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Valley Health’s Epic JourneyMay 18, 2015
Hugh Stubblefield
In the 4th Quarter of 2011, Valley Health began exploring options to replace its Electronic Health Record system. In May 2014, we went live with Epic.
This is the story of our “Epic” Journey.
Electronic Health Record (EHR) - A Digital Version of a Patient's Paper Chart
Includes All Actions Performed for the Patient: Registration, Documentation, Orders, Medications, Test Results (i.e. Radiology, Lab), Billing, etc.
Epic is the EHR Software Valley Health Implemented
Electronic Health Record
Introduction to Valley HealthValley Health:
Winchester Medical CenterWarren Memorial HospitalShenandoah Memorial HospitalWar Memorial HospitalHampshire Memorial HospitalPage Memorial Hospital3 Urgent Care Centers3 Long Term Care Facilities
Introduction to Valley HealthValley Health includes:
2 Acute Care HospitalsLevel 2 Trauma CenterNeonatal Intensive Care Unit (NICU)4 Critical Access Hospitals
Introduction to Valley HealthIn 2013:
610 Licensed Beds166 Long Term Care Beds33,391 Admissions204,404 Emergency Room / Urgent Care Visits4,840 Employees500+ Medical Staff (Physicians, Physician
Assistants, Nurse Practitioners)
EHR Series
Patient Accounting, Registration, Billing SystemAS400Older Coding TechnologyMany Modifications, Unstandardized
ClinicalsOne Vendor (Mostly)Un-integrated – IT Built All Interfaces Between
Clinicals, Series and Other SystemsVendor – Discontinuing Support of Products
Heath Care Regulations – EnvironmentHealthcare Reform
Meaningful Use Stage 1 in 2012 Preparing for Stage 2 (July 2014)
ICD10 – Delayed initially, expected in October 2014
Accountable Care
EHR Replacement GoalsHealthcare Reform CapabilitiesStreamline Throughput – Unified DatabaseImprove Data IntegrityImprove Operational Efficiency
Improve Clinical OutcomesImprove Revenue Cycle
Improve Patient Experience
Vendor Selection2012 Formed EHR Selection Task Force
30 Representatives Cross-Functional Backgrounds Employed and Community Physicians
Engaged Kurt Salmon Consulting to Assist Experience in the Market Marketplace Education Organized the Effort
Initial Evaluation Narrowed to 4 Vendors High Level Demos KLAS Ratings Vendor Fair
Vendor FairAugust 2012 – 2 Days of Demos from Each VendorSpecialized Focus Groups from All Valley Health
Stakeholder Groups:Ambulatory Revenue CyclePhysiciansER Home HealthEtc.
Each Group Tasked with Completing a Standardized Evaluation Form with Recommendations
Vendor FairRoom
L&D Classroom ANorth Tower - Mall Level
ED ClassroomNorth Tower - Mall Level
Lab Conf RmNorth Tower Annex - 2nd
L&D Classroom BNorth Tower - Mall Level
8:00 AMExecutive Briefing
Taskforce Committee
Day in Life Group1ER Inpatient OR Ancillaries
Home-Health
Day in the Life Group2ER Inpatient OR Ancillaries
Home-Health
Ambulatory Group1Physician Office
VPE EMR UCC VPE Admin
9:00 AM
Ambulatory Group1Physician Office
VPE EMR UCC VPE Admin
Executive Briefing Taskforce Committee
Day in Life Group1ER Inpatient OR Ancillaries
Home-Health
Day in the Life Group2ER Inpatient OR Ancillaries
