parking garages, and fairgrounds," said Jackie Gerhart, a physician on Epic’s Clinical Informatics team, in a statement. "Epic is partnering with these groups to get facilities up and running, and we offer a roadmap."
When planning a surge facility, there are critical considerations such as what type of patients will be seen at the field hospital and what type of care will be provided, which helps to determine the resources that will be needed, Frenzer said.
Alternative care sites need hardware and supplies, such as rooms and beds, computers and monitors for nurses’ stations, printers, barcode readers and phones or tablets for clinicians to document patient care.
For instance, Boston Medical Center was seeing an increase in the numbers of COVID-19 patients and wanted to adapt existing spaces or create new facilities to handle the surge, according to Jeff Kalish, associate chief medical information officer at Boston Medical Center. The hospital worked with state officials and Epic to reopen the East Newton Pavilion, a closed off-campus hospital.
EHR expansion projects, or extensions of live Epic sites, can take several weeks to go live. Boston Medical Center was able to go live with the new site in three days.
“We partnered with the Commonwealth of Massachusetts to develop a plan to address the needs of our most vulnerable population—homeless and housing-unstable patients. It was a Herculean effort to prepare and re-open the East Newton Pavilion, but our multi-disciplinary teams came together seamlessly, and with Epic's partnership and detailed project plan we successfully accomplished this feat within three and a half days," Kalish, the physician IT lead on the project, said in a statement.
COVID cases are starting to decline in some regions. President Donald Trump said April 15 that the U.S. has “passed the peak” of the coronavirus outbreak and the White House has released guidelines for reopening communities.
But there are 120 hospital expansion projects still in progress, Frenzer said, as some state officials and hospital leaders are concerned about a resurgence of the virus.
"We are moving ahead with those projects and hoping we won’t need them. If we never have to use them, then we will have been successful," he said.