Cleveland-based University Hospitals CIO Robert Eardley told Becker's that the guiding principle in its process to convert 5.6 million patient records into a single Epic EHR was ensuring that patient care was seamless and uninterrupted.
Prior to installing Epic, University Hospitals' clinicians provided care through 20 different computer applications. University Hospitals CEO Cliff Megerian had aimed to finish the installation, a process which brought together 80 different work groups, by the end of 2023.
Despite the massive implementation process, Mr. Eardley said that the health system has been able to "stay on budget."
As other large health systems, such as Salt Lake City-based Intermountain Health and Pittsburgh-based UPMC, also transition to Epic, Becker's caught up with Mr. Eardley to learn more about the implementation process.
Question: How do you keep costs from ballooning when installing a new EHR?
Robert Eardley: It's important to get the implementation right the first time. The most important step in the process is developing a solid, comprehensive cost model. This way you can gain confidence with senior leadership and the board that varied costs are accounted for in the budget plan. At University Hospitals (UH), we spent a lot of time getting the cost model to be fully comprehensive and partnered with outside consultants to ensure there were no material surprises later.
When it comes to installing a new EHR, there are large costs associated with education and activation support. Some areas of cost that were not in the original plan surrounded chart abstracting (for those elements not electronically converted) and paying for our own UH Epic Super Users to be available for activation support after the go-live date. We usually make the decision whether to cover these costs based on whether this will allow us to adopt the new technology more quickly, and whether we have favorability elsewhere to cover. Overall, we continue to stay on budget.
Q: How did you work with Epic throughout the process?
RE: Epic Implementation Services is the primary partner on an implementation of this scale. UH engaged with their team of about 110 individuals. Not all were fully involved in each phase of the project, but generally about 80 individuals were part of the engagement throughout. Epic has a sequencing template that provided a great start for implementation. We also utilized key learnings from a number of other systems we've implemented at UH over the years.
Q: Did the process create new jobs at University Hospitals?
RE: In the short term, new jobs were created due to having some of our IT caregivers fully committed to the UH Epic implementation program. This was beneficial so that other IT caregivers could focus on maintaining our prior legacy systems.
Q: How do you ensure care isn't interrupted when overhauling your EHR?
RE: This is a significant focus of ours at UH. Our most foundational guiding principle was "Put the Patient First; ensure patient experience is seamless, consistent and simple across the system." Before the cutover, we spent a lot of time building a marketing and communications plan to walk our patients through where to find their information after we make the change to Epic.
During the cutover, we mitigated much of the confusion by migrating 5.6 million patient records from multiple prior systems into Epic. We brought at least five years of patient information from our prior systems into Epic. We also brought over future dated appointments. Having Epic "pre-primed" with historical information and future appointments allowed our patients to have an effective patient portal experience with MyChart on day one.
Q: What advice would you give to other health IT leaders considering installing a new EHR system?
RE: In most cases, installing a new EHR is a multi-year implementation, so it's important to put in the work during the business case and pre-initiate stage in order to build a plan that can stay relatively consistent. At UH, for example, we had to manage five budgets — one capital throughout as well as four annual operating budgets.
Also, make sure that in addition to the Epic implementation team, you find and contract with a trusted labor agency for certified trainers and for activation support. This will likely be one of your largest expenses. It's important to really understand your split between capital and operating expense — more than 35 percent of our total budget was operating expense. Find a great implementation advisor who can supplement your implementation team in selected domain areas. Finally, make sure that your overall organization understands the transformational and all-encompassing nature of a full-scale, integrated EHR system.