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An Epic Sprint to aid clinics

In February 2011, the University of Colorado Anschutz Medical Campus took a major step toward fundamentally changing its health care delivery. The change would eventually affect every provider, researcher and staff member on the campus and beyond – and the reverberations continue today.

The revolution began with a handful of ambulatory clinics at University of Colorado Hospital that began using the Epic electronic health record (EHR). The aim: shelve dozens of discrete applications and towering paper stacks in favor of a single system that would allow all providers to view a patient’s entire medical record online.

Sprint Team Conference Room
Sprint team at work near the end of its four weeks of work in the OB/Gyn Clinic.

The Epic implementation included a massive training effort and a phased, multi-year rollout that ensconced the EHR on the Anschutz Medical Campus and at UCH satellite clinics. With the formation and growth of UCHealth, Epic now links hospitals and clinics up and down the Front Range and beyond.

But the challenges of ­working efficiently and effectively with an EHR remain. Memorizing sequences of clicks in record charting can be frustrating for providers focused on patient care. Patients now have an electronic conduit to their providers through My Health Connection; figuring out how best to route and respond to questions can be challenging and time-consuming for clinics. The basic Epic framework requires ongoing customization to meet the needs of dozens of specialists and subspecialists – most them with the CU School of Medicine – and their UCHealth patients.

These challenges help to explain why Epic training, in the form of tip sheets, webinars, emails, and other support, has never ended. The past year has produced a new twist: a dedicated team that gives clinic providers and staff focused, face-to-face help with making the most of the EHR.

On the run

The Sprint team, as it’s called, consists of Epic analysts, trainers, and a project manager, as well as a nurse and physicians who combine clinical and information technology skills. Together they help to define the clinical and operational needs of providers and staff and collaborate with IT, clinical and other experts to meet them. Their guiding principle: people learn best when they have face-to-face help from people who are interested in listening to them, answering their questions and solving their problems.

“It’s a collaborative effort,” said Christine Gonzalez, the Sprint team’s project manager. “When you need to make rapid changes, nothing beats live help. Providers and staff feel safe with working one-on-one.”

The Sprint team is a response to a problem that is both local and national, said Amber Sieja, MD, a physician informaticist for the Anschutz Medical Campus and an internist with the CU School of Medicine. Maintaining paper medical records might have been cumbersome, but for many providers meeting the demands of an electronic system has made practicing medicine more difficult than ever.

“The problem we face is that providers are burned out with their clinical practice,” Sieja said. She noted that in national surveys, providers routinely identify EHRs as a major contributor to that problem. “Locally, our providers have told us the EHR takes up too much time,” she added. “That’s our problem to solve.”

That’s a tall order, however. Epic is a dynamic tool that receives annual upgrades as well as ongoing customized changes for specific clinical areas. How to communicate the changes to the couple of thousand providers with the School of Medicine and UCHealth Medical Group? The Epic team has tried spreading the word with regularly scheduled Skype videos, newsletters, tip sheets, and open training sessions. It’s all fallen well short of reaching anywhere near most providers, Sieja said.

“The message we got is ‘we want somebody in our clinics,’” she said.

Face time

Sprint Team
Members of the Epic Sprint team outside the OB/Gyn Clinic at University of Colorado Hospital. Left to right, back row: Amber Sieja, MD – physician informaticist; Todd Andrews – lead analyst; Dan Golightly – analyst; Rob Lewis – analyst; Dan Kroening – trainer; Diane Pruitt, RN – clinical informaticist. Left to right, front row: Scott Carpenter – lead trainer; Barbara Noble – trainer; Christine Gonzalez – project manager; Megan Cortez – analyst; Tally Talyai, PA – physician informaticist.

That demand spurred the creation of the first “Sprint” in 2016. Sieja, fellow physician informaticist Katie Markley, MD, and UCHealth Chief Medical Information Officer CT Lin, MD, put together a team that parachuted into the Endocrinology Clinic at UCH for a two-week, hands-on helping stint. Their work drew praise from both providers and staff for helping to decrease burnout, reduce charting time and improve patient care.

