Practicum Reflections

Sharp Spectrum (Onsite)

November 15, 2022

Hours 9
Total Hours 9

Much of the day was spent getting my bearings at Sharp Spectrum. Ariana took me around the

building and showed me where all the safety and emergency routes are located, as well as where to park

and how to enter the building moving forward. We went over the layout of Sharp Spectrum and I was

introduced to different members of the team. We attended a meeting that went over different requests

for clinical applications, such as modifications for better clinical decision support. We also attended a

meeting with an EPIC representative that went over educational goals and projects. Much of the meeting

required input from a nursing perspective, and it was crucial that the Sharp team, including myself, could

offer a nursing practice context that will be critical to properly training the entire nursing team at Sharp. I

was able to get a context of where Sharp sits as it relates to the EPIC implementation and I have found

that the behind-the-scenes strategy has proved to be robust. I am encouraged to see how EPIC will allow

my fellow clinicians and me to better execute the Sharp Experience. I am privileged to be doing my

practicum during such a stimulating period.

Sharp Spectrum (Onsite)

December 1, 2022

Hours 8
Total Hours 17

We attended a one-on-one EPIC class that explored documentation as it relates to obstetrics,

such as Labor and Delivery. We also attended a meeting with several individuals as it relates to

pharmaceutical needs. For example, some processes are paper-dependent and a future state involving
Epic would have to consider some processes, such as codes, that currently rely on after-event data input.

I worked on gaining access to the Epic ecosystem and was able to experiment with different features and

applications that will soon be available. This was my first time in the EPIC environment since nursing

school and I was surprised by how much I retained from those formative years. The intuitive nature of

EPIC means that navigating the system often proves relatively straightforward. Ariana also showed me

the EPIC community page and library. This is where different healthcare systems that utilize EPIC can post

and share what they are doing at their facilities to help other systems. I was able to use the search

feature to see quickly how common problems can be handled differently by different systems. If an

individual encounters a problem or question as it relates to a build or workflow, there is a good chance

that someone else had a similar problem which means that reinventing the wheel is often not necessary.

Sharp Spectrum (Onsite)

December 15, 2022

Hours 8
Total Hours 25

This session with Ariana felt simply like a partnership in several meetings. One of the meetings I

found particularly interesting was one where several members of the team discussed what regulatory

and governmental data sets are required to be collected and how frequently. Much of the meeting was

centered on how data is currently collected from Cerner and what future data collection from Epic would

look like once implementation takes place. There was also discussion of voluntary collectives and/or

databases that Sharp should consider exiting even if temporarily because of the demand on staff to

continue to provide data when energy will be directed elsewhere. Ariana and I also spent some time

during this session discussing my capstone project. I know that in my unit we are heavily dependent on a

specific workflow when it comes to assigning nurses to patients. The charge nurse can run a report on

Cerner that tells her what nurses have taken care of all the patients across the unit. So with one click, the
charge nurse can see a wealth of helpful information as it relates to what nurse was where and when

which helps greatly when making new assignments. Although Ariana was hesitant to explore this topic as

a project, she did offer me guidance as to where to explore. She indicated that the Nursing Assignment

Wizard may be helpful in this respect. Moving forward, I am not sure if this will be my project, but

regardless I am encouraged to find a way to help my unit find a new workflow that achieves the same

goal once EPIC is implemented.

Sharp Spectrum (Onsite)

January 9, 2023

Hours 8
Total Hours 33

This day proved especially informative. I attended a weekly meeting of the clinical informaticists

specific to Spectrum where EPIC implementation was discussed, and the different work groups were

explored. I met the Director of Clinical Informatics, John Lussier, and it was fascinating to hear him

discuss the team structure moving forward. Because Sharp Healthcare has many different entities that

serve specific aspects of the San Diego community, each of the entities has a distinct and unique identity.

Mr. Lussier described the Clinical Informatics team at headquarters as one that is like the federal

government which oversees each state government and could be considered a unique entity. Moving

forward, Sharp Healthcare is attempting to merge missions and have one overarching strategy. Attending

the group with all of the Clinical Informatics team across the system later in the day showed me how

difficult that can be at times with different team members working across different facilities. Because

most of these meetings are via Zoom, I must imagine that these virtual forums are more beneficial to

communicate across the system than previously utilized methods. During this session with Ariana, I have

dived deeper into my capstone project which is the reworking of the care plans from Cerner to Epic. The
ensuing gap analysis and alteration of the workflow for the bedside nurse fascinates me in ways that I am

sure will advance my learning in new and exciting ways.

