Collaboration Story: Baptist Health & DrFirst

CHIME Member:

Aaron Miri, MBA, FCHIME, FHIMSS, CHCIO

Sr. Vice President, Chief Digital & Information Officer, Baptist Health

CHIME Foundation Firm: DrFirst

Executive Summary

In 2020, Baptist Health began our Epic Together project to consolidate disparate EHRs and create one comprehensive patient record across the system. Naturally, our goal was to implement an effective instance of Epic that would aid clinician decision-making and improve patient outcomes. Medication management is a critical component of providing quality care across the continuum. When accurate medication data isn’t readily available to clinicians at the point of care, patients often become a source of truth—an often unreliable way to gather data that can lead to adverse drug events (ADEs).

Furthermore, missing data burdens clinicians with the chore of entering information into the EHR during a patient visit, taking their time and attention away from patient care. So, when Baptist decided to move to an enterprise-wide instance of Epic, we knew that medication management would be a key success factor.

After researching vendors, Baptist established a partnership with healthcare technology leader DrFirst. We were driven to partner with DrFirst due to their AI-powered medication management solutions, which aim to optimize clinical data in two unique ways: by providing more medication history data for more patients from local and national sources, and by using clinical-grade AI to clean medication data and translate it into consistent terms that can be mapped to discrete fields in our Epic EHR. These differentiators aligned with our goals of relieving clinician burnout caused by manual data entry, while reducing the risk of ADEs and readmissions. Our analysts and operations teams collaborated with DrFirst’s clinical and technical implementation teams to build, implement, and test new medication history tools that gave our clinicians accurate information to inform clinical decisions.

Introduction

Based in Jacksonville, Florida, Baptist Health is a locally governed, mission-driven organization that serves its community across the full continuum of health services for every stage of life. With six hospitals and more than 200 primary care and specialty physician practices, we prioritize the adoption of new technology that automates tasks for our clinicians, empowering them to work smarter, not harder. Our IT team collaborates with nurses, physicians, and allied staff to understand their challenges and determine how technology can improve their workflows. But innovation isn’t a new tool we can simply buy: We work closely with our technology vendors to understand how that technology can be applied to resolve some of healthcare’s biggest challenges, to help our clinicians work at the top of their licenses, and to provide the best possible care to every patient.

Before 2022, Baptist Health was like many other health systems in that we were using multiple electronic health record (EHR) systems across our hospitals and ambulatory care settings. Unfortunately, these systems didn’t communicate with each other, which caused interoperability challenges.

The Problem: Medication Data Safety Issues and Clinician Dissatisfaction

One of those challenges was the difficulty that clinicians experienced when trying to access accurate medication history data. Our patient records were dispersed across different locations, which was ineffective and increased the risk of medication errors that could impact patient safety. Ideally, a patient’s home medication list and prescription fill history would be available in the EHR and would include all the medications prescribed by any doctor and filled by any pharmacy, but that’s often not the case.

When accurate medication data isn’t readily available to clinicians at the point of care, patients often become a source of truth, which is an unreliable way to gather data and can lead to adverse drug events (ADEs). Missing data also burdens clinicians with the chore of entering information into the EHR during a patient visit, taking their time and attention away from patient care. So, when we decided to eliminate disparate EHR systems and consolidate our patient records into a single enterprise-wide instance of Epic, we identified an opportunity to improve medication management as well.

The Solution: A Collaborative Partnership

After researching vendors, Baptist sought a partnership with healthcare technology leader DrFirst. Their AI-powered medication management solutions optimize clinical data in two unique ways: by providing more medication history data for more patients from local and national sources, and by using clinicalgrade AI to clean medication data and translate it into consistent terms that can be mapped to discrete fields in our Epic EHR. These differentiators aligned with our goals of relieving clinician burnout caused by manual data entry, while reducing the risk of ADEs and readmissions.

Our collaborative effort involved multiple stakeholders throughout Baptist Health working in close partnership with DrFirst to:

* Improve patient care by seamlessly sharing health information across practice venues

* Improve transfer of data from legacy EHRs by using AI to pre-populate medication data into discrete fields in our Epic EHR

* Improve operational efficiency by spending less time gathering and manually entering medication history data in our Epic EHR

* Improve price transparency and medication adherence by making patient benefits information available at the point of care to inform prescribing decisions

* Improve our ability to make evidence-based decisions as an organization by having all data points for our practice available on one platform

Collaborative Strategies

EHR Consolidation

A major change will never be successful if stakeholders don’t trust the process, so we started our EHR consolidation project by consulting with nurses, physicians, pharmacists, and medication technicians to get their buy-in. Beginning in early 2020 and continuing until our official Epic EHR project kickoff in October 2020, the Baptist Health clinical applications team worked with more than 170 clinic partners who were running different EHR platforms to show them the benefits of consolidation. Next, we collaborated with clinicians in our inpatient units to understand and document legacy workflows for medication history and reconciliation so we could ensure the new EHR configurations would accommodate clinical workflows for all practice areas.

