Tag Archives: EHR implementation

IT takes a village

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GLRA is an acronym recognized by anyone who has been through a large-scale system implementation. Spelled out it is Go Live Readiness Assessment. It is typically done at the 90, 60, and 30-day mark before canstockphoto16594838 (1) hands puzzlea go live. At the University of Vermont Health Network (UVMHN), our 90-day GLRA for Epic Wave 1 was this week.

Dr. John Brumsted, UVMHN CEO, kicked the day off with a powerful message on how important the Epic project is to the network and our patients. He talked about why we are doing this for the region that includes six hospitals, a medical group, many ambulatory locations and home health and hospice in both Vermont and New York. He set realistic expectations saying it wouldn’t be perfect and there would be issues. But he expressed confidence in the project, and everyone involved in making it a success. His presence for a good portion of the morning spoke volumes about his support for this massive initiative and appreciation for all involved. The network CFO and the University of Vermont Medical Center (UVMMC) president, CNO, CMO and VP for Medical Group Operations were also there for a good portion of the morning.

Dr. Adam Buckley, UVMHN CIO, followed Dr. Brumsted by talking about how the journey to a common, fully integrated EHR began back in 2013.  A journey that included a Certificate of Need (CON) review and approval by the Green Mountain Care Board. He too set realistic expectations about how many tickets we’ll have at go live just like every other major EHR implementation around the country and thanked the interdisciplinary team involved.

Lori Boisjoli, UVMHN VP Application Portfolio, then framed the day for everyone. The morning would be focused on the UVMMC with revenue cycle and the full suite of specialty modules going live. The afternoon would be focused on the three affiliate sites where ambulatory clinical and revenue cycle are going live. She highlighted that GLRA is the time to raise any significant issues and risks so project leadership can capture them for follow-up. Continue reading →

Crunch time and why IT matters

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It’s crunch time. Every day counts. Can’t miss a deadline. All hands-on deck. Go live readiness assessments (GLRA). If you work in health IT and have been through a major EHR implementation, canstockphoto60328456 (1) EHR UVMHNyou’ve heard all these phrases.

At the University of Vermont Health Network (UVMHN), the Epic Wave 1 go live is less than 5 months away. The University of Vermont Medical Center (UVMMC) has been on Epic for inpatient and ambulatory core clinicals for years. Wave 1 includes the full revenue cycle, lab and anatomic pathology, radiology, OR and anesthesia, cardiology, ophthalmology, orthopedics, behavioral health, rehab, wound care, infection control, and predictive analytics at UVMMC.

Wave 1 also includes the first Epic implementations at three Vermont and New York hospitals in the network starting with ambulatory systems for billing and clinical functions. Waves 2 (2020) and 3 (2021) will be the full suite of inpatient systems at those same hospitals – Central Vermont Medical Center in Berlin, Vermont; Porter Medical Center in Middlebury, Vermont; and Champlain Valley Physicians Hospital in Plattsburgh, New York. Yet to be scheduled are Elizabethtown Community Hospital in Elizabethtown, New York; Alice Hyde Medical Center in Malone, New York; and Home Health and Hospice.

The core infrastructure is largely in place to support the November 1st go live though we have more to do at the device level. Over 10,000 users will be trained in a 6-week period. The first GLRA at 120 days pre go-live is coming up soon.

When I saw Epic on the agenda for the UVMMC quarterly leadership meeting, I assumed it was a project status update. How wrong I was. Continue reading →

Physician satisfaction with EHRs

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I am a huge fan of Dr. Atul Gawande. Who isn’t? He is a surgeon, an author and one of the most insightful and influential physicians of our time. His books are best sellers and his articles in The New Yorker canstockphoto3914104 (1) physician computermagazine are widely read. He was recently named as CEO of the non-profit-seeking health care venture formed by Amazon, Berkshire Hathaway, and JPMorgan Chase to deliver better outcomes, satisfaction, and cost efficiency in care. He will be the opening keynote speaker at HIMSS19 in Orlando this coming February.

His books include Better, Being Mortal: Medicine and What Matters in the End, Complications: A Surgeon’s Notes on an Imperfect Science, and The Checklist Manifesto. I gave one of his early books to all my IT leaders one holiday season. My tradition was to give them an insightful and inspiring book each year. Gawande’s books are clearly some of the best for health care leaders.

Gawande has been a staff writer for The New Yorker since 1998. His latest piece was titled “The Upgrade: Why Doctors Hate Their Computers”. It’s a long read but worth the time if you work in health IT and care about your physicians. Gawande describes the challenges of EHR’s from the front lines of medicine. He talks about the significant amount of time spent doing documentation after a patient visit and the loss of physician to patient connection with the computer competing for attention in the exam room.

In discussing physician burnout, he referenced Berkeley psychologist Christina Maslach’s work studying occupational burnout where she defined burnout as a combination of three distinct feelings – emotional exhaustion, depersonalization and a sense of personal ineffectiveness. He noted that in 2014, 54%% of physicians reported at least one of the three symptoms compared to 46% three years earlier. He shadowed a scribe and talked with surgeons and primary care physicians on the impact of the EHR on their work and their time. He learned from a patient who works as a construction supervisor that others are also challenged in their work to make the necessary human connections. Continue reading →

A salute to the nurses among us

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National Nurses Week officially ends today, May 12th on Florence Nightingale’s birthday. But of course you can thank a nurse and recognize him or her any day, any time. Many of us have personal stories of being cared for by a nurse with great skill and empathy.

When I was growing up, I wanted to be a teacher. But my part-time high school and college jobs were actually as a nurse aide in nursing homes. I saw firsthand how nurses cared for the elderly and how hard their work was.

There are several nurses in my family whom I love dearly and respect greatly. I know I can call on them whenever I have a health question. I have to be careful to not abuse this access.  Every family who has a nurse or doctor amongst them knows how valuable they can be.

My sister, Mary Sheehan, is a nurse. She went on to get a master’s degree in public health. She ran just about every division in the Minnesota public health department during her long tenure with the state. Before retiring she served as a county health and human services director. Continue reading →

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

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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.

 

Resources 

Harvard School of Public Health’s Executive and Continuing Professional Education program, “Leadership Strategies for Information Technology in Health Care”

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User group meetings — learning from others (part 2)

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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 →

Site visits — learning from others

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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 →