What better time than year end to reflect on our collective progress as an IT team. You will see a lot of “top 10” type stories in December – top trends, breakthroughs, stories, and even top predictions for the coming year. I’ll leave those to people with far more time to research and write. What I’d like to share is the progress my incredible IT team has made in partnership with our many internal customers at UMHS in 2015. These are common journeys for health care CIOs around the country. Continue reading
In August 2014, I posted “Beyond the core Electronic Health Record” about our primary integrated vendor strategy at UMHS. We have already implemented the core suite of products from Epic. We continue to be committed to this strategy and it continues to serve us well.
We are in what we call MiChart Stage 4 which includes radiology, home care, and part of cardiology. We had agreed that anesthesiology and transplant would be in a future stage. As we plan for those future stages, we’re also considering ambulatory pharmacy, care management, infection control and other specialty areas.
Outside these major stages, there are ongoing needs to support strategic initiatives in capacity management, patient engagement and telehealth. We are planning for the Bed Management module to replace an existing third party product, Bedside in the hospitals that don’t already have a solution, and telehealth functions.
We are also discussing another critical area where Epic is building out functionality. Continue reading
I spent the better part of a day this week at the annual meeting of the Epic Michigan Users Group (we call it eMUG). But I don’t want to focus on Epic. I want to talk about the value of learning from your peers. It could be any vendor or any user group.
This was our fourth annual eMUG conference. Given space limitations, we had 200 attendees last year and with the venue this year we were able to accommodate 400, a significant increase. With 11 health systems in Michigan on Epic, that’s a good size group from each organization.
When asked for a show of hands on how many had been to Epic’s national user group meeting (UGM) before, only 25-30% of the attendees raised their hands. Local user group meetings like eMUG give many more staff a chance to attend and connect with their peers. National user group meetings are costly with airline and hotel expenses for a couple days.
This eMUG meeting was a content rich day: Continue reading
We make all kinds of decisions every day. Some are small yet seem difficult at the time. One I sometimes joke about is ordering off a restaurant menu that has too many good choices. When I finally make my order, I tell the server that I have made my “major life decision” for the night.
Sometimes a group makes a decision after weeks or months of lengthy deliberation: many groups have weighed in, expressed their concerns, asked their questions, refined the plan or recommendation, and only then ultimately provided their support.
And then there are the potentially very impactful decisions that must be made in a matter of minutes with the best information you have available after a very quick weighing of the risks. I had to make one of those decisions last Friday.
We had scheduled our Epic version 2014 upgrade for the weekend. The plan was to bring down the production system at 12:30 AM Saturday. The system would be down until 5:00 AM while the final conversion tasks were completed. IT and operations staff were scheduled in the command center to monitor the upgrade and address any problems. Leadership calls were scheduled daily to review issues starting Saturday.
At 11:51 AM on Friday, I got a text Continue reading
I had the opportunity to talk about lessons learned from EHR implementations as part of the faculty for the “Leadership Strategies for Information Technology in Health Care” course at the Harvard School of Public Health (HSPH) last week. And yes, I was fortunate to make it in and out of Boston between snowstorms for the one day I was there.
The course is part of Executive and Continuing Professional Education at HSPH. It is a two week course with 4 modules. The first week covers Module 1 on IT Strategy and Governance and Module 2 on the EHR.
The faculty lineup for the first week is impressive. John Glaser, CEO Health Services at Siemens Healthcare and former CIO at Partners HealthCare System, lectured on “IT Strategy Considerations.” John Halamka, CIO at Beth Israel Deaconess Medical Center in Boston covered “The National Perspective and IT in the Era of Health Care Reform.” Vi Shaffer, Research Vice President and Global Industry Services Director at Gartner, provided an “Overview of the IT Industry.” Meg Aranow, Senior Research Director and Health Care IT Advisor at The Advisory Board Company, discussed analytics. New care models including telehealth, retail clinics, and accountable care organizations were also covered by various faculty members. Mary Finlay, Professor Simmons School of Management and former Deputy CIO at Partners, discussed IT Governance. Mary is the program director for the course and does a terrific job.
Students come from various roles in health care. The course has also become well known internationally at this point – with about 30% from other countries. For this session some students came from as far away as Australia and India.
I was happy to be part of the faculty and get a chance to hear a few other lectures that day as well as interact with the students over lunch. Here are some of the EHR implementation lessons I shared in my talk:
- The CIO and executive leadership in health care organizations have many priority initiatives at any given time. The EHR implementation will become a primary focus, especially as it gets closer to the go live date. As the CIO, you need to know where and when to be deeply involved vs. maintaining an overall awareness of the project’s progress, being ready to address issues as they are escalated.
- Engaged executive sponsors are needed throughout the life of the project. If the CIO is the only one worrying about the project, there’s something wrong. At the same time, the CIO should avoid saying “it is not an IT project”. To be successful, it has to be a true partnership between clinicians, operations, and IT.
- An EHR implementation has a significant impact on your entire organization and all staff members. A robust change management program is critical given the multi-disciplinary effort that EHRs require.
- Many decisions get made through the life of the project. Establish early on very clear decision rights. Know which group makes what decisions and define the escalation path when issues can’t get resolved at lower levels of the project governance structure.