Data Migration

Once we started migrating patient data to our new Epic EHR, we realized that medication data from our legacy EHR systems was essentially unusable. Due to inconsistent language for prescription instructions (sigs), different national drug codes (NDCs), and the inability to pre-populate free text into discrete fields, we could not directly migrate legacy medication data into Epic. Instead, our clinicians had to manually enter or correct information every time a patient presented at a Baptist Health facility.

This was a major source of frustration and dissatisfaction for our clinicians, who were spending several hours a day reconciling medication data. Our Epic analyst team and DrFirst would need to be flexible to implement a solution that would provide fast relief to clinicians without overburdening the analyst team, which was also triaging other go-live issues.

Our goal was to minimize the repeat work that was necessary due to not implementing DrFirst’s data migration strategy prior to moving the problem, allergy, medication, and immunization (PAMI) data into Epic. The PAMI data came into Epic as free text that had to be mapped into discrete fields to eliminate duplicates and errors.

Due to our close partnership with DrFirst, we quickly pivoted to a revised process for data migration. DrFirst’s AI engine uses clinical and statistical context to clean and structure medication data to prevent missing information while avoiding manual entry. For example, it normalizes sigs into consistent terms, translates NDCs between different databases, safely infers missing information, and processes free text so it pre-populates into discrete fields. By addressing discrepancies and variations from the legacy EHRs, the AI inferred missing data with context from medication histories to prevent blank fields, while avoiding labor-intensive manual entry. It also enabled our staff to convert continuity of care documents (CCDs) from the legacy EHR systems into Epic.

Based on DrFirst’s previous experience migrating data from legacy EHRs into Epic, they were able to help guide us in the best ways to consolidate millions of medications, normalize prescription sigs, and ensure free text was entered into discrete fields in the new EHR so clinicians could access it easily. Working closely with the Baptist team, DrFirst helped establish a process for transferring files to their data migration solution. After those files were processed, they sent them back to our team as formatted files that were ready for import. Based on DrFirst’s experience in removing data from Epic prior to import, we requested that a specific clean-up utility be run by Epic Technical Services.

Medication History

Our analysts and operations teams worked with DrFirst’s clinical and technical implementation teams to build, implement, and test new medication history tools that gave our clinicians accurate information to inform clinical decisions. The data feed we implemented delivers 12 months of medication data from pharmacy benefit managers, EHRs, pharmacy fill data, and payer records. Powered by AI, the solution greatly improved the amount and quality of medication information available directly in the clinical workflow, enabling an effective medication reconciliation that didn’t require manual intervention and wasted time.

This continues to be essential to preventing inaccuracies reported by patients and families and has proved exceptionally crucial when patients arrive in the emergency department unable to communicate. We have also used the solution to streamline admissions and discharge processes and avoid errors in medication reconciliation during transitions of care. This has been a huge satisfier in our inpatient settings.

Prescription Renewals

Our ambulatory providers receive approximately 2,500 electronic renewal requests every day, requiring clinicians and staff to collectively spend hours manually entering prescription data from the pharmacy system into the correct fields in our EHR system. That’s because the EHR receives the requests with prescription instructions, or sigs, such as medication dosage, route, and frequency, that are missing or don’t match our nomenclature (for example, “by mouth” versus “oral”).

The manual data entry by clinicians or staff—with back-and-forth comparison of the sigs to ensure an error hasn’t been made while filling in details—can take one to three seconds per field and up to a minute per medication. While our Epic EHR enables use of a sig-mapping table, which allows sigs that have a perfect match in the table to be imported into the patient record, keeping the table up to date is a time-intensive, manual process for our IT department.

We worked with DrFirst to ensure our system was configured to receive structured and codified information, working directly with Epic to implement a prescription renewal solution that works seamlessly in our EHR. This saved us time and coordination as we are an Epic-hosted system, and our Epic Technical Services were heavily involved. DrFirst also helped us gather baseline information for a successful comparison of pre- and post-live performance.

Medication Adherence

The cost of medications is a major determining factor for patients deciding whether to pick up prescriptions from the pharmacy. When medications are too expensive, patients may abandon them regardless of how important they are to their health. Baptist Health has several initiatives that involve reducing prescription abandonment, reducing readmissions, and improving patient outcomes with better medication adherence.

