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?