Anytime I begin working with a client, I make sure to mention the importance of data governance, regardless of whether we are working on implementation or optimization. As the scope of credentialing software such as CredentialStream expands to cover all facets of the provider experience from onboarding to enrollment within a single platform, data governance has become increasingly important. With multiple users comes the risk of variation in data entry. Is the medical staff office (MSO) using the same address format as physician recruitment and the enrollment team? For that matter, is everyone within the MSO using the same address format? Is physician recruiting exclusively capturing a provider's married name, only for the MSO to realize later that the provider is licensed under their maiden name? These are just a few examples of how easily data can come into your software in a myriad of ways. Most of us working in the field have spent a significant portion, maybe even years, of our careers doing data cleanup.
While data governance is taking an increasingly important role in many MSO’s as we look to gain further insight, it has been a consideration for physician leaders for years. I know many medical staff professionals (MSPs) find going from one credentialing software to another to be a monumental task, but what if you had to go from one electronic health record (EHR) system to another? To consider how we can apply such experience to our own data governance, implementations, and optimizations, I reached out to Dr. Bonnie Boles regarding the implementation of Epic at Tanner Health System.
Dr. Boles is a Senior Vice President and the Chief Medical Information Officer at Tanner Health System. As the chief medical information officer, Dr. Boles provides leadership and vision for the optimization of the Epic platform and serves as the bridge between technology and clinical care delivery within all facilities. She is responsible for data governance, which is used to enhance data driven process change, to deliver more efficient, effective care. Board certified in pulmonary and critical care medicine; Dr. Boles earned her medical degree from Emory University. She completed internship, residency and fellowship at Emory University and received her executive MBA from Auburn University.
Data Governance is critical to bring trusted and accurate analytics to an organization for driving strategic goals and initiatives. Data Governance is the people, process and culture around the data which is voluminous and often overwhelming. Data Governance brings standards, definitions, and policies so that different parts of an organization are using the same data to make decisions. Understanding Data Governance is the responsibility of everyone who collects and uses data. There are many examples of data issues leading to catastrophic events when there are no common terms or definitions in place. These are typically avoided if data literacy is a priority and leaders know how to request and use data. Healthcare is so data rich and the lack of data governance is an issue. We have recently launched our data governance project that will “advance analytics” at our organization. Defining metrics and prioritizing data needs are critical with all the challenges facing healthcare teams.
Training, personalization, and post go live “at the elbow” support is critical. The approach “specialists training specialists” really works. Epic trains the providers in their specific specialty and then those providers train their peers. This creates physician or APP subject matter experts (SMEs). We called them “Epic Physician Champions,” (and we had a surgery PA that was included and was a phenomenal Epic trainer for her surgeons) in each specialty and they become another resource during and after go-live.
Dr. Boles hits on a really important point here about having a champion for your software and this is a great term. Here at VerityStream, we often refer to these users as super users. However, using the term “Champion” can be an additional way to empower the end user. I can think of several champions among our clients who have contributed to discussions and ideas.
The biggest takeaway from optimizing Epic is that you never finish optimizing Epic. Interestingly, that is not a negative. Epic upgrades the product quarterly to offer ongoing improvements and solutions, like your smartphone updates. This and ongoing feedback from end users create a situation that keeps optimization going. We continue to refine and “tweak” our order sets, workflows, and alerts to help our team provide the highest quality, safest care for our patients. We put our patients at the center of all that we do and that lends itself to ongoing optimization as well. Epic has been a true partner in these efforts. There are Epic team members that become your technical support and you have a BFF (best friend forever) from Epic. They have been supportive, helpful, and available which makes a very positive impact on our work with optimization.
As Dr. Boles stated, “The biggest takeaway from optimizing Epic is that you never finish optimizing Epic.” Now, let’s all repeat that three times, however, replace Epic with my credentialing software. This is such an important point. Credentialing and Enrollment software continues to be enhanced with updates, many of which are inspired by users. For many, this is a shift from what has traditionally taken place when it comes to credentialing software.
I would not have gone live with as many “best practice alerts” (BPAs) as we did when we went live on Epic. We attempted to vet these, but we kept many of them because we thought they would help providers (physicians, nurses, APPs, respiratory, etc.) with patient care. However, many of them are not useful because they interrupt the workflow and bring attention to things that are already being addressed. We have a project now to remove many of the BPAs that are dismissed 100% of the time with no action taken. It would have been easier to introduce BPAs along the way with better vetting of them from end users after go-live instead of before go-live.
The underlying sentiment above about not interrupting the workflow of the end user is a key takeaway. Recently, a client mentioned to me that when they first got into the software, they felt like kids in a candy store. They could build anything and everything they wanted! However, over time and through testing they realized perhaps this wasn’t the best approach when it was creating unnecessary change on the user side. Not only did it create extra work for their end users, but for the providers as well.
Whether you are utilizing data governance, implementing, or optimizing an EHR or credentialing software, the end goal is the same – a commitment to patient safety. This may be done through different methods, but as you can see our goals and challenges are the same.
I would like to thank Dr. Boles for taking the time out of her busy schedule to partner with me on this article and an upcoming piece on physician leadership!