To give our clinicians more complete, up-to-date benefits information, we implemented DrFirst’s benefit-checking solution, which delivers additional prescription benefit information directly into our Epic EHR workflow. With this information available at the point of care, our clinicians have more data to identify the most clinically appropriate therapy at the most affordable cost, ultimately driving medication adherence for more patients.

Other common barriers, such as forgetting to pick up prescriptions or confusion about clinical instructions, can also prevent patients from taking their medications as directed. To reinforce our clinicians’ recommendations after the patient leaves the exam room, we integrated DrFirst’s automated messaging system with our Epic EHR. Now, when a clinician orders a new medication, an SMS message is triggered and sent directly to the patient with a link to pharmacy information, educational material about the prescription, and an option to schedule a pickup reminder.

Measurable Results

From our Epic go-live on July 30, 2022, through July 30, 2023, we have converted 9,102,472 medication sigs without clinician intervention using DrFirst’s medication management solutions. A subset of these conversions had no sig provided in third-party data, and the sig was inferred by the AI technology.

Another subset had a sig available, but only in free-text form, and Epic converted these to a discretely defined sig in the database. Prior to the EHR consolidation and integration of DrFirst solutions, clinicians would have been responsible for manually converting all 9,102,472 medication sigs, which would have included more than 87.7 million sig transactions. By avoiding this conversion, Baptist Health saved critical time (estimated at more than 19,000 hours) for our clinicians and reduced the likelihood of transcription errors.

We also identified more than 20,725 additional high-risk medications from more than 5,437 unique patient medication profiles that would not have been identified by our legacy EHR systems. Awareness of these medications improves patient safety and informs better prescribing and medication management by our clinicians. We also enabled our medication history technicians to perform teleconsultation to efficiently perform medication histories remotely, which has been hugely successful.

Now that all our facilities are on one EHR system and our data has been cleaned in partnership with DrFirst, our pharmacy partners in the community are receiving electronic prescriptions from only one EHR system rather than many. Walgreens, for example, knows Baptist Health is using Epic across all care settings, and they trust our data.

Next Steps

We are continuing our partnership with DrFirst on new projects. Most recently, we began working with DrFirst and Epic to apply the clinical-grade AI on data we receive in real time from one of our CareEverywhere connections. This will provide a seamless experience for clinicians when reconciling medications, saving our clinicians time and manual entry, and making their workflow easier.

Aaron Miri, MBA, FCHIME, FHIMSS, CHCIO

Sr. Vice President, Chief Digital & Information Officer

Aaron Miri, MBA, FCHIME, FHIMSS, CHCIO, is Senior Vice President, Chief Digital & Information Officer (CDIO) for Baptist Health System in Jacksonville, Florida. Throughout his 23-year career, Aaron has been dedicated to fostering innovation that transforms healthcare delivery for patients and providers. He is passionate about orchestrating collaboration among clinicians, technology partners, business champions, and state and federal representatives to humanize technology in a way that enables and empowers clinicians to work smarter. Aaron is a candidate for his Doctor of Health Administration from the Medical University of South Carolina. He earned his MBA with distinction from the University of Dallas, and his Bachelor of Science in Management Information Systems from the University of Texas at Arlington. Aaron is a distinguished Fellow (FCHIME) and Certified Healthcare Chief Information Officer (CHCIO) in CHIME, and a distinguished Fellow (FHIMSS) with HIMSS.

Public Policy Appointments

2023: Appointed to the Florida Cybersecurity Advisory Council by Governor Ron DeSantis

2022: Appointed to the Board of Trustees for Florida State College of Jacksonville (FSCJ) by Governor Ron DeSantis

2020: Appointed for a second term to the Health and Human Services, Health IT Advisory

Committee (HITAC) and elevated to the role of Committee Co-Chairman

2018: Appointed to HITAC by the United States Senate

2016: Appointed to serve on the Health IT Policy Committee by the Obama Administration

Prior Chairman of the HIMSS National Public Policy Committee

2014: Co-Chair of the CHIME Public Policy Committee

Industry Awards

2023: Named as a Becker’s Hospital Review “CIOs to Know”

2020: CHIME Healthcare Heroes Award

2019: Constellation Research Business Transformation 150 Award

2017: Texas Health IT Advocacy Leadership Award

2016: Computerworld Premier 100 Technology Leaders Award

Advisory Boards

CHIME Board of Trustees

CommonWell Health Alliance Board of Directors

Dell Technologies CIO Advisory Board