On Best Practices

Conducting project “lessons learned” as continuous improvement

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As I caught up on my industry reading this past weekend, I saw several implementation best practices articles – advice from experts on EHR, Telehealth, Pop Health, and Medical Device implementations. These kinds of resources are always helpful to think beyond your organization’s experience, get a different perspective, and learn from others.

At the same time, conducting lessons learned sessions internally after major projects is critical. While it’s still fresh in your mind, being able to look as a team at what worked well and what didn’t work well over the life of the project is an important step before moving on to the next project or next phase of a multi-year project. This should be done in the spirit of continuous improvement. Ask yourself, what can be learned from this project that can be applied to future projects. And be sure to document that in a way that is referenceable in the future.

We are just over 3 weeks post go live for Wave 1 of our Epic project at the University of Vermont Health Network (UVMHN). We start a series of lessons learned/debrief sessions this week. IT managers have been asked to think about three questions and submit them in advance so they can be compiled for review and discussion:

  • What worked well?
  • What didn’t work well that we should modify?
  • What didn’t work well (or was unnecessary and we should no longer do)?

As we planned for the sessions, I suggested that we have a few guidelines – no blame, assume positive intent, and ensure everyone is heard. UVMHN has a very collaborative and team-oriented culture so that shouldn’t be difficult.

Often, it’s easy to go right to what didn’t work well. Those examples may be top of mind. But there is so much in a project of this magnitude that is done well. Capturing those points and making sure you repeat them in the future is important.

Wave 2 planning started before the Wave 1 go live. Certain lessons have already been looked at as part of that planning. But the upcoming sessions will be an opportunity to look more broadly and get the input of all areas involved. Given I’ve been interim CTO since late May, my involvement did not span the entire project but rather certain aspects in the last few months including the go live. I look forward to hearing everyone’s perspective on how we can do better and build on the successes to date.

Related posts:

10 Go Live Command Center lessons from the field

Epic Go Live – report from the field

9 Tips for Go Live support success

Plans, processes, people: lessons from a successful EHR implementation

10 Go Live Command Center lessons from the field

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Week 2 post Epic Go Live has begun. We continue to learn and adjust. Building on my previous Epic Go Live and Command Center planning posts, there are more lessons to share.canstockphoto15204222 (1) keep calm

The last point in my most recent post was about camaraderie – defined as “mutual trust and friendship among people who spend a lot of time together”. I should add, in close quarters!

I continue to be impressed with the hardworking, dedicated IT team at the University of Vermont Health Network. I have seen many examples of teaching, helping one another and stepping up to new roles since the November 9th Go Live.

The rate of new tickets slowed down as Week 1 ended but the issues became more complex as expected. We have resolved over 65% of the tickets opened since cutover and addressed many cross cutting issues.

As promised, more lessons to share:

  • Handoffs between shifts – Ensure that key issues and work in process is reviewed and turned over to the next shift to keep things moving smoothly. Try to have people scheduled several days in a row for continuity vs on one day and off the next.
  • Seeing the “forest for the trees” – In the first few days, the focus is on closing tickets but as cross cutting issues and themes emerge, the focus needs to shift. As broad issues are defined, you need clarity on what teams and modules are involved, who is on point to lead the issue resolution, and what help is needed.
  • Escalations – It is very helpful to have highly engaged executives and operational leaders rounding and raising up the greatest pain points for users that need more focus. These escalations may come through in-person visits to the command center or email.
  • Ticket analysis – Have resources available who know the tool and can slice and dice the data to help leaders and teams see trends and where to focus.
  • Hospital daily huddle – If the organization has a daily huddle, the command center lead should attend. It’s good way to hear firsthand how all departments are doing and what their key concerns are.
  • Command center “walk-ins” – If the main command center is at the hospital you may get walk-ins – well intentioned users who want to escalate a specific ticket or issue. Command center leaders should manage this so the teams working tickets aren’t given conflicting direction on priorities.
  • Email management on steroids – Staff working tickets stay in the system and don’t watch their email. But leaders get a lot of emails and it’s hard to keep up given the pace. At the end of each command center shift, go back through your inbox to ensure that any escalations are dealt with – other email can wait.
  • Multiple locations for support – If there are a main command center and multiple other locations for support staff and triage, ensure they are well coordinated with good communication between.
  • Document management – Everyone involved needs easy online access to reference material. Dynamic information such as shift schedules need to be maintained. Having at least a few binders of printed reference information helps as well.
  • Ramp down plan – When you start adjusting command center hours, it will help to have a checklist ready on what needs to be considered and implemented (i.e. staff schedules, re-location of teams, communication to users, logistics like food and transportation, etc).

