In June 2024, two Boston-area hospitals went dwell with transitions to unified Epic EHR platforms. As a part of the Harvard Scientific Informatics Lecture Collection, chief medical info officers from Beth Israel Lahey Well being and Boston Kids’s Hospital not too long ago mentioned the advantages of the transition and among the challenges they confronted alongside the way in which.
“It was humorous for us to go dwell on the identical time, as a result of I am certain all of the Boston-area inns had been booked with Epic assist,” mentioned Terrance Lee, M.D., M.P.H., affiliate chief medical info officer at Beth Israel Lahey Well being.
The tales that Lee and Chase Parsons, D.O., M.B.I., chief medical info officer for Boston Kids’s Hospital, advised about their processes, governance and challenges overcome earlier than and throughout the go-live paralleled one another in some ways, together with a deal with whittling down the variety of third-party purposes and migrating knowledge from legacy methods into Epic.
Parsons defined that Boston Kids’s has satellites throughout the Boston space and shut relationships with the Pediatric Physicians Group of Kids’s, which is a big impartial ambulatory outpatient apply that has been on Epic for a very long time. It shares sufferers with Dana Farber Most cancers Institute on an occasion of Epic. And it shared an occasion of Cerner with Franciscan Kids’s Hospital. Franciscan went dwell on Boston’s Kids’s Epic occasion in October.
Boston Kids’s had been utilizing Cerner since 2007 for its medical EHR. “We had a hybrid system the place we had Epic for registration and scheduling, and Cerner for the entrance finish for clinicals,” Parsons defined. “We had 398 customized purposes or integrations with our EHR. We had a customized interface for billing. As an example, our affected person portal was a hybrid of the Epic scheduling, so sufferers might see when their visits had been, with the Cerner clinicals, so sufferers might see their lab knowledge. Now we have a central knowledge warehouse, which was an information repository for all these methods and it nonetheless exists at present.”
In spring 2022 Boston Kids’s made the choice to maneuver to Epic, and the mission kicked off in January 2023. “We actually wished to strengthen our system integration to make sure that because the EHR matures, as we mature as a corporation, that we’re capable of preserve and strengthen our integration to our third-party methods….and guarantee that it is all one built-in system,” Parsons added. “We need to make sure that sufferers are capable of self-schedule, which is continues to be being optimized right now, and that they’ll rapidly schedule appointments, and that the lead time for affected person entry is improved.”
Boston Kids’s additionally wished to combine with analysis, which, previous to final June, had been outdoors of the medical methods, and performed by different processes — both customized purposes or on paper, in some situations. “We need to preserve our protected and high quality care as we look after our advanced sufferers, and make sure that we improve fairness and the affected person household expertise and the group and supplier expertise as effectively,” he mentioned.
In late 2022, Boston Kids’s started to type its governance construction to have a look at its legacy knowledge. “We needed to resolve what knowledge we’d like sooner or later, and what shall be our strategy to creating knowledge accessible inside our Epic occasion from our Cerner days,” Parsons mentioned, “then additionally guaranteeing that we had institutional and operational alignment on key choices that we wanted to make throughout our Epic implementation.”
They began off by trying on the present state of their third-party and customized purposes. “We had practically 400 of these, and we went by them, utility or integration by utility or integration, row by row with all the institutional stakeholders previous to the go-live of the Epic mission,” he remembered. “And we had Epic concerned. We needed to know, does Epic meet the wants for this answer? If not, what are the gaps and what’s going to we be dropping out on? Or is there a special third social gathering that we needs to be utilizing or ought to we preserve this tradition utility now we have?”
They had been capable of whittle it right down to round 100 third-party or customized purposes at present.
A part of the pre-work was getting funding from the mission to make sure that that they had sufficient doctor subject material consultants. “We had over 100 physicians who had been receiving funding from the mission to be carefully concerned with duties like medical content material design, coaching their colleagues previous to go-live, speaking their must us in IT and speaking adjustments domestically throughout the mission,” Parsons mentioned.
One instance of a giant mission was adopting an digital consent course of throughout the group, and IT bought mission assets to develop the digital consents. Immediately they’re fairly extensively used throughout the establishment, though paper consents are utilized in some areas as effectively.
The governance construction had government sponsors who’re chief medical and chief nursing officers, in addition to a steering committee, which was a spot to deliver escalations in order that they might guarantee the fitting assets had been in the fitting locations on the proper time. It additionally concerned many workgroups throughout the group that reported up escalations to their related physique.
The medical work teams primarily replicate the totally different Epic modules. As an example, orthopedics had their very own work group to configure Bones, which is the Epic product for orthopedics, and oncology configured the Beacon module for the oncology therapy plans. Choices for every work group had been based mostly on an Epic mission administration device referred to as Orion.
Exterior of these workgroups that align with Epic modules, in addition they had all of their ambulatory specialties and inpatient specialties configure content material in fast sprints in order that that they had the fitting templates and a few good phrases that they introduced over from legacy order units. As a part of the Epic implementation, they reviewed all Epic medical choice assist after which determined which of them had been applicable for shifting ahead, and which choice assist that they had in Cerner that they wanted to constructed out in they Epic system.
