Alrighty, well thank you everybody for, you know, attending our session today. We're going to share our experience at UCSD with the new EHR integration and share some of our challenges and success. Just a quick disclosure, I'm part of the EPIC steering committee and a part of a couple sections. Please, please join our health informatics. We have a lot of projects and we would love to have more engaged members join us. Would like to share some great news. So the paper was actually just published, so you're going to, you can, you know, look online. It's free access and it does explain in a little bit more detail our journey integrating our EHR enterprise. So as you all know, integrated EHR systems are known to improve health outcomes. Demonstrated here is the CDC five pillars for meaningful use. You improve health outcomes by engaging patients, improving care coordination, improve public health, ensure the PHR, personal protective information privacy, improve safety, quality, efficiency, while reducing health disparities. How we are engaging patients. So we improved of two-way communication between patient and providers and employers. We have a work status portal that we can control what can we share with the employer. And it's all electronic. We also, our questionnaires now are electronically. So we did just in the past year about 6,500 questionnaires a year. Not only is paperless, but the time that someone will take to fill up a questionnaire that was supposed to be 20, 30 minutes, now they fill up even before the visit and it will take just very few minutes and the patient satisfaction is incredible. Access to workers' comp notes. As you know, with the 21st Century Cures Act, you're supposed to share notes. So with that, you know, our workers' comp progress notes is shared with patients unless we feel that that's not safe to send and we just click another button. The other nice feature is that readily available testing results, so, you know, radiology results, lab immunization, that is seen in both sides of the firewall. And very easy to use telehealth. We also have free inpatient care coordination with easy access to employer-sponsored vaccination. So once we went all on the large enterprise, we also launched the peer-to-peer and we actually were able to sponsor 5,000 vaccinations a day. With the flu, we eliminated our on-site vaccinations, mostly peer-to-peer or drive-through of our 10,000 vaccines a year. Our referral work use now is much more coordinated and we have metrics. Secure communication with providers within the health system with our PT consultants. When we send someone to ER, we explain why we're sending them and they can see our notes. That's compared to when we were isolated on a separate EHR. So much better patient care coordinator. We also released pertinent data in a secure and compliant manner to environment health and safety and HR. In HR, the work status is released through a portal, but through environment health and safety, we were able to create a super-fired wall space that they can see our clearances and they also can document the fit testing. The nice thing is all records are in one place. We're not coordinating with 5, 10 different systems like we were in the past. Just a quick example of secure communication that we do through PT. It sounds very simple for family practice, but quite challenging if you're in an isolated EHR, separate from your enterprise EHR. Between public health, comprehensive vaccination programs like we talked about the peer-to-peer and drive-through. So we don't have to have like a 5,000 vaccination on-site clinic. It's much smoother, much less loss in work time. Streamline exposure medical management. We had built-in algorithm. So not only for the day-to-day blood-blood pathogen exposure, but because we have a campus just across the street for our high-containment BSL-3, for example, B-virus, vaccinia, lentivirus, COX-E, we do have algorithm with the post-exposure management on that. We enhanced our data segregation, aggregation and reporting with the immunization registry. So we are able to get from outside the vaccination, especially for COVID, surveys and track reporting, regulatory like, for example, for the blood-blood pathogen, and Arthur is going to talk a little bit more. We were able to retire the EPINET and run reports really very fast. And leveraging the technology with telehealth, secure management in the future for e-consult that we can consult other specialties within our EHR frame, no calls or pagers. Well, it's all wonderful, meaningful use, right? But why occupational medicine is a little behind what other specialty are, I believe it was because of the increased concern for the digital security. So we're going to talk a little bit about how we were able to get the boast of both words, having meaningful use of EHR while also respecting the employee digital privacy. And just as a background, I worked two years for the implementation integration for the EHR. One year only was in regards to compliance. So I hope with the paper and with the experience today, it will open the gates for you, be able to talk to your compliance or how much improved health care metrics and management you can achieve with the integrated EHR. And, you know, pretty much I believe that the secret sauce was, you know, the respect in digital privacy built around the digital privacy. And again, we're ever being able to have a space for the EH&S to put the fee testing and the PPE documentation on one place. So what are the challenges? And all of you are specialists on all of this. I don't