Urgent Care Centers – Epic ASAP or EpicCare Ambulatory

You work in an urgent care center (UCC) and your organization has chosen Epic for your electronic health record. The next question may be, “should we use the ASAP or the EpicCare Ambulatory module?” Keep reading! I will share my experience and give some helpful tips.
At an organization I recently worked at, we didn’t initially have a choice. Our emergency department and UCC were using a legacy application specifically designed for the ED. At initial implementation, the decision was already made to go-live with the ASAP module. Advice from Epic convinced us that this was the correct decision; our UCC evolved from our ED and the biggest difference was that the UCC treated fewer acute patients. Our UCC was not like our ambulatory clinics because of the fact that we didn’t schedule patients; we actually used a third party ADT system. All was well, or at least we thought.

As our project went along and the clinics started to roll out with EpicCare Ambulatory, the UCC staff started to question the choice. New providers were coming on board. Most of them were now using EpicCare Ambulatory in their office. We started investigating whether to switch the UCC to the ambulatory module.
Epic has excellent guidelines to make this decision. We started by reviewing four basic workflows –

  • Staff mix and whether they work in other departments
  • The ADT process
  • Patient tracking needs
  • Our admission to the hospital process

We already knew that the acuity of our patient population was varied from low to medium-high acuity. These patients would be treated more efficiently with the ASAP module. The use of the Nursing Narrator facilitated documentation of staff, medication administration, and vital signs, to move many patients through the system efficiently. These tools provide for much more efficient documentation. Even though very acute patients were diverted to the main hospital, our workflows were enhanced by tools like the Nursing Narrator.

At initial go-live, most of our nursing staff worked full time at our UCC and they were comfortable with the emergency room application they were currently using. If the majority of your staff also work in an office environment, you may want to consider EpicCare Ambulatory. The transition may be smoother.
If your patients are pre-scheduled and checked in when they arrive, this may also indicate that EpicCare Ambulatory is a better choice. Because we worked with a third party ADT system that was also used for billing, our choice at the time was non-negotiable.
The most important topic, that confirmed we wanted to stay with ASAP, was the tracking functionality built into ASAP. We already tracked patient wait times, throughput times, and were already using an electronic ‘grease board’. We knew where the patients were located and their status. This was functionality that we ultimately decided we could not give up.

The final decision was also based on our admission and billing process. If a patient needed admission to our hospital, we had to discharge them first, due to billing concerns, and then “arrive” them to the hospital. This was also non-negotiable and made our decision to stay with ASAP final. Often your billing process will influence the decision. If your patients are admitted directly to a hospital, does the UCC bill roll over to the hospital bill or are they kept separate?

When making your decision, you also need to consider Meaningful Use (MU). ASAP is not part of the software package Epic certified for EP MU. Consider your options and workflows carefully before making this decision.

So, which module works best for you? This can be answered by researching your current state workflow. If you are like my previous organization, our UCC is run like an ED, the staff do not work in an office setting, the ADT process is similar to the ED, and most importantly, we rely on the patient tracking functionality for the majority of our day, you may choose the ASAP module. Your choice may be EpicCare Ambulatory if your providers are planning to attest to EP MU guidelines, your workflows are more similar to an office visit where patients are scheduled and checked in, and the patient population is more similar in acuity to an office visit. And lastly, collecting co-pays in EpicCare Ambulatory is an easier process than attempting to document copay collection in ASAP.

The good news is that whichever application you choose, you may be able to use functionality from both modules. If you chose ASAP, and still want the ability to schedule patients, you can use the ‘expected patient’ workflow to pre-create a patient encounter. You can free-text the reason for the visit and the expected time of the patient’s arrival and then arrive them in ASAP. For EP MU attestation, when using the ASAP module, you will may need to create custom reports. Also, EpicCare Ambulatory does track some patient event times like check-in, registration, and total stay times. This may satisfy your patient tracking needs. If you have staff who work in both the UCC and the ED, the user roles can be configured to allow them to access tools needed in both departments.

The choice of which module to use, ASAP or EpicCare Ambulatory should only be made after reviewing your current state workflows and prioritizing what functionality you must have. After evaluating which MU incentives apply to your organization, your choice should clearly be one over the other. Let me hear about your experience.

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