MEDITECH Expanse: Bringing Ambulatory and Acute Under One EHR

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By Samantha McInnis | Apr 1, 2022

3 minute read Blog| MEDITECH| EHR/EPR

MEDITECH’s Expanse Ambulatory platform provides an opportunity for healthcare organizations to unite their ambulatory practices and the acute care system within a single electronic health record. What are the benefits of having an integrated record – one EHR? What challenges can you expect? Keep reading for insights into these questions and recommendations based on our experience working with clients on their journey toward a single EHR. 

The Benefits: What You Can Gain 

Patients, clinicians, and hospital staff have much to gain when it comes to using Expanse Ambulatory – at the forefront being more streamlined and coordinated patient care.   

  • Patient Experience: Patients will reap the benefits of a single EHR with one medication, allergy and problem list across all care settings within the health system, eliminating repetition, increasing efficiency and promoting safety. The Expanse Patient Portal builds on this concept with seamless integration to the Ambulatory platform, allowing patients the opportunity to schedule, update information, review results and connect with their care team from home.  
  • Standardization: Beyond one EHR, you will have the option to standardize build and workflows. Consolidating provider templates, maintaining one charge master and fine-tuning workflows for better quality outcomes are all possibilities with a migration to Expanse Ambulatory. Additionally, any third-party interfacing could be standardized from contracting through production phases. Lastly, new clinics can later be constructed into Expanse Ambulatory with this uniformed approach. 
  • Data Centralization: Centralized Scheduling allows all patient appointments across the organization to be visible when coordinating future visits. Functionality such as auto-creating pending appointments from an order placed in the practice to an outpatient service, while leveraging data from the existing encounter, will hold value for many departments. Maintaining insurance, authorization and financial data throughout the patient’s health information record are all inherent features of the Expanse system. 

The Challenges: What You Might Discover 

As you would expect with any EHR implementation project, challenges are just around the corner. When partnering with a hospital system on their journey to a single EHR, we recommend they consider operational change management areas like these. Hear from Dr. Tom Kurtz, Vice President of Information Services and CIO, Memorial Healthcare, about his Expanse experience.  

  • Breaking Silos: Marrying your Ambulatory and Acute EHR with Expanse may expose a divide within your organization. Patient data, workflow mapping and system build ownership have lived within two (or many) divisions in the past. While some of these components may remain unique to the care setting, much will centralize. Recognizing and addressing the need for cohesion among all departments within your health system will yield a favorable outcome.
  • Patient Data Governance: It’s only fair when we review the benefits of a single patient record, we also cite the challenges governing the patients’ data. Policies should be in place that supplement workflows to ensure data is robust without being overwhelming and ineffective. The absence of this structure can result in complications, such as active problem lists flooded with acute and resolved problems or medication lists containing outdated or “free-text” drugs.
  • Build Collaboration: During the implementation of Expanse, it will become apparent the applications are designed to work in concert. Leveraging techniques such as the “One Query Theory”- where “Does the patient smoke?” can be answered in the ED and flow to Inpatient as well as the Clinics - are important considerations. This link between data can be easily fragmented when groups fail to coordinate efforts in the early phases of the implementation.
  • Infrastructure Considerations: Those moving from older versions will need to consider the networking and server workload requirements needed for increased integration and system availability. Right-sizing the environment to support the modern capabilities of Expanse will prevent surprise costs.  

Recommendations: Where to Begin 

Read more advice from Dr. Tom Kurtz about the single EHR implementation at Memorial Healthcare. Regardless of where you are on your journey to MEDITECH Expanse, here are some next steps that will help set your hospital up for success.  

  • Determine Scope: Outline priorities based on resources and timeline. Will you stagger the clinic go-live dates or go big-bang? Determine if there are optimization items that can be addressed post-live. It’s important to be cautious moving elements to the “parking lot” that might affect the end user experience negatively.
  • Content Design: Consider creating a style guide for dictionary build. Unified naming conventions across departments will maintain quality and also delineate content unique to a care setting or specialty. A database for the multi-application shared dictionaries, such as Query, is also something to evaluate. Understand deviating from standard content in one functional area may require adjustments in other areas as well.
  • Leveraging Acute Counterparts: Establish a cadence for subject matter experts in integrated application areas to meet. Groups such as Acute and Ambulatory Ordering, Documentation, Registration or Revenue Cycle should have a communication plan to review and reconcile build with workflows. If adding Ambulatory onto an existing Expanse Acute environment, review and take advantage of the current build whenever possible.
  • Physician Advisory Committee: While your organization may have an existing PAC, revisit the current structure to ensure physician champions from clinics are represented, including specialty areas and quality as needed. The group should have an investment in the Expanse migration as well as ownership of decisions settled by this committee.  

Learn from experts   
Looking for how to videos, tips and tricks on MEDITECH Expanse? Subscribe to the CereCore MEDITECH Resource library and get access to demos of features deployed in the CereCore Expanse system (Provider's Medical Center). 

Planning a move to Expanse Ambulatory? Our IT infrastructure teams can help you assess your IT infrastructure requirements as well as legacy and backup data strategies. 

About the Author:
Samantha McInnis

Consultant, MEDITECH Services, CereCore

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