In June 2024, two Boston-area hospitals went reside with transitions to unified Epic EHR platforms. As a part of the Harvard Medical Informatics Lecture Collection, 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 few of the challenges they confronted alongside the best way.
“It was humorous for us to go reside on the identical time, as a result of I am certain all of the Boston-area lodges 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 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 methods 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 observe 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 might see when their visits have been, with the Cerner clinicals, so sufferers might see their lab information. We’ve got a central information warehouse, which was an information repository for all these methods and it nonetheless exists as we speak.”
In spring 2022 Boston Kids’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 corporation, that we’re in a position to preserve and strengthen our integration to our third-party methods….and guarantee that it is all one built-in system,” Parsons added. “We need to be sure that sufferers are in a position to self-schedule, which is continues to be being optimized right now, and that they’ll rapidly schedule appointments, and that the lead time for affected person entry is improved.”
Boston Kids’s additionally needed to combine with analysis, which, previous to final June, had been exterior of the scientific methods, and performed via different processes — both customized functions or on paper, in some situations. “We need to preserve our secure and high quality care as we look after our complicated sufferers, and be sure that we improve fairness and the affected person household expertise and the group and supplier expertise as nicely,” 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 will probably be our strategy to creating information accessible inside our Epic occasion from our Cerner days,” Parsons mentioned, “then additionally guaranteeing that we had institutional and operational alignment on key choices that we wanted to make throughout our Epic implementation.”
They began off by trying on the present state of their third-party and customized functions. “We had almost 400 of these, and we went via them, software or integration by software or integration, row by row with the entire 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 answer? If not, what are the gaps and what is going to we be shedding out on? Or is there a distinct third occasion that we must be utilizing or ought to we preserve this tradition software we now have?”
They have been in a position to whittle it all the way down to round 100 third-party or customized functions as we speak.
A part of the pre-work was getting funding from the undertaking to make sure that they’d sufficient doctor material consultants. “We had over 100 physicians who have been receiving funding from the undertaking 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 domestically in the course of the undertaking,” Parsons mentioned.
One instance of a giant undertaking was adopting an digital consent course of throughout the group, and IT obtained undertaking sources to develop the digital consents. Right now they’re fairly extensively 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 carry escalations in order that they might guarantee the suitable sources have been in the suitable 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 completely 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 remedy plans. Choices for every work group have been based mostly on an Epic undertaking administration instrument 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 suitable 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 have been applicable for transferring ahead, and which choice help they’d 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 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 accessible 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 accessible on day one in every of Epic go-live there.”
The coaching for the go-live concerned plenty 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 thought 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 personalised to their scientific workflows, and we needed to do plenty of reorganizing and reassigning coaching in order that we might 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 methods go, we went down for just a few 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 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 growing a blueprint for the long run, one of many foundations was a unified EHR. The group has over 39,000 staff, together with 4,700 physicians. “We’ve got a big major care arm on high of our specialties in addition to house well being,” Lee mentioned, “so we knew that the muse for lots of the work that we need to do for the long run was it could be pushed by a unified system.”
Lee described the legacy EHR scenario as fragmented. “We had a minimum of 13 giant EMRs and lots of, many different completely different situations right here. We even had a pair situations of Epic already in our system, and lots 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 transformation, 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 largest hospitals, together with Beth Israel. Additionally they needed to carry websites that have been already on Epic onto the OneBILH configuration.Then in fall of final yr, they went reside with one other wave on the neighborhood hospitals affiliated with Beth, Israel. They’ve a 3rd wave developing this yr. “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 a giant job and wanted to be completed thoughtfully, Lee mentioned. One large precept of the implementation, he mentioned, is “Why not Epic?” If there’s an built-in instrument, they selected to implement that as an alternative of retaining area of interest options. For ones they did need to retain, they wanted to guarantee that they’d an integration with Epic. For those that they selected to interchange or retire, they should extract that information and put it into Epic.
One of many high points round go-live is figuring out the sources to assist with information conversion and validation. “Knowledge conversion is a giant, large, large deal,” Lee mentioned. “We transformed 5 years of knowledge into our system right here, nevertheless it’s very time-intensive, on the again finish, and plenty of customers do not realize what we in informatics do to organize this conversion. We need to map that information. We have to validate that information. Loads of that on our aspect was completed by our informatics group. We needed to establish these scientific and administrative of us who may 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 difficult, as a result of it is a transferring goal, and you are not going to fulfill everybody. So we actually needed to make considerate choices 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 1 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 degree 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 all the pieces from these hours there, nevertheless it’s vital to get that basis and get your toes moist right here, but in addition proceed that post-training with different readiness actions.”
As at Boston Kids’s, mapping individuals to the suitable 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 will probably be even higher.”
Publish go-live points embrace remedy reconciliation, each within the ambulatory area and inpatient area, ensuring they’re getting prescription refills out, and stabilizing the best way they can order labs. “Additionally, ensuring we’re routing outcomes to the suitable 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 nicely.”