The Endocrinology pilot wasn’t perfect, Sieja said. Most importantly, it showed that future Sprint projects would need more lead time to prioritize clinic needs, schedule rooms and meeting times, identify potential new EHR builds, and so on. They settled on 90 days of preparation, said Sieja, who used that time to develop a curriculum for the Neurology Clinic at UCH.

The Sprint project in Neuro, which began in January 2017, represented a major challenge. Its nearly 100 providers handled more than 26,000 patient visits in 2016. It also includes eight subspecialties, all with specific patient care needs. A major part of the work involved meeting with “clinical content leaders” to identify priorities for new Epic builds, such as flowsheets to help ensure that patients with neuromuscular diseases like ALS (amyotrophic lateral sclerosis, or Lou Gehrig’s disease) and other complex neurologic conditions receive evidence-based standards of care.

“These are tools that allow us to track patients over time,” said Laura Strom, MD, an epilepsy specialist who helped to lead the Sprint effort in the Neurology Clinic. “They are invaluable in Epic.” The flowsheets, however, had to be built from scratch, a time-consuming process, she added. All told, seven subspecialties requested and received customized builds as part of the Sprint project.

The Sprint team spent a pair of two-week stints, separated by a one-week break, in the Neurology Clinic, wrapping up the work in February. Much of the effort focused on helping providers use Epic more efficiently for their basic work: pulling needed information from patient charts; ordering labs, imaging studies and other tests; responding to patient questions and referral requests; and preparing to address patients’ chief complaints in advance of the visit. Providers learned to use templates, preference lists, keywords and phrases, and other shortcuts to reduce the number of clicks – and therefore time – they spend at the keyboard, Sieja said.

Making work simpler

The key is to reduce frustration with practical help, said Gonzalez, who handles the planning, coordination and other logistical details of each Sprint mission.

“I feel we come in to take a good tool [Epic] that we already have and make it better,” Gonzalez said. Many providers on the Anschutz Medical Campus, she noted, have not had additional guidance in using Epic since the first go-live six-plus years ago.

“Who doesn’t need more training?” Gonzalez asked. She cited the example of a UCHealth Colorado Springs provider who was surprised when she found how much time she could save by using Epic’s Dragon voice-recognition software for her progress notes instead of typing. The shortcut helped her get home to her family earlier.

“She told us the change helped her to become a better mother,” Gonzalez said.

Strom said more than 90 percent of the Neurology Clinic’s providers received the Sprint training in some form. The attention generally helped to increase individuals’ confidence in using shortcuts in Epic to trim their documentation time, she said. One example: “dictionaries” Epic uses to translate shorthand for frequently used terms into the real word.

“People applauded the one-on-one teaching,” Strom said. Some critics of Epic who had viewed it as nothing more than a “billing tool,” she added, changed their minds after the Sprint initiative.

“They saw that Epic could be used to take better care of patients and to help to improve the growth of understanding about their disease,” Strom said. A post-intervention survey showed that both providers and staff viewed Epic in a more favorable light than they had before the Sprint team worked with them. For example, the percentages of those who agreed that the clinic improved its use of the EHR and the patient care it provided increased significantly in both groups.

The Sprint team followed the Neurology Clinic assignment with a regular schedule of visits to UCHealth facilities in Northern and Southern Colorado as well as the Anschutz Medical Campus. For example, they worked with the respective Hematology/Oncology practices at UCHealth’s Memorial Hospital in Colorado Springs and Poudre Valley Hospital in Fort Collins. They wrapped up a four-week stint with the OB/Gyn Clinic at UCH – another with close to 100 providers and several subspecialties – on July 21. They are booked on a two-week on, one-week off schedule through June 2018 (with some extra time off for the next Epic upgrade this October), Gonzalez said.

Important challenges remain, including how to ensure that the positive changes in clinics visited by Sprint continue. Sieja points to the importance of super users and clinical content leaders to “carry the improvements forward.” Sprint success also brings to light questions of “scalability,” said Chief Medical Information Officer Lin, noting that it could be increasingly difficult for a single Sprint team to meet clinic demand. For now, the team splits to work with clinics with fewer providers and subspecialists.

