October 31, 2023

When the Texas Children’s project team started the journey to implement the Epic software system 15 years ago, they didn’t expect to change the landscape of pediatric health care, but they did just that. Our strategy proved to be the winning formula for integrating the software system in to pediatric health care operations, and we became the Epic best practice for the industry.

“The project team set out with a goal to ensure our version of Epic would be a game changer for our patients, staff and Texas Children’s, and they certainly delivered,” said Teresa Tonthat, vice president, Information Services. “I’m so proud of what we’ve accomplished together and what we’ve developed for our staff, patients and other health care professionals. This is an important milestone to take time and celebrate, but we have no plans of stopping. I’m excited for what comes next.”

Together, our IS and clinical teams approached the implementation with a goal to provide a best-in-class software platform tailored to fit the specific needs of our staff and patients. The result was a comprehensive resource with the right tools to help us provide more thorough and efficient care for our patients.

“Nurses are dedicated to providing the highest quality, safest care possible to our patients. We must be up to speed at all times with accurate information at our fingertips. Having the right information available from one source at bedside has been a huge advantage,” Jennifer Sanders, vice president and associate chief nurse executive. “Epic helps us be more efficient, better informed and in the best position to deliver exceptional care to our patients.”

The Epic system is comprised of 54 modules our clinical teams use to help them make informed decisions on patient care. There are a handful, which have had the biggest impact, including:

  • MyChart Patient Portal. Allows patients to access their medical records, schedule appointments and communicate with their doctors online. It’s help make it easier for patients to be involved in their own care and have a better understanding of their health.
  • Mobility. Epic Rover has become an indispensable tool for healthcare professionals, particularly nurses, in various clinical settings. By providing secure and mobile access to patient information and streamlining critical processes like medication administration, specimen collection and infusion pump management, Epic Rover enhances patient safety, reduces errors and improves the efficiency of healthcare delivery.
  • Interoperability. This has allowed different healthcare systems to share information with each other making it easier for doctors to get the information they need to make informed decisions about their patients’ care. This proves especially beneficial to parents and patients when they need to transition care or seek a second opinion at Texas Children’s.
  • Telemedicine. Using telecommunications technology to provide medical care from a distance has made it possible for patients to receive care even if they live in rural areas or have difficulty getting to a doctor’s office.

“When the system went live, I saw immediate value in the first clinic session. I had a patient with ear infections and because I could see all her Texas Children’s Pediatrics notes and medication history in Epic, I was able to make a surgical recommendation without requesting outside records,” said Dr. Carla Giannoni, chief medical information officer. “Today we use it for so much more, and Epic adds new modules and features every few months.”

Giannoni continued, “Epic has streamlined data collection so we can improve our operational processes, and that has resulted in added efficiency and convenience. I also absolutely love that I can get most of the Epic data I need on call through the mobile app, Haiku. I can see OR schedules, my team’s patient list as well as my schedule, and chat securely with the bedside nurse.”

Click here to view a video about the Epic anniversary. Congratulations to everyone at Texas Children’s for 15 years of Epic success.

June 1, 2022

The Front Door for Data and Technology (Front Door) has undergone a major transformation to meet users’ growing demand for data and create a more robust data exploration experience. You’re going to want to bookmark the new Front Door, located on Connect – navigation bar – Tools. The new portal was officially launched on May 25 by the Quality Outcomes & Analytics, Clinical Informatics, and Information Services (IS) teams.

The Front Door was formed in 2017 to serve as Texas Children’s portal for requesting data reports, access to existing reports and dashboards, E-changes (Epic optimizations and other clinical technologies), and computer technology (tools, software and help). In an increasingly data-driven world and organization, a greater demand for data and more desire from users to learn about and use self-service tools drove the need to reimagine the Front Door user experience.

“We formed a partnership six months ago and set out to understand users’ data consumption needs and modify Front Door in a way that will help people help themselves when it comes to data research, reports, technology requests and understanding clinical technologies,” said Dr. Carla Giannoni, Chief Medical Information Officer and Professor, Pediatric Otolaryngology.

The Front Door transformation team includes Dr. Giannoni, Toni Powell-Fontenot, Assistant Director of Quality Outcomes & Analytics, and Ashok Kurian, IS Director of Enterprise Systems.

