Tag Archives: teamwork

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!

Related Posts: 

Crunch time and why IT matters

IT takes a village

Three Days and Counting…

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

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 →

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 →

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 →

Leadership transitions – learning a new organization

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“Working together, we improve people’s lives”. That’s the vision of The University of Vermont Health Network (UVMHN) where I started this week as the interim Chief Technology Officer. I am excited to be canstockphoto3439718 time to learnpart of a healthcare provider organization again – even though it is temporary.

The first week has been what you’d expect – meeting new people, learning new acronyms, understanding the key issues, getting accounts and devices setup, getting access to systems, and gathering documents for review. While healthcare organizations differ, the issues and challenges are common.

My focus over the next several months will be to drive forward major infrastructure projects. With the Epic Wave 1 implementation scheduled for November at multiple UVMHN affiliates, there are critical interdependent projects that my teams will need to complete.

The opportunity to be part of a team, solving problems and making a difference is something I love doing. Yes, the days will be long, there will be lots of meetings and email, and production support issues. But, at the end of the day, I’ll know that the systems and solutions we provide and support make a difference in the lives of clinicians and in turn our patients and families.

As I act like a sponge and drink from the fire hose in the early weeks, I’ll need to get up to speed quickly on all the current activity and issues. Fortunately, the organization is not entirely new for me. I worked with Dr. Adam Buckley, Chief Information Officer, and his leadership team in late 2017 and again recently on consulting engagements focused on IT redesign.  But consulting is nothing like how deep and broad you need to go as an interim leader. As I said at our redesign retreat this week, I’m switching gears from an outside view to an inside view and excited to be part of the team. Continue reading →

Polar vortex – yet hospitals remain open

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10 states in the Midwest cancelled postal service. Schools were closed for days. Transportation was slowed due to the bitter cold. The frigid cold was blamed for at least 9 deaths. If you live in one of theopen states that had temperatures as cold as -25 or -35 with windchills lower than -50 and you could stay inside or work from home, you probably did. But hospital employees in all those states did what they do every day. They somehow made it into work and cared for others. Because hospitals never close. People need them even more at times of extreme weather conditions.

I grew up in Minnesota and except for a few years in the 1990’s, I have always lived in the north. Growing up, we had many bitter cold days and many feet of snow every winter. I remember back then trying to get my head around the concept of windchill when I first heard a number like -60. Growing up in Minnesota you learned to deal with cold and snow. But this is different. With global warming (yes, I believe it is real and we must address) we now see very extreme temperatures in both summer and winter and more frequent, more dangerous and disastrous storms.

I’ve written about every day heroes in previous posts. Hospital employees are certainly on that list! In appreciation of all they do every day, even on the coldest of winter days, I share again a post I wrote a few years ago while serving as a CIO in Michigan after a major blizzard.

Snow days and everyday heroes

If you live in the north, you know about snow days. Your kids feel cheated if there aren’t a few each winter. Parents juggle to find backup plans when school closings are announced. If your employer is quick to close when there is a major storm or tells you to work from home you may breathe a sigh of relief.  You’re just glad that you don’t have to get up at the crack of dawn to shovel out your driveway and try to get down your unplowed street.

But hospitals never close, nor can they or should they. The everyday heroes I want to recognize are everywhere at the University of Michigan Health System. The nurses who pulled a double shift because their colleagues couldn’t make it in to relieve them. The support staff throughout the hospital who ensure patients are cared for, in a safe, clean environment. The diligent teams who ensure there are meals for patients and staff.  There are too many to mention but just think about all the hospital staff you see on a normal day – they all keep the hospital operating like nothing happened.
Continue reading →

Technology making a difference at scale

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Post HIMSS18, there have been many recaps from people who attended. I won’t try to do that but have listed several of them at the end of this post under “resources”.  Instead, I want to share with you a keynote on the final day of the conference. It represents what is possible when a team of dedicated engineers set out to solve a real problem in healthcare at scale. In fact, as I listened, it seemed like the ultimate in “health IT connect” – the name I gave this weekly blog back in 2014.

Keller Rinaudo, co-founder and CEO of Zipline, captivated those still around on Friday morning with his keynote full of stories and video clips describing the first autonomous logistics system delivering blood and medical supplies to people in Rwanda and Tanzania. Or as one of my colleagues called it this week when we were talking about it – the “blood bomber”.

As their website says, “Zipline operates the world’s only drone delivery system at national scale to send urgent medicines, such as blood and animal vaccines, to those in need – no matter where they live.” The problem they are addressing is that “more than two billion people lack adequate access to essential medical products, such as blood and vaccines, due to challenging terrain and gaps in infrastructure.”  In his opening at the keynote, Keller showed a truck stuck in the mud on an impassable road and asked, “Why depend on roads?”

Zipline developed a solution to improve access to supplies “by flying over impassable mountains and washed-out roads, delivering directly to remote clinics”. Continue reading →

Working remote: self-sufficiency required, collaboration a plus

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I woke up Monday morning after a sleepless night with a text from my daughter, Ann, “do you have power?”. Only 10 miles from our house, her neighborhood had lost power and Internet access due to the Lunch Learn Graphicstorm while we were up-and-running. Ann works from home as Communications Manager for a national company, and was not interested in wasting a sick day sitting in the dark. So after dropping my granddaughters off at daycare, she set up shop in our dining room.

Except for being limited to just her laptop and not the two large extension monitors in her home office, she was ready for a productive day. A year ago, I would have thought she was crazy for needing two monitors, but she convinced me to get a second. There’s nothing like it for multi-tasking and having multiple windows open when you are working on a project.

We respected each other’s space and work. We had minimal conversation when I went to the kitchen for coffee. But in our two brief morning interactions, we casually discussed the common challenges of remote workers – one being the isolation. And I got some new ideas from her.

Half the dining room table was covered in my receipts as I was working on expense reports. I used to just hand the task over to my executive assistant, but in my new life, I do them myself. I dislike the task so much that I get way behind. Monday was the day to catch up. Continue reading →

Different organizations, common IT challenges

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I had the opportunity to participate in the CIO panel at the New England HIMSS Chapter Spring Conference this week. The questions for the panelists covered a range of issues that currently challenge canstockphoto5451287healthcare CIOs.

Some were:

  • how mergers and acquisitions impact IT;
  • how to improve patient engagement given the move to accountable care models;
  • how to provide growth opportunities for our teams and;
  • how to find time and resources to drive innovation.

I have been a CIO in a few different healthcare organizations recently, so I could describe multiple experiences with these challenges. While we have similar internal drivers, and face similar external constraints, no two organizations are the same.

These questions connected well with some of my focus areas during this current interim CIO engagement at Stony Brook Medicine. After about a month in the role, I summarized what I thought to be my focus areas and shared them with the executives. The feedback was that it was ambitious but on target.

Here’s that list. It’s generalized so you can consider it a good sampling of what interim CIOs can do for an organization, and what other CIOs may be focusing on: Continue reading →