Mayo Clinic Plummer Project co-chair Dr. Steve Peters on EHR customization, innovation

Steve Peters, MD, clinical informaticist and co-chair of Mayo Clinic's EHR implementation, shares how the Rochester, Minn.-based health system promotes innovation and customization to its EHR system.

With a special interest in clinical informatics, Dr. Peters serves as co-chair of the Plummer Project, the nickname for Mayo Clinic's Epic EHR implementation and a reference to Henry Plummer, MD, who is credited with creating the first unified health record at Mayo Clinic more than 100 years ago. The multiyear technology upgrade, completed in the fall of last year, is estimated to encompass $1.5 billion worth of investments. 

In addition to his clinical IT expertise, Dr. Peters specializes in heart and lung transplants as well as critical care. He is co-chair of the EMR Convergence Steering Group and is a member of the American Thoracic Society.

Here, Dr. Peters discusses his experience helping lead Mayo Clinic's EHR implementation and key considerations for hospitals to consider when approaching an EHR customization.

Editor's Note: Responses have been lightly edited for clarity and length.

Question: What is one recent initiative you've taken to customize your EHR system? 

Dr. Steve Peters: We have undertaken a large-scale revision of our physician ordering process. Our enterprise EHR implementation required the convergence of literally thousands of orderable items, procedures and consultations. At times, the accommodation of different practices, especially in primary care versus subspecialty sites, created confusing pick lists for orders — for example, general surgery or cardiology consult in one site versus a specific colorectal surgeon or cardiac valve clinic at another site. By revising the order panels, we have been able to guide the clinician to the appropriate choice.

We also found that after EHR implementation, some team-based workflows had become fragmented, so there was opportunity to facilitate sharing of works, such as pending orders for physician review and signature, and recover the team model.

Q: What advice do you have for other hospitals looking to implement an EHR customization? 

SP: Obtain as much data as possible to guide the planning of optimization or customization. Surveys will identify the perceived pain points; objective data such as time to create and finalize a document, time spent in chart review and orders or inbox are also invaluable. With goals and priorities established, you need to leverage the simplest solutions first, like secondary training, configuration and personal settings for efficiency, templates for documentation, favorites for ordering and shortcuts for handling messages. If clinicians are hand-entering notes, a potentially major enhancement is the addition of voice-recognition tools for self-documentation. Only after these steps would I consider true customization — that is, asking for vendor enhancements that might add significant cost and result in non-standard code that requires maintenance and extra work at every upgrade.

Q: How do you promote innovation among your team members? 

SP: A risk inherent in the conversion to a large integrated EHR is a natural regression to the mean, leaving your medical center or practices the same as every other client or customer. It has always been our goal to allow for differentiation by innovative use of the EHR tools, or by additional applications that might run underneath, alongside or on top of the EHR. We have structured governance for the EHR-run organization that prioritizes enhancements and innovative proposals. In addition, we have a number of departmental and institutional competitive funding awards for practice improvements.

Q: What has been one of your most memorable moments as co-chair of the Plummer Project? 

SP: My most memorable moment is the completion of our enterprise EHR convergence in the fall of 2018, replacing what will ultimately be around 200 applications with a single instance of Epic for nearly 60,000 users, across three time zones. This occurred in four implementation phases over two years, but with many months of planning before the first go-live. It was truly a practice convergence project rather than an IT implementation, and required intense collaboration across medical and surgical specialties, every allied health group, all of finance and administration. We are now "circling back" for secondary training and personalization, and looking forward to an increasingly digital practice, including the broad application of artificial intelligence in many aspects of healthcare.

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