For the fifth episode of our Monday Morning Healthcare IT Podcast Series, we take a call with Chelsea Wyatt, our Director of Epic Services here at the HCI Group. Tom and Chelsea will be going over some key strategies and cost considerations that healthcare organizations should be keeping in mind during an Epic upgrade project.
In case you missed it, make sure to check out last week’s episode, where Bob Steele discussed some costs, scheduling concerns, and best practices for an EMR Training project.
Transcript
Tom:
Hello and welcome everyone, my name is Tom Letro of the HCI Group, and today I will be joined on the phone by Chelsea Wyatt, our director of Epic services here at the HCI Group. Our conversation today will be centered around Epic upgrades, placing emphasis on key upgrade strategies and cost considerations. Thank you for joining us Chelsea.
Chelsea:
Thanks for having me, Tom.
Key Strategies for an Epic Upgrade
Tom:
Absolutely, now Chelsea, let’s dive right in here - what are some key strategies that you think could help make an Epic upgrade successful?
Chelsea:
Absolutely, one of the key ones is during the planning phase, make sure you really align all stakeholders, make sure you have your executive team on board, that operations knows that the upgrade is going on, that the help desk is aware that this is coming, and then some of your other applications, too, which may tie into Epic or your other EHR also now. So ensure your diagnostic imaging sites, like radiology, like cardiology, also know what is going on and are aware. And one of the biggest ones is to make sure you do some outreach so that your end users also know that an upgrade is coming. The team is not going to be able to do as many activities related to just regular keeping the lights on and maintenance, and they’re not going to be able to be as quickly responsive to initial development that folks are requesting for the current version now, while they are going through the upgrade process, because the upgrade is so much work.
Optimization of Epic Upgrades
Tom:
So with all the additional workflow that an upgrade can bring, how do you balance your efforts between the optimization of the system, and the upgrade itself?
Chelsea:
So one thing that I tell our clients to sometimes do, which really helps segment things a bit better, and set expectations for the organization, is to do half year of optimization where you’re going at everything that you possibly can and improving the version for the current version, and incorporating a lot of the changes that makes their lives easier for what they are using now, and then you spend the other half year to six months doing the upgrade.
Budget of an Epic Upgrade
Tom:
Right, and moving on to one of the biggest questions when it comes to cost – What are some things that go into planning your budget for an Epic upgrade?
Chelsea:
Sure, the planning and the budgeting for the upgrade are kind of one of the key spots for making sure that you are successful. So making sure that you are planning well, again, make sure that you have all stakeholders identified, and everybody really knows that the upgrade is coming, and the general timelines for the upgrade, and just doing regular communications around that. Then you also want to work in existing governance structures for the hospital, whatever has been set up before. So you may also have an executive committee that you need to talk to, and get operational and executive approval and buy in on the plan, on the scope, on the budget. And then you definitely want to get finance committee approval on the budget as well, so that you’ve got the ability to use the resources that you’re going to need.
Outside Help
Tom:
Thanks Chelsea. And, while some organizations look to take on an Epic upgrade with their own resources, others look to outside help as a means of helping them through their project. What’s the value in bringing in outside help?
Chelsea:
Absolutely, outside help can really be helpful and be brought in for assessing how much outside help you may need. So what I mean by that is, potentially bringing somebody in at an upgrade director level, or a high level project manager review level to look at areas where you may need staff augmentation to look at areas where, or modules where you’ve had difficulty before. Research is often one of those test areas, and really evaluate what you may need for your resources for the full upgrade. And that’s something that we at HCI are really confident and comfortable with helping prepare and taking folks through.
Role of the Project Director
Tom:
Ok, and obviously, the Project Director is going to play a crucial role in an upgrade project, but what would you say are their main responsibilities during an upgrade?
Chelsea:
Absolutely, so, project directors are critical because it gives you one central person to work with the team, to work with the vendor, to set up the project for success in terms of making sure that it stays on budget and on the timeline. That’s their main responsibility is to lead the charge. This person can also lead leadership through some decisions that need to be made, like what version are you going to go up on, and within that version, what install update, or IU, are you going to go up on, if that is an option. And then, how detailed is the upgrade going to get? Are we doing a technical only upgrade, where we are just making the basic fixes because maybe the organization has a different focus for that year? Or, are we going to do some key enhancements, or are we going to do an all-out review and take just about everything that we can to make it the best upgrade that we possibly can?
Those things are critical. And one thing that hospitals don’t do, either because they don’t have the knowledge to do this, or they may not have the funds, but it can be hugely critical, and it can help things be a success, is to make sure that you have got a technical project lead as well as just an overall clinical project director. Sometimes the skills between those two folks aren’t in common, sometimes the technical lead will need to know a lot more about servers, and will need to know a lot more about hardware considerations, desktop considerations, and then the clinical person is going to need to understand a lot more about how the application functions, what enhancements might be touching multiple applications, and may need to have a really good feel for working with people, and when folks need to be recruited, if someone on the team may be a little bit weaker in a certain area, or to help handle disputes that may come up within the different teams, if there’s any issues going on. And just to kind of do strategic direction for the clinical side. So often it helps to have different people in those two roles, especially if you have a lot of environmental moves, or changes, or technical things going on at the same time.
We recently just had a client who not only was doing an upgrade, but was doing a major data center move at the same time, and that definitely was very, very helpful, and we brought it maybe a little too late in the game.
Challenges to an Epic Upgrade
Tom:
Right, and what kind of things can stall the upgrade process? Is there any way in avoiding them, or do you see these hindrances as more of an inevitability?
