Epic Implementation Guide for a Multi-Hospital Install

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1 Epic Implementation Guide for a Multi-Hospital Install There is no doubt that installing Epic s systems within a single hospital can be a complicated process, but when you are an organization that is planning to roll out Epic across multiple inpatient sites, their associate clinics, in house physicians groups and revenue cycle you have likely discovered an entirely new set of roadblocks that could inhibit your successful, on time installation. The good news is that, with proper planning, these obstacles can be overcome. Plan, Plan, and Plan Again Give me six hours to cut down a tree and I will spend the first four sharpening the axe. Abraham Lincoln was a brilliant man, but none of his wisdom is more relevant today for large Integrated Delivery Networks installing Epic. Lincoln s quote implies that proper preparation and analysis is as important as the action, and this rings true for large implementation projects. There is no room for guess work when it comes to planning and executing your project. Cost overruns can be severe for hospitals that learn their mistakes as they progress along the project lifecycle. For example, poor build, ineffective staff, limited testing, and improper considerations that ancillary systems will have on the build process are just a few areas to consider. It is extremely important for leadership to plan effectively and monitor their project s development to avoid such mistakes. With lengthy, multi-year timelines any missed deadlines early in your project will likely become more impactful as setbacks tend to cause a ripple effect throughout the duration of the project. We can see planning s importance when it comes to building records in Epic. Though it seems easy enough to begin by adding records into your build environment, it s better to begin by first understanding your facility s structure before developing a strategy for both a naming and numbering convention. Once you begin naming and numbering records, it is a very difficult (and sometimes impossible) to reverse course after the fact. It is important to craft a good plan early and stick with it throughout. Departments and locations may have differences, but it is the similarities between them that are needed to provide your team with an easier naming convention and build. Using a blank field in an Epic record will still respect the setting in the higher record in the facility structure. If all of your outpatient units act a certain way, you can set that particular piece in the overall system definitions rather than separating it

2 out department by department. Using this process will save your build team time and effort. It should be noted that this strategy can also be applied to your users and providers as well. Communication and Compromise With so many hospitals and locations going up on an integrated system, there is an obvious need for communication between not only the project teams, end users, and hospital leadership but between those groups at your different facilities as well. This might seem obvious, but it's important to remember the level of autonomy many of these departments and centers once had that may be lessened with your new EMR. This adjustment can easily be overlooked. Decisions that could once be made by one group of localized leadership that are usually very familiar with one another will now typically need to include everyone within that specialty (or, in the EMR world, by application) from all locations. If you have multiple emergency departments for example, they should be making decisions together as standard workflows and build whenever possible allows for several benefits: floating staff between hospitals at critical peak times, allowing insight and lessons learned across your enterprise, a smoother training process, and faster optimization beyond go-live as you can reach more users in a more streamline fashion are just a few benefits you ll be able to reap. You should also remember that there are going to be tough decisions over which your locations may butt heads - often times there may be opposing views on how to handle a setting in system definitions that cannot be split out by area. In these cases it becomes paramount to address them early on the installation to give your staff time to work through them and reach a compromise that all parties find fair. You can bet that if these types of decisions aren't looked at until a later phase that they may need to be rushed for the sake of deadlines, if this happens you can bet feelings are going to get hurt and some users may begin to suspect your leadership of playing favorites. It's critical this isn't the case - you cannot afford to have staff harboring resentment against leadership or other hospitals over something that may be trivial and could be easily resolved with time. Our staff has the knowledge and insight to help you avoid falling into the pitfall of putting something off until tomorrow which should be examined today. 2