Among their findings, the team learned that many users are seeking self-service education about nearly everything, including available reports, the components of those reports, and Epic features and functionality. Their main goal for the new site was to create a space to serve all informatics needs, where users can easily find guidance, facts and forms. Each page includes user-friendly summaries, how-to guidance and quick links that will take you where you need to go to get your work done. On Front Door you can:

  • access request forms for technology and data reports
  • learn about the data request process, all self-service data tools available to you, and how to create robust data requests based on your unique research and reporting needs
  • get links to a vast array of credible and valuable external education resources
Tips for navigating Front Door

When you enter Front Door you will get a taste for how the rest of the site works. Quick link icons connect you with the most-used tools and information, such as How to Get Your Own Data, the IS Request Center, and E-Change Request Form. FAQs are available for everything the team could think of to help you connect with the data and tools you need including request status, determining the type of request you need, and learning more about Epic clinical and data features. The Epic Video Library covers everything Epic, ranging from how to use Epic features such as SlicerDicer and Reporting Workbench to help with physician efficiencies such as writing notes. The Epic “It’s Possible” series are 60- to 90-second videos addressing how to work efficiently.

Quick links for common items are cross-referenced throughout the site. For example, you can always build your own unique dashboard or report based on your team’s needs, although “Data, Tools and Access” shows you what type of reports, dashboards and data sources are already available, and allows you to filter them by type, self-service access request required, source, and other helpful information. If you are contemplating whether to “build” or “request” a report that reveals several clinical data points, you might want to review “Thinking About Data: Tools and Access” for guidance. Other helpful quick links include HELP for the IS Service Portal and Quality and Safety Home.

“We appreciate everyone’s patience as we worked with Ashok’s team to migrate from the initial Front Door and construct and launch the new site,” said Fontenot. “We are excited about its functionality and potential, and we encourage you to take a spin, dive in and give us feedback.”

The Front Door will evolve as the team learns of more reports and tools that can help leadership and work teams with insight and forecasting, such as Epic Executive Dashboards.

Welcome in! Reach out to Toni Fontenot or Dr. Carla Giannoni if you have any questions about the new Front Door.

May 4, 2021
Front row – Anita Harris-Brown. Back row (left to right) – Kathleen Ulanday, REgina Wysocki, Pippa Andrews-Brown, Lakeesha Etienne

The Smart Pump Interoperability Project recently went live at the Medical Center, West Campus and The Woodlands, thanks to a committed team that pushed forward to bring the innovative technology to Texas Children’s despite disruptions from the ongoing pandemic.

Smart pumps are known to help prevent adverse drug events, especially when linked with electronic health records. These pumps include auto-programming, which allows for specific medications to be transferred directly from a patient’s records to the smart infusion pump, and auto documentation, which allows information like start and stop times to be sent electronically.

To support the project, a total of 2,111 Texas Children’s nurses completed Alaris Interoperability training and gained the skills to improve medication safety and quality practices, and reduce infusion administration errors.

Epic Trainers, Nursing Professional Development Specialists and Clinical Nursing Informaticists collaborated to deploy the training, which was provided as part of nursing education at the system level with the support of Biomedical Engineering, Information Services and Pharmacy. The curriculum included 15 online learning modules with video demonstrations and learner engagement simulations, followed by live hands-on practice.

Additionally, more than 230 nurses served as Interoperability Skill Validators and used the Rover, Alaris pump and Epic EMR integration in an interactive training environment to prepare in-patient and Emergency Center nurses to implement the new practices in time for go-live on January 19 at the Medical Center/Pavilion for Women, and February 9 at West Campus and The Woodlands. Tabletops were conducted with various specialties to assist in preparing clinicians, and a clinical readiness training video was livestreamed with the help of the Simulation Center to give nurses a view of workflows and answer their questions.

Making the project happen

The go-live was implemented in two phases to ensure that nursing staff and those working behind the scenes at each campus would have the necessary support. During the transition at Medical Center/the Pavilion, 233 current infusions were connected to smart pump interoperability. At West Campus and The Woodlands, 35 infusions were connected within just a few hours.