need to go in details, but quite a bit. You're on top of the HIPAA, ADA, GINA, EEOC. EEOC actually does have a letter recommending a firewall. The HSS, the OSHA recordkeeping, you want to have information from the employer necessary for the person to perform the work safely. Workers' compensation, that although, you know, it's not HIPAA under HIPAA, I believe all of us consider that as a protected entity. And the 21st Century Act that is promoting sharing of information. How do we ensure privacy of PHI? Again, joining the enterprise, the nice thing is that we did have already a very robust compliance infrastructures with lawyers and IT analysts. But we did build additional privacy for employment-related data and exams that could be interpreted as conflict of interest, especially on the pre-placement, on the surveillance, and secure communication between employees and providers. So how did we do? We did build a firewall, and the provider will have two views. The department will have two views. One is that, you know, you're under workers' comp, so you'll have full view of the chart. And the other one is, as an employee health physician, that you're only going to see, again, what is important to keep the patient safe. For example, I'm not going to be able to see that the patient went to the oncology clinic. I'm not going to be able to see labs that were done on HIV or something like that. There was not order with the department. But I'm going to be able to see if the person had titers or vaccination, for example, measles, mumps, rubella, varicella, that is pertinent to work. So we were able to filter all that. On the other hand, when you're on the mainframe as a primary care, you're not going to be able to see the physical that I did for the pre-placement. And most importantly, you're not going to see any drug testing results, any under suspicion exams or fit-for-duty exams. But the patient has access to their labs. Again, another slide here talking about the firewall, a little bit more simpler for the workers' comp and non-occupational medicine notes. And the employee health view with the pre-placement, medical surveillance, drug testing, fit-for-duty, and the labs. But again, the labs you're able to see on both views, including the vaccination. Talking about background, the legacy of the system that we retired quite a bit, we actually were able to retire six medical records database. We had an off-shell EMR, we had a partial use of our mainframe EHR, we had a home-grown flu vaccine database. And the challenge of that is that the person, the patient, would not be able to get the documentation because it was an isolated EHR. We also had a compliance database, was 30 years old, and most of the types of fit testing were there. We traditionally would lock the employee out of EHR, the main EHR, if they were not compliant to TB or fit testing, so it was a very efficient way for compliance. EpiNet, I think many of you from MedCenter used for needle stick, we were able to retire. And actually, we would just reproduce all the information within our EHR. In our mass exposure, we built some algorithm and some space of that, and we were able to do forensics on the exposures. Communication methods, especially on COVID, was crazy on how much information you're doing on iShare, phone calls, emails, Zoom, DocuSign. We were able to retire all that. And then the database intake, just simple paper questionnaires transformed into electronic questionnaires, made rooming patient satisfactionally greatly improved. Outcome, scheduling efficient. Our visits, you know, rooming is much shorter. Patient portals, smart sets. We're also able to, I don't want to say control, but guide desired behavior from providers. For example, not forgetting all the requirement for onboarding and also managing not to have too much loss of work days. We reduce and duplicate data because before we're pretty much working on a day-to-day on two or three systems. Integrated lab and radiology systems, again, all in one place. Immunization and titer. We have a portal for the clearances. And integrated billing, telemedicine. Again, the patients also are able to schedule their own test and their own vaccinations through a portal. What happened is that when we went on COVID, we went really aggressive on self-testing. And our lab have capacity for five tests a day. So pretty much you can just check yourself in through the EHR, schedule your test. And if you want to test every day, by all means, you could do that. And then also for vaccination. What also happened and helped us a lot is that all our employees are now integrated into our EHR. So when you log into EHR, you just can put your actually employee login and password instead of the EHR. And with that, we're also able to run reports. And Arthur will talk a little bit more on what we did. We were able also, as you know, we were quite short of N95. So fit testing got quite challenges and got behind. So we're able to then very fast do 5,000 in a few months fit testing with the mobile vaccination. And we also did with distant medical clearance with the nurse clearing with the OSHA questionnaire for the mobile vaccination. So we did a pretty streamlined report and we still continue to build metrics. Improving quality data, safety, efficiency, and reducing health disparities for the medication, enhancing reports, success, loss of workdays. Arthur is going to talk a little bit about that, how we manage that. Access workers' comp and non-occupational medicine notes. The ED or specialist now can read our notes and is very important for