3 Flexibility is Key At the same time, flexibility shouldn t be overlooked either. One of the big advantages to installing Epic at multiple locations is that you can learn important lessons from your first hospital to apply to the others. For example, if unit testing at your first hospital was problematic, it is advisable to understand why, make corrections and consider adding extra time and resources to that particular task as you continue planning phase I, II and beyond. If physicians found your call center particularly helpful, advertise that as a useful resource moving forward to build trust and buy in. Adjust your expectations and project plans accordingly to make things run more smoothly as you continue. Though anecdotal evidence is helpful, it s also important to examine things quantitatively as well. Reporting is an essential tool that can shine a light on specific successes and failures for each application and for the project as a whole. Having your ASAP team monitoring waiting room times, your billing teams tracking levels of service and department revenues, and your HIM teams checking your error queues (to name a few) through reports and key performance indicators will help you to see specific areas that you may want to train more intensely or re-work for future Go-Lives. Our consultants have experience working with a variety of such reports and can help your application teams create and run these reports with ease. Learning lessons and building on your successes, as simple as it seems, is something that can prevent a rollout from greatness if not taken to heart. Accountability Though flexibility is indeed a huge asset, you have deadlines and goals for a reason. You aren't going to get to Go-Live without a level of firmness: it's important to hold everyone accountable as well. Make it known early in the installation where you're willing to be flexible and what you see as areas that are more set in stone and less negotiable. And tying in with the theme of not playing favorites, it is critical to keep all your departments and locations to the same standards. If you have units or departments that are stronger than others, set your standards high in order to promote excellence. Don't set easy benchmarks and let your leaders lead. A small amount of competition can be a great source of success and innovation and can help to propel you to a successful installation. Though you will want to hold everyone to the same levels of accountability, treating all your locations the exact same way is not always a winning strategy. Different staff and groups usually have different preferences towards certain management styles, organizational structures, and project direction and though your expectations should remain the same your way of getting

4 them to meet them may certainly differ. Oftentimes, transparency of this strategy can go a long way towards dismissing any notions of a preference to one location over another. Make it known that though your leadership may handle things differently depending upon which hospital or department or branch is involved that you still expect a level of excellence and timeliness from everyone involved in the project, regardless of location. Winning Hearts & Minds While project guidance and sound project planning is important you cannot discount the value of establishing a strong internal project marketing plan. Information Systems cannot be seen as driving your EHR installation, rather, as only a tool to implement the needs of the Health System s clinicians. Unification of leadership across the C-suite is imperative and hospital providers and staff must be involved as early as possible. Key stakeholders must be given a voice and the opportunity to help in the design process and should be prepared to help build and prepared teams across your health system for the upcoming install. Early involvement from all departments is key. There is no question that it is challenging to keep everyone involved in the decision making process. However, if done effectively, it will pay dividends in terms of end user adoption and improve the quality of your build. Also consider developing inter system communications when building your provider records. Though one hospital may not be going up for several years you may need those doctors, nurses, and machine/room records for referrals, follow ups, or after visit instructions. When physicians need to float between hospitals, they will need records available as well. Without involvement across your organization it is very easy to miss these records which can be a major strain on active providers at Go-Live. Early involvement with hospitals that are set for later phase activation shows your commitment and gives credence to the notion that the first hospital going up is as important as the rest. Building positive communication in your organization can turn feelings of dread over a future changes into excitement for their 4

5 upcoming install. There is no shortage of value on developing strong internal communications, project marketing and working to build excitement amongst your health system. Conclusion There s no silver bullet to making sure a Go-Live is successful, but keeping these tips in mind early in the installation will make the entire process run far more smoothly. If you re diligent about keeping every hospital in the mix, even when their Go-Live seems impossibly far away, and do an excellent job planning you ll be streets ahead from the start. Couple that with a hard look in the mirror between Go-Lives and you re on track for a successful multi-hospital Epic installation. To talk with HCI about your Epic Implementation, please call us at or The HCI Group, a world leader in healthcare IT consulting, is proud to be INC Magazine's 2013 fastest-growing healthcare company in the U.S. Our services include implementation and training of all EHR vendors as well as specialty service lines in optimization, clinical adoption, integration and testing, go-live, and advisory services, among others. From Johns Hopkins and Tenet Health to the United Kingdom and beyond, we ve developed a track record of proven excellence in developing smarter approaches to solving healthcare IT challenges.

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