Sharp Spectrum (Onsite)

January 18, 2023

Hours 8
Total Hours 41

For this visit, I was able to see more of the hard discussions and brainstorming that is required in

order to get the Epic implementation moving forward. I attended a meeting with several Epic project

managers and clinical nursing specialists who specialize in women’s health. They discussed different

clinical tools that are in use for Triage and Labor and Delivery that does not currently have a corollary in

Epic. It was interesting to see the discussion because much of the meeting was important, however, no

decision was made because many individuals were hesitant to make a decision that affected such large

departments. I could tell from what the CNS’s were saying that they were largely unfamiliar with Epic and

what it offers the end-user. There was a larger discussion on access to Epic and who can currently

explore the environment. Sharp and Epic have decided that only a limited number of people can access

the environment, but that means that people who are responsible for making decisions and offering

input have a hard time understanding what they are committing to moving forward. This is something

that needs to be addressed moving forward. This entire dynamic has shown me that stakeholders can

and should be involved in the process of implementation, however it is crucial that enough

understanding and information is offered to them so that responsible decisions can be made on a large

scale.

Sharp Spectrum (Remote)

January 25, 2023

Hours 2
Total Hours 43
 During this session, I found myself in a Teams meeting with several of my NICU colleagues along

with Ariana. We were discussing how the assessment screen would appear to the NICU nurse which

required a lot of discussion about what was currently offered through Cerner and how the EPIC

environment will require nurses to chart their assessments differently. For example, a portion of the

discussion focused on the respiratory portion of the assessment. Currently, we have an assessment flow

sheet that is largely unique to the neonate population. However, EPIC utilizes a respiratory assessment

portion that is the same regardless of patient. Neonates do not generally cough which suggests we can

remove that option. And neonates have partially digested food as a sputum option that needs to be

added. This reality showcases why every aspect of the flowsheet must be crosswalked and modified

before moving forward.

Sharp Spectrum (Onsite)

February 2, 2023

Hours 8
Total Hours 51

For most of this day, I was with Cindy Drake who is another Clinical Informatics Specialist. Similar

to Ariana, she works with several work groups as it relates to the EPIC implementation project. And so I

found the shadow beneficial because I was exposed to different areas of the overall project. For

example, there was one meeting with the cardiovascular department that focused on the different

applications that will need to be integrated into EPIC charting moving forward. It was fascinating learning

about an area of nursing that I know nothing about. On this day, what I enjoyed the most was another

meeting that we participated in regarding the respiratory therapy team. Because they chart on a

different screen that does flow into the nursing screen and vice versa, it felt very familiar to the previous

NICU meeting I participated in previously. For example, I was able to offer the group guidance with

respect to how NICU and/or pediatric patients should be chartered so that it could be properly organized
with what the nurses are charting. By the end of the meeting, it was decided that we need to have

respiratory and nursing representation on these various groups for this portion so that there was no

disagreement on how to move forward and maximum consistency can be accomplished. It was

fascinating to see the same part of the implementation project through different points in the process.

Sharp Spectrum (Onsite)

February 6, 2023

Hours 8
Total Hours 59

Today was an exciting day because I was fortunate enough to follow John Lussier who is the

Director of Clinical Informatics at Sharp Healthcare. Mr. Lussier is also my professor for Advanced

Healthcare Information Management which provides a wonderful sense of context for what I am

learning in and outside of the classroom. The meeting that we attended together was one with the

safety committee where specific patient stories were discussed. Without going into too much detail, I

was surprised to hear about the keynote story that was shared. Like many mistakes that happen in

healthcare, a process breakdown was to blame. It was impressive to see the clinical safety specialists lay

out the process they used to understand why the process did not work and how to do it better. Mr.

Lussier presented during the meeting and his focus was on the tools that EPIC will offer Sharp in the form

of clinical decision support as it relates to patient safety issues. For example, there are many order sets

and protocols that the clinician can implement based on the context at hand. One tool, the sepsis alert,

was of interest to me because I know that many nurses at Sharp complain about the current sepsis alert

that is used in Cerner. This complaint is related to the reality that the alert fires so frequently that it is

easier to ignore the alert than to actually consider if there is something that the clinician should care

about. Mr. Lussier and I agree that moving forward that the sepsis alert should have criteria that is

evidence-based and clinically-important, but must not be so broad that it would apply to almost all
contexts. This is because clinicians will always ignore alerts if they fundamentally feel that is provides no

value in the context of their care.