At the center of the effort was the Clinical Subgroup, which drove all decisions and clinical practice. The subgroup consists of clinical nurse specialists and nurse educators from across the organization.

Also instrumental were informatics resource liaisons (IRLs), who worked along with the IS Command Center to help centralize calls surrounding the project. IRLs validated other bedside nurses with hands-on demonstrations; provided necessary feedback related to decision on workflows impacting the project; relayed necessary concerns and information from other bedside staff; and provided hands-on support while maintaining their own patient care load. As trusted liaisons, IRLs communicated problems to IS and communicated their findings and additional information back to their units.

A particular point of pride was the interaction at the unit level, which proved critical to the project’s success. Led by CVICU Clinical Specialist Lauren H. Salinas, nursing staff prepared their units by providing a worksheet to transition their current infusions. At the Pavilion for Women, High- Risk OB Clinical Specialist Tara Barrick and RNC-OB Educator Coordinator Melinda Trussell led the way in validating their staff by adopting the theme, “Operation Interop.”

Praising the project’s success

Nursing staff and vendors who supported the project had plenty had of good things to say about bringing the Smart Pump Interoperability Project to life:

  • “It was easier than I thought; we should have done this earlier.” – 14WT RN
  • “The modules made this way scarier than it truly was.” She said “I felt like I was going to forget something when it’s actually just 2 more steps to our BCMA process.” – 12WT RN
  • “So far, it’s been a smooth transition with no major issues!” – West Campus PICU RN
  • “Back association is beautiful where I never have to guess and go all the way back in the MAR then document my fluid. With back association, it all pulls in and do it right there at the bedside with another nurse.” – RN Float Nurse West Campus
  • “That is excellent work! The average pumps go live will see organizations hover at around 70% compliance for the first week, so we’re trending above that which is great news.” – Bryan K. (Epic TS)
  • “This is the best go-live I have ever supported. Expect some phone calls from our other pediatric customers.” – BD support team
November 2, 2020

The patient is at the center of the 21st Century Cures Act in order to provide more power in the delivery of their health care, which includes access to their medical information.

In 2016, the Office of the National Coordinator (ONC) for Health Information Technology passed federal legislation called the 21st Century Cures Act Final Rule that puts patients in charge of their health records, which is a key piece of Health and Human Services (HHS) work toward a value-based health care system. The ONC Final Rule enables the health care delivery system to deliver an “app economy” to providers and patients, physicians, hospitals, payers, and employers with innovation and choice.

Through the delivery of modern smartphone and software apps, patients and providers will see benefits in accessing electronic health information (EHI). Patients will have more convenient and easier options to gain on-demand access to their EHI whenever and wherever they need it. In addition, there will be the increasing ability for patients to choose apps that will assemble and read their records. The interoperability, information blocking, and patient access to data and electronic health record certification requirements outlined in the 21st Century Cures Act will go into effect in multiple phases and will impact our patients, health care providers and health IT software developers.

To learn more about this effort, click here.

Changes go live with the Epic upgrade on November 8. Texas Children’s will release data via MyChart, and other patient portals, in order to make information more accessible and not require patients to go through the traditional medical record release process. Several other changes on the horizon include:

  • Patient Access API – Beginning December 31, 2022, CMS-regulated payers (including Medicaid MCOs) are required to implement a secure, standards-based application programming interface (API) that allows patients to access their claims, encounter information and some clinical data.
  • CMS Payer-to-Payer Data Exchange – This provision will require CMS-regulated payers to share certain clinical data with each other and other payers. This allows the patient to take their information with them as they move from payer to payer over time to help create a cumulative health record with their current payer.
  • United States Core Data for Interoperability (USCDI) standard expands – Starting in October 2022, under ONC’s rule, the definition of EHI will expand beyond the USCDI. The EHI definition will include the full HIPAA electronic designated data set.

To prepare, educate, and ensure compliance across the organization, a workgroup has been assembled to carefully review the regulation, review our policies, procedures and business practices, and develop a system wide communication plan to ensure our providers are compliant with this new federal regulation. All Texas Children’s team members are invited to learn more about this regulation and its implementation via a virtual Town Hall for providers; see details below:

Provider Virtual Town Hall Hosted by Dr. Giannoni
Wednesday, November 4 | Noon to 1 p.m.
To join via MS Teams, click here.