continuing medical care. Targeted health information and wellness initiative. We're able to identify them by groups of, by union. And we also going to talk a little bit later on another presentation about vaccination grant. Then we're going to leverage what we have in EHR so we can do targeted intervention. Implementing effective metrics. As my old professor at Penn, Dr. Emmett, used to tell me nonstop, I don't know if he's here, but actually this is from Peter Drucker. He kept on saying, Marcia, if you cannot measure, you cannot manage. And that's so true. And so we're taking that now with implementation. Our next step right now is really metrics. Are we doing good? Are we doing bad? We're not doing so well. Let's face it. Let's create intervention while we're doing good. We go show off to the C-suite so we get more resources. So now Arthur is going to talk a little bit more in details of our data reporting. He's going to go a little bit of rabbit hole. And for example, how we controlling loss of workdays. Very simple actually. How we build the work status. I was able then to pull when they're off work, then we run a monthly report, and then we have meetings, meet with our provider's team, and we have targeted case management. The results of that are incredible with just this intervention. So we do have dashboards from UC-wide. We call UC Office of the Presidents. So it'd be UCLA, UCSF, UCI, all the UCs you can imagine. And we are right now at minus 35% of predicted loss of workdays. What it translated is from June to today, we saved on more than 3,000 lost workdays. That's pretty incredible. And we kept our satisfaction and retention up. But again, we are trying to have better metrics and then have targeted intervention. And I really hope our successful journey will inspire other institutions to integrate and customize their EHR. Thank you. So my name is Arthur. I'm one of the nurse practitioners at UC San Diego. And I wanted to talk to you a little bit about kind of where we are and where we're going. I have nothing to disclose. So let's talk a little bit about why EHR integration. Is there anybody in here that uses a standalone EHR? Anybody? A couple people? Right. So do you ever feel like you're kind of on an island, right? It's not a bad place to be, but you kind of lack some resources that you would get if you were kind of part of a bigger situation. So for us, EHR integration in a way kind of means we became a peninsula, right? And full disclosure, I'm from Florida. That's why Florida is on there. But we're attached to the mainland, right? So you have access to all these resources. But like Dr. Izakari talks about privacy, those things, we're still kind of surrounded by water. And I think that that's one of the big benefits for us. Again, being part of a large healthcare institution gives us access to certain resources. One of those being robust IT. That's so important, right? There's so much that we can do if we have a solid IT infrastructure that's in-house. And we can go to them and tell them, hey, we need this, and have them make that happen for us. Again, really big on reporting and data analytics. Like Dr. Izakari says, you can't manage what you can't measure. And it allows us to do ongoing QI and PI work. Training and support. This is huge. I don't know, for those of you that use a standalone EHR, getting a password reset can be a real pain in the rear end, right? So it's nice for us to be able to just call 3HELP and get a password reset, or even help within our EMR. And then the last thing is population health. Sorry about that. And we are beginning to use the EMR kind of in different ways to help guide targeted interventions for our worker population. I'll talk a little bit more about that. Again, robust IT allows us to push boundaries. So we're doing things that maybe are a little bit different, and we're learning to do things in different ways. And it gives us the ability to do certain things. Like Dr. Izakari talked about the peer-to-peer, the COVID testing and the drive-thrus, right? Mobile mass fits. All these things, the biggest challenge that we had as an organization once we were transitioned was finding a place to set up. Because internet, computer, we were ready to go. And also the integration with the resources both inside and outside the health care system, lab, radiology, the registries, having access to query the registries, the state registry for immunizations for employees for onboarding, as well as having a direct line to pharmacy. So when we went through our build-out, one of the things that we were thinking about, the strategic vision is, when I input data into the EMR, how can I get good reporting out of it? So a lot of the things that we did when we built, like she talked about work status and those things, we're thinking, hey, later on down the road, how can we pull good reporting? And we're also, again, learning to use that reporting in creative ways for day-to-day management and targeted interventions for our workers. CDC says, a workplace health program should include the ability to track changes in the health status of employees over time, such as part of an annual health assessment. A system should be established to track changes in the health status of employees over time. Is that really that easy in a standalone, with a standalone EMR? It can be a little bit of a challenge, right? So a lot of what happens for us, the biggest challenge is how do we get the employee information into the integrated EMR? How does all this happen, right? And to a certain extent, we kind of operate two