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7 successful inpatient EPR implementation approaches

As of June 2014, St. Joseph’s Health Centre (Toronto, Ontario, Canada) is live on its new eCare inpatient electronic patient record (EPR)*, powered with Allscripts SunriseTM. We’re shining a spotlight here because it’s a great example of a successful implementation.

Throughout the project, patient care remained top priority, which shows in a video St. Joseph’s developed:

St. Joseph’s Chief Information Officer, Anne Trafford, is truly in a class by herself. She and her team employed several approaches worth sharing:

1. Let the clinicians drive

The St. Joseph’s implementation team emphasizes that health IT system deployments should be clinically driven, not “just an IT project.”  Keep the EPR in perspective; it’s an important tool to help clinicians deliver better patient care at the bedside.

2. Incorporate electronic medication reconciliation

St. Joseph’s is one of very few hospitals in Canada that is performing electronic medication reconciliation during transitions of care. The organization is tracking rates of completion for Best Possible Medication History and Admission Reconciliation and has a multi-disciplinary team focused on process and system improvements.

3. Communicate consistently and intentionally

Goals for eCare started at the very top levels of the organization, and the implementation team communicated regularly to staff about how the new system would improve patient care. This thoughtful communication continued throughout the entire project

4. Expect to optimize


Some hospitals want a perfect EPR configuration before launching, which is an unrealistic expectation. At St. Joseph’s, the team managed the scope well to ensure it started with a solid foundation that they could continue to evolve and optimize. It’s an extension of the organization’s commitment to continuous improvement.

5. Gain more functionality with a comprehensive approach

While St. Joseph’s is a long-time user of Sunrise solutions, it rolled out its first electronic tools for CPOE and documentation within the last 12 months. The first inpatient unit went live in November 2013 and rolled out to all inpatient and critical care units by June 2014.

6. Build in multiple training options

A comprehensive training strategy for 200 physicians and 800 other clinical users helped smooth the switch from paper to electronic orders. A combination of e-learning and role-based classroom training received positive feedback. The team also engaged clinicians as “super users” to build in-house capacity for after the rollout.

7. Use the data

Beyond the day-to-day improvements in clinical decision support, St. Joseph’s will mine the data to feed strategic planning efforts and new models of care. It’s also participating in a provincial project to share EPR data with an Ontario repository, scheduled to be live within the next 12 to 18 months.

These strategies worked well. Between March and June 2014, physicians directly placed more than 90% of orders in Sunrise and completed nearly 200,000 entries into nursing and health discipline flowsheets. Between March and June 2014, the clinicians verified 4,000 medications and Sunrise fired 974 alerts for ordering providers to indicate potential drug-to-drug interactions or allergies.

Thanks to the team who shared their thoughts with us, including Chief Information Officer Anne Trafford, Deputy CIO Purvi Desai, Director of Information Technology Liz Goff, Chief of Staff Dr. Ted Rogovein, and Director of Interprofessional Practice and Chief Nursing Officer Jenni Glad Timmons.

* Editor’s Note: Electronic Patient Record (EPR) is another term for Electronic Medical Record (EMR) or Electronic Health Record (EHR).

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