“We need people to bring along others at the basic level,” Strom agreed. “But the sense of what is possible with Epic is now much more keen. More people are saying, ‘We really can use this tool.’”

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CU Anschutz Spring Commencement 2017

More than 1,300 graduates from a wide range of health care disciplines celebrated their achievement with friends and family at CU Anschutz Commencement on May 26. The ceremonies included the graduation of the 10,000th student from the CU Anschutz Medical Campus in its current location, reflecting the campus’s tremendous growth since relocating from the location at 9th Avenue and Colorado Boulevard.

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Donor dinner recognizes the power of giving

“They told me I had less than a year to live, and here I am four years later.”  – Polly Rogers, patient at University of Colorado Cancer Center

It is with the generosity and vision of Joyce Zeff and the Zeff family that Ross Camidge, MD, PhD, is pioneering new treatment options for people like Polly Rogers diagnosed with lung cancer. When Denver philanthropist Joyce Zeff was diagnosed with stage IV lung cancer in 2014, she was focused on living her life on her own terms and dancing at her grandson’s upcoming bar mitzvah.

While stage IV lung cancer is oftentimes considered a death sentence, Camidge said, “Whilst we would love to turn lung cancer into a curable disease, the immediate goal is to turn it into a long-term controllable disease.” And that is just what his current research is doing with the help of philanthropic support. Zeff made it to her grandson’s bar mitzvah, before passing away in 2015. Zeff and her family created an endowed chair, currently held by Camidge, so others in the Rocky Mountain region would have access to the world-class care Zeff received.

CU President Bruce Benson and Marcy Benson
CU President Bruce Benson and CU First Lady Marcy Benson speak at the 10th Annual Donor Recognition Dinner.

Every year, the Donor Recognition Dinner honors CU’s dedicated philanthropic community and provides updates for both CU Denver and the CU Anschutz Medical Campus. This year, the Daniels Fund, Comcast and Joyce Zeff and the Zeff Family were honored for their outstanding commitment to CU.

2016 Honorees

  • Comcast: Global media and technology company Comcast provides critical resources for students at CU Denver. The company supports learning opportunities in the College of Engineering and Applied Science and the College of Arts & Media, as well as student veterans through the Office of Veteran & Military Student Services.
  • Daniels Fund: Support from the Daniels Fund is central to several programs at both CU Denver and the CU Anschutz Medical Campus. From funding for the Addiction Research and Treatment Services program to scholarships at the Business School and much more, the Daniels Fund is helping CU transform lives in the Denver metro area.
  • Joyce Zeff and the Zeff Family: Zeff’s legacy lives on throughout the entire Denver metro area, and her gift to CU is just one example. The named endowed chair in lung cancer research is allowing breakthroughs in the lab to reach patient bedsides quicker than ever before.
CU First Lady Marcy Benson and leaders
Pictured from left at the Donor Recognition Dinner are Andrea Wagner, Vice Chancellor of Advancement, CU Denver; CU First Lady Marcy Benson; Regina Kilkenny, Chief of Staff, Office of the CU Denver Chancellor; and Leanna Clark, Vice Chancellor of University Communications

Videos detailing the generosity of each honoree were presented at the dinner.

Guests enjoyed a musical performance by CU Denver student group, Voz de la Clave, and mingled with other benefactors, faculty and staff. There were also four activities sponsored by students and faculty from each campus. Activities included learning wellness techniques, an interactive art project, a virtual-reality experiment and a Lego project illustrating mechanisms for preventing dental decay.

CU Denver Chancellor Dorothy Horrell and Nadeen Ibrahim
CU Denver Chancellor Dorothy Horrell stands with CU Denver student Nadeen Ibrahim who was recently named 2017 Colorado Student Leader.

Chancellor Dorothy Horrell gave updates for CU Denver, noting its unique place as Colorado’s only public urban research university. She also recognized the hard work of students around campus, touting the campus’ diversity. Of note, student Nadeen Ibrahim attended and was recognized for her outstanding contribution to CU Denver and her many accomplishments as a pre-med student. Horrell said, “Those of you who have generously invested in CU Denver scholarships help students like Nadeen make the most of their education. Scholarships for these hard-working students are investments in their lives and in Colorado’s future.”

