Epic's EHR: Challenges and lessons learned at Mass General
It is well known that implementing an electronic health record (EHR) system is a challenging and expensive undertaking. But implementations of Epic Systems Corp.'s EHR seem to be the most infamous.
Keith Jennings, CIO at Massachusetts General Hospital (MGH), discussed the hospital's experience so far in rolling out Epic's EHR as well as the EHR challenges they encountered and overcame. MGH is one of several Partners HealthCare hospitals rolling out Epic's EHR, which took three years to build and the initial price tag of $600 million doubled to $1.2 billion.
Jennings has learned a lot during this process and one big lesson learned is that, "a project like this, this is not an IT implementation, this is a business transformation for your clinical systems, your clinical user," he said.
Jennings explained that for MGH, the move to Epic involved many moving parts including a staggered implementation and transitioning off of homegrown systems.
Keith JenningsCIO, Massachusetts General Hospital
MGH first went live with Epic's revenue cycle management system about two and a half years ago, and in April of 2016 they went live with Epic's clinical systems. Jennings believes this staggered approach will ultimately prove beneficial for the hospital.
For example, MGH started the Epic EHR project with just 200 physicians. This experience helped the hospital when they encountered EHR challenges or mistakes as the roll out continued.
Jennings gave an example of one of the EHR challenges they encountered concerning provider numbers. He explained that when importing provider numbers into a spreadsheet, if a provider number had a zero at the beginning, sometimes that zero would get dropped.
"We learned that with [the first] 200 docs," Jennings said. "So when we did the next 200 in January, we didn't have that problem because we knew to pay attention to it."
But possibly the most challenging task for Jennings' team was transitioning off of homegrown systems.
"That's one of our biggest bugaboos," he said. "The hospital doesn't close right? If you look at Mass General, we've been around since 1811 and I don't think we've closed a day since and so there's no time for us to turn anything off."
This meant that Jennings' team has to simultaneously keep the homegrown systems running, plan for data extractions and conversions, go through cycles of testing, and go through training on the new Epic EHR system in order to learn how it all works.
While this is a daunting challenge for the IT team, Jennings said the ultimate goal is, "one patient, one record, one bill and hopefully the best care to our patients across the whole continuum in a very efficient or most efficient way possible."
Transcript - Epic's EHR: Challenges and lessons learned at Mass General
Kristen Lee: Massachusetts General Hospital's journey to Epic Systems Corporation's EHR has by no means been easy. Obstacles for the hospital included transitioning off of home governed systems to a staggered implementation. Mass General first went live with Epic's revenue cycle management system about two and a half years ago.
In April of 2016, they went live with Epic's clinical systems. For Keith Jennings, CIO at Mass General in Boston and his team, this was a big undertaking that included many moving parts. And ultimately, Jennings learned that an EHR implementation does not equal an IT implementation.
The impetus for Mass General and the other Partners HealthCare hospitals that are also implementing Epic to switch to one EHR system was to make all the aspects of patient care flow more seamlessly.
Keith Jennings: We did start on the revenue cycle component and say that we would go with one system, get every. ... So you were a partner's patient, you'd get one medical record number and eventually you'd come to any one of our facilities, and you'd get one bill as opposed to a bill from three or four different places.
That seemed to be an area that we could control, and that is kind of the overarching partner's goal, to have one patient, one record, one bill and hopefully provide the best care to our patients across the whole continuum in a very efficient or most efficient way possible.
Lee: Jennings said he is cautiously optimistic about the Epic rollout. He explained that he thinks the staged approach has and will prove helpful because the hospital initially started the Epic project with just 200 physicians, was able to learn from that experience, and therefore he and his team are better able to handle any problems as the rollout continues. Jennings gave an example concerning provider numbers.
Jennings: We imported old Mass General doctors into the system, and we discovered that we have numbers that have a zero in front of it, right, you know, a doctor has a six digit number. Some of the old ones have used to have five digits, so now we put a zero in front. Boy, if you're not careful when you import those into a spreadsheet or something, it drops the leading zero. We learned that, and we learned that with 200 docs that we could fix things, and so when we did the next 200 in January we didn't have that problem because we knew to pay attention to it.
Lee: Jennings said other CIOs can improve their chances for a successful EHR implementation by thinking big. In other words, "Going beyond the walls of the IT department."
Jennings: A project like this, this is not an IT implementation. This is a business transformation for your clinical systems, your clinical users. So the key component is IT has to be right there, and you have to be supporting these folks. But if you do not have administrative and clinical leadership running this project, I think these types of projects, I think that's a recipe for disaster and failure.
There's a disproportionate number of CIOs who led Epic implementations who are now looking for other jobs. That's not really a condonation on Epic. It's a condonation I think that some of these projects were treated as an IT project, and they are not. Moving, as we did, from some home-grown systems, which we liked very much into a vendor application. And it could've been any other vendor. This one, we just happened to choose Epic. It fundamentally changes the way your clinicians practice.
Lee: Not only that, but moving off of home-grown technologies to a fully integrated EHR meant Jennings' IT team had to maintain a balancing act of keeping the existing technologies running, while also continuing to work on getting Epic up and running.
Jennings: This is probably one of the hardest parts for my staff. They have to keep the existing systems running right up until the day we cut over, and in fact in most cases a couple of days later because you have to finish up some things, they have to keep those systems running.
They also have to. ...There's a lot of data in those existing systems that needs to be converted. So keeping the existing systems running, they now have to plan for data extractions and conversions and go through cycles and cycles of testing. Because we want to make sure that whatever is in the system, you know, on the moment before we shut it off, and gets into Epic the moment it turns on because clinicians can't be bouncing back and forth; that all has to be in there and be correct. So their existing job is there. They now have to do these conversion and cutover tasks. And then somewhere along the way they have to find the time to go to training and figure out how Epic works.