Altru Health System

How a Cross-Divisional Team Facilitated Rapid Adoption of UpToDate at Altru Health System

Altru Health System is a community-owned, not-for-profit system serving Grand Forks, North Dakota and the surrounding region. The organization includes an acute care hospital, a specialty hospital, more than a dozen clinics, a large home care network, and a congregate living facility. Altru Health System employs more than 200 physicians and 4,000 staff, and has annual revenue of more than $450 million.

When Marlene Miller joined Altru Health System as Manager of Learning and Organizational Development, she initiated a basic needs assessment on the information requirements of the medical staff.

Assessing the Need for UpToDate

Since digital information resources have dramatically changed the role of medical libraries, Ms. Miller wanted to ensure that Altru Health System was providing solutions that satisfied their clinicians' evolving needs. In conversations with the medical librarian, both agreed it would be productive to conduct focus groups of staff members to better understand which resources were highly valued and which were underutilized, and to identify items on the staff members' wish list.

Ms. Miller organized a series of discussions with relevant stakeholders, including physicians, nurses, and the advanced practice team. In response to an internal survey, 76% of clinicians responded that they would use UpToDate if Altru purchased an enterprise-wide site license.

In fact, one physician noted, "I would love to have access to UpToDate…it would be a great tool to use with medical students during their clinical rotations." Another remarked, "UpToDate is such a valuable tool, not only for physicians but also for the great information it has to give to patients."

"Physicians were essentially saying, 'This is one of the tools we need to help ensure our commitment to provide world-class care,'" said Ms. Miller. "The voice of the stakeholders was there for everyone to see." She found that many physicians were already using UpToDate by paying for their own individual subscriptions.

Marlene Miller

"Physicians were essentially saying, 'This [UpToDate] is one of the tools we need to help ensure our commitment to provide world-class care.'"

— Marlene Miller, Manager of Learning and Organizational Development, Altru Health System

Based on this feedback, Ms. Miller and her team began investigating the feasibility of adopting UpToDate. She spoke with librarians, the Chief Medical Officer, and the Administrative Director of IT. "As I talked with more people, UpToDate kept coming up," said Ms. Miller. "I felt it was important to do a full evaluation, to determine the budget issues and any support concerns for the library and the technology components, so that we could give our physicians a clear-cut explanation of our decision, one way or another."

To move forward, Ms. Miller knew it was important to build a business case for UpToDate. She had quantified the physicians' input and also determined approximately how many employees had individual subscriptions. While these subscriptions were being paid by an annual education allotment for physicians, she suspected it would be more cost-effective for the organization to shift to an organization-wide license, which also would enable other clinicians to take advantage of UpToDate.

Once she completed her research and a preliminary implementation plan, Ms. Miller met with Mark Waind, Administrative Director for Information Services, who had budgeting authority for UpToDate. He supported her rationale and agreed that the timing was right to implement UpToDate, which would embed within Altru's Epic EHR system to provide clinical decision support access from within the patient's electronic medical record. Based on the popularity of mobile devices among the staff, they also wanted to provide clinicians with award-winning UpToDate Mobile Apps — so that they would have access anywhere, at anytime.

A Best Practices Project Plan — The Foundation of a Smooth Adoption

Altru adoption rates at two months

Mr. Waind and Ms. Miller agreed that they wanted access through Epic to be part of the initial rollout. The clinicians were already accustomed to working in Epic, and would be trained to access UpToDate from within the EHR system.

To encourage swift adoption, Ms. Miller built a cross-discipline project team, including representatives from the clinical area, the medical library, patient education, IT, the CME program, and UpToDate. "Having this broad-based team helped us think through the different angles, from communications to implementation to sustainability," said Ms. Miller. "It's essential to have a project plan to maintain focus, as well as a point person to lead the project."

Seven Epic trainers and four educators participated in an UpToDate certification program conducted by the UpToDate training team. This enabled them to serve as trainers and help coach others within the hospital on how to access UpToDate from their mobile devices or from Epic.

UpToDate Training Resources and Best Practices

Once UpToDate was available within the Epic EHR, the Altru team began a broader communications campaign to the general clinical staff. Ms. Miller and the Chief Medical Officer used templates from the online UpToDate Customer Success Center to create an email announcement.

"I strongly recommend leveraging the training tools and guidelines that UpToDate provides," said Ms. Miller. "We took advantage of sample flyers and training materials, working with our corporate development team to brand them and make them our own. These ready-made samples saved staff time and made the whole process more professional and efficient."

The launch kicked off with a two-day event in the physicians' lounge, adjacent to the medical library. The team was fully prepared to get staffers up and running during the session. They helped clinicians download the Mobile App and showed them how to find UpToDate within Epic. If a clinician had previously had an individual subscription to UpToDate, the trainers demonstrated how to transfer continuing medical education (CME) credits.

"Our team was very engaged and enthusiastic," said Ms. Miller. "We had the right people there to talk with our clinicians, and we were asked lots of good questions. We know our clinicians are busy, so we made the session as efficient as possible, with lots of one-on-one help tailored to individuals."

An Ongoing Communication Plan Ensures Success

After the initial launch, "getting-started" instructions and updates were posted on the system's intranet. For every new clinician hired (including residents), an UpToDate tutorial is included as part of the Epic training curriculum and Altru's IT trainers conduct a one-on-one orientation. The IT help desk team also has been briefed via a tutorial and FAQ, so they can respond to general questions when staffers call.

Ms. Miller notes that the rollout went smoothly. "Our support team reports it has been quiet post implementation — a good sign — and adoption rates have been high," she said. "We can attribute that to careful planning, our efforts to get input from a wide range of stakeholders, and a committed project team."

Dr. Eric Lunn

"The careful planning, training, and support provided by Ms. Miller's cross-divisional team were instrumental in achieving such a successful launch."

— Dr. Eric Lunn, President, Altru Health System

To date, physicians, nurse practitioners, and physicians' assistants have fully embraced UpToDate. Within two months of the launch, 56% of clinicians had registered to use UpToDate, 43% were using UpToDate via their mobile device, and more than 20% of the searches conducted on a monthly basis take place from within the Epic EHR.

Since providing UpToDate through the Epic EHR, UpToDate use at Altru Health System has doubled. Dr. Eric Lunn, President, remarked, "The careful planning, training, and support provided by Ms. Miller's cross-divisional team were instrumental in achieving such a successful launch."

Next, the team will roll out UpToDate to the nursing staff to ensure that all of the clinicians at Altru Health System are taking full advantage of the site license. Ms. Miller is confident the nurses will find UpToDate beneficial in supporting the clinicians and providing patient care.

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1 Isaac T, Zheng J, Jha A. Use of UpToDate and outcomes in US hospitals. J Hosp Med. 2011 Nov 16. doi: 10.1002/jhm.944.

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