Stay tuned for more reports from the field….

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Epic Go Live – report from the field

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Epic Go Live – report from the field

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Many of you have been through a major EHR implementation and go live. I’ve been through them before as well. The teamwork of a go live is like nothing else I’ve ever experienced.canstockphoto16071239 (1) teamwork

There is the overnight cutover period that was practiced numerous times as “cutover dry runs” with the goal of making sure it goes smooth and can be done in the shortest time possible. After all, you are asking a hospital to go to downtime procedures until you can bring up the new system.

There is the excitement as others gather for the proverbial “flip the switch” moment. The applause and high fives for people who have been working hard towards this moment for many months. The appreciation from operations leaders on hand.

There is the wait for the first user calls and tickets to roll in. The wondering if all the planning for the command center and support structure was on target.

There is the settling in as ticket volume increases, teams start working them, and tickets start getting resolved.

There are the periodic reports from operational leaders who are rounding on the floors. They report on the pulse of staff who are dealing with a new system while trying to care for patients. They report on the issues that seem most problematic.

There is the dashboard monitoring to see which teams are getting the most tickets and whether adjustments in staffing need to be made. There is the ongoing review of tickets to ensure they are prioritized appropriately. Continue reading →

9 Tips for Go Live support success

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My first blog post published back in 2014 was called “Three Days and Counting…” written as we approached a major Epic go live at Michigan Medicine. This week’s post could be called “Five days and canstockphoto15204222 (1) keep calmcounting….” as we approach our Wave 1 Epic go live at University of Vermont Health Network on Saturday 11/9.

We were originally scheduled for a 11/1 go live. But in mid-October after much deliberation with operations and IT leadership, our CEO, Dr. John Brumsted, made the decision to move the go live back one week. As he said in his communication to the entire organization, “This decision is in the best interests of our patients, our people and our Network. It gives us the time we need to get to a place where we are confident to go live and it allows users additional opportunities to prepare”.

Planning for the two-week 24/7 command center and support structure started a few months ago. With just five days to go, the plan is pretty much finalized. Highlights and some tips to share based on our game plan:

  • Physical setup/location – Where your command center is located will depend on space available but ideally it will be in the hospital. We are fortunate to have primary and secondary locations at the University of Vermont Medical Center where we’ll have approximately 80 people. We will also have a triage team (to review and route the tickets entered online) and trainers (to answer “how to” questions) co-located offsite. In addition, we’ll have local support centers at each of the hospitals involved in Wave 1.
  • Overall call flow and phone setup – We have a documented decision tree/call flow starting with the super users reporting issues they can’t address. Phones are programmed to route calls to the appropriate support staff depending on user role and/or application involved.
  • Reporting issues – When you are dealing with thousands of issues, you need to use a common tool and standard process. We use ServiceNow and all tickets will be entered and tracked through this tool. Dashboards have been created for leaders to monitor ticket volume and trends.
  • Staffing – A command center operating 24 hours a day for two weeks means people are scheduled for 12.5 hour shifts including time for handoff to the next shift.
  • Leadership roles – Multiple leadership roles have been defined and scheduled for these same shifts. Roles include a physician and nurse leader from IT, someone to monitor ServiceNow tickets and trends, and someone to be overall command center leader.
  • Huddles – There are huddles scheduled throughout the day for each operational area to review broad issues and trends that will then role up to the executive huddle at the end of the day.
  • Communications – This is a critical function to embed in any command center. As high impact issues are resolved and trends are identified, communications staff will work closely with command center leadership to push out daily updates and specific tip sheets.
  • Reference documentation for support staff – Wwith the intensity and pace of a major go live like this, you can’t rely on personal knowledge. Documentation will be available to all support staff and will be reviewed in advance to ensure everyone is comfortable with the plan and what is expected of them.
  • Logistics – And last, but not least, don’t forget about food, parking and transportation arrangements.

Our command center and support plans for go live are well defined. They may not be perfect, but a lot of thought and preparation has gone into them. The key is to be flexible and adaptive as the days go by.

As I always tell my IT teams, we are part of the extended care team. While we don’t touch patients directly, the staff who do depend on the systems and support services we provide. This is never truer than at go live time!