Home-Health
10:00 AM
Day in the Life Group2ER Inpatient OR Ancillaries
Home-Health
Ambulatory Group1Physician Office
VPE EMR UCC VPE Admin
Executive Briefing Taskforce Committee
Day in Life Group1ER Inpatient OR Ancillaries
Home-Health
11:00 AM
Day in Life Group1ER Inpatient OR Ancillaries
Home-Health
Day in the Life Group2ER Inpatient OR Ancillaries
Home-Health
Ambulatory Group1Physician Office
VPE EMR UCC VPE Admin
Executive Briefing Taskforce Committee
Vendor Decision270+ Employees and Physicians AttendedBased on Evaluation Responses, Narrowed
Candidates to 2 Vendors
Further Review of RFP and Total Cost of Ownership Estimates Indicated Finalist for Further Evaluation:
EPIC
Due DiligenceFormed Workgroups for each Area:
Clinicals (Inpatients and Ambulatory)Ancillary Departments (Lab, Radiology, etc.)Patient Access / Revenue CyclePost-Acute Work Group (Rehab, Long Term
Care, etc.)Analytics Technical
Due DiligenceSite Visits:
Bon SecoursInovaCarillion ClinicAnne ArundelOthers
Reference CallsProfessional Organizations (HIMSS, etc.)Demos (Remote and On-site)Colleagues / PeersInternet – Blogs, Reviews, Articles
RecommendationJanuary 2013 – EHR Task Force
Recommended Purchasing and Implementing Epic software
May 2013 – Final Approval to Move Ahead by the Valley Health Board of Directors
How ?CostRecommended Duration: 18-24 MonthsStaffingExpertiseProject Team Space
Alliance with Inova – Region ConnectEpic Region Connect Program – Larger
Healthcare Systems can “Share” their Instance of Epic with a Smaller System
Proposed to Partner with Inova Health through Region Connect
Inova Completing Final Epic Implementation in June 2013 - 5 Hospitals
Valley Health Would License Epic through InovaUtilize Inova’s Build as Much as PossibleLargest Region Connect To Date
TimingEpic Recommends 18-24 Months
Ambulatory Sites Go Live FirstStagger Hospital Go Lives
Meaningful Use Stage 2 Scheduled for July 2014
ICD10 Scheduled for October 2014 Decided on a “Big Bang” Go Live on 5/30/14
to Meet Those Regulatory Deadlines
Staffing “Beg, Borrow, Steal” Valley Health is a Very Functionally Oriented
OrganizationWhere Will the Staff Come From?
IT/Clinical Informatics/OperationsBackfilled Essential Functions with Consultants
CTG – Consulting Firm that Assisted Inova with Epic
Inova Team – Supplement Staff
CertificationEpic “Builders” Must Be Certified by Epic
TrainingProjectCertification Test
Multiple Certifications for Some Applications3 Month Deadline for Each
First Group went to Training on 6/1/14
LogisticsNeeded Dedicated Space for the Project
TeamApprox. 75 Valley Health EmployeesApprox. 25 CTG StaffAs needed, 59 Inova Staff
Training Phase Used Space at Valley Health“Requisitioned” Classroom Space and Office
Space On-Site
C.O.V.E.July 8, 2013 – Signed Lease on 52,741 Sq.
Foot Office Space/ Warehouse in WinchesterNamed C.O.V.E. “Creating One Valley with
Epic” after Naming Contest86 Days – Converted Space into 18 Training
and Conference Rooms, 108 Cubicles; 8 Offices, 6 Conference Rooms, Break Rooms, Restrooms
Capacity to Train 444 People at a TimeSeptember 2013 - Team Moved to C.O.V.E.