different things. There's a little IT wizardry that happens. We have an employee database, an HR database, and we also have the EMR. And the data kind of communicates between the two using the employee's ID number. So certain things are fed in, and that allows that data to be used for a tableau, that reconciliation to happen for tableau for those dashboards that Dr. Izakari talked about. But the other portion, and I read some of the listservs, and one of the things that people complain about is, hey, I have an EMR, and I run reports, but when it's running a report, my EMR is useless, right? It's super slow. And with some of these kind of off-the-shelf EMRs, they use this SQL server database, and don't ask me exactly what that means, because I'm not an IT person. But I will tell you that this allows you to run these ad hoc reports, kind of these labor-intensive reporting. It allows it to happen on the background and separate from your EMR. So your EMR doesn't slow down because you're running these ridiculous reports over thousands of visits over a year. And I'll add, I'll go back to this, this portion using the SQL server, this is not new. This is not something that UCSD is doing different. In fact, most healthcare systems that use large EMRs are already doing this. It's just learning to leverage this for our purposes in occupational medicine. And again, how are we using the data? So this is really interesting. This is a map of San Diego, and it's broken down by zip code. And this tells us our employees that are overdue for flu vaccination based on their geographical location. And this is a really cool thing. We don't really know 100% what we're going to do with it, right, because we're still learning. But we think that in the future, this is going to allow us to do more targeted intervention in those locations, right? So is it drive-throughs? Is it more peer-to-peer? What are we going to do in those locations? And these are the little things that we're kind of learning as we go through this transition period. And then secure patient portal activations. For us, this is really significant as a metric, because the higher this number is, the more ability we have to reach our patients electronically through the portal. And that's really important for having those questionnaires filled out pre-visit, you as a provider being able to communicate with the patient, and the patient being able to communicate back to you. And it's not just questionnaires. It's really anything from referrals to labs to you name it, very, very important for us. And then, like Dr. Zakari mentioned, we've really put a big focus on tracking our return to work. Using the EMR, we're able to pull a report. We run it monthly, but again, having the ability to do ad hoc, we can do this by week, by whatever. And we pull the patients, the list of patients, when they are off work, when we're expecting them to go back, and we do targeted intervention with these group of patients, right? We talk as a group. We kind of discuss the case management, how we're going to move them forward to try to limit the loss of work days. And talk a little bit about reimagining our workflows. That's a very legitimate picture. That is the floor of my office, like was, was, yes, a very legitimate picture. This was our animal allergy risk assessments. This was 100% paper-based. We had a clinic. People would come and drop off their papers in a drop box, and things would get lost, maybe. I mean, I can't even tell you. This was a real mess. Not to mention the administrative burden, right? So the scanning of the forms after the fact, scheduling follow-ups, having to call the patients, sometimes they don't answer. All these things are pretty significant. So we simplified our process. I know it doesn't look very simple on here, but it is. Everything is done electronically at this point. From the initial forms that we send to the patient, to us scheduling the visits, quote unquote visits, which are really electronic visits, they don't have to come in, notifying employee health and safety once they're cleared, and notifying the patient as well, or if we need them to come into clinic for a vaccine, or some additional assessments, biro, whatever, we're able to notify them through our patient portal. This is a screenshot of the message that we send to patients to schedule. I want to kind of draw your attention to the bolding, the color of the font, and those sorts of things. This is really interesting, because based on the response that we get from the patients, we've kind of tweaked the message a little bit, so that way they don't, you know, they're not necessarily calling us. But it's nice to know that we can do this. And also, if you look at the bottom, it's pretty small, it'll tell you when the patient read it and the time. So you know that the patient got it, you know the patient's aware, and you have kind of like that double check. And then I'll talk a little bit about looking forward. We really need to, as a specialty, we need to advocate more for better off-the-shelf solutions in terms of the EMR, that whole island to peninsula concept, right? And the other thing is to leverage resources that are available in the health system. So you have really great analytics, I'm sure, that they're doing already for your inpatients and your other ambulatory clinics. So why shouldn't we take advantage of that, right? Really great IT resources, password resets, something as simple as that, training, software updates. It's nice to get those updates with those changes, those modifications pretty regularly, right? And