Whether you are converting from Allscripts, athenahealth, MEDITECH, eClinicalWorks, Oracle Health, or another EHR, you’ll need a staffing model to support and execute the conversion, but more importantly, you’ll need a strategy.
Step #1: Legacy support and Epic resources
Technology is only as good as the people deploying it, so talent should be your first consideration. Your healthcare IT (HIT) staffing and outsourcing plans should anticipate the need for three general groups of people:
- Legacy Support
- Epic Specialists
- Post-Implementation Resources
While your HIT staff invests in preparing for the new EHR, your current system’s maintenance requirements can’t fall by the wayside. Considering various staffing model options to allow for current system maintenance is a priority to ensure no interruptions to operations and patient care.
Your ‘keep the lights on’ crew should not only maintain your legacy EHR, but also help your HIT team avoid unnecessary projects, enhancements, and/or optimization that detract from the upcoming implementation. Their job is to minimize the noise so that your healthcare organization can focus on the road ahead. Consider outsourcing legacy support during post-implementation so that your team has the bandwidth to train and prepare for the Epic install.
When planning resource allocation for your current system and Epic installation, it is crucial to consider both the short-term staffing needs for project support and the long-term staffing needs going forward. The Epic group is typically a combination of contractors and full-time staff: many healthcare organizations choose to hire Epic-certified talent to buttress their forces during conversion. This move infuses the organization with short-term Epic expertise for all necessary system design, build, and testing and provides an opportunity for direct transfer of knowledge to your team. When the conversion is completed, contractors move on to their next engagement, and the healthcare system is left with a stronger and more confident team for stabilization and optimization.
Pro Tip: Be sure to consider Epic’s training and certification requirements when assigning current team resources to the implementation team vs legacy team. When selecting staff for these projects, take into account each individual's interests, abilities, and expected tenure, as both you and the employee will be making a considerable investment in their training and development for the future.
Once the conversion is complete and the Epic consultants move on, this group becomes your EHR support staff. Strategize how you will retain and develop your HIT department’s Epic talent. Be sure to maximize the consultant’s team knowledge and expertise prior to their departure. While foundation build training will align with build tasks of the install, post Go-Live enhancement requests and workflow optimization often requires additional training beyond that received in certification.
Step #2: Transformation and Clinical Adoption planning
In a large health system, thousands of employees will need to adopt your new Epic EHR. Even if employees strongly dislike the current EHR system, learning and mastering a new system requires a significant amount of effort, which often leads to resistance from staff. Change is hard.
Shrewd change management can assure employees are on board. Clinicians are likely frustrated with at least some aspects of the legacy EHR and looking forward to new system capabilities. Your messaging should leverage that instinctive peevishness. Help them envision the ways their jobs will be easier once they clear the training hurdle. They will spend less time on data capture and clinical documentation, for example, and they will have better data reporting available. Further, once they master Epic, clinicians will spend less time on HIT and more time focusing on why they go to work every day: taking care of patients.
During this step, work with end users to plan what your healthcare organization will stop, keep, and start (SKS). As you plan, think beyond the EHR and scrutinize third-party integrated software that handles imaging, revenue cycle management, and other functions. Decide which software needs to carry over to Epic and which software Epic will replace.
Step #3: Plan how your healthcare organization will train physicians and end users
How will you optimize the time and energy employees will need to invest in training? Will you deploy classroom training, online training, or a hybrid of the two? Will you provide workflow-driven training or function-based training? How will you assess competency? How will you tie competency assessments to Epic access privileges?
The training period is a good time to strategize how your HIT team will personalize the Epic experience for job functions and/or roles. Decide how you will support work queues, inboxes, preference lists, order sets and individual reporting needs, just as a few examples. The list goes on and on regarding the personalization support needed as part of training.
As part of the training strategy, identify super users’ roles, staffing, and a model that works for your organization. Super users receive enhanced training, champion Epic’s benefits, support their colleagues during training, and serve as resources after conversion. Don’t select super users simply because they might have some bandwidth or seem to want to nerd out on Epic. Consider impact to operations and patient access as part of the super user staffing plan.
Effective super users master Epic and exemplify your organization’s culture, understand operations, and are well-connected to peers and administrators. People feel comfortable coming to them with questions, and they are excellent communicators.
Step #4: Strategize for Go-Live
The Go-Live process involves a large number of tasks and deliverables that need extensive planning and strategy. Cutover is the official switch to the new system, or what we all refer to as Go-Live. During this cutover period, your organization officially stops using your legacy EHR and starts using your new Epic EHR. Patient data for those currently under care moves from your legacy EHR to Epic. Throughout the testing phase your team will prepare for Go-Live and host a technical dress rehearsal to assure a smooth transition on the technical side of the house. That’s just the beginning of the Go-Live experience.
Even if you served up A+ Epic training for everyone prior to Go-Live, you need to plan how you will support end users during the first two to four weeks of Go-Live. Ideally, you will offer two kinds of support:
- At-the-elbow (ATE) support: This team of subject matter experts provides direct, onsite support to end users. They understand workflow agreements, your organization’s Epic build, and third-party integrations.
- Command center support: This centralized call center provides the standard support your organization provided for the legacy EHR including security and access needs, simple password resets, and ticket management. This group deploys at-the-elbow (ATE) support where your organization needs it most, targeting areas in need of additional support. The command center acts as a central point of communication for your Epic team, super users, trainers and ATE resources.
During the Go-Live period, the ATE resources work closely with the command center to collect data to assess whether end users truly had the training and support they need to operate effectively. Some departments, such as the busy ED, will likely need ATE support for a longer period. Data collection should be specific and measure overall system adoption and utilization. Stabilization periods can range based on the success of your training and Go-Live programs.
Step #5: Anticipate the sunset
Once his job is done, a cowboy in a western gets to hop on his horse and ride off into the sunset without looking back. HIT heroes don’t have that luxury. Even the sunset requires careful planning.
If you’re not migrating old patient data from your legacy EHR to Epic, you’ll need to decommission your legacy EHR and archive the old clinical and financial data to meet various compliance requirements. You also need to figure out how interface continuity will meet HL7 standards.
Does your healthcare organization need some help with some of these 5 steps? Healthcare IT Leaders is here for you. We offer end-to-end support for your Epic conversion needs.
Doug Herr is Healthcare IT Leaders' Executive Director, Epic Practice. He draws on his 24+ years of provider and consulting experience in Operations, Information Technology, and Electronic Health Records systems.