Van­der­bilt is a case study for the dreaded EHR con­ver­sion

Modern Healthcare - - NEWS - By Dave Barkholz

To pre­pare for its new elec­tronic health record sys­tem, Van­der­bilt Univer­sity Med­i­cal Cen­ter is al­ready re­duc­ing pa­tient ap­point­ments at its more than 120 clin­ics and out­pa­tient sites. The date for the dreaded go-live? Nov. 2, said Dr. Kevin John­son, Van­der­bilt’s EHR project leader.

The Nashville-based aca­demic health sys­tem also in­tends to beef up staffing in its emer­gency rooms that week, John­son said, as pa­tients who can’t se­cure clinic and out­pa­tient ap­point­ments will likely show up at the ER for care.

And 1,000 third-party con­sul­tants

The new Epic sys­tem is be­ing tai­lored for Van­der­bilt’s needs, but it re­mains stan­dard enough to re­ceive fre­quent com­pany up­grades, while al­low­ing clin­i­cians and re­searchers to use a mod­ern soft­ware sys­tem that won’t feel for­eign if they have to work with oth­ers out­side of Van­der­bilt.

and train­ers will be fan­ning out across Van­der­bilt’s en­tire sys­tem—to the three hos­pi­tals on the city’s west end, across Ten­nessee and into south­ern Ken­tucky—to be on the ground to as­sist em­ploy­ees dur­ing the first two weeks of the con­ver­sion to the new Epic Sys­tems Corp. sys­tem, he said.

Hos­pi­tal sys­tems change EHRs in­fre­quently—of­ten after sev­eral years—to take ad­van­tage of new technology and help their clin­i­cians and staff run their op­er­a­tions more ef­fec­tively. But it’s a daunt­ing and ex­pen­sive task that, if ex­e­cuted poorly, can cost mil­lions of dol­lars to re­pair and ex­ec­u­tives their jobs.

“It’s like chang­ing a jet en­gine mid­flight,” said John­son, a pe­di­atrics pro­fes­sor who is the med­i­cal cen­ter’s se­nior vice pres­i­dent for health IT and chief in­for­mat­ics of­fi­cer.

The med­i­cal cen­ter, which legally split from the univer­sity last May, has been pre­par­ing em­ploy­ees for the switch to Epic since it pub­licly an­nounced the plan in De­cem­ber 2015.

The long run­way to launch is cru­cial for train­ing, John­son said.

Hun­dreds of staffers and clin­i­cians have helped iron out wrin­kles be­fore launch day.

Van­der­bilt has $214 mil­lion bud­geted for the con­ver­sion and un­told more dol­lars at risk if it leads to a big­ger-than-an­tic­i­pated drop in pa­tient vol­umes. An EHR is the elec­tronic ner­vous sys­tem of a hos­pi­tal or clinic, al­low­ing staff to on­board pa­tients, track care, view clin­i­cal work­flow and bill for ser­vices.

UMass Me­mo­rial Health Care is go­ing live with its own Epic roll­out later this year. Al­ready, the prepa­ra­tion is hit­ting the bot­tom line.

The four-hos­pi­tal aca­demic med­i­cal sys­tem based in Worces­ter, Mass., saw EHR ex­penses mount to $26.1 mil­lion in fis­cal 2016, erod­ing op­er­at­ing in-

come to $40.7 mil­lion for the year with big ad­di­tional spend­ing on tap for the launch.

The up­front costs are worth it be­cause if em­ploy­ees hate the sys­tem and can’t get used to it, go­ing back to re­fine pro­cesses and soft­ware is ex­or­bi­tant, said Vince Vick­ers, health­care technology leader at KPMG, which is a ma­jor con­sul­tant to health sys­tems on EHR in­stalls. KPMG shep­herds through 25 to 30 EHR in­stalls an­nu­ally.

Vick­ers said the big­gest complaint he hears comes from physi­cians strug­gling with the new sys­tems and the ac­com­pa­ny­ing work­flows. That’s why it’s crit­i­cal that physi­cians have a voice in sys­tem de­sign and get plenty of train­ing. In fact, ser­vices for an EHR in­stall tend to be two to three times the ac­tual cost of the soft­ware and hard­ware of the sys­tem, Vick­ers said.

If there’s dis­sat­is­fac­tion with the sys­tem, “the cost to go back and ‘op­ti­mize’ it is ex­po­nen­tial,” he said.

Van­der­bilt won’t be ac­cused of fail­ing to com­mu­ni­cate its goals to staff.

From the ini­tial an­nounce­ment, Van­der­bilt has ex­plained the rea­sons be­hind the con­ver­sion. Van­der­bilt to­day uses a hy­brid sys­tem fea­tur­ing home­grown and McKes- son-built func­tions, John­son said.

The McKes­son part of the sys­tem is older and won’t be up­dated by the com­pany be­yond March 2018.

The new Epic sys­tem is be­ing tai­lored for Van­der­bilt’s needs, John­son said, but it re­mains stan­dard enough to re­ceive fre­quent com­pany up­grades, while al­low­ing clin­i­cians and re­searchers to use a mod­ern soft­ware sys­tem that won’t feel for­eign if they have to work with oth­ers out­side of Van­der­bilt, he said.

Van­der­bilt re­cently en­cour­aged em­ploy­ees to fa­mil­iar­ize them­selves with the new sys­tem at in­ter­ac­tive events called “space sta­tions.” For­mal train­ing on the sys­tem for 15,000 em­ploy­ees be­gins Aug. 21 for most users, with “su­per users” start­ing train­ing two weeks ear­lier. Moody’s In­vestors Ser­vice es­ti­mates that the cost of the new EHR and any pa­tient dis­lo­ca­tion caused by the staff learn­ing curve will cause Van­der­bilt’s op­er­at­ing cash flow mar­gin to dip to 6.1% in fis­cal 2018. That com­pares with a solid 7.7% it has been running through­out the sys­tem’s fis­cal 2017.

Clunky hos­pi­tal EHR roll­outs can also be haz- ar­dous to ca­reers.

Last year, MD An­der­son Can­cer Cen­ter in Hous­ton said its Epic im­ple­men­ta­tion sparked a rev­enue de­cline and a $405 mil­lion, or 77%, drop in ad­justed in­come in the 10 months that ended June 30.

MD An­der­son Pres­i­dent Dr. Ron­ald DePinho re­signed his post this March un­der a fi­nan­cial cloud, say­ing he could have done a bet­ter job ad­min­is­tra­tively and com­mu­ni­cat­ing with staff.

MD An­der­son and Van­der­bilt are about the same size, with the for­mer post­ing rev­enue of $4 bil­lion in fis­cal 2016 and Van­der­bilt track­ing to record rev­enue of about $3.8 bil­lion in fis­cal 2017.

Van­der­bilt is call­ing the overnight switch in all lo­ca­tions from the old EHR to the new Epic sys­tem “the big bang.”

Staff de­ter­mined that rolling out dif­fer­ent func­tion­al­ity in phases or of­fice-by-of­fice would just pro­long the learn­ing curve, John­son said.

He be­lieves em­ploy­ees and clin­i­cians will be so well-pre­pared ahead of launch that they’ll get pa­tient vol­umes back up to speed after that tu­mul­tuous first week.

Van­der­bilt plans to video­tape the launch at mul­ti­ple lo­ca­tions and study the film to learn how it can im­prove pro­cesses—a ben­e­fit it re­ceived by bench­mark­ing launches at other hos­pi­tal sys­tems, John­son said.

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