the other thing is to use our EHR as a tool to drive growth and continuous improvement in our clinics. So with that, I will hand it over to Manny, who's going to talk a little bit about the 2022 survey results. »» All righty. Thank you all for sticking around. So just a few disclosures. So I am actually going to be one of the authors coming out on some position statements that will be coming through ACOM in the next year. I'm also a federal employee. So what I'm going to be presenting today does not represent the views of my employer. So just as a little aside, I currently work at the VA Long Beach Healthcare System in Long Beach, California. I also have a faculty appointment at UC Irvine Schools of Medicine and Public Health. But I've had the fortune of working with Dr. Issacari, Arthur, and some of the folks over at UC San Diego and really trying to understand the work that they've done over the last few years when it comes to developing an integrated EHR for occupational health, especially in academic medical centers. I work at UC Irvine and this is something that I'm very interested in and hopefully potentially developing a consortium across all the University of California hospitals to really try to better serve our workforce across all the UCs. I was asked to contribute to this effort continuing the work of one of the former UCSD preventive medicine residents, Rosie Connick, who is currently doing her PM&R residency in Florida. And it's been an honor and pleasure to continue this work because as a UC Irvine faculty member and a committed person who is trying to expand health informatics across all occupational health practices, not only at academic medical centers but really across the board, how can we create an integrated system that's going to work for all of us? This is something that I am personally invested in and hopefully we can get as many of you as possible involved in this work. So with that being said, I wanted to provide some additional information about this survey that was disseminated to ACOM members. I believe the dates were February 1st through March 27th of last year. And I know some of this work had been initially presented at AOHC 2022. And this is just a continuation of the survey results for you. So just to give you all some background, 48 persons from the ACOM membership, this includes folks from the health informatics section, pharma section, et cetera, actually completed this survey. And when we take a look at the breakdown of who participated in the survey, we can see the vast majority were occupational medicine physicians. But we also have a hodgepodge of family medicine and emergency medicine as well as other affiliated professionals. So when we look at the folks who were part of the occupational and environmental medicine contingent and we look at how many years they've been in practice, clearly you can see that most of these folks were in practice for 20 plus years. And when we look at practice settings, we can see that the majority were in hospital-based systems followed by outpatient clinics and corporations. And with respect to what types of organizations our members who participated in the survey work for, we can see that, again, a hodgepodge of academic health centers, nonprofit health centers, as well as corporations. This is looking at how large the organizations for our members who participated in the survey. So we can see here that the vast majority of the folks who participated were employers who worked, employers who have greater than 15,000 plus employees. When we actually look at what type of employee health services are being offered, we can see here that the vast majority worked in employee health services offering medical surveillance, pre-employment, et cetera. And this is looking at the question that was asked when looking at what type of medical care that's offered to employees outside the scope of occupational medicine. The vast majority answered that they do not offer such services. So this is actually interesting when you say how many electronic health record systems you actually use in your clinical practice. And I mean, it still amazes me that we still have to use so many different systems to be able to manage our employees. And you can see that here, that 55% of respondents stated that they actually have to use more than one system. So with respect to primary electronic health record system that the members used, they primarily use it for occupational medicine and clinical practice. But we can see here that it's also used for a variety of different tasks, including internal employee health tracking systems, external employee health tracking systems. And when the respondents were asked what type of EHR that they use and what purposes do they use them for, primarily clinical note-taking was the number one at 82.6%. But we can see that for ordering labs, reviewing and receiving test results, as well as electronic prescriptions, there's still a lot of utility for primary EHR system use. This is a continuation of the previous question when we asked the participants what type of — why do they use the EHR in their respective practices. We can see here tracking authorization requests, medical surveillance clinic exam notes. So it's used for a variety of different purposes across all these respective practices that the participants work in. This is again a continuation of the previous question. Again we're seeing a variety of different utilizations for primary EHR use. And this is again a continuation of the previous question. This question was specifically asking the