By Merin C. MacDonald
The Department of Medicine’s Transitional Care Team (TCT) is responsible for tracking the movement of patients between teams, departments, campuses, and other institutions. Most commonly this involves patients pending admission from the Emergency Department. Until now, this has been a manual process using Excel spreadsheets (a system that predates the UMass upgrade to Epic in 2017). TCT routinely tracks over 50 patients daily while providing direct patient care. Over the last 5 years, the health system’s utilization of Epic has matured, and patient volume and acuity have increased. The Excel-based system has been increasingly unable to meet the demands of the system it serves.
During his Internal Medicine residency at UMass Chan Medical School, Matthew Greenwood, MD, had first-hand experience working in TCT and knew there had to be a better way. “This [Excel] system is a testament to the permanence of a temporary solution. It was not an ideal system and ‘misbehaved’ frequently,” said Dr. Greenwood. “As a resident, I developed an interest in clinical informatics, completing Epic Physician Builder training during residency. The first piece of build I released for UMass was a SmartPhrase to help input data into the Excel list; however, I knew this was a Band-Aid, and there was more work to be done.”
When he joined the faculty as an assistant professor of medicine in the Division of Hospital Medicine in the fall of 2022, Dr. Greenwood met with Dr. David McManus, chair of the Department of Medicine, and expressed interest in participating in digital medicine initiatives. Dr. McManus charged him with coming up with a solution to the admissions process issues that he had identified as a resident.
Over the last year and a half, Dr. Greenwood has led efforts to develop an upgrade where admissions to Medicine services will now be tracked in Epic rather than Excel. “This upgrade will eliminate Excel entirely from the workflow, so we are no longer tracking patients on a spreadsheet,” said Dr. Greenwood. “Epic will now automatically keep track of patients so that we will be able to see where they are, how they're doing, and where they are assigned. It will help us coordinate care and cognitively unburden members of TCT so that they can focus on the care of patients.” The new system will also be integrated with the transfer center, allowing for better awareness of patients coming in from other locations.
The upgrade was a collaborative effort that involved support and guidance support from Drs. Kim Eisenstock, Eric Alper, and Prince Philip, as well as Mr. Eric Cucchi, who was extremely helpful having completed a similar upgrade for the eICU. Systems analysts and the UMass Memorial Information Services team were also integral to the development process. The project was awarded a Digital Health Insights (DIGI) grant, which supports UMass Memorial Health providers and fosters innovation in digital health.
Training was conducted during the last week of May and the upgrade will officially go live for TCT at the University campus on June 10. The hope is that it will also be rolled out at the New Inpatient Building when it opens in early 2025 and at the Memorial campus in the near future.