Sharp Grossmont Hospital (Onsite)

February 21, 2023

Hours 8
Total Hours 67

On this day, I went to Sharp Grossmont to join the informatics teams as they did several

walk-throughs regarding a new device called a Capsule. Currently, Sharp uses a device attached to

ventilators and anesthesia machines to sync data regarding settings to Cerner to ease the clinicians

charting. However, because the Epic implementation will make those devices obsolete, Sharp has found

a replacement device, called the Capsule, that will do the same thing to sync data for Epic. We went to

several departments, including several intensive care units, the emergency department, and the

operating rooms. The team noticed that the Capsule device is much larger than the one currently being

used. This provides several difficult decisions that must be made by the project team because some

clinicians expressed frustration that the device is difficult to maneuver behind the ventilator or

anesthesia machines and that when people move them that the Capsule device will likely be hit or

damaged since it must be so precariously positioned. This may be an example of an IT team making a

decision before consulting the clinician on the ground. I say this because the Capsule device does come

in a smaller version with less ports. The smaller version still has more ports than the Cerner simile. I

admit that I am not involved with the project in depth enough to know, but I am curious as to whether

this discussion about which exact device should be used should have been had before Sharp completed a

purchase order of several hundred thousand dollars. Regardless, on this day, it was a beneficial learning

experience to take informatics to the Gemba and see the end-users offer real insight and input to help

guide the project forward.

Sharp Spectrum (Onsite)
March 6, 2023

Hours 8
Total Hours 75

On this day, I spent the entire day with Ariana as she attended several meetings. One meeting

that she attended that I found particularly interesting was on the Best Practice Advisories (BPA’s) or

clinical decision support. I was amazed at how many there were across the Epic system since there were

easily over 1,000 BPA’s that can be utilized. Although I am unclear as to how many of these BPA’s Sharp

will ultimately go with, I know that they are categorized into Critical, High, Important, and Suggested.

Sharp has planned to go through all of these and decide if Sharp will take them on as part of the

implementation. Later in the day, there was a meeting we attended that discussed how Sharp will better

capture costs for patient care. For example, when an RN charts that a Foley catheter is placed or a PICC

line is inserted, there is a line in Epic to indicate that this is a charge item. This charting will be new to

Sharp which means that all of the RN’s must learn this portion of charting. It is Sharp’s hope that this

new workflow will allow for better revenue, however, in order for this to be successful it must be simple.

Cost capture should not be an added confusion, but rather a seamless part of charting that does not

require an added stress for the clinician. As Ariana and I attended the meetings throughout the day, I

took the opportunity to also work on my NICU Care Plan Gap Analysis Project. As part of the project, I

was able to notice how many of the current Cerner interventions were individualized. Current state has

10 care plan templates and many of the interventions were specifically made for Sharp Healthcare which

means that moving forward, my unit must decide which ones are truly needed since taking the Epic care

plan package will organize the care plan templates in a much more concise and organized manner. Once I

am complete with the gap analysis, I look forward to having this conversation with the NICU team at

Mary Birch.
Sharp Spectrum (Onsite)
March 7, 2023

Hours 8
Total Hours 83

For today’s session with Arianna, I attended several meetings with her while also making sure to

make good progress on my gap analysis regarding care plans. One meeting we attended was regarding

the AngelEye MilkTracker. There has been much confusion regarding the way that physician orders are

communicated between Epic and the application. The vendor does not utilize teaspoons and ounces as

part of the recipes. They use grams for measurement, and Mary Birch does not want to change how the

nurses make the milk in order to comply with the application’s workflow. Moving forward, Sharp is

encouraging the vendor to make an in-person demo so that a decision can be made. Sharp is hoping that

the vendor will agree to change how the application incorporates measurement when the nurses use the

application. Much of the confusion can be attributed to the reality that several of the participants in the

decision group and the project manager themself changed midstream of the project. We also attended a

meeting regarding Krames which will be the education component that will be incorporated into the Epic

flowsheet. I have to admit that the meeting did not accomplish much because the vendor has not

granted Sharp permission to access much of the application as it will appear in Epic. Because many of the

questions regard how the end user will use it as part of their workflow, much of the conversation

centered on what to get ready in preparation for when access will be granted. This, ironically, will be

done once the contract is finalized. So during this day with Ariana, I learned that with projects involving

vendors it is important to make sure that the participants are carefully selected since you want them to

be able to see it through and it is important to make sure vendor demonstrations or presentations

thoroughly demonstrate all facets of the application.

Sharp Spectrum (Onsite)

March 13, 2023
 Hours 8
Total Hours 91

Today, I attended several meetings with Arianna. One of the meetings centered around order

sets. One of the responsibilities that clinical informaticists have is to manage requests for modifications

to order sets that providers use across Sharp Healthcare to serve their patients. This is true throughout

the different departments and specialities. What was clear during the meeting with every clinical

informaticist across the system was that there has been no defining of when requests for order set

modifications should be stopped. Requests to improve order sets can come from clinicians at every

entity and within almost every workflow. However, with the implementation of Epic being front and

center, resources are stretched and that includes the time and energy needed to make the changes for

Cerner that employees request. Everyone agreed that better communication needed to be made to

everyone company-wide that Cerner changes are not going to happen unless there is a clear reason that

makes it a safety or regulatory concern. There is no real appetite among the team to invest their energy

into Cerner changes when those same changes will be irrelevant once Epic is fully implemented. Besides

that meeting, I found myself joining Ariana for an Epic webinar on a wellness application and a meeting

that discussed the logistics of approving physician-related input. It is important to note that Sharp has

been having a difficult time finding an appropriate Chief Medical Information Officer which would

normally make those important decisions. It is unfortunate that this is true during an EHR

implementation. Most of the day with Ariana was dedicated to working on my gap analysis project which

is close to being completed.

