The 430 IT staffers at Bethlehem, Pennsylvania-based St. Luke's University Health Network are no strangers to big, ambitious projects.
When Mount Sinai Hospital set out to upgrade its clinical workflow in 2005, the IT team estimated it would be a three-year job. The scope of that project was to replace the paper charts and an aging GE Logician system at the New York City teaching hospital which was founded in 1858 and borders Manhattan’s Central Park.
What the original team didn’t plan on was the hyper-growth that was coming. In the years that followed, Mount Sinai merged with one of New York City’s largest hospital systems, Continuum, and now operates seven hospitals and 100 ambulatory practices. With more than 38,000 staff members, it has become the second-largest private employer in the city.
Through all of that growth, the Epic project is still underway with completion now scheduled for 2020. But rather than simply replacing paper charts with digital records, Epic modules have transformed every aspect of care throughout the system. Epic modules will be used in all departments throughout the system, including revenue cycle management.
The Mount Sinai team has no regrets about taking its time. It is proud that the process caused minimal disruption to clinical and administrative operations. Go-live events run smoothly and the platform has been embraced by physicians and nurses.
The Mount Sinai system, which includes the Icahn School of Medicine, has a prestigious record of medical discovery. Just in the last month, physicians have announced the following breakthroughs:
- A study demonstrating successful application of gene therapy to improve heart function in non-ischemic heart failure, reversing cardiac damage from congestive heart failure in a large animal model.
- Discovery of a predictive model for inflammatory bowel disease, published in Nature Genetics.
- Using machine learning, researchers identified unique insights in the way different opioid drugs activate the receptors and specific signaling pathways in the brain.
Susan Brassell-Knox, senior director IT Program Management Office, attributes the success to having a Program Management Office working in partnership with the Epic IT team.
"Having a change management resource is critical."
“Having a change management resource is critical,” she said. The PMO team takes on a communications role throughout the project, and works to ensure that adoption goes well.
Launched in 2008, the PMO team is in touch with clinicians at all phases of the process. It holds frequent town halls, and engages even the chairs of the departments in the roll-out process.
“We need to make sure everyone knows this is coming, even if it doesn’t impact their department,” she said.
The merger with Continuum brought to the team the challenge of supporting “a mixed bag of EMRs” in the words of Ken Koppenhaver, senior director, Epic applications. At the different hospitals, which include St. Luke’s, Roosevelt and Beth Israel, support for eClinicalWorks and GE Centricity PRISM needed to continue as Epic transitions were planned. The team estimates another two years of work will be needed to complete the upgrade in all of the ambulatory areas.
Koppenhaver said the process of keeping legacy systems running during a period when the vendors know Epic is the future has been challenging. “They are not incentivized to solve problems,” he said. But there have been no serious difficulties.
"We made sure there was a major investment in infrastructure: emergency power, the network, Wi-Fi, the data center, making sure we had the right sizing of the servers to handle the capacity."
Some of the challenges stem from the need to continue running systems on a “very old mainframe” that occasionally need to communicate with the newer software. Mount Sinai continues to maintain its own data center.
Roll-outs of new Epic modules into different units have become almost routine.
“We’ll have go-lives in the ambulatory areas for the rest of this year and into the next,” said Elena Sethi, director, IT Program Management Office. One of the main projects right now is deploying Epic’s scheduling, ambulatory electronic medical record and professional billing modules.
Sethi said that the department has adopted a strong focus on change management techniques. They prioritize stakeholder involvement at all stages of the project.
“We’re putting our clinicians in front of the change,” she said acknowledging that the message wouldn’t carry the same weight if was coming from IT.
The change management methodology is continually refined, with best practices from industry incorporated into the playbook. “With every implementation we look at new elements to add,” Sethi said.
"We’re putting our clinicians in front of the change."
As new modules were selected, Mount Sinai did not simply go back to Epic. It performed competitive reviews and included clinicians in the evaluation process. In the end, it has stayed with Epic.
Last year’s rollouts were focused on scheduling and professional billing. But successful implementations required more than just software.
“When we went live we couldn’t have people saying I can’t find a PC to work on,” Koppenhaver said. “We made sure there was a major investment in infrastructure: emergency power, the network, Wi-Fi, the data center, making sure we had the right sizing of the servers to handle the capacity.”
The 950-member IT staff has 145 people devoted to Epic support. Citrix connects PCs into the EHR application and documents are managed through OnBase by Hyland.
The side benefits of having the system so tightly integrated are becoming apparent. Mount Sinai staff is doing work on population health and predictive analytics and they appreciate the availability of a “command center” dashboard that displays statistics like how many patients are waiting in the emergency department and how many patients are in the OR.
“We’re going to take that to the next step with data,” said Kristin Myers, senior vice president, information technology. “How do we predict patient throughput and capacity, how do we predict staffing, how does this impact patient care?”
One thing the team may be able to predict soon: a date when the Epic transformation is complete and the mainframe can finally be retired.
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