In June 2024, two Boston-area hospitals went reside with transitions to unified Epic EHR platforms. As a part of the Harvard Scientific Informatics Lecture Sequence, chief medical info officers from Beth Israel Lahey Well being and Boston Kids’s Hospital just lately mentioned the advantages of the transition and a number of the challenges they confronted alongside the way in which.
“It was humorous for us to go reside on the similar time, as a result of I am positive all of the Boston-area inns have been booked with Epic help,” mentioned Terrance Lee, M.D., M.P.H., affiliate chief medical info officer at Beth Israel Lahey Well being.
The tales that Lee and Chase Parsons, D.O., M.B.I., chief medical info officer for Boston Kids’s Hospital, advised about their processes, governance and challenges overcome earlier than and through the go-live paralleled one another in some ways, together with a give attention to whittling down the variety of third-party functions and migrating information from legacy programs into Epic.
Parsons defined that Boston Kids’s has satellites throughout the Boston space and shut relationships with the Pediatric Physicians Group of Kids’s, which is a big impartial ambulatory outpatient apply that has been on Epic for a very long time. It shares sufferers with Dana Farber Most cancers Institute on an occasion of Epic. And it shared an occasion of Cerner with Franciscan Kids’s Hospital. Franciscan went reside on Boston’s Kids’s Epic occasion in October.
Boston Kids’s had been utilizing Cerner since 2007 for its scientific EHR. “We had a hybrid system the place we had Epic for registration and scheduling, and Cerner for the entrance finish for clinicals,” Parsons defined. “We had 398 customized functions or integrations with our EHR. We had a customized interface for billing. For example, our affected person portal was a hybrid of the Epic scheduling, so sufferers may see when their visits have been, with the Cerner clinicals, so sufferers may see their lab information. We have now a central information warehouse, which was a knowledge repository for all these programs and it nonetheless exists at the moment.”
In spring 2022 Boston Kids’s made the choice to maneuver to Epic, and the mission kicked off in January 2023. “We actually wished to strengthen our system integration to make sure that because the EHR matures, as we mature as a corporation, that we’re capable of keep and strengthen our integration to our third-party programs….and ensure that it is all one built-in system,” Parsons added. “We wish to make sure that sufferers are capable of self-schedule, which is remains to be being optimized presently, and that they’ll shortly schedule appointments, and that the lead time for affected person entry is improved.”
Boston Kids’s additionally wished to combine with analysis, which, previous to final June, had been outdoors of the scientific programs, and carried out via different processes — both customized functions or on paper, in some situations. “We wish to keep our protected and high quality care as we look after our advanced sufferers, and make sure that we improve fairness and the affected person household expertise and the workforce and supplier expertise as properly,” he mentioned.
In late 2022, Boston Kids’s started to type its governance construction to have a look at its legacy information. “We needed to determine what information we’d like sooner or later, and what can be our strategy to creating information obtainable inside our Epic occasion from our Cerner days,” Parsons mentioned, “then additionally guaranteeing that we had institutional and operational alignment on key selections that we wanted to make throughout our Epic implementation.”
They began off by wanting on the present state of their third-party and customized functions. “We had practically 400 of these, and we went via them, software or integration by software or integration, row by row with all the institutional stakeholders previous to the go-live of the Epic mission,” he remembered. “And we had Epic concerned. We needed to know, does Epic meet the wants for this resolution? If not, what are the gaps and what is going to we be dropping out on? Or is there a distinct third occasion that we ought to be utilizing or ought to we keep this practice software now we have?”
They have been capable of whittle it right down to round 100 third-party or customized functions at the moment.
A part of the pre-work was getting funding from the mission to make sure that that they had sufficient doctor subject material specialists. “We had over 100 physicians who have been receiving funding from the mission to be intently concerned with duties like scientific content material design, coaching their colleagues previous to go-live, speaking their must us in IT and speaking modifications regionally through the mission,” Parsons mentioned.
One instance of an enormous mission was adopting an digital consent course of throughout the group, and IT received mission assets to develop the digital consents. Right now they’re fairly extensively used throughout the establishment, though paper consents are utilized in some areas as properly.
The governance construction had govt sponsors who’re chief medical and chief nursing officers, in addition to a steering committee, which was a spot to convey escalations in order that they may guarantee the appropriate assets have been in the appropriate locations on the proper time. It additionally concerned many workgroups throughout the group that reported up escalations to their related physique.
The scientific work teams primarily mirror the totally different Epic modules. For example, orthopedics had their very own work group to configure Bones, which is the Epic product for orthopedics, and oncology configured the Beacon module for the oncology therapy plans. Choices for every work group have been based mostly on an Epic mission administration instrument referred to as Orion.
Exterior of these workgroups that align with Epic modules, additionally they had all of their ambulatory specialties and inpatient specialties configure content material in fast sprints in order that that they had the appropriate templates and a few sensible phrases that they introduced over from legacy order units. As a part of the Epic implementation, they reviewed all Epic scientific determination help after which determined which of them have been acceptable for transferring ahead, and which determination help that they had in Cerner that they wanted to constructed out in they Epic system.