Sharp Mary Birch Hospital for Women and Newborns (Onsite)

March 20, 2023

Hours 7
Total Hours 98
 I was at Sharp Mary Birch Hospital for Women and Newborns on this day with Ariana because

there was a vendor on site for a walkthrough. The vendor was AngelEye which is the company behind

MilkTracker. This is the application that the nurses in the NICU will use to administer and prepare the

breast milk. It is also the application that mothers and nurses will use to track and store the milk that is

pumped. I think I have learned a lot because of this experience. I was involved from the very beginning

of this process since I was part of the decision group in the NICU who assessed several vendors. I know

that AngelEye was judged to be the design that had the simplest interface and workflow. However, there

has been some discontent among the NICU team with the application demos because of AngelEye’s

insistence on order-matching being part of the bedside nurse workflow. Order-matching in the

application is when the scanned milk is not only verified to match mother’s milk with the proper baby,

but also to match the milk with the order that is indicated in the EHR. This is something that was vague

when originally presented and the NICU staff, including me, was not presented with an accurate

depiction of what that particular feature would mean for the workflow. And if AngelEye, in fact,

presented this feature to us, I certainly do not remember them indicating that the feature was

mandatory and not something we can opt out of. It is an interesting experience now that I was sitting

next to Ariana and I could see the project a year out and from a different perspective. The experience

showed me how vitally important it is to have a vendor present as accurate a picture of how their

application will integrate into current workflow truly is. I also learned that when those affected by the

change express their displeasure with something about the project, hear them out because their

perspective can sometimes be the only one that dictates whether the overall project can be a success or

not.

Sharp Spectrum (Onsite)

March 27, 2023

Hours 6
Total Hours 104
 On this day, I was able to focus mainly on finishing my gap analysis. I was able to include

screenshots of what the care plans will look like in Epic. I also was able to add notes so that I can

properly address where changes are needed as we move forward. I am a bit nervous about presenting to

the decision group, but I am confident that the notes I have taken and completed will provide me with

assistance should questions arise in real time. I think that it will be important for clinical staff to

appreciate that Epic does not structure their care plans in the same way as Cerner. This means that any

desired change should take into account that if a specific intervention is desired that it must be attached

to a specific goal or outcome. Cerner structures their care plans in a “bucket” manner whereby there is

no obvious relationship between intervention and goal. This is important to note as we move forward. I

was also fortunate enough to attend the weekly clinical informatics meeting where different items were

discussed. Much of the meeting focused on when super user training would take place and how best to

support those team members moving forward. I am excited to be a super user on my own unit and

because I have seen Epic from a more engaged perspective than my peers I have enjoyed the insight.

Sharp Spectrum (Onsite)

April 4, 2023

Hours 8
Total Hours 112

I was with Ariana as she attended several meetings on this day. One of the meetings I found

interesting was one where Cerner change tickets were reviewed. As the Epic implementation ramps up,

it is important for Sharp to decide which projects are worthy of time and energy. Many of the projects,

however, have been determined to be safety improvements. Because of this, Sharp is adopting an

approach whereby those particular projects will be completed because it will allow better understanding

of what Epic counterparts can be developed. If improvements can truly be beneficial to clinical staff and
patients, every effort should be made to make sure that an EHR implementation does not stand in the

way. Another meeting we attended was one where physician role mapping was discussed. Because Sharp

is a large healthcare organization it is important to know what physicians need EHR access and what that

access will look like once Epic is in place. We know that the different patient types will require different

aspects of the Epic platform and we also know that providers may not know exactly what they need. This

is because some providers may not have much experience with Epic and how to maximize its use. The

meeting discussed how to properly audit which providers may visit different facilities and/or practice

under different specialties. The owner of this project made sure to communicate to the group that they

will thoroughly check the list to make sure that appropriate permissions are granted as we move forward

with the development of the training portion of the project.