participants in the survey, how long have you been using this particular EHR system? And you can see here it's a mixed response. Many folks were using their respective systems for 0-3 years. But the vast majority have been using a system for greater than 6-9 years. And this question was asking participants how did they develop their respective primary EHR system? And the vast — well, I guess 43% of folks responded that they purchased a commercial product with minimal customization. This is something that actually has come up in various conversations I've had with folks. And really trying to identify commercial products that best fit your respective practices is important. But customization is also important because all of us work in different healthcare environments. We have different needs of our employees. So how do we better serve our employees? And customization is something that could be beneficial. This question was asking participants what other electronic health record systems do they currently use? And the respondents had a variety of respective responses here. Probably clinical practice. But again, they were using it for internal and external employee health tracking. This question asked participants how was the secondary electronic health record or database developed? And you can see here there was a variety of different responses. So I'm not sure about you all, but I've been doing some reflecting lately about the COVID pandemic and lessons learned. And I'm not sure how you all feel coming out of the pandemic. But it's interesting to see how much we were able to develop with respect to our variety of practice settings that we work in and how we were able to really take the challenges on when it came to mass COVID testing for employees and how we were actually able to develop systems in such a short amount of time. I haven't forgotten about that and really looking towards the future. How do we take these lessons learned and focus on pandemic preparedness? And how do we incorporate that into our electronic health record systems? So again, this survey was conducted last year. But you can see here that respondents felt that the COVID pandemic had impacted their respective applications positively. This question was looking at how respondents looked at their current primary EHR system and whether it's meeting their COVID-19 related needs. And you can see it was kind of a mixed response here. This question was looking at what confidentiality or privacy concerns that the participants may have with respect to their EHR. And again, a very mixed response. I feel like digital privacy is something that's going to continue to affect us in our respective health practices. I think it's important to continue to share best practices with respect to what works. And this question was looking at how satisfied the participants were with their respective electronic health record with respect to digital privacy. And you can see here that mixed responses, but again this is something that we need to hopefully expand upon in our respective discussions. Compliance. I feel like compliance is always something that comes up, right. So this question looked at how our participants looked at compliance concerns. And we can see that the vast majority didn't really have major compliance concerns, but this is something that we have to think about. This question was looking at specific compliance concerns. And you can see here that 53% of folks said that reliance on scanning documents and paper charting was one of their major concerns. And lastly, this question was looking at how respective members were looking at specific measures to improve digital privacy and compliance. And we can see here that firewalls came up, and we can also see that break the glass came up, and complete separation of the EHR system for employers and patients came up as well. So I think that concludes our presentation. Thank you so much. Hi, can you hear me? Yes. Hi, my name is Anna. I'm from Australia. I'm an occupational environmental medicine resident over there, currently studying at Stanford in clinical informatics. One thing I'm really interested in is when there's new deployment of EHRs, often there's an issue with provider burnout because of the sheer administrative burden. Have you found that with your deployment at UCSD or any other places, particularly in occupational medicine? So I think our our health care system, one of the things that, for me, I was not like an Achmed MP. I came to Achmed like, what, three years ago, Dr. Bakari? She kind of recruited me. And for me, one of the biggest challenges was like note-writing, and like labs, and working out of multiple systems. So one of the nice things for us that we gained with integration was really like good note-writing, good templating, ability to modify templating. We use dot phrases, which are really helpful, dictation, all those things. And we're finding that as our providers have gotten better at using those things, people aren't going home at seven o'clock. You know, they're usually able to get out pretty quickly. So we think that that's helping. Plus, using some of the reporting to really like hone in and address issues, we think that that's helping as well. Oh yeah, and having access on our phone, secure messaging. One of the nice things is we can look at like how much time providers are spending managing labs. So we've kind of come up with some ideas for that to have our ancillary staff help manage certain things. Those are like the little things that we're doing that are helping. I think organizationally, too, we