managing a legacy team in an ehr transition: …...14 ehr upgrade team= 64 team members additions:...
TRANSCRIPT
1
Managing a Legacy Team in an EHR Transition: Success & SerendipitySession #75
February 21, 2017
Penny Black, Director
Houston Methodist Hospital
Alan Perkins, Associate Principal
The Chartis Group
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Speaker Introduction
Penny Black Alan Perkins
Director
Houston Methodist
Hospital
Associate Principal,
Informatics and
Technology Practice
The Chartis Group
3
Conflict of Interest
Penny Black and Alan Perkins:
Have no real or apparent conflicts of interest to report.
*All images and graphs are property of The Chartis Group
4
Agenda
Preparation: Upgrading the Legacy EHR
Transition: Managing a Legacy Team &
Supplementing Clinical IT Leadership
New Reality and Lessons Learned
5
Learning Objectives
• Identify potential pitfalls in staffing a
major EHR project
• Define key principles for maintaining
employee satisfaction on legacy teams
• Analyze successful strategies for
integrating employee and contract labor
into a cohesive team
• Develop a staffing plan which supports
an effective leadership strategy
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Realizing Benefits for the Value of Health IT
Our system will enhance our ability to provide
high quality evidence-based care in a safe
environment and will enable us to quantify our
care and deliver metrics in a meaningful way.
Our system will highlight the Houston Methodist experience
by connecting our patients and families with clinicians,
physicians, and employees.
7
Legacy Systems: Mission Critical
Today(and for the next 2 years) Tomorrow
8
About Houston Methodist
Houston Methodist comprises a leading academic medical center in the Texas Medical Center and six
community hospitals serving the Greater Houston area.
2,550
Total Beds> 4,000 Physicians
1,983
Beds in Service
36
Residency Programs
18,000+ Employees260
Residents
467
Employed Physicians
$3.1B
(FY’14)
Total Revenue
9
Houston Methodist ICARE ValuesHouston Methodist employees recognize and support the organization’s values, reinforce positive
behaviors, and celebrate the contributions of those who exemplify our values.
Integrity Compassion Accountability Respect Excellence
We are honest
and ethical in all
we say and do.
We embrace the
whole person and
respond to emotional,
ethical, and spiritual
concerns as well as
physical needs.
We hold ourselves
accountable for our
actions.
We treat every
individual as a
person of
worth, dignity,
and value.
We strive to be the
best at what we do
and a model for
others to emulate.
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Start with the End in MindGoals:
• Replace existing “Best of Breed” applications
• Utilize HMH employees (IT and Clinical) for implementation team
• Ensure resources maintain HMH employment
– Implementation team transitions
– Legacy team placement post sunset
• Maintain “Legacy” team to maintain current systems
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Agenda
Preparation: Upgrading the Legacy EHR
New Reality and Lessons Learned
Transition: Managing a Legacy Team &
Supplementing Clinical IT Leadership
12
Preparation: Upgrading the Legacy EHR
Upgrade EHR to most current version
– Final version to sunset (3 year plan)
Meaningful Use readiness considerations
Upgrade additional ancillary systems
Hire consultants to supplement team
Goals
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Our Initial Team=51 Team Members
• 1 Director
• 1 Systems
Architect
• 2 Managers
• 5 Lead Analysts
• 8 Report Writers
• 5 Periop Analysts
• 3 Pharmacy
Analysts
• 8 EMR Build
Analysts
• 13 Clinical
Coordinators
• 3 Trainers
• 2 Support Analysts
Director
ManagerManagerSystems Architect
Lead Trainer
Trainer 1
Trainer 2
Trainer 3
Support 1
Support 2
Lead Coordinator
Coordinator 1
Coordinator 2
Coordinator3
Coordinator 4
Coordinator 5
Coordinator 6
Coordinator 7
Coordinator 8
Coordinator 9
Coordinator 10
Coordinator 11
Coordinator 12
Team Lead 1
Pharmacy Lead
Senior Rx
Pharm Tech
Analyst 1
Analyst 2
Analyst 3
Analyst 4
Analyst 5
Analyst 6
Analyst 7
Analyst 8
Lead Periop
Periop 1
Periop 2
Periop 3
Periop 4
Periop 5
Lead Report Writer
Report 1
Report 2
Report 3
Report 4
Report 5
Report 6
Report 7
Report 8
Coordinator 13
Preparation: Upgrading the Legacy EHR
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EHR Upgrade Team=64 Team Members
Additions:
• 1 Project Manager
• 5 EHR Analysts
• 2 Periop Analysts
• 3 Report Analysts
• 2 Support Analysts
Director
ManagerManagerSystems Architect
Lead Trainer
Trainer 1
Trainer 2
Trainer 3
Support 1
Support 2
Lead Coordinator
Coordinator 1
Coordinator 2
Coordinator3
Coordinator 4
Coordinator 5
Coordinator 6
Coordinator 7
Coordinator 8
Coordinator 9
Coordinator 10
Coordinator 11
Coordinator 12
Team Lead 1
Pharmacy Lead
Senior Rx
Pharm Tech
Analyst 1
Analyst 2
Analyst 3
Analyst 4
Analyst 5
Analyst 6