Sharp Spectrum (Onsite)

April 12, 2023

Hours 7
Total Hours 119

I worked with Ariana as she attended several meetings throughout the day. One of the meetings

regarded ticket management regarding tickets that are submitted throughout Sharp Healthcare from a

variety of departments. These tickets are change requests as they relate to how the Cerner EHR

operates. For example, one of the requests was continuing to enhance the clinical decision support

feature that allows patients that refuse blood products to have more options on which specific products

are refused rather than a generalized refusal. Much of the meeting was deciding how items would be

prioritized, especially as resources are stretched due to the Epic transformation. There is still a desire to

have some Cerner changes made, but time and energy spent on an EHR that Sharp is moving away from

is not productive. The discussion centered around how value-added projects would be the only one

green-lighted. Another meeting Ariana and I attended regarded mapping provider privileges. Ariana

explained to me that ensuring providers, and any users for that matter, have the appropriate level of
access to patient information. Each user profile must have access to the Epic EHR that aligns with their

roles and responsibilities. This is especially true since Cerner does not treat user access similarly. For

example, Epic has many different “types” of nurses based on speciality whereas Cerner has a generalized

nursing role that can be assigned to certain users. This mapping will be heavily involved, especially as you

consider how certain users have different roles currently and will need similar access once Epic is

launched. I enjoyed shadowing Ariana today because it exposed me to processes, challenges, and

projects that are at the core of nursing informatics.

HIMMS Conference (Offsite - Chicago, IL)

April 17, 2023

Hours 8
Total Hours 127

To continue my practicum experience, I decided to join Cindy Drake to Chicago as she attended

the Healthcare Information and Management Systems Society World Conference. It was a privilege

representing both the University of San Diego and Sharp Healthcare as a Program Assistant. On this day,

there was a pre conference event that focused on nursing informatics. The Nursing Informatics Forum

focused on various informatics topics that relate to nursing. One topic focused on downtime procedures

when an EHR goes dark. When a healthcare system loses access to vital information, there must be

processes and procedures in place that allow the healthcare system to continue operating so that patient

health and safety is protected. Another topic focused on robots and how they can help retrieve certain

things or provide patient surveillance. While not replacing nurses, the robots can help the nursing field

by offloading certain tasks that can burden the nurses attention. The last topic of the day at the forum

focused on Press Ganey and how surveys across the United States reveal certain powerful discoveries.

One thing that the data revealed is that being able to separate work and home life is vital to decreasing

nurse burnout. Nurses that left the field or were contemplating leaving the field more often suggested
that work communications, such as email, texts, or scheduling required that they bring their nursing

world home with them. Employees of healthcare systems that were able to genuinely disconnect from

work were better able to maintain the job satisfaction that is vital to retaining workers. Cindy and I

agreed that the entire forum and the topics discussed proved to be stimulating in so many inspiring

ways.

HIMMS Conference (Offsite - Chicago, IL)

April 18, 2023

Hours 8
Total Hours 135

On this day, Cindy and I attended the opening ceremony where responsible artificial intelligence

was discussed. The talk highlighted the potential benefits of artificial intelligence in improving patient

outcomes, but in a way that should be focused on ethical concerns. These concerns included discussion

surrounding bias and transparency with how these models are made and designed. There were several

stories shared regarding how difficult cases were diagnosed only with the help of artificial intelligence.

Because of the powerful potential to recognize patterns with greater consistency, artificial intelligence

can be used to help patients find the diagnosis that helps them improve their lives. The talk also

explored challenges and risks related to the privacy of patient data that can be used as artificial

intelligence input. For this reason and others, there is a need for regulations and guidelines governing

the use of artificial intelligence which means that there must be healthcare stakeholders that participate

in the development of safeguards. This would require ongoing monitoring and evaluating of artificial

intelligence systems so that potential safety and ethical concerns can be addressed in responsible ways.

Cindy and I thoroughly enjoyed the talk and it has inspired me to read more about artificial intelligence.

Later in the evening, I attended the HIMSS Conference Emerging Healthcare Leaders Reception.

This reception was a great experience because it allowed me to network with people from across the
country who are entering the informatics space or are making strides already. I met several people from

Canada that enjoyed the vendors at the conference. When I discussed this further with them, I was

surprised to hear their perspective because they felt that there was not a lot of innovation in the

healthcare space because it is not privatized like it is in the United States. For that reason, the amount of

companies and products that they experienced at the conference surprised and excited them. However,

they also felt that many of the products or services would not be able to translate to their healthcare

system because the public funding is much more strict on what expenses are justified and which are not.

It is these discussions and connections that I enjoyed the most from the conference because I would not

otherwise be exposed to these perspectives otherwise.