Information conversion and archiving
Boston Kids’s introduced over three years of most kinds of knowledge from Cerner into the Epic occasion. “On the finish of this month, we must always have all of our scanned paperwork from the previous three years accessible in Epic from Cerner,” Parsons mentioned. “Over 8 million paperwork or PDFs are being introduced over to complete that work up now, however a lot of the knowledge was accessible on day considered one of Epic go-live there.”
The coaching for the go-live concerned a whole lot of personalization, and it was significant for clinicians to study the Epic workflows from their friends. “One factor to say about coaching is that I want we had a greater concept previous to beginning our coaching who was working towards exactly the place — which physician labored in each an inpatient and ambulatory setting, which of them had been simply inpatient, and which of them crossed specialties, like which physician labored within the ICU and within the ED, as a result of coaching was actually personalised to their medical workflows, and we needed to do a whole lot of reorganizing and reassigning coaching in order that we might perceive who was nonetheless poor of their coaching earlier than go-live,” Parsons added.
The go-live went easily, he mentioned. “So far as our full medical methods go, we went down for a couple of hours after midnight after which got here again up with our Epic system. On June 1, we went dwell with our Epic system. We continued in-patient care, and we did have barely decreased capability over the primary few weeks of our go-live, so far as clinics went, however actually rapidly went again to regular capability, and we even had some advanced surgical procedures accomplished in a single day.”
The go-live at Beth Israel Lahey Well being
The implementation at Beth Israel Lahey Well being was referred to as “OneBILH.”
As Lee defined, the background is that Beth Israel merged with Lahey Well being in 2019 and the mixed group has 14 acute hospitals. In creating a blueprint for the longer term, one of many foundations was a unified EHR. The group has over 39,000 staff, together with 4,700 physicians. “Now we have a huge main care arm on prime of our specialties in addition to dwelling well being,” Lee mentioned, “so we knew that the muse for lots of the work that we need to do for the longer term was it will be pushed by a unified system.”
Lee described the legacy EHR state of affairs as fragmented. “We had no less than 13 massive EMRs and plenty of, many different totally different situations right here. We even had a pair situations of Epic already in our system, and plenty of situations of eCW in our main care area. All of our customers clearly noticed the use case for this.” Sufferers in main care would go to the acute hospital to get their diagnostic testing and be on a special system. “Everybody was actually anticipating this modification, which really made change administration simpler, he mentioned.
Lee famous that in distinction to Boston Kids’s, Beth Israel Lahey Well being is doing a phased strategy. They went dwell on June 1 at their largest hospitals, together with Beth Israel. In addition they needed to deliver websites that had been already on Epic onto the OneBILH configuration.Then in fall of final yr, they went dwell with one other wave on the group hospitals affiliated with Beth, Israel. They’ve a 3rd wave developing this yr. “On September 6, we’re going dwell with one other hospital at Mount Auburn, in addition to our hospital in New Hampshire,” he mentioned.
Simply as at Boston Kids’s, reviewing third-party purposes was a giant process and wanted to be carried out thoughtfully, Lee mentioned. One huge precept of the implementation, he mentioned, is “Why not Epic?” If there may be an built-in device, they selected to implement that as a substitute of retaining area of interest options. For ones they did need to retain, they wanted to guarantee that that they had an integration with Epic. For those that they selected to interchange or retire, they should extract that knowledge and put it into Epic.
One of many prime points round go-live is figuring out the assets to assist with knowledge conversion and validation. “Information conversion is a giant, huge, huge deal,” Lee mentioned. “We transformed 5 years of information into our system right here, however it’s very time-intensive, on the again finish, and a whole lot of customers do not understand what we in informatics do to arrange this conversion. We need to map that knowledge. We have to validate that knowledge. Plenty of that on our facet was carried out by our informatics group. We needed to determine these medical and administrative of us who will help us manually summary a few of that knowledge that we’re not changing routinely. Even figuring out the scope of what we’re changing and what we’re not is hard, as a result of it is a shifting goal, and you are not going to fulfill everybody. So we actually needed to make considerate choices on what’s highest yield and what wanted to be manually abstracted.”
Virtually like a mini-go-live inside a go-live was the switch-over to 1 safe chat messaging platform. It meant comprehensively going by each division and understanding what their communication technique is and shifting them over, Lee mentioned.
The OneBILH mantra about coaching was: “no coaching, no entry, no kidding.” Everybody as much as the manager and hospital management stage supported this concept, Lee mentioned. “Everybody understood the significance of the coaching, but additionally the restrictions of the coaching. You are not going to retain the whole lot from these hours there, however it’s vital to get that basis and get your toes moist right here, but additionally proceed that post-training with different readiness actions.”
As at Boston Kids’s, mapping individuals to the fitting roles for the coaching was very difficult, and that is one thing that has been a lesson realized, Lee mentioned. “After our wave one and wave two, we’re getting higher at it, and hopefully our wave three shall be even higher.”
Publish go-live points embrace treatment reconciliation, each within the ambulatory area and inpatient area, ensuring they’re getting prescription refills out, and stabilizing the way in which they’re able to order labs. “Additionally, ensuring we’re routing outcomes to the fitting of us on the proper time has been difficult, and we’re working by that,” Lee mentioned, “and as all the time, watching our hospital costs as effectively.”