Knowledge conversion and archiving
Boston Kids’s introduced over three years of most varieties of information from Cerner into the Epic occasion. “On the finish of this month, we should always have all of our scanned paperwork from the previous three years obtainable in Epic from Cerner,” Parsons mentioned. “Over 8 million paperwork or PDFs are being introduced over to complete that work up now, however a lot of the information was obtainable on day one in every of Epic go-live there.”
The coaching for the go-live concerned loads of personalization, and it was significant for clinicians to be taught the Epic workflows from their friends. “One factor to say about coaching is that I want we had a greater concept previous to beginning our coaching who was practising exactly the place — which physician labored in each an inpatient and ambulatory setting, which of them have been simply inpatient, and which of them crossed specialties, like which physician labored within the ICU and within the ED, as a result of coaching was actually customized to their scientific workflows, and we needed to do loads of reorganizing and reassigning coaching in order that we may perceive who was nonetheless poor of their coaching earlier than go-live,” Parsons added.
The go-live went easily, he mentioned. “So far as our full scientific programs go, we went down for a number of hours after midnight after which got here again up with our Epic system. On June 1, we went reside with our Epic system. We continued in-patient care, and we did have barely decreased capability over the primary few weeks of our go-live, so far as clinics went, however actually shortly went again to regular capability, and we even had some advanced surgical procedures accomplished in a single day.”
The go-live at Beth Israel Lahey Well being
The implementation at Beth Israel Lahey Well being was referred to as “OneBILH.”
As Lee defined, the background is that Beth Israel merged with Lahey Well being in 2019 and the mixed group has 14 acute hospitals. In growing a blueprint for the longer term, one of many foundations was a unified EHR. The group has over 39,000 staff, together with 4,700 physicians. “We have now a huge major care arm on high of our specialties in addition to dwelling well being,” Lee mentioned, “so we knew that the muse for lots of the work that we wish to do for the longer term was it will be pushed by a unified system.”
Lee described the legacy EHR state of affairs as fragmented. “We had no less than 13 massive EMRs and plenty of, many different totally different situations right here. We even had a pair situations of Epic already in our system, and plenty of situations of eCW in our major care area. All of our customers clearly noticed the use case for this.” Sufferers in major care would go to the acute hospital to get their diagnostic testing and be on a distinct system. “Everybody was actually anticipating this variation, which truly made change administration simpler, he mentioned.
Lee famous that in distinction to Boston Kids’s, Beth Israel Lahey Well being is doing a phased strategy. They went reside on June 1 at their greatest hospitals, together with Beth Israel. Additionally they needed to convey websites that have been already on Epic onto the OneBILH configuration.Then in fall of final 12 months, they went reside with one other wave on the neighborhood hospitals affiliated with Beth, Israel. They’ve a 3rd wave arising this 12 months. “On September 6, we’re going reside with one other hospital at Mount Auburn, in addition to our hospital in New Hampshire,” he mentioned.
Simply as at Boston Kids’s, reviewing third-party functions was an enormous job and wanted to be finished thoughtfully, Lee mentioned. One huge precept of the implementation, he mentioned, is “Why not Epic?” If there may be an built-in instrument, they selected to implement that as an alternative of retaining area of interest options. For ones they did wish to retain, they wanted to ensure that that they had an integration with Epic. For those that they selected to switch or retire, they should extract that information and put it into Epic.
One of many high points round go-live is figuring out the assets to assist with information conversion and validation. “Knowledge conversion is an enormous, huge, huge deal,” Lee mentioned. “We transformed 5 years of information into our system right here, nevertheless it’s very time-intensive, on the again finish, and loads of customers do not understand what we in informatics do to organize this conversion. We wish to map that information. We have to validate that information. A variety of that on our facet was finished by our informatics workforce. We needed to establish these scientific and administrative of us who might help us manually summary a few of that information that we’re not changing routinely. Even figuring out the scope of what we’re changing and what we’re not is hard, as a result of it is a transferring goal, and you are not going to fulfill everybody. So we actually needed to make considerate selections on what’s highest yield and what wanted to be manually abstracted.”
Virtually like a mini-go-live inside a go-live was the switch-over to at least one safe chat messaging platform. It meant comprehensively going via each division and understanding what their communication technique is and transferring them over, Lee mentioned.
The OneBILH mantra about coaching was: “no coaching, no entry, no kidding.” Everybody as much as the manager and hospital management stage supported this concept, Lee mentioned. “Everybody understood the significance of the coaching, but in addition the restrictions of the coaching. You are not going to retain the whole lot from these hours there, nevertheless it’s vital to get that basis and get your ft moist right here, but in addition proceed that post-training with different readiness actions.”
As at Boston Kids’s, mapping individuals to the appropriate roles for the coaching was very difficult, and that is one thing that has been a lesson discovered, Lee mentioned. “After our wave one and wave two, we’re getting higher at it, and hopefully our wave three can be even higher.”
Put up go-live points embrace remedy reconciliation, each within the ambulatory area and inpatient area, ensuring they’re getting prescription refills out, and stabilizing the way in which they’re able to order labs. “Additionally, ensuring we’re routing outcomes to the appropriate of us on the proper time has been tough, and we’re working via that,” Lee mentioned, “and as all the time, watching our hospital prices as properly.”