Chancellor Don Elliman gave an overview of the CU Anschutz Medical Campus and recognized the benefactors making the research, education and clinical care possible. Elliman said, “We’ve attracted some of the best minds in medicine and health from around the globe – more than 300 new faculty last year alone.” Much of this growth is because of the continued support of philanthropy and other private support, which reached a record $203 million in the last fiscal year.

Guest contributor: Devin Lynn, development writer. 

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Middle schoolers dissect brains, peer into healthcare careers

Student outreach at CU Anschutz
Students and teachers at West Leadership Academy visit CU Anschutz as part of the WeLLCOMe Program.

As soon as 20 middle school students step into the hall and put on white lab coats and glasses, a noticeable change comes over them. There’s a sense of confidence, of feeling important.

“It feels like I’m a scientist,” Denajsha Vialpando says while flashing a smile. “It just feels like I’m working here, like I’m a medical student.” Another eighth-grader, Jacqueline Tarin, adds, “I feel like I’m in health care training. When I grow up I want to dissect brains and stuff like that.”

Just down the hall in the “bone room,” they will perform a cranial nerve exam, slice away slivers of brain, and study the three-dimensional images of the Visible Human.

This hands-on exploration of science, health and health careers is the idea of the WeLL-COMe Program at the University of Colorado Anschutz Medical Campus. WeLL-COMe stands for Wellness, Lifelong Learning and Career Orientation Mentorship, and it’s geared toward middle-school students.

The program is a collaboration between the Department of Neurology, the Department of Cell & Developmental Biology, the master’s program in Modern Human Anatomy – all within the CU School of Medicine (SOM) – and Colorado Uplift, a nonprofit that provides guidance to underrepresented minority students. This spring, six waves of students from Denver and Aurora schools will participate, touring in groups of 10 to 25 students.

‘Change in their mindset’

On a recent morning, the group from Denver’s West Leadership Academy tours the anatomy labs on the fifth floor of Education 1. They are led through various health stations, including the brain dissection room, by several graduate-student volunteers from the Modern Human Anatomy program.

Brain lab at CU Anschutz
Maureen Stabio, PhD, assistant professor in the Department of Cell & Developmental Biology, hands students from West Leadership Academy parts of a human brain to inspect.

The group starts with an introductory lesson in neurons and brain plasticity. “We teach the students that their brains have enormous capacity to learn and change. Through practice and hard work, they can do science,” says Maureen Stabio, PhD, assistant professor in the SOM’s Department of Cell & Developmental Biology. “I think that change in their mindset is important.”

Hannah Benjamin, an anatomy graduate student, enjoys volunteering for the outreach sessions because they blend two of her passions – working with kids and studying human anatomy. “My favorite part is getting in the labs and doing hands-on work, because I don’t think this kind of opportunity is as available for middle school students as it is for high school students,” Benjamin says. “Watching their faces when they pick up a brain makes my day.”

Students in bone room at CU Anschutz
Denajsha Vialpando, left, a student at West Leadership Academy, and fellow student Jacqueline Tarin, right, perform a cranial nerve exam along with a teacher from the academy, in the bone room in Education 1 at CU Anschutz.

She says the students are especially fascinated by the brain slicing and cranial nerve demonstrations. When Vialpando steps up to cranial nerve station, she’s repulsed and fascinated at the same time. “Oh my God, are those eyes?!” she exclaims as she grasps the eyeballs dangling from slender nerves. In her next breath, the eighth-grader asks the graduate student, “What’s this black thing?” as she points to a blood vessel at the base of a brain.

“It’s squishy,” another student observes as he touches the gray matter.

Opening doors to science

Veronica Contreras de Raya, marketing and communications coordinator for Colorado Uplift, says the CU Anschutz outings leave a profound impression. “A lot of kids don’t consider a future in math or science as a possibility, so this kind of hands-on experience can really open doors,” she says.

Colorado Uplift is an essential collaborator for the program, says Alina Rich, education manager in the Department of Neurology, since the organization has strong connections to schools across Denver and Aurora.