Stay tuned to Connect for more updates on the 21st Century Cures Act and the organization’s implementation efforts. In the meantime, we invite you to review this site, which provides details on what you need to know, including a crash course, handouts and much more.

October 19, 2020

On October 19, Texas Children’s Specialty Pharmacy celebrated another milestone with a brand new, specially designed space that will enhance operational efficiency and service to more than 1,700 patients. The Specialty Pharmacy’s call center and dispensing operations moved from the Abercrombie and Mark A. Wallace Tower buildings to its new home on the eighth floor of the Jan and Dan Duncan Neurological Research Institute (NRI).

“Previously, the Specialty Pharmacy dispensing team worked from the Abercrombie basement in small rooms making work flow processes difficult,” said Josephine Hurtado, Director for Specialty Pharmacy. “Additionally, the operation had so many manual workflows requiring checks and balances to be in place to minimize the opportunity for error. Not only is the new space at the NRI ergonomic and lean, new technology from McKesson HVS has been implemented to improve the prescription filling process such as integrated bar code technology and workflow automation which guarantees efficiency and the safest patient care. The team is excited to embark on this new endeavor.”

Specialty Pharmacy began four years ago and serves numerous clinics including Neurology, Endocrine, Rheumatology, Pulmonary, Renal, Hematology-Oncology, Dermatology, Gastroenterology, Retrovirology, Pulmonary Hypertension, Transplant Services, Allergy and Immunology, Prader-Willi, and also serves Texas Children’s Hospital West Campus and Texas Children’s Hospital The Woodlands.

The Specialty Pharmacy team provides service to many patients with complex and chronic conditions that require comprehensive, ongoing communication and management for their medications which are typically expensive. The team collaborates with physicians to manage medication-related issues as part of the plan of care. Texas Children’s Specialty Pharmacy patients have direct access to pharmacists who are dedicated liaisons to assist them in navigating the many complex aspects of specialty drugs including insurance authorization, financial assistance and therapy adherence.

For over the last several months, the Specialty Pharmacy team has been engaged in the design of the new space and have considered every aspect of the project to bring this massive undertaking to fruition.

“Every detail has been addressed in the most thoughtful manner,” said Rosemary Nguyen, assistant director of Specialty Pharmacy. “This expansion will enable us expand our patient volume and to provide the best patient care. The ability to improve our workflows allows the team to continue to focus on improving health outcomes by reducing the administrative burdens that patients typically experience with specialty medications and therefore provide an extraordinary level of service and patient experience as part of an overall plan of care.”

June 29, 2020

The rapid spread of COVID-19 has resulted in more than 4 million cases worldwide. The disease has a marked preference for adults with children being relatively spared. Understanding this preference might hold the key to the identification of therapeutic targets and is the topic of a paper Texas Children’s, Baylor College of Medicine, University of Texas Health Science Center and University of Texas McGovern Medical School physicians recently published in The American Journal of Physiology-Lung Cellular and Molecular Physiology.

The paper suggests differences in lung physiology and immune function as possible reasons why children are often spared from severe illness associated with SARS-CoV-2, the novel coronavirus that causes COVID-19.

The number of children under the age of 18 infected with SARS-CoV-2 has been found to be considerably lower than adults. Early reports from China and Italy have shown that children who become infected with the virus show symptoms less often than adults and even when they are symptomatic, are less likely to develop respiratory symptoms such as a cough or shortness of breath. In most cases, the infected under-18 population does not become as severely ill as their older counterparts. The newly identified multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19, though serious, affects only about 1 percent of young people exposed to SARS-CoV-2.

“These profoundly decreased rates of symptomatic infection, hospitalization and death are well beyond statistical significance, require further examination and may hold the key to identifying therapeutic agents,” said the paper’s lead author, Texas Children’s Neonatologist Dr. Krithika Lingappan.

The way the SARS-CoV-2 virus enters the body and the state of the immune system itself are thought to be two primary differences in how children and adults become infected with the novel coronarvirus.