- Your plan should include a “Go Live Readiness Assessment” at 120, 90, 60 and 30 days prior to go live. All teams are expected to report out their progress and open issues in detail. Project leadership then creates a readiness scorecard. This allows leadership to focus on the areas that are behind schedule and address issues to ensure an on-time, successful go live.
- Contingency planning needs to be part of the overall plan. Any major system implementation needs a back-out plan if something goes wrong. But you also need to account for the operational impact. You can’t stop the flow of patients into the emergency room but do you reduce your surgical or clinic schedules? Each organization has to determine what’s right for them. And then there’s the unrelated and unanticipated crisis that you have no control over – it could be a major facility issue like a power outage, a weather incident like the snowstorms we’ve seen the past few weeks, or a mass casualty incident in your area. Be sure to include your organization’s emergency management team in your activation and contingency planning.
- At go live, it’s all hands on deck in the command center and throughout the organization. Everyone has their specific roles. Leaders need to be present. The CIO may not be running the project but maintains a very visible presence in and around the command center. It’s a 24/7 operation for the first few weeks after go live. And be sure to round – find out how things are going for front-line staff and thank them for their work.
- Once the system is up and running, you have to recognize that optimization is ongoing. Don’t minimize the requests. Listen carefully to your users. At the same time, manage expectations about how much will get done and by when. Help shape the message. Multiple communications channels are important. Structured processes for intake of requests and a formal prioritization process with agreed upon criteria are critical. While optimization for your organization and the unique workflows is needed, don’t get stuck there. Learn from others how they have leveraged the product. Reach out to your colleagues and learn from them. Many have gone before you at this point.
And when you’re ready, be sure to share your own lessons with others.
Harvard School of Public Health’s Executive and Continuing Professional Education program, “Leadership Strategies for Information Technology in Health Care”
It’s a game-changer if it has the potential to change the outcomes. We often see how new technology creates a big shift in the market.
Uber car service has been taking hold in large cities over the past few years. It’s even come to Ann Arbor. Is it a game-changer in local transportation? Looks like it. I know there is plenty of controversy right now about Uber and their business practices but you have to admit they have figured out how to leverage GPS technology and mobile devices in new ways. I experienced this first hand recently when I used an Uber to get to the airport. No question it was easy and convenient.
And that’s what consumers look for in the products and services they buy: easy, reliable, convenient, and low cost. We all love that one-click purchasing on Amazon: buy a book and it immediately downloads to our Kindle readers – a game-changer in the book business!
We, health care IT leaders, are sometimes criticized for Continue reading
“EHR Flaw at Core of US Ebola Case”. No CIO could ignore this October 3rd headline. As a CIO, one of our nightmares is that a problem in the systems we implement could cause a major medical error. One of our core missions in health care information technology is to prevent medical errors.
The statement blaming “EHR flaw” was retracted within 24 hours as the facts became clear. But as hospitals prepare to safely care for patients with Ebola, the role of the Electronic Health Record becomes more clear.
The EHR is a critical tool for handling any kind of infectious disease. It is the means by which the appropriate information is captured at patient intake and is clearly accessible and visible to all caregivers. Close coordination between clinicians, operations and IT are extraordinarily critical in designing and implementing clinical systems. Continue reading
Last week, I wrote about the value of site visits as a way to learn from others. Fresh off the annual Epic User Group Meeting (UGM), I’ll call it a site visit on steroids. There are over 10,000 attendees, 100’s of educational sessions presented by users, direct access to Epic staff, and plenty of networking time; you see what I mean?
This was the first year it made sense to invite my executive colleagues from UMHS to attend. Our core Electronic Health Record is now in place, our executives need to look to the future: what else is possible with the product we already have, what new functionality is planned for future upgrades, and what other Epic users are doing.
Three UMHS executives answered my call and they were glad they did: the Hospitals and Health Centers CEO, and the executive directors of the children and women’s hospital and the adult hospital. We will debrief as a group soon about what they saw and heard, and to explore what functionality we should prioritize next. Continue reading
What do NHS Trusts (hospitals in the UK), the Department of Defense Military Health System (MHS) and Brigham and Women’s Health Care (BWHC) have in common? They all think they can learn from our experience implementing an integrated electronic health record (EHR) at UMHS. We hosted a group from the UK in early July and hosted military leaders from MHS this week. And we are planning to host a team from BWHC in late October. The UK and MHS are in the planning and vendor selection phase while BWHC is less than a year away from their big bang implementation of a new integrated EHR.
One of the great things about the health care industry is that we are always willing to learn from one another. Continue reading
Hospitals have been either implementing or replacing their core electronic health record (EHR) in recent years. The work has included the entire suite of applications that make up the revenue cycle, patient access, and advanced clinicals in both inpatient and outpatient settings. But as we look beyond the core EHR, there is much more potential for technology.
This week at UMHS, clinicians and staff did a two day “deep dive” into the next group of applications as we move forward with our EHR. Teams from transplant, anesthesiology, radiology, cardiology, and home care reviewed Epic’s capabilities so we can decide what will be included in our next phase of work – what we call MiChart Stage 4. These important assessments require an in-depth review of current capabilities, and an understanding of the product roadmap. Continue reading