Electronic health record system conversions are one of the largest undertakings an organization can undertake, and Epic go-lives are famous for sometimes going wrong.
However, Kevin Johnson, MD, thinks that doesn’t have to be the case.
“Every EHR install tests the entire structure of an organization, such as governance, accountability and communication skills,” said Johnson, who is vice president for health IT and chief informatics officer at Nashville-based Vanderbilt University Medical Center.
Johnson, who is the EHR project leader of Vanderbilt’s conversion, is focusing on three core components to successfully launch its Epic EHR in November: people, process and technology. And technology is the smallest concern of the three.
“It’s almost invariable when people have challenges with their Epic, Cerner and Athenahealth installations that people and process issues are at the core,” said Johnson.
Training, communication and governance
While it’s difficult to compare installations, there are core functions of the organizational structure that can make an install easier. Vanderbilt’s 120 clinics and outpatient sites are focusing on unique training techniques for its 19,000 employees to bolster the rollout.
Training consists of a combination of e-learning, view-only use and some basics available on the users’ own time. Epic also provides face-to-face training and a sandbox that allows users to play around in the system to see how it would function in their environment.
Vanderbilt also worked with Epic to install “space stations” for more hands-on training. The system helps users understand their role and how the platform functions on different devices.
Training is also broken down by specialties, so users are only focusing on elements relevant to their role.
Johnson is most excited about Vanderbilt’s innovative Hubbl mobile app built into the environment, which helps all staff involved with the project to communicate. There’s a countdown to the platform launch, training materials, workflows and user-specific task-lists related to the project.
“All the data is sent back for an analytics process,” said Johnson. “It’s a multi-pronged approach.”
More than 1,500 Vanderbilt employees have been contributing to the design and validation process, through over 1,000 adoption sessions. Johnson said these users can look at the platform and provide input.
“Employees have brilliant questions” that can only help with the system development. The idea is to incorporate these ideas the right way to make sure staff and clinicians “don’t get burned out.”
There’s also another 80 to 100 people who function as ambassadors. Johnson said their primary role is to learn the ins-and-outs of the system to be able to answer any potential questions from employees.
A governing structure that runs from the ground-level all the way to the CEO works with Johnson to help alleviate any concerns. Johnson said it helps ensure all voices are heard and all projects are properly prioritized.
Collaboration is crucial in EHR installation
Vanderbilt is also banking on the experience of other organizations to ensure its own success.
Johnson and his team have spoken with IT departments of larger medical centers like Duke, Johns Hopkins, the University of North Carolina, Partners and Mayo to see what went well during their EHR installations and conversions — and to make sure Vanderbilt is on the right page.
“We also want to see where we can improve,” said Johnson. “We can all learn from each other.”
One major piece of advice Vanderbilt has gained during this project is to “make sure you understand the process issues and understand who owns each process.”
“Involve users as real owners of implementation, so they know what the implementation will do to current processes and ensure they have the support to manage these changes appropriately,” said Johnson.
Vanderbilt is known for its technology development work. And for Johnson, projects like Hubbl can benefit other organizations.
What Johnson’s team has learned during its implementation and collaboration process is that, from a technology perspective, “it’s far easier to implement Epic all at once. It’s always a bigger challenge to bring up pieces of a system, as it’s not designed as well to be seamlessly integrated.”
The medical center is also using the project to work with Epic on building components that both organizations feel would help other users. One example is inpatient alerts and adding research electronic data capture information that can be used both in and out of Epic. That announcement is expected sometime later this year.