HIMMS Conference (Offsite - Chicago, IL)

April 19, 2023

Hours 8
Total Hours 143

The entire HIMSS Conference was extremely enjoyable. I was able to learn a lot and I gained a

great deal from the experience. On this day, I enjoyed being a program assistant for several sessions that

discussed important and interesting topics. One of the sessions I assisted was entitled, “How Can

Automation and Predictive Insights Help Improve Patient Care?”. The session automation technology,

such as robotics and artificial intelligence, could help the healthcare industry by streamlining

administrative tasks, reducing errors, and improving operational efficiency. Through predictive analysis,

patient care can be personalized in a way that could detect disease, improve treatment plans, and

enhance management of chronic conditions. The talk concluded with a discussion surrounding the

challenges surrounding this dynamic. These challenges included patient privacy, security and the

importance of validating what automated models give as output. Validating what is suggested is an

important part of making sure that automation can help healthcare professionals in ways that assist
rather than hinder processes key to success.

Another session that I helped facilitate was entitled “Data for Health Equity: Improving Maternal

Health Outcomes Through Interoperability”. The session focused on how maternal health outcomes have

a large degree of disparity, especially as it relates to African American women. The talk centered around

how exchanging information between healthcare providers, systems, and public agencies can improve

maternal health outcomes because of its potential to allow data to reveal patterns to try to pinpoint

areas for improvment. The talk then concluded with a discussion surrounding how policymakers can

facilitate health information exchanges and standardized data formats so that data can be collected,

analyzed, and visualized in powerful ways that help communicate the degree of the disparity. I attended

other sessions on this day, but these two were the ones that I thoroughly enjoyed the most because it

allowed me to think of informatics in ways that truly inspire.

HIMMS Conference (Offsite - Chicago, IL)

April 20, 2023

Hours 8
Total Hours 151

During the conference, there were several vendors that were on exhibit that were advertising

their company and the product of service they provide. On this day, I wanted to visit the vendor hall so

that I could see what was on display. I was able to see Zebra which currently provides Sharp Healthcare

with the phones that nurses and others use to communicate throughout the hospital. I also visited the

Epic exhibit since Sharp Healthcare is in the process of transitioning their EHR onto the Epic platform. It

was informative to see these companies because I was able to learn even more about the companies

and how to optimize the use of their products. One of the companies that I saw in the hall that I had not

previously heard about was a company called Health Gorilla. The company operates an interoperability

platform that permits access to actionable data that allows for insight. The company hopes that these
insights will allow for more equitable healthcare and more streamlined workflows. There are many

companies that have a large amount of data with no appreciation for how to unravel its trends or

patterns. Health Gorilla hopes to help with that problem. I enjoyed seeing all of the companies.

Earlier in the day, I attended a session entitled “Customers or Patients? Effective Strategies for

Building Brand Loyalty”. I could not have foreseen how appropriate attending this session was right

before exploring the companies at the exhibit hall. The class discussed the importance of brand loyalty in

healthcare. The healthcare industry is unique in that it should focus on empathy, communication, and

personalized care as the path to making sure their patients return. On top of that, the session also

revealed that patient engagement and empowerment has been shown to promote brand loyalty in the

healthcare industry with patients. Examples of how to accomplish this include patient portals, mobile

apps, and telehealth services. Overall, the session kept reiterating the importance of organizational

culture as the vehicle for the shift of mentality that demands you see patients as customers as well.

HIMMS Conference (Offsite - Chicago, IL)

April 21, 2023

Hours 4
Total Hours 155

This was the last day of the HIMSS Conference and Cindy and I had quite a wonderful experience

in Chicago. I was able to learn a great deal and connect with many people that shared my interest in

informatics and its power to continue improving the healthcare industry. Because the conference was

ending, I was only able to spend 4 hours at the conference. Most people were only interested in the

Closing Keynote by Damar Hamlin. Damar Hamlin is the NFL player that had experienced a medical

emergency during a football game with millions of Americans watching live. The talk centered around

how appreciative he was of all of the people that rushed to his aide and those in the hospital that helped

save his life. Damar Hamlin is now championing the importance of CPR training and how that simple

initiative can save many lives.

 In addition, there was also a closing presentation from economist Mark Zandi. The talk discussed

the shift from fee-for-service to value-based care models and how that will create difficult decisions for

healthcare organizations as they navigate how to depend on certain reimbursement models. He

indicated that innovation, research development, and new technologies should focus on improving

healthcare cost-effectiveness rather than just add to the cost accrued by organizations. He ended the talk

by discussing how workforce shortages, wages and labor market dynamics will also play a part in what

healthcare organizations should consider in their calculus, especially since the pandemic has created a

global economy that has made everything cost more. This cost also means that workers want more from

their employers to help manage how they grapple with increasing costs. The closing remarks were great

because both talks proved to be a great capstone to the conference which I thoroughly enjoyed.

