Ambulatory and Inpatient care have historically been two different worlds with two very different mindsets. At times, they might as well be speaking two different languages. Bringing the two together during an Epic implementation is an absolute must for improving overall efficiency as well as patient safety. Both sides have legitimate concerns and needs.
With the right ingredients integrating Epic Ambulatory with Inpatient doesn't have to be a hard pill to swallow.
With Epic in place, Ambulatory and Inpatient now share System Definition (global settings) and ERX Master File. Inpatient typically owns about 80% of this master file, but as Epic continues to expand, more and more fields from the Master File are shared. In order to implement Ambulatory Medications (Discrete Sig and Discrete Dispense), a pharmacist familiar with both inpatient and retail pharmacy practices is needed. Adding to the complexity are modules and ancillaries such as OpTime, Anesthesia, Beacon Oncology med build, and Willow Ambulatory. Conflicts appear when the common practices and requirements for each side are analyzed:
Hospitals are acquiring more clinics through Community Connect. Different specialties will have particular medication requirements. So, keeping the new physicians happy with the changes is an ongoing challenge. Many physicians for example, order liquid medications by the teaspoon. For liability, it is safer to order in milliliters. Determining whether inpatient or the clinic will accept a change is no easy task.
Accommodating the simultaneous needs of retail and inpatient pharmacies sharing a master file undoubtedly requires a little finesse. Some things you should consider:
Combining Epic Ambulatory with Inpatient doesn’t have to be the nightmare that it at first appears. It does, however, take a good deal of planning and preparation to make sure things go well. Having someone with Epic clinical implementation experience can keep the lines of communication open between hospitals and clinics and is the key to smoothing transitions and ensuring everyone’s needs are addressed; all the while improving operational efficiency and patient safety.