Analyst 7
Analyst 8
Lead Periop
Periop 1
Periop 2
Periop 3
Periop 4
Periop 5
Lead Report Writer
Report 1
Report 2
Report 3
Report 4
Report 5
Report 6
Report 7
Report 8
Support 3
Support 4
Analyst 9
Analyst 10
Analyst 11
Analyst 12
Analyst 13
Periop 6
Periop 7
Report 9
Report 10
Report 11
Project Manager
Coordinator 13
Preparation: Upgrading the Legacy EHR
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Key Success Factors
Preparation: Upgrading the Legacy EHR
Plan the work, work the plan, and embrace…
• Change management and communications
• Extensive training plan
• Super users
• Detailed planning, testing, and mock go-lives
• Command center logistics and processes
16
Agenda
New Reality and Lessons Learned
Transition: Managing a Legacy Team &
Supplementing Clinical IT Leadership
Preparation: Upgrading the Legacy EHR
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Transition: Managing a Legacy Team
Keep core systems running and maintained
Limit interruptions for EHR implementation team
Goals
Keep legacy team turnover low and engagement
and satisfaction high
Implement new governance model
Limit requests to appliance core measures, quality,
patient safety or critical business needs
Ensure streamlined teams meet customer needs
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Transition: Managing a Legacy Team
Core Clinical (Legacy) Team 2014
Day five, post upgradeTeam Members
Director
Trainer 1Coordinator 8Senior RxPeriop 5Report 7
Trainer 2
Trainer 3
Support 1
Support 2
Coordinator 9
Coordinator 10
Coordinator 11
Coordinator 12
Report 8
Support 3
Support 4
Analyst 9
Analyst 10
Analyst 11
Analyst 12
Analyst 13
Periop 6
Periop 7Report 9
Report 10
Report 11
Coordinator 13
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Transition: Managing a Legacy Team
New Implementation Team - 2014Project Executive
Exec Admin
Project Director
Clinical Director
Epic SystemsDirector Clinical
Systems
App Mgr. ClinDoc/
Stork/LTAC/ASAP
App Mgr.Orders/
Willow/Beacon
Director
Physician
Initiatives
Director
Revenue Cycle
Resource
Resource
Resource
Resource
Resource
Resource
Resource
Resource
Resource
Resource
Resource
Resource
Resource
Resource
Resource
ClinDoc
Resource Resource
Resource Resource
Resource Resource
Stork
ASAP
Resource
Resource Resource
Resource Resource
Resource Resource
Resource Resource
Resource
Resource
Resource
Resource
Resource
Resource
Resource
Resource
Resource Resource
Resource
Orders
Willow
Beacon
Open FTE
Contractor / Staff Aug
(In FTE position)
Resource
Resource
Resource
Resource
Resource
Resource
Resource
Resource
Resource
PMO
Mgr Appl Tech
Mgr
Integration
Resource
Resource
Resource
Resource
Resource
Resource
Resource
Resource
Resource
Resource
Resource
Resource
Resource
Resource
Technical Apps
Integration
Ambulatory Mgr
Resource
Resource
Resource
Resource
Resource
Resource
Resource
Resource
Resource
Resource
Resource
Resolute Billing
Mgr
Resource
Resource
Resource
ResourceResource
Resource
Resource
Resource
ResourceResource
Resource
Resource
Resource
Resource
Resource
Ambulatory
Resolute Hosp Billing
Infrastructure
Mgr
Resource
Resource
Resource
Resource
Resource
Resource
Resource
Infrastructure
Resource
Resolute Phys Billing
Resource
Resource
Resource
Resource
App Mgr Radiant/
OpTime-Anes/Cupid
ResourceResource
ResourceResource
Resour
ce
Resource Resource
OpTime/Anesthesia
Resource Resource
Resource
Resource Resource
ResourceResourc
e
Resource
Resource Resource
Resource Resource
Resource Resource
Radiant
Cupid
Nurse
Champion
Resource
Resource
Resource
Director CM/
Comm/Edu
Resource Resource
ResourceResource
Resource Resource
Resource
Resource
Resource
Resource
Resource
Resource
Resource
Resource
Resource
Resource
Resource
Resource
Resource
Resource
ResourceResource
Resource
Resource
n
Training Mgr
Resource Resource
Resource
Instructional Designers
Change Mgt/Comm
Resource
Resource
Resource
Resource
Resource
Patient Mgmt
Mgr
Resource
Resource
Resource
Resource
Resource
Resource
Resource
Resource
Resource
ResourceResource
Resource
ResourceResource
Resource
Resource
Resource
Resource
Resource
Resource
ADT/Prelude
CadenceHIM
Director
Patient Access
Reporting Mgr
Reporting
Resource Resource
Resource
Resource
Resource
Resource
Resource
Resource
Resource
ResourceResource
Resourc
eResource
ResourceResource
Resource
Resource
Resource
Resource
Resource
Resource
Resource
Resource
Resource
Testing Manager
Testing
Resource
Resource
Resource
Resource
Resource
Resource
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Transition: Managing a Legacy Team
Compassion Strategy – Critical Core
• Strong leadership support
• Created retention bonus
• Continued internal promotions
• Celebrated successes
• Created work close to home options and remote work alternatives
• Eliminated primary pager responsibility
• Continued management support
We embrace the whole person and respond to emotional, ethical, and spiritual concerns as well
as physical needs.