Sharp Spectrum (Onsite)

April 26, 2023

Hours 8
Total Hours 163

On this day, I was finally able to present my capstone to the Stork working group. Throughout my

time with Ariana, I found myself working on the project in between meetings. This was finally my

opportunity to present it to the NICU team to see what input they had to offer. It was nerve wracking,

but the presentation went smoothly. The questions that I was asked were valid, and because I was

prepared I was able to answer the questions. For example, there were questions related to pain and

comfort which were found in other care plans. If we chart that comfort measures were done for pain

management, it doesn’t need to be charted necessarily under a developmental care plan. Overall, I was

able to show how the Epic care plans will improve compliance among the clinicians. This is because

Cerner had many care plans with many interventions that were found in multiple places. This

redundancy created a dynamic where clinicians were wasting time charting things that were already
charted. This may seem subtle, but many clinicians find charting time-consuming already and any

reduction in that would be seen as a win.

The gap analysis I performed taught me several things. It showed me that it is important to

recognize that some systems offer features that are more concise and organized than others.

Customization can be a damaging thing if not reined in and managed. This is because more does not

always mean better and leads to redundancy and superfluous elements. The entire time I worked on my

project, I did not lose sight that a smaller and more concise process will likely promote staff compliance

and that potential changes and/or optimization should be purposeful. I appreciated Ariana’s help during

this entire process and I think that it was a great project to work on.

Sharp Spectrum (Onsite)

May 3, 2023

Hours 8
Total Hours 171

On this day with Ariana, we worked on order set validation. It is important with order set

validation that you invite the proper stakeholders to offer input on their construction. Because of this,

the meetings each had at least one physician that was offering their opinion on how the order set should

look and what they should include. Because an order set is a preset grouping of orders for a certain type

of task, the process requires standardization that allows for seamless workflow integration. For example,

an order set that involves sepsis screening should include certain laboratory tests, certain patient

procedures and certain nursing care that can be bundled in a way that ensures efficiency and consistency

while maintaining safety. Because order sets often include evidence-based interventions, Ariana made

sure to mention to me how important updating order sets is because they often need to include new

research as evidence emerges. I know that in the NICU, Sharp conducts its own research which means

that we often update order sets as our policies and procedures change regarding certain patient

populations.
 During one of the meetings, there was one physician who felt uncomfortable making decisions.

Ariana pressed the doctor on whether certain order sets, as they appear in Cerner, should translate over

into Epic. These decisions were further flavored by the reality that Epic has order sets of its own for

certain patient populations that have differences to the ones we currently use. This physician indicated

that they did not want to make decisions that would affect the entire speciality of doctors for which

these order sets were concerned. When Ariana indicated to the doctor that they were suggested by the

doctor overseeing physician involvement in order sets, the doctor indicated that they would like their

name taken out of Epic involvement. Later in the day, Ariana met with Dr. LeMoine, who is Sharp’s Chief

Medical Information Officer, and informed him what had occurred and he shared that he was frustrated

because physicians who are “comfortable making life and death decisions for patients should be alright

making decisions regarding the electronic medical record.” Ariana and I agreed.

Sharp Spectrum (Onsite)

May 23, 2023

Hours 6
Total Hours 177

The time on this day was spent doing Alaris testing in the Epic environment. I scanned multiple

fake medications in the Epic system to see which ones would load appropriately and which ones still

needed modification. Because of my bedside experience, I know that it is extremely important for

medications to properly scan in the medication administration environment within any EHR that the

nurse accesses. Most of the medications I scanned worked, however, there were a fair number of

medications that were scanned that indicated an incorrect concentration or incorrect guardrails.

Guardrails are programmed within Alaris to allow upper and lower administration durations to be

programmed into the infusion pump so as to prevent medications from being administered in an unsafe

manner. This dynamic was new to me because Cerner, at least in the NICU, does not communicate with
the Alaris pumps in a way that allows for data transfer. However, Epic will allow this which requires that

every medication must be tested in the way that we did that day. I look forward to this process being

integrated into my bedside workflow because it will allow for a more seamless documentation process

for my intake and output. The entire time spent testing the Alaris pumps against the Epic environment

was tedious, but my fellow testers and I made sure to take frequent breaks from the process with music

so as to not have fatigue affect our ability to properly perform the testing. Over a hundred different

medications with varying concentrations were tested and I was glad to see a more “behind the scenes”

context to what I have been doing for many years.

Sharp Spectrum (Onsite)

May 30, 2023

Hours 8
Total Hours 185

With Ariana on this day, I was able to attend more meetings and understand more about how

Sharp is making sure the Epic transformation is a successful one. One of the meetings centered around

how the ventilator equipment would integrate into the EHR. Sharp’s current state has several units

across the system having ventilator equipment that communicates with the EHR in a way that loads

information, such as tidal volume, peak end-expiratory power (PEEP), and other important settings into

the chart. Because Epic does not utilize the same technology or appliances that Cerner does to transfer

data over, the meetings centered around testing. There was a vendor for a company by the name of

Cadence that was present during the meeting. The vendor indicated which dates they were available to

round with the informatics team to ensure that it is working as planned. I know from my previous

experiences with the informatics team that they were still trying to navigate how the apparatus (which is

rather large) would fit onto the ventilator. Apparently, the Cadence company had made some helpful

recommendations about locating them near where other appliances are being offloaded as a result of

the Epic transition.