GovernanceCommittees – Included All Stakeholder
Groups At Valley HealthHospital Operations, Revenue Cycle,
Ambulatory, Nursing, Pharmacy, Analytics, Etc.All Provided Review, Approval and Input to the
ProcessOversight Committee
Final Review of ScopeApproval of Change RequestsReview of Progress and Final Escalation Point
ScopeBig-Bang Go Live:
4/8/14 - 18 Physician Practices5/30/14 - 6 Hospitals, 3 Urgent Care Centers,
Remaining 135 Physician Practices, Specialty Clinics and Hospital Outpatient Departments
Modules: Ambulatory, Patient Registration, Patient Scheduling, Emergency Department, Operating Room, Anesthesia, Clinical Documentation, Orders, In-patient Pharmacy, Professional Billing, Hospital Billing, Claims, Health Information Management, MyChart
Scope, Cont’d Use As Much of the Inova and Epic “Model”
Build as PossibleReports – Validate, Revise and Build New if
NecessaryInterfaces – Replace Existing Interfaces and
Build New Ones as Needed 40 +
Data Conversion – 5 Years of Patient Demographic and Clinical Data One Year at a Time
SecurityEpic Security = Role Based
Replacing Years of EntriesReview Physician Credentialing and PrivilegesSignificant Amount of Validation and Cleanup
Distributed Security Templates to Each DepartmentCompleted for Each EmployeeReturned to Security Team for Build
Security Team Built and Distributed User ID and Password to Users After Training Completion
DevicesEpic Recommends 17” Monitors With Dual
Monitors for Non-Clinical UsersReplaced Nearly All Monitors for Epic UsersReplaced Laptops in Hospitals Specialized Units Required New Devices
Install Test Integrate
Printers – Needed to be Mapped to Departments for Registration, Orders, Wristbands, etc.
Training 5,073 People Completed Classroom Training600 View - Only Users Completed Web-based
Training20,863 Total Class Completions12 Instructional Designers40 Certified Trainers900 + Super UsersTraining Was Required for All Users
No Access without TrainingAverage Training Hours Per User= 16
Up to 30 Hours for some
TestingTest All Devices, Integration and Printer
MappingTest Security – UsersOver 268 Integrated Test Scripts
Users, Team TestedEnd to End Integrated Process TestingEach Script Required to Pass Twice
Change ControlS.B.A.R. –
Situation BackgroundAssessmentOptions – Required 2Recommendation – Prepared by Requestor
Presented to Oversight Committee Reviewed and Voted OnChanges Documented and Added to Scope
Documents
CommunicationExternal Consultant (Inova Experience) and Internal
Marketing Lead the Team
Committee MeetingsWeeklyExplained Issues, Concerns, Changes, ImpactsCommunicated To Dos, Progress and Status
Weekly Communications to OrganizationEntity Representatives Met with Team, Communicated Back to
EntityE-mail CommunicationsWebinarsNewsletters
GLRAGo Live Readiness Assessment
Every 30 Days Starting at 120 Days from Go LiveLeadership and Key StakeholdersEach Application and Team Presented Status, Issues
and Resolution Plans Red, Yellow Green Based on Schedule and Go Live Status Q & A
Encourages TransparencyDisplays Progress per Session
120 Day – Very Red, 30 Day – Very GreenInitial Go vs. No Go Decision after Abbreviated 15
Day GLRA
Status – ProgressEpic Does Not Follow PMI
Build Trackers (Spreadsheets)PercentagesMilestones
Used MS Project for Overall Schedule and ReportingBuilt Communication Plan Around Project MilestonesPublished Percentages Complete to Organization
Published Weekly Dashboards Highlighting Positives, Issues and Risks to Oversight Committee
Very Transparent
Command CenterWMC Conference Center
Converted into Space for 100+ StaffHelp Desk – Record Issues, Team Work Issues
Based on Priority:CriticalHighMediumLow
Cutover and Command Center
CutoverMay 30 – 6:00 am
Command Center StaffedMonitor Census Files are Synching
Monitor Patient Locations in Both Series and Epic Track Orders
Meds – Built in both Current System and Epic Pharmacy
Labs – Update Lab Orders and Results in both Current System and Epic
Downtime at 9:00 pm to Complete and Ensure the Synch
Go LiveMay 31, 2:07 am Cutover Complete –
Valley Health CEO On-Site Made the Final Go Live Decision
Live on Epic!!!!Command Center Open for 30 Days:
24x7 for Two Weeks 12x7 for Two Weeks
No Critical Issues Reported Few High Issues Remained at End of Command
Center
What Now? 2014 Upgrade – 5/9/15
Live on Version 2010, Inova Delayed 2012 Upgrade for Valley
Governance (Valley and Inova)RelationshipIssue PrioritizationDirection and Decisions of Future Modules
Optimization Managing RequestsPrioritizing Requests
StaffingCorrect SizeProper Skill Set
Questions?