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Transition: Managing a Legacy Team
Excellence Strategy – Critical Core
• Implemented new governance model
• Applied new work management model
• Taught Clinical Coordinators configuration
• Completed cross training between EHR and Periop.
• Eliminated “on call” physician training; published schedule
We strive to be the best at what we do and a model for others to emulate.
22
Transition: Managing a Legacy Team
Respect Strategy – Critical Core Consultants
• Initial participation in employee outings
• Option to work remote exclusively
• Occasional one-on-one with director
• Transparency with SOWs and budget plans
• Created opportunities for additional training and certifications
We treat every individual as a person of worth, dignity, and value.
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Transition 1: Critical Core Team 2016
Transition: Managing a Legacy Team
Director
Trainer 1Coordinator 8Senior RxPeriop 5Report 7
Trainer 2
Trainer 3
Support 1
Support 2
Coordinator 9
Coordinator 10
Coordinator 11
Coordinator 12
Report 8
Support 3
Support 4
Analyst 9
Analyst 10
Analyst 11
Analyst 12
Analyst 13
Periop 6
Periop 7Report 9
Report 10
Report 11
Coordinator 13
Director
Trainer 1Coordinator 8Analyst 9Periop LeadReport 7
Trainer 2
Support 1
Support 2
Coordinator 9
Coordinator 10
Coordinator 11
Coordinator 12
Report 8
Support 3
Analyst 10
Analyst 11
Analyst 12
Analyst 13
Periop 6
Periop 7
Report 9
Report 10
Report 11
Coordinator 13
Senior Rx
Analyst 11Periop 5
2015 = 28 2016 = 27
Five successful core team transitions
to implementation team positions
One employee transition
to clinical area
One consultant
resignation
Addition of consultants to
backfill employee transitions
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Employee Engagement – Success
4.59
Tier 2
Tier 3
4.79
2013Teams reporting to Penny Black
2015
Teams reporting to Penny Black
Employee
Satisfaction
Scores
Transition: Managing a Legacy Team
2016
Teams reporting to Penny Black
Tier 3
Tier 2
Tier 1 Tier 1
4.67
Tier 2
Tier 3
Tier 1
25
Employee Engagement – Benefits
• Willing to go above and beyond,
exerting additional effort
• Energetic and enthusiastic
• Loyal to the organization –
more likely to stay
• Proud of the organization and
willing to recommend as a place to
work and to receive care
• More satisfied employees overall
Sense of belonging
Confidence HMH will
be successful
Work unit members
are honest/ethical
Key Drivers
26
Key Success Factors –What Makes This Work?
Leadership commitment to employees that no individuals
will be left behind
Carefully choose 3rd party resources who compliment
and blend in to the team
Allow time for team bonding and knowledge transfer
Share organization value system and align values where possible
Trust and accountability
Flexibility
Transition: Managing a Legacy Team
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Transition: Supplementing IT Leadership Team
Ensure that existing core IT systems remain
Productive and effective for business and
clinical operations
Goal
Current with regulatory and health reform requirements
Supportive of ongoing operational performance
improvements
Benefits
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• Engage a consulting partner
firm to provide experienced management
resources to oversee core operations
(multiple leadership positions)
• Engaged partner firm to provide
experienced leads and project
managers to supplement PMO resources
Logistics
Houston Methodist IT Leadership
Consulting Partner IT Leadership
Retains HR-related responsibilities
(annual reviews, promotions)
Retains financial authority
(approval of invoices, budget approval)
Provides feedback for the consultants’
annual review process
Function seamlessly as part
of the Houston Methodist IT
leadership team
Manage onboarding and oversight
of other third party staff resources
Approach
Transition: Supplementing IT CL Team
29
Key Success Factors –What Makes This Work?