In fact, the 3-year-old WeLL-COMe program, which is funded by the Maggie George Foundation, this year expanded to include Aurora Public Schools, joining Denver Public Schools students in the lab rotations.

Benjamin, who helped develop the outreach curriculum, has been accepted into the CU SOM for fall 2017. She’s delighted that she will be able to continue promoting healthy lifestyles and interest in health professions among middle school students.

“Hopefully some of them will walk out of here wanting to wear a lab coat again and be a doctor, nurse or other health care professional someday,” Benjamin says.

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Housestaff Association advocates for residents and fellows

There is a diverse group of health care professionals on the CU Anschutz Medical Campus who work rather quietly – often into skinny hours of the night – but register a significant impact.

Jeremy Hosein, MD
Jeremy Hosein, MD, co-president of the Housestaff Association

“We’re a pretty large population on campus,” said Jeremy Hosein, MD, a third-year neurosurgery resident. “You can’t walk around on campus without rubbing elbows with a resident or a fellow.”

Hosein and Christie Osborne, MD, are this year’s co-presidents of the Housestaff Association (HA), which represents 1,100 residents and fellows at CU Anschutz Medical Campus. Most of that number – about 800 – are residents, who are collectively known as the “house staff” or “houseofficers” of a hospital.

Front lines of health care

Christie Osborne, MD
Christie Osborne, MD, co-president of the Housestaff Association

The HA is a nonprofit organization, solely funded through houseofficer dues, which advocates on behalf of members who, as trainee physicians, often serve on the front lines of health care in area hospitals. The HA represents houseofficers who serve at University of Colorado Hospital (UCH), Children’s Hospital Colorado, Denver Health, Rose Medical Center, Swedish Medical Center and National Jewish Health.

Hosein said the HA wants to improve its visibility as some members are unaware that the association serves as a resource for their unique circumstances. Added Osborne, “We try to work as best as we can within the system to try to advocate for resident and fellow interests.”

For example, the HA negotiates on issues such as work conditions, health coverage and stipends which, ideally, reflect the area’s cost of living.

Improve conditions, reduce burnout

The HA is affiliated with the CU Graduate Medical Education (GME) but is not a training program and does not fall under GME’s direction. The HA Executive Committee meets monthly, while Housestaff representatives serve on standing committees including in the GME, the School of Medicine and UCH. Representatives also give feedback to the Accreditation Council of Graduate Medical Education (ACGME) when the ACGME makes campus visits.

More Housestaff Association information

Reach the Housestaff Association at its website, or call 303-724-3039. Want to get more CU Anschutz news? Subscribe to the CU Anschutz Today newsletter here.

Each year, the HA sends out a confidential education survey to all houseofficers. In addition to fair stipends, the co-presidents say, members are generally interested in ways to reduce burnout amid a national health care environment that is seeing rising patient volumes. On average, medical residents put in 80 hours a week.

Osborne is a third-year pediatrics resident. “My residency program director has often said, ‘I’d like to see what would happen if the residents didn’t show up one day,’” Osborne said. “They’re such an integral part of the day-to-day operations of the hospitals.”

‘Residents and fellows work extremely hard’

Both Osborne and Hosein said they enjoy the collaborative environment in which they work with administrators and other leaders across the CU Anschutz Medical Campus. They also point to the exceptional service the organization has received for many years from HA Administrator Sally Robben.

“Christie, Sally and I feel very strongly that residents and fellows work extremely hard on this campus,” Hosein said. “We are a resource for them and are proud to represent them.”

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Student-led project benefits pre-health majors

On an October Sunday, as a crowd of people maneuvered through a maze of tables in search of their next stop, Nevan McCabe stood on the sidelines of a transformed campus gymnasium beaming. His “baby,” the first 9Health Fair ever held on the CU Denver campus, was a bustling success, attracting more than 150 people, a welcome reward for McCabe and his fellow students who worked diligently since July to make it happen.

Nevan McCabe is a CU Denver pre-health major
Nevan McCabe is a CU Denver pre-health student and vice president of CU Denver Future Doctors. He got the ball rolling for the first 9Health Fair ever held on the CU Denver campus.

