The Epic Implementation Series
There is no doubt that installing Epic’s systems within a single hospital can be a complicated process. But when you’re an organization that is planning to roll out Epic across multiple inpatient sites, their associate clinics, in house physicians groups, including revenue cycle management, you have likely discovered an entirely new set of roadblocks that could inhibit your successful, on-time installation. The good news is that, with proper planning, these obstacles can be overcome.
Plan, Plan, and Plan Again
“Give me six hours to cut down a tree and I will spend the first four sharpening the axe.” Abraham Lincoln was a brilliant man, but none of his wisdom is more relevant today for a large Integrated Delivery Network installing Epic. Lincoln’s quote implies that proper preparation and analysis are as important as the action,
and this rings true for large implementation projects as well.
There is no room for guesswork when it comes to planning and executing your project. Cost overruns can be severe for hospitals that learn their mistakes as they progress along the project lifecycle. Poor build, ineffective staff, limited testing, and failing to build process are just a few areas to consider. It is extremely important for leadership to plan effectively and monitor their project’s development in order to avoid such mistakes. With lengthy, multi-year timelines, any missed deadlines early in the project will likely become more impactful, as setbacks tend to cause a ripple effect throughout the duration of the project.
We can see planning’s importance when it comes to building records in Epic. Though it seems easy enough to begin by adding records into your build environment, it’s better to start by first understanding your facility’s structure before developing a strategy for both a naming and numbering convention. Once you begin naming and numbering records, it is very difficult (and sometimes impossible) to reverse course. It is important to craft a good plan early on and stick to it. Departments and locations may have differences, but it is the similarities between them that are needed to provide your team with an easier naming convention and build. Using a blank field in an Epic record will still respect the setting in the “higher” record in the facility structure. If all of your outpatient units act a certain way, you can set that particular piece in the overall system definitions rather than separating it out department by department. Using this process will save your build team time and effort. It should be noted that this strategy can be applied to your users and providers as well.
Forward planning can also have a positive impact on the revenue cycle side of your implementation. For a multiple hospital install, you may be combining most or all of the charges for all of your hospitals, clinics and health plan locations into one charge description master (CDM). Taking the initiative to start this process before you begin your implementation can highlight any duplicate codes, outdated codes, or large pricing discrepancies, which may exist across the enterprise. Fixing these items before other EMR build begins will minimize build and testing issues related to charging. Effective consolidation of all the charges in your CDM will ensure the team builds out every charge correctly. This allows your organization to reach revenue baselines more quickly after Go-Live. Our consultants have experience consolidating the CDM for multiple-hospital organizations.
With so many hospitals and locations going up on an integrated system, there is an obvious need for communication not only between the project teams, end-users, and hospital leadership, but also between those groups at your different facilities. This might seem obvious, but it’s important to remember the level of autonomy many of these departments and centers once had that may be lessened with your new EMR. This adjustment can easily be overlooked. Decisions that once could be made by a single group of localized leadership that is usually very familiar with one another will now typically need to include everyone within that specialty (or, in the EMR world, that application) from all locations.
If you have multiple emergency departments, for example, they should make decisions together whenever possible. Having standard workflows, build, and even charges allows for several benefits: floating staff between hospitals at critical peak times, allowing insight and lessons learned to be shared across your enterprise, smoothing the training process, recognizing charges that may have been missed in the legacy system, and allowing for faster optimization beyond Go-Live, since you can reach more users in a more streamlined fashion are just a few of the benefits you’ll be able to reap.
You should also remember that there are going to be tough decisions over which of your locations may be at odds. Often there are opposing views on how to handle a setting in system definitions that cannot be split out by area. In these cases it becomes paramount to address them early on in the installation to give your staff time to work through them and reach a compromise that all parties find fair. You can bet that if these types of decisions aren’t looked at until a later phase, they may need to be rushed in order to meet deadlines. If this happens, feelings will probably be hurt and some users may begin to suspect your leadership of playing favorites. It’s critical that you avoid this – you cannot afford to have staff harboring resentment against leadership or other hospitals over something possibly trivial that could have easily been resolved with more time. Our staff has the knowledge and insight to help you avoid making the mistake of putting something off till tomorrow which should be examined today.
To download the entire Epic Implementation Guide for a Multi-Hospital Install, click here.