In June 2024, two Boston-area hospitals went dwell 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 Youngsters’s Hospital not too long ago mentioned the advantages of the transition and a number of the challenges they confronted alongside the best way.
“It was humorous for us to go dwell on the identical time, as a result of I am positive all of the Boston-area inns had been booked with Epic help,” stated 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 Youngsters’s Hospital, instructed about their processes, governance and challenges overcome earlier than and in the course of the go-live paralleled one another in some ways, together with a deal with whittling down the variety of third-party functions and migrating information from legacy programs into Epic.
Parsons defined that Boston Youngsters’s has satellites throughout the Boston space and shut relationships with the Pediatric Physicians Group of Youngsters’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 Youngsters’s Hospital. Franciscan went dwell on Boston’s Youngsters’s Epic occasion in October.
Boston Youngsters’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 had 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 right this moment.”
In spring 2022 Boston Youngsters’s made the choice to maneuver to Epic, and the undertaking kicked off in January 2023. “We actually needed to strengthen our system integration to make sure that because the EHR matures, as we mature as a company, that we’re in a position to preserve and strengthen our integration to our third-party programs….and guarantee that it is all one built-in system,” Parsons added. “We wish to be sure that sufferers are in a position to self-schedule, which is remains to be being optimized right now, and that they will rapidly schedule appointments, and that the lead time for affected person entry is improved.”
Boston Youngsters’s additionally needed to combine with analysis, which, previous to final June, had been outdoors of the scientific programs, and performed via different processes — both customized functions or on paper, in some situations. “We wish to preserve our secure and high quality care as we take care of our complicated sufferers, and be sure that we improve fairness and the affected person household expertise and the staff and supplier expertise as nicely,” he stated.
In late 2022, Boston Youngsters’s started to kind its governance construction to take a look at its legacy information. “We needed to resolve what information we want sooner or later, and what will likely be our strategy to creating information obtainable inside our Epic occasion from our Cerner days,” Parsons stated, “then additionally making certain that we had institutional and operational alignment on key selections that we would have liked 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 undertaking,” 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 shedding out on? Or is there a special third get together that we must be utilizing or ought to we preserve this practice software we’ve?”
They had been in a position to whittle it right down to round 100 third-party or customized functions right this moment.
A part of the pre-work was getting funding from the undertaking to make sure that they’d sufficient doctor material specialists. “We had over 100 physicians who had been receiving funding from the undertaking to be carefully 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 in the course of the undertaking,” Parsons stated.
One instance of an enormous undertaking was adopting an digital consent course of throughout the group, and IT bought undertaking assets to develop the digital consents. At the moment they’re fairly broadly used throughout the establishment, though paper consents are utilized in some areas as nicely.
The governance construction had government 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 precise assets had been in the precise 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 replicate 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. Selections for every work group had been primarily based on an Epic undertaking administration software known as Orion.
Exterior of these workgroups that align with Epic modules, in addition they had all of their ambulatory specialties and inpatient specialties configure content material in fast sprints in order that they’d the precise 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 choice help after which determined which of them had been acceptable for shifting ahead, and which choice help they’d in Cerner that they wanted to constructed out in they Epic system.
Information conversion and archiving
Boston Youngsters’s introduced over three years of most kinds of information from Cerner into the Epic occasion. “On the finish of this month, we must always have all of our scanned paperwork from the previous three years obtainable in Epic from Cerner,” Parsons stated. “Over 8 million paperwork or PDFs are being introduced over to complete that work up now, however many of the information was obtainable on day one in all Epic go-live there.”
The coaching for the go-live concerned a number of personalization, and it was significant for clinicians to study the Epic workflows from their friends. “One factor to say about coaching is that I want we had a greater thought previous to beginning our coaching who was training exactly the place — which physician labored in each an inpatient and ambulatory setting, which of them had 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 a number 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 stated. “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 dwell with our Epic system. We continued in-patient care, and we did have barely lowered capability over the primary few weeks of our go-live, so far as clinics went, however actually rapidly went again to regular capability, and we even had some complicated 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 known 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 creating a blueprint for the long run, one of many foundations was a unified EHR. The group has over 39,000 workers, together with 4,700 physicians. “We have now a huge main care arm on prime of our specialties in addition to house well being,” Lee stated, “so we knew that the muse for lots of the work that we wish to do for the long run was it could be pushed by a unified system.”
Lee described the legacy EHR state of affairs as fragmented. “We had at the least 13 giant EMRs and lots of, many different totally different situations right here. We even had a pair situations of Epic already in our system, and lots of situations of eCW in our main care house. All of our customers clearly noticed the use case for this.” Sufferers in main care would go to the acute hospital to get their diagnostic testing and be on a special system. “Everybody was actually anticipating this alteration, which truly made change administration simpler, he stated.
Lee famous that in distinction to Boston Youngsters’s, Beth Israel Lahey Well being is doing a phased strategy. They went dwell on June 1 at their greatest hospitals, together with Beth Israel. Additionally they needed to convey websites that had been already on Epic onto the OneBILH configuration.Then in fall of final 12 months, they went dwell with one other wave on the neighborhood hospitals affiliated with Beth, Israel. They’ve a 3rd wave developing this 12 months. “On September 6, we’re going dwell with one other hospital at Mount Auburn, in addition to our hospital in New Hampshire,” he stated.
Simply as at Boston Youngsters’s, reviewing third-party functions was an enormous job and wanted to be executed thoughtfully, Lee stated. One large precept of the implementation, he stated, is “Why not Epic?” If there may be an built-in software, they selected to implement that as an alternative of retaining area of interest options. For ones they did wish to retain, they wanted to guarantee that they’d an integration with Epic. For those that they selected to exchange or retire, they should extract that information and put it into Epic.
One of many prime points round go-live is figuring out the assets to assist with information conversion and validation. “Information conversion is an enormous, large, large deal,” Lee stated. “We transformed 5 years of knowledge into our system right here, nevertheless it’s very time-intensive, on the again finish, and a number of customers do not realize what we in informatics do to arrange this conversion. We wish to map that information. We have to validate that information. Loads of that on our facet was executed by our informatics staff. We needed to determine these scientific and administrative people who will help us manually summary a few of that information that we’re not changing mechanically. Even figuring out the scope of what we’re changing and what we’re not is difficult, as a result of it is a shifting 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.”
Nearly 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 shifting them over, Lee stated.
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 stated. “Everybody understood the significance of the coaching, but additionally the constraints of the coaching. You are not going to retain every part from these hours there, nevertheless it’s essential to get that basis and get your toes moist right here, but additionally proceed that post-training with different readiness actions.”
As at Boston Youngsters’s, mapping individuals to the precise roles for the coaching was very difficult, and that is one thing that has been a lesson discovered, Lee stated. “After our wave one and wave two, we’re getting higher at it, and hopefully our wave three will likely be even higher.”
Submit go-live points embody treatment reconciliation, each within the ambulatory house and inpatient house, ensuring they’re getting prescription refills out, and stabilizing the best way they’re able to order labs. “Additionally, ensuring we’re routing outcomes to the precise people on the proper time has been tough, and we’re working via that,” Lee stated, “and as all the time, watching our hospital prices as nicely.”