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Crunch time and why IT matters

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Three Days and Counting…

Plans, processes, people: lessons from a successful EHR implementation

The power of your network and learning from others

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Healthcare is one of the most collaborative industries I know. Granted, my entire professional career has been in health IT so maybe that’s a bold but uninformed statement. Healthcare organizations are very canstockphoto12450988 (1) networkingopen, transparent and willing to learn from one another. Whether it’s sharing best practices, hosting site visits, or the many collaborative groups that leaders participate in, we are constantly learning from one another.

Our upcoming Epic go live at the University of Vermont Health Network is no exception. Of course, we rely on the experience that our implementation partner and vendors have had at other similar organizations. That’s why organizations utilize their services.

But there’s also the professional networks that we develop and nurture over the years to draw on. When our CIO, Adam Buckley, asked me to look at an area that he was concerned about as we approach the go live, I did what I do. First, learn from the people doing the work and find out their concerns and what they think we need to do to ensure success. Then, turn to colleagues who have gone before us.

While I wasn’t close to this specific area when I was CIO at University of Michigan Hospitals and Health Centers and we implemented Epic, I knew I could talk to someone who was. I reached out to my CIO successor and one of the executive directors there to get a contact to talk to. Within an afternoon I had gotten a good sense from them of how they handled that function and insights from colleagues at two other large healthcare organizations. And then a follow-up call to drill down further with someone who manages the function. That’s the power of having a strong network and being able to learn from others. I owe them one! Continue reading →

12 tips for effective vendor management

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An EHR implementation involves more than just the EHR vendor. As we approach the November 1st Epic go live at the University of Vermont Health Network, the interfaces and interdependencies with other canstockphoto26237556 (1) VRMvendors become more critical. As we review issues and risks that need executive level attention, multiple vendors are involved. Whether it’s ensuring their system implementation and interfaces are ready on or in advance of November 1st, or it’s a product that we already use that just needs to work in a new environment, we are counting on them to share our sense of urgency and deliver as expected.

As I assist with some of these vendor relationships and escalations, I’m drawing on many years of experience with IT vendors – both software and infrastructure. We are fortunate to have a strong supply chain management team that partners with IT. They are involved from early on in vendor evaluations through contracting. They stay connected to IT and step in to lead or assist when we have vendor issues after implementation.

Two of my previous blog posts provide guidance on creating win-win relationships with vendors. In “Keys to successful vendor management” I outlined some key success factors:

  1. A good product roadmap: It should be clear what core solutions are available now and what their path forward is for the next several years.
  2. More service than sales – a strong service culture should be evident in the sales cycle and demonstrated throughout the duration of the relationship. A focus on service should be engrained in every one of their employees.
  3. Total Cost of Ownership (TCO) – you and the vendor should develop this together. It should include initial one-time fees, ongoing costs for their products and services, all required 3rd party products, and your internal staff. There should be no hidden costs or “gotchas” later.
  4. Reputation – be sure to do your in-depth reference checks. Colleagues in similar organizations are a great source of honest, candid information and experience – good and bad. If your vendor is going to host or manage the application/service for you, check on the change management and operational maturity with colleagues and references. Resources like KLAS, Gartner and others can be leveraged as needed.
  5. Solid contract – once it is negotiated and signed, you may never have to look at it again. But if you do, ensure you are protected.  There is growing market consolidation among larger vendors; start-ups are often acquired by larger firms. Ensure you are protected under these scenarios. Ideally you have someone in your Legal or IT department who focuses on technology contracts and knows the common issues and standard terms.
  6. Implementation – your vendor should provide onsite resources that are integrated with your internal team. Issues tracking and resolution is a joint effort. Status reporting should be a shared effort with a very objective, accurate view.  It should include an executive dashboard on status, milestones, issues and budget.
  7. Escalation – problems will inevitably occur. Escalation process should be clear from the start with a point person for both the vendor and your organization.

Continue reading →

10 best practices for project success

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It’s the final few weeks before our major Epic go live at the University of Vermont Health Network on November 1st. Yes, we have some parts of the project still in yellow or red status as of our 30 day Go Live canstockphoto19779100 (1) gearsReadiness Assessment (GLRA). But the majority are green (on track) or blue (complete).  I’m seeing many best practices that have us on a path towards success. Individual and team behaviors and practices that are worth sharing:

Flexibility – On any given day, you don’t know what issues you might need to deal with or what meeting you’ll have to add to your calendar.  Be willing to adjust as needed throughout the day and know what can wait for another day.

Raising issues – Don’t be afraid to raise issues that need resolution. Don’t assume someone else has more time or knowledge to handle the issue – be willing to take ownership if you can.

Utility players – You need generalists who can be put into a variety of situations to temporarily help. If you are one of these people, don’t hesitate to raise your hand when you see gaps.