 Another meeting we had centered around OBIX software which is going to be used for fetal

monitoring. What I found the most exciting about this meeting was the realization that fetal heart rate

strips can be loaded into the patient’s charts. In a world that is depending less on paper and one that

depends on clinicians to chart data in real time, OBIX software will offer Sharp nurses to have strips

loaded into the charts in a way that offers them huge time-saving benefits. Physicians in the meeting

were excited about seeing the strip and assessing it without relying on the nurses to see it first. The

potential to see a fetal heart rate strip in real time was one that made everyone in the meeting eager to

help make a reality. It was another meeting with Ariana that showed the breadth of expertise informatics

teams must always possess.

Sharp Spectrum (Onsite)

June 5, 2023

Hours 4
Total Hours 189

On this day with Ariana, she attended several meetings at Spectrum before we were to round

later in the day at Sharp Mary Birch. One of the meetings she attended centered around the new Sharp

application that will be available for download on people’s phones. The application will be available for

patients to access their own healthcare information in a way that is convenient for them. What surprised

me about the meeting was the agreement among everyone to continue calling the application “Sharp

Health Companion.” While I do not have an alternative, the name doesn’t roll off the tongue and doesn’t

appear to really catch the ears of patients as they are told by clinicians. Regardless, the meeting also

discussed what Epic would mean for the application and how the EHR would communicate to the

patient. Epic allows more information to be shared than Cerner, and there was some discussion

regarding how scheduling will appear on the application. This is the case, because current reviews for the

application from patients agree that the best part of the application is the ability to get reminders of
appointments and prescription refills on their phone. After some discussion of my gap analysis regarding

the care plans, Ariana and I prepared for the rest of the day at Sharp Mary Birch.

Sharp Mary Birch Hospital for Women and Newborns (Onsite)

June 5, 2023

Hours 4
Total Hours 193

This was an exciting day with Ariana because it was the first time that I rounded with her at the

hospital. The inspiration behind the rounding was related to the CareAware phones that many clinicians

and ancillary staff utilize to perform their job duties. Ariana and I went throughout the hospital asking

how staff perceived the phones. I know from personal experience that the phones themselves, which are

made by a company called “Zebra”, have complications. For example, after clinicians log-in to the phone,

the phone can automatically log a user out. This proves frustrating when attempting to call the nurse

because it bounces back and the caller is left without an ability to page or ping the nurse. A recurring

complaint was that the phones did not connect to WiFi which proved difficult. Passing medications with

the phone has proven more difficult, so some nurses prefer not to use the phones. Ariana was able to

communicate that Sharp is moving towards iPhones when Epic rolls out. Many of the staff were

optimistic about this change and were eager to see that happen. Overall, the experience was a good

experience because it made many classroom concepts a reality. I say this because staff champions and

staff buy-in are critical elements in any new tools that are incorporated into a staff’s workflow.

Sharp Spectrum (Onsite)

June 15, 2023

Hours 7
Total Hours 200

It was a bittersweet day, because Ariana and I knew our journey together was coming to a close.
As we jumped from meeting to meeting centered around this singular theme, Ariana made sure to offer

her advice while working on informatics projects. One thing she shared that she is cognizant of is that

sometimes when you ask others to work on certain projects that you do not know or fully understand

their current bandwidth. In other words, you may not know if they can handle or do what you are asking.

Another thing that she shared is that it is very important to understand what resources you have

available. This is because whenever you consult resources, what you are looking for may be under a

different category. This is especially true when we consider that Epic has a resource called Galaxy

whereby you can consult what other entities are doing with Epic and what tools are available. Because of

this, it can require different searches with different criteria or components. What you initially cannot find

may be found somewhere else. Being able to be your own resource is important to being the most

productive you can be in any project.

Other strategies that Ariana shared with me is that projects must have clearly defined objectives

and have the appropriate stakeholders involved. This is because success can only be gauged properly if

we know before we start what is trying to be accomplished. Success can most often be achieved if the

proper stakeholders are part of the process. Managers, directors, and team leads that are involved in the

departments you affect will know how best success can be accomplished. They will also be invested in

making sure that the project is ultimately completed. Overall, it was a great day and I really appreciated

Ariana’s willingness to share what she has learned during her career. Sometimes the concepts are easy to

understand, but mastering them can be challenging. That reality was not lost on me.