SARS-CoV-2 enters the body by binding to angiotensin converting enzyme-2 (ACE2), an enzyme that is attached to the outer surface of cells in the lungs, arteries, heart and other organs. This interaction is analogous to the virus unlocking the door to a cell. The higher the expression of ACE2 in the body, the more likely the virus will get in.

Studies have found that expression of ACE2 in the lungs increases with age. Infants and very young children have very low ACE2 expression, and older children still have lower expression than adults. Research suggests that children may be protected from the serious respiratory components of COVID-19 — including acute respiratory distress syndrome — due to their reduced ACE2 expression.

The immune system also plays a role in the novel coronavirus infection. Heightened immune response is often a factor in the inflammatory “cytokine storm” phase of COVID-19, in which the body attacks itself. Studies have found that CD4+ fighter cells in the immune system play an important role in limiting replication of the virus and that adults with moderate-to-severe COVID-19 had lower levels of CD4+ and CD8+ cells. Lung tissue in children naturally has a higher concentration of regulator T-cells, which may protect against severe COVID-19 by suppressing the immune response that, in adults, may lead to a cytokine storm.

“Selective, age-associated mortality render[s] COVID-19 a unique, infectious disease,” said Texas Children’s Neonatologist and Dr. Jonathan Davies, another author of the paper. “Insights into age-related variability in pathophysiological processes may offer critical observations, revealing focused paths of therapeutic investigation.”

Davies and Lingappan both said multidisciplinary collaboration between physicians and scientists, engaged in both pediatric and adult pursuits, holds significant promise and should be encouraged.

Click here to read the full article, “Understanding the age divide in COVID-19: Why are children overwhelmingly spared?”

Authors of the paper are:

Dr. Krithika Lingappan, Texas Children’s and Baylor College of Medicine
Dr. Harry Karimouty-Quintana, University of Texas Health Science Center
Dr. Jonathan Davies, Texas Children’s and Baylor College of Medicine
Dr. Bindu Akkanti, University of Texas Health Science Center
Dr. Matthew Harting, University of Texas Health Science Center

May 20, 2020

After months of planning and renovating, the Department of Radiology is excited to announce that it has installed a brand new state-of-the art 3 Tesla MRI unit at Texas Children’s Hospital West Campus. The Siemens 3T unit is one of now two MRIs at West Campus.

The ultra-high magnetic field strength of 3 Tesla will allow for:

  • Higher resolution imaging with optimized contrast
  • Bio-matrix guided imaging for faster scanning
  • Improved and expanded functional MRI capabilities

In addition, the modern design and high-end technology has multiple additional advantages including:

  • Wide Bore to accommodate a better fit and enhanced accessibility to the patient
  • Virtual Cockpit – Siemens scanner access from other locations Texas Children’s locations.

“This is a very exciting step toward broadening the scope of highly specialized care we can offer our patients in the West Houston area,” said Radiologist-in-Chief Dr. Thierry A. Huisman. “One of our main goals in the Department of Radiology, and across the Texas Children’s system, is to provide the right care, at the right time at the right place. The addition of the Siemens 3T helps us do that more so than ever.”

The room where the new MRI unit is housed was designed specifically for children. Covered in an aquatic-themed mural, the soothing ambiance helps reduce anxiety and decrease the need for sedation.

“We also use MRI- safe video goggles designed specifically to assist patients in MRI with minimizing claustrophobia and anxiety,” Huisman said, adding that children can pick a movie to watch during their procedure. “These goggles create a 3D virtual entertainment environment while reducing MRI noise.”

Due to the use of this entertainment environment and child-friendly atmosphere, 70 percent of MRI exams are now performed without sedation.

The addition of the Siemens 3T MRI adds to what is already a comprehensive suite of radiology services offered at West Campus. What is now offered at the community hospital is:

  • MRI (1.5 T and 3T)
  • CT
  • Ultrasound
  • X-ray and Fluoroscopy
  • Interventional Radiology
  • Multiple subspecialty pediatric radiology expertise including Musculoskeletal Radiology, Neuroradiology, Cardiac Imaging and much more.

“I’m very excited about what this new addition will bring to the hospital, our medical staff, and most importantly, our patients,” Huisman said.