Step up and lead – Leadership takes many forms. Even if you may feel unready, don’t be afraid to step in and fill a leadership gap if needed.

Cross coverage – Being dependent on one person’s knowledge and skills can create delays when that person is unexpectedly unavailable. Knowing who you can hand off to and having confidence in that person stepping in is critical to projects staying on schedule. Continue reading →

Time to stop and smell the roses – part 2

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Alternatively, I could call this post “take time for leaf peeping”! I have had the good fortune to spend a lot of time on the road in northern New England this past summer – something I had not done in all the years canstockphoto872429 (1) fall colorsI lived in the Boston area. New England is now approaching its peak fall glory. The 5-hour weekly drive from Providence to Burlington for my interim engagement was quite spectacular this week. Yet the colors were probably only a third of what they will be in another week or two.

A few years ago, I wrote a post called “Time to stop and smell the roses”. I commented then on the need to create routines that include think time, reading, reflection, relaxing and taking care of ourselves.

We spend our days in meetings or looking at computer screens. We spend many hours when not at work looking at our smart phones. But we don’t spend enough time appreciating the beauty surrounding us. When I’m doing that long drive each week, there’s not much I can do other than look at the scenery and of course the road! A few calls maybe and plenty of listening to the news, but I am always looking as I drive.

As our team at University of Vermont Health Network (UVMHN) approaches the big Epic go live in just over 30 days, it is important that we take care of ourselves and stay healthy. For me, a key component of self-care is taking time to slow down and enjoy the beauty around me.

When driving my weekly commute or my daily commute from the hotel to my office, or looking out the window from one of our conference rooms (we have an incredible view of the Adirondack Mountains), or walking along Lake Champlain at sunset, I am reminded of the beauty surrounding us. We are all working very long days and focused on a successful go live November 1st. But taking time to enjoy this incredible changing of the colors is something I will do when I can. All too soon the yellows, oranges and reds will be gone, and we will be left with bare trees and brown landscape and then snow. For this first official week of fall, I’ll focus on the beauty of this season and try not to think of the snow to come.

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Project in trouble? Some dos and don’ts

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If you work in IT, you’ve probably seen your share of projects that need help getting back on track. I could share a lot of stories from my many years in IT in multiple organizations. The complexity and scale of what canstockphoto12827499 (1) dowe do in IT continues to amaze me. Drawing on that experience, I want to share my tips on what to do and not to do if you find yourself taking on a troubled project.

What to do if you want to ensure success:

  • First, stop the churn
  • Get up to speed on the project scope, issues, and challenges as quickly as possible
  • Seek to understand enough of the past to inform the future
  • Focus on getting the project back on track and moving forward
  • Figure out who’s who, what their respective roles are and who owns what
  • Assume positive intent
  • Show respect and gratitude for all involved
  • Ensure all issues are surfaced, assigned to an owner for resolution, and tracked
  • Remove obstacles as they arise
  • Be transparent with leadership about the status and issues
  • Track progress using key metrics
  • Use daily huddles to ensure team members are on the same page, focused, and raising issues
  • Manage expectations for all involved and impacted
  • Document decisions so you don’t have to revisit or rehash them later
  • Consider what levers you can pull such as timeline, resources, budget, or scope
  • When you can’t change the timeline, be ruthless about scope changes
  • Keep calm – reduce team stress, diffuse conflict, and avoid finger pointing

And some tips on what not to do: Continue reading →

Working together, we improve people’s lives

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That’s the vision of the University of Vermont Health Network (UVMHN) where I’m currently serving as the interim Chief Technology Officer. It’s a simple but powerful statement and a great reminder of the canstockphoto10098870 (1) working togetherimportance of “we” and the work we do together. With our major Epic go live less than two months away, we are constantly reminded what a critical foundational  piece the common, integrated EHR is for the health network. No pressure!

I described the scope of our Epic project in my post “Crunch time and why IT matters” and shared stories from our 90-day Go Live Readiness Assessment (GLRA) in my post “IT takes a village”. Our 60-day GLRA was a few days ago. Dr. John Brumsted, UVMHN CEO, and the presidents from the hospitals and the medical group kicked off the day thanking everyone involved and describing what the common, integrated EHR will mean for our patients. And as Dr. Brumsted noted, the Epic project is the biggest undertaking to date for the organization as an integrated network.

UVMHN is not the first nor the last organization on the journey to create an integrated care delivery system to serve the patients in a region.  To be a truly integrated network, common values and strong relationships are key. Continue reading →