McCabe first envisioned the event last spring, when he volunteered at one of the more than 130 9Health Fairs across the state to gain experience drawing blood. “I was hearing a lot of testimonials from patients who had had huge life changes and life-saving experiences,” said McCabe, a CU Denver pre-health student. “So I thought, ‘Why don’t we have one of these?’ It just seemed obvious.”

Selling his idea was the easy part. McCabe, vice president of the student group CU Denver Future Doctors, had his fellow officers and adviser, Charles Ferguson, PhD, convinced almost before he finished his pitch. One reason for the easy bite, said Ferguson: The idea captures his chief message to his students.

Screenings at 9Health Fair at CU Denver
Screenings for a variety of health conditions were offered at the 9Health Fair at Auraria on Oct. 16.

“One of the big pushes in health care today is helping students learn how to work collaboratively and understand that medicine has to be about serving the community. It’s not just about the technical aspects of healing. It’s about understanding culture. It’s about understanding the barriers that people have to getting adequate healthcare. They need to do things for people because it’s the right thing to do, not just because it strengthens their application.”

A student and neighborhood boon

Since its launch, the project has been student-led, and most of Sunday’s 80 volunteers filling the PE Event Center gymnasium were also pre-health students given “first dibs” on positions. “The medical field is starting to rotate toward a more public health-centric mindset of preventing disease instead of just treating it, and the 9Health Fair is all about public health,” McCabe said, explaining the student benefit. An Aurora native who somehow finds time for regular workouts, climbing 14ers, playing the guitar and, most recently, learning the tricks of latte art, McCabe hopes to attend the CU School of Medicine on the CU Anschutz Medical Campus and become an orthopedic surgeon.

Health care professionals from CU Anschutz were represented among the volunteers, as Kevin Deane, MD, PhD, associate professor of medicine, and his team offered a rheumatoid arthritis screening.

As youngsters bared their arms for flu shots and opened their mouths for dental exams, McCabe explained the decision to include children in the fair. The campus has a relatively large nontraditional-student population with families, he said, and a significant number of area neighborhood families struggle financially. “We found that from Colfax and Speer to Colfax and Federal, the average income for a family of four was $20,000,” McCabe said.

Dental screening at 9Health Fair at Auraria
Dental screenings were among the services offered at the 9Health Fair at the Auraria Campus.

While most of the fair services are free, a few, such as the comprehensive blood test, which looks for indictors of everything from thyroid issues to heart disease, have fees. So the students added fund-raising to their long list of preparation, so that they could offer testing to some families at no charge. Marketing was also a big focus, with the group canvassing the campus and neighborhoods, dropping off flyers in English and Spanish.

Only the beginning

After all of the tables were put away and the fair-goers long gone, the students’ work wasn’t done. “It’s just beginning,” McCabe said. Quest Diagnostics, which volunteers its services for all of the 9Health Fair blood-testing, will send the students itemized data, which the students will forward to public-health researchers.  Among other things, screenings included diabetes, oral health, body mass index, vitamin-D levels, and colon, skin and prostate cancers, which will help researchers study health disparities in the region.

Also, so that the project doesn’t die when he graduates, McCabe and the student group will continue their documentation for future students, so that the fair becomes an annual event. “We’ve created a huge master list online detailing everything we’ve done,” he said. “This way, they don’t have to re-create the wheel every time.”

Ferguson definitely envisions McCabe’s brainchild enduring.  “Nevan gets the gold medal for the idea; he and his team have worked really hard. But the whole campus community just stepped right up,” he said, noting that student and staff volunteers from across campus, not just CU, have made big contributions, including from Facilities Services and the Health Center at Auraria. “9Health Fair was really excited about it, too, because they have always wanted to have something in this area. It’s been an amazing experience.”

Gazing at the big turnout Sunday, McCabe couldn’t help smiling. “It’s not just me. It takes a whole team of people. But the idea that I could even get the ball rolling on something like this that impacts a whole community in such a great way is amazing,” McCabe said. “There’s no better way to serve people than by educating them about their health. It’s kind of my baby. I’m really proud of this.”

Guest contributor: Deb Melani

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