Choose the right partner!
Quality of interim leadership resources – knowledge,
experience, interpersonal skills
Trust and accountability
Bi-directional transparency
Ability to function effectively in a hybrid leadership
environment with some ambiguity
Flexibility
Transition: Supplementing IT CL Team
30
Agenda
New Reality and Lessons Learned
Transition: Managing a Legacy Team &
Supplementing Clinical IT Leadership
Preparation: Upgrading the Legacy EHR
31
The New Reality and Lessons Learned
Support the successful go-lives of the new
EHR across the health system
Establish an IT staffing foundation which will
support the needs of clinical IT once the EHR
is fully deployed
Ensure a smooth transition of staff from current
roles to future roles on the consolidated new
EHR/Core team
Goals
32
New System Implementation Timeline
The New Reality and Lessons Learned
Q4 14 Q1 15 Q2 15 Q3 15 Q4 15 Q1 16 Q2 16 Q3 16 Q4 16 Q1 17 Q2 17 Q3 17
Hospital Go-Live
PO Go-Live
Project
Primary Design Complete
System Build Complete
WFWT
Upgrade
Testing Starts
SPG/PCG 1st Go-Live (3/1)
IP Content Build Complete
SPG/PCG Training
4 Hospital
Training
West Houston, St. Catherine
St. John, Woodlands Go-Lives (3/4)
Willowbrook,
San Jac,
Sugar Land
Go-Live (6/3)
HMH Training
HMH Go-Live (5/22)
SPG/PCG 2nd Go-Live (7/19)
SPG/PCG 3rd Go-Live (11/1) 3 Hospital
Training
3 Hospital “Go-Live” 2/19/17
33
2016 Core Team Projection
The New Reality and Lessons Learned
Director
Trainer 1Coordinator 8Analyst 9Periop LeadReport 7
Trainer 2
Support 1
Support 2
Coordinator 9
Coordinator 10
Coordinator 11
Coordinator 12
Report 8
Support 3
Analyst 10
Analyst 11
Analyst 12
Analyst 13
Periop 6
Periop 7
Report 9
Report 10
Report 11
Coordinator 13
Senior Rx
Analyst 11Periop 5
2016 =27 Resources
Director
Trainer 1Coordinator 8Analyst 9Periop LeadReport 7
Trainer 2
Support 1
Support 2
Coordinator 9
Coordinator 10
Coordinator 11
Coordinator 12
Report 8
Support 3
Analyst 10
Analyst 11
Analyst 12
Analyst 13
Periop 6Report 9
Coordinator 13
Analyst 11Periop 5
2017 =15 Resources
Change freeze, reduced number
of change requests
Continued successful
core team transitions
Expect third-party
resource attrition
New system
continued rollout
34
2017 Reality
The New Reality and Lessons Learned
Director
Trainer 1Coordinator 8Analyst 9Periop LeadReport 7
Trainer 2
Support 1
Support 2
Coordinator 9
Coordinator 10
Coordinator 11
Coordinator 12
Report 8
Support 3
Analyst 10
Analyst 11
Analyst 12
Analyst 13
Periop 6Report 9
Coordinator 13
Analyst 11Periop 5
2017 =15 Resources
Director
Coordinator 8Analyst 9Periop LeadReport 7
Coordinator 9
Coordinator 10
Coordinator 11
Report 8 Analyst 10
Analyst 11Periop 6Report 9
Analyst 11Periop 5
2017 =4 Consultants
Number of changes requests
significantly reduced
All core team members have
suitable transition plans
Third party resource reduction
occurred organically
Rollouts
continue
35
Implementation Complete
The New Reality and Lessons Learned
Director
Analyst 10Periop 6Report 9
Analyst 10
2017Transition Complete
Significant reduced number
of change requests
All core team members
successfully transitioned
Consultant colleagues will
transfer to new projects
New system fully rolled
out by mid-2017
36
Lessons Learned
The New Reality and Lessons Learned
Success Serendipity• Managing a legacy team
during a major EHR transition
can be done successfully
• Be true to your
organization’s values
• Work with partner firms
that share your values
• Transparency is essential to
build trust and reduce anxiety
• The prior success of the EHR
upgrade created confidence
inside and outside of IT
• Bringing consulting team
members on board in advance
gave time for them to integrate
• Staff adjusted surprisingly well
to new roles – were able to
“train up” and develop
additional skill sets
37
Realizing Benefits for the Value of Health IT
Our system will enhance our ability to provide
high quality evidence-based care in a safe
environment and will enable us to quantify our
care and deliver metrics in a meaningful way.
Our system will highlight the Houston Methodist experience
by connecting our patients and families with clinicians,
physicians, and employees.
38
Questions
Penny BlackHouston Methodist Hospital
Alan PerkinsThe Chartis Group
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