Chelsea:
Yeah, one of the biggest things that can stall the upgrade, and that is a great question, are having to stop for hardware orders. If you don’t have a good hardware configuration guide from Epic, or if you don’t get that as soon as possible, and you find that you really need to expand this space, or you need to pull in additional hardware, you need to get additional rack space, there can be long procurement times for some of those items, and then you always want to test and make sure that they work effectively, and you may need to migrate some of your existing environments or systems to them. So that can be one of the big areas that can really stall or push back an upgrade. Another one is if you find too many issues around one big topic during testing, so really making sure that you’ve got a very concrete, good, long testing schedule, and that you have allowed for enough rounds of testing, to where you can get two clean rounds of testing. That is what I always advocate for, and that way you have enough time if something big comes up like that, that your build may not have accounted for.
Tom:
Ok, and let’s say that is exactly what happens, Chelsea, where something occurs in your build that you haven’t accounted for. What can be done in that situation?
Chelsea:
Yeah, well hopefully, first, you never get to that situation because you have your builders unit test while they’re building. So one of the biggest things that can happen when you find something integrated testing later is because the team never unit tested to make sure that little pieces of functionality that roll up to something big worked. So really, advocating for that and doing a whole application, or unit testing cycle, ahead of time. Once you do find those issues, though, maybe even taking a pause in the testing schedule, you know, if you’re doing one week of testing, and then two weeks of build 6, maybe you need another week, and you need to take a pause. Or, if you just allow for two weeks of a build 6 period, following a testing week period, so that way you’ve got the time to accommodate for things like that. And then, you can always speed up a testing period if you need to as well if things are done.
Training During Implementation versus an Upgrade
Tom:
Ok, and what are some major differences you see in training during an implementation versus training during an upgrade?
Chelsea:
Absolutely, so training is not the same with an upgrade as it is for a national install. Don’t overtrain. That is one of the biggest mistakes a lot of folks make, but do come up with a best fit training plan, so what I mean by that is that there may be some folks in some applications that need to do a lot more training, because they have huge functionality changes that aren’t just the look and feel of the system. You may have other areas where it is just look and feel updates, and you need to do little if any training, but make sure that you train to the level that is a lot lower than what you did for the actual install. In person training is just a huge expense, not just for preparing for the training and getting different documentation together and the session itself for the trainer, but that makes the need to be paid, and you may need backfill staff to fill in for the nurses or providers or other folks who are away at training. So make sure that you really best fit your training and use captivate videos, which is a really popular tool that we at HCI actually teach our clients to use too and can help with, and tip sheets, or power point presentations wherever possible. Really try to automate it as best as you can.
Cost-Related Issues of an Epic Upgrade
Tom:
Alright, and moving right along here, one of the most important things for an organization to keep in consideration during an upgrade is cost. And what would you say are some of the most common cost-related issues that you can encounter during an Epic upgrade?
Chelsea:
Yeah, it is all about the dollars, you have to make sure you can keep the organization functioning and do fund projects like this. In this case, they are necessary projects, so it is definitely one of the most critical things. Usually cost overruns are always related to hardware, so you want to make sure, again, you get that hardware configuration guide completed per your hospitals specifications, because it’s always different based on what your hospital is up on and using now, that you want to do that far in advance during the planning stages. For the upgrades, again, you may have procurement timelines, where you need to get additional hardware, and that may really affect your timeline.
Another big thing for hardware is to always monitor your capacity for your existing servers for all environments too, for disk space capacity, we usually, at HCI, get our clients to stay under 75% of capacity for those servers at all times, it just helps you run better, and then you’ve got some room to grow. You may want to purchase disk space otherwise, and then you need to look at what implications the upgrade will have on growth, so you may really want to look at some of your hardware items there, to make sure you are incorporating those into your overall budget before you start. This is sometimes forgotten.
Hidden Costs in an Epic Upgrade
Tom:
Right, and then, of course, comes one of every organization’s greatest fears and dreads, and that is, of course, hidden costs. Are there any hidden costs associated with an Epic upgrade?
Chelsea:
Oh you bet. One of the other key areas that deal with hardware that folks don’t evaluate enough during the budgeting process is training. Training definitely costs money, so there may be costs for sending your trainers back to Epic for training. This is called head training, and they may need to all go back, which could be to the tune of $30,000 to send everybody, and to pay for the training and then to pay for expenses. You also may also have a big expense too for MST rebuilds. If your environment for master train has gotten really out of sync with where it should be in terms of build not being pushed there regularly, you may have to do an entire complete rebuild, and that could be a couple months of effort, so that could be really expensive.
And then, if you’re planning for in-person training, see whether backfill staff is needed, especially for nursing, if you have to pay hourly staff for attending training, and then make sure you add transportation costs, too, if you have to take people to a different site for training, and then any training site cost needs as well if you don’t have a site like that already set up, can be really huge.
I’d say the last one for hidden costs is those pesky third party application testing and interface testing items that you really should be doing. By that I mean your devices, making sure that they work with the upgrade, making sure that you are doing interface testing, and all of that works through the upgrade, and then lastly doing claims testing, and making sure that your claims items are coming out affectively as well. One of the big things that have bit clients in the, you know, a bit before we worked with them is that they didn’t do extensive claims testing, and so they didn’t realize that “hey, everything works to get charges out, but we’ve got a real problem when it comes to claims and getting paid.” So they’ve maybe not been able to submit their claims for several months after the upgrade, and that can really, really have an effect on your revenue stream.
Summary
Tom:
Alright, and thank you Chelsea but that is all the time we have here today.
Thank you to everyone for listening, and make sure to subscribe to our blog and our podcast as well as to follow us on social media. Also, make sure you comment below with anything that you feel we may have missed with regards to Epic upgrades, so that we can keep the conversation going.
For Chelsea Wyatt, this has been Tom Letro of the HCI Group. The HCI Group, offering a smarter approach to healthcare IT.