From selecting the system to go-live and beyond, the implementation of a single EHR system across a large health system is a daunting task.
Steve Hess joined University of Colorado Hospital (UCH), based in Aurora, as CIO in 2009. In January 2012, University of Colorado Hospital merged with a large community health system. Ten months later, the health system acquired another system in Colorado Springs. Three large systems joined together to form University of Colorado Health (UCHealth). The system includes 1,600 beds and $2.8 billion in annual revenue. Mr. Hess and his team lead the initial implementation of the Epic enterprise system at University of Colorado Hospital and then extended the IT solution across the entire health system. The process consolidated over 40 separate IT systems across all care settings to just one.
Despite the enormity of the task ahead, Mr. Hess did not want to agonize over the decisions leading up to the go-live."We made sure we included all stakeholders, but we didn't want to spin our wheels," says Mr. Hess. "Going live fast was important to us. Go live and you will know how the system works, and what needs to be changed. The elongated, multi-stage approach will be death by 1,000 cuts." This fast, but carefully crafted, process has worked for UCHealth across all of its hospitals and ambulatory practices.
The initial implementation of Epic at UCH began by bringing together IT analysts, business analysts, physicians and nurses to create the implementation model that would eventually stretch across all of UCHealth. The next step was to split the existing IT team. "We separated our project team from the team supporting our legacy systems," he says. "We went to bare bones for the legacy system support, focusing only on regulatory, financial and patient safety issues. We redirected everyone else to the new project: implementation."
Mr. Hess and his team were able to go live on time and under budget, without any major obstacles along the way. "Most EHR implementations don't fail because of the technology or the vendor, they fail because organizations aren't ready, don't have the appropriate decision-making structures setup, and/or don't have the right buy-in," he says. "We like to blame the software, but often it isn't that."
Gaining buy-in begins well before a go-live, by demonstrating how the system works and how it will impact day-to-day workflow. "Our focus in initial training is to get people comfortable. We can always come back to optimization," says Mr. Hess. The key is to understand how the system will be integrated into different workflows. For example, workflow for a primary care physician will be different from that of a surgeon. Tailor the system for different types of physicians and nurses. Bring a comfort level to each role and continue refining the system after going live; make it work for individual roles.
In the case of UCHealth, the implementation of a common IT system across three previously separate systems was critical to developing a shared culture. "We were coming together as a new system. There were different cultures and egos to contend with," says Mr. Hess. "We purposely moved quickly with the IT integration. It is tough to collaborate when you have different IT platforms." The common system now allows a better level of clinical collaboration and allows UCHealth to grow as a cohesive unit.
Go-lives loom large as endpoint goals, but CIOs and their teams must always think beyond that point. "The go-live is not the end of the journey. In many ways, it is just the beginning," says Mr. Hess. "Don't forget about optimization and training." If a health system does not have the structure in place to sustain an IT system's success after the go-live, IT roadblocks and team dissatisfaction are inevitable.