have the Home for Dinner program, too, which works with the providers to help them become more efficient, set up better templating, and that sort of thing to get them home earlier. Yeah, awesome. Hi. I might have missed this. Was it, is it Epic that you all are using or have customized? And so with that, have you, was it this part of the Occupational Medicine pilot program or is this something that Epic is providing? So, you know, historically UC San Diego has a very robust Epic team, in-house Epic team. So we're able to customize the way we want. We also provide the EHR for UCR Irvine and UC Riverside. So historically, we had a very robust team that can customize the EHR. It was actually home-customized by us. Epic does have a new portal and is geared more to commercial clients, but it does help a lot because it does have a portal for employers so it can capture better, specifically, like client-based. This client wanted DOT, wanted a drug test, and X, Y, and Z. So we just did that parallel to Epic. But now, which, you know, I'm part of the steering committee, so we're starting to work together, but it's pretty much, it came, came from, from us and what we believe it was right and we were able to get the tools and the resources to say, no, the build's not as we want. I want better than that. No, I had an idea. So it, again, it was an incredible experience because it was not Epic team or UCS COEM team. We end up becoming one. We still meet monthly and we still continue to improve and then we still filter requests that it makes or make no sense in operations. And we do have also transformation team at UCSD level. So if it needs more, we need like a lean champion, need a bigger intervention, we can just request for the transformation team to help us on that. So that's the nice part of being in the peninsula. So we're not so isolated and now our metrics is starting to make a little bit more sense to the entire organization. It's interesting. So we're, we're a fairly decent-sized healthcare system, Atrium Health, in the southeast now, Midwest. So we were looking at a separate EHR because we can't get Epic to, is there any Epic in the room? I have to tell them to come next year. I don't get paid a cent though. Right, so we've had a lot of issues. We have our own internal team, but they won't customize based on our needs. So that forced us to look outside for another out-of-the-box. Yeah, they have a new build right now, but I think, and I was talking to someone who was looking to that, one thing that they do have a new build and it's great for commercial clients, but for the employee health you want to have your compliance engaged and you want to have a firewall. There's a new paper coming out, it's already for distribution, and it talks about the firewall and it pretty much described the firewall that we had. And again, it went through a really strict compliance and legal review, and not only a UCSD level, but also the Office of the President. And we do have electronic release of information and stuff like that. And that's on the ACOM website to access the paper? Which paper? The paper that we have, that we published, is at the JOEM. It's on early access. I think in paper will be in a few months, but it just got in, like, at early access, the draft. Good afternoon, almost. I know, lunchtime. How did you all deal with some of the employees concerns regarding privacy when you have one EHR where you have potential workman's comp injury information, but you may also be acting as their primary care provider? In my experience, we've got employees who really do not want their workman's comp or their injury report shared with their PCP. So how did you address that with the employees? How did you get over that stumbling block? So, you know, UCY is highly represented by unions, right? But luckily we do not have challenges on that. I think proactively we had our CMO and the EPIC team doing townhouse and address concerns on how we're going to deal with the data. We do have internal registry and stuff like that, but I think the most important, the only concern they had was for the employee health part on the surveillance and stuff like that. We did not get any issues on being on the mainframe. Actually, all the patients got happier with that because they can see the notes and then the consultants can see the notes, but very fortunate we did not have that because that was discussed in the townhouse and we, again, it matches the Cures Act, it matches the five pillars of CDC. But we do have a release of information. Just in case, I keep on telling the compliance folks, I don't have an extra million dollars because of a civil lawsuit. So we do have electronic release of information and also that was the first time it was custom-made for us, but looks like other institutions can use, is also the e-form filler, so we use on the state forms for workers' comp. Hi there. So user acceptance and buy-in is really important. What did your implementation planning schedule look like and how did you, or what interventions did you include to increase the success of user acceptance? You mean user acceptance meaning the EHR user or you mean the patients' employees? The employees. Oh, the employees. Well, this was one of the, is when you make lemonade out of lemons out of COVID because we, and also UC, we had mandatory COVID vaccination and very strict testing. So for you to have the testing, you have to be in the EHR, but the nice thing is that you don't need actually to create electronic medical records. Our EHR team created medical records for every employees. So now that's one of the things that we have called with the UC people soft that it automatically create a medical record and then they can log in just with their personal electronic information and the results are electronically. So everybody got access for that and now we continue on the onboarding because the questionnaires are electronically done. They can do paper, but electronically done we have iPads and they get registered right away on that. So we just kind of, whatever we could do to make the system easier, we did. Whatever we can automate it, we did. And, you know, save time and, you know, having iPads and stuff like that. And it's been really fantastic, especially with the resident onboarding. We have almost 400 from emails, you know, fax and stuff like that. They do all electronically. It became really nice. Hey, how are you? I apologize if you mentioned this. I did have to come in late. I was trying to see another talk also. With this electronic health record, are you able to populate the California formulary? Yeah. And then do you also have like the PR2, the PR4, the California forms? So that's what we built. Actually, we heard that that was something, not a feature for the EHR, but we ended up, you know, it was a paid customization that the headquarters did for us. So we have our doctor's first report, the PR2, the RFA, and the doctor's first report, PR2, RFA, and the PR4. They're all done with that. It took a little, you know, we just, just the way we build, we just have to mirror how it is and put as an attachment. Also, when a mid-level sees a patient, we automatically put for the physician to co-sign. So, and I heard that I think Sharp, that's our next-door neighbor, is going to use this feature. So that's one of the things that I really, you know, open, open barriers on that. On your question here, so I'm a primary care physician as well as an occupational physician, and in particular, the question I have is about the firewall. I read the white paper, and I wanted to follow up on that about having a dual role as a employer position and a primary care physician. So one unique way we looked at doing this is we place occupational data into our occupational EMR, and then during a surveillance exam in a corporate setting, right? So then if the employee would like to partake in primary care, we actually place that information in a separate EMR. So any thoughts on the swivel chair approach? It's not pretty, it's ugly, but it separates the information. Yeah, so we used to have a separate EHR. You know, we were one of the early users for a well known EHR here, but it just didn't make sense. You know, you know, everything was, especially in a workers' company, everything was separate, and you have to, you know, look into the other system to make sure everything's okay. Even medication, like on, on, you know, does this medication, is it okay for the patient or not? So I, we had, we have a user satisfaction survey after our implementation one year after, and it was a sky high. It was like between 80 and 90 percent. Even the ones that, the baby boomers that have problems using EHR, they went so smoothly on the new system because it was one. It's not perfect, you know, but just being in one place, the safety measure, like the allergies, you know, medication, knowing previous results, then, you know, going to two records, it's, it's something that you would not go back. So I, I know we are so vested on integration. I'll just add one little thought on that. Just that, again, the purpose would be that if you're functioning as an agent of the employer, that data would stay in the employer's EMR. Yeah. But if we, again, function as the... We do that. Right. And we had a difficult time, I guess, trying to separate that out with Epic, and that's why we went to two separate EMRs. And, you know... Yeah, yeah. That's that, and that's the, I think that's the, you know, if you, like, you look at the survey that we did, that's what the vast majority did, but, you know, UCSD has historical GBDARing, and we wanted to accomplish more. We have been in, in this dual system now, like in what integration over a year, and when we do surveillance, we really separate, you know. We cannot see what we shouldn't see, and there's many ways you can, you know, you could see through the lab, you could see through the, just the visit name, you could see through referrals. It's totally isolated, and again, it's just this strategy. We didn't create anything new, we changed context, and it's, we're firewall when you're doing employee health, when we're doing workers' comp, then all the benefits of integrated EHR. So, again, this went through incredible scrutiny through the legal department, you know. UC has a really, really robust legal, not only locally, but also at the office-to-president level, and actually, it, the, we felt it was so successful and got so much attention UC-wide that UC Davis and UC Berkeley and UCLA are integrating. UCLA integrated a little bit, it's going to do more, but UC Davis and UC Berkeley are going to be in the same process as we do, and I hear all the other, you know, I think where's Wendy on Stanford, right? And then Penn and stuff like that. So, I'm not sure if it's timing, what it was, but our experience UC-wide did create positive waves and influence everybody else. Thank you. You're welcome. All righty, I will give you two quality minutes back. Thank you very much.

electronic health record

EHR system

patient engagement

two-way communication

telehealth

data security

privacy

analytics

health outcomes