'Epic' success: How Children's Hospital of Philadelphia mastered its EHR update

Technology is in a constant state of flux: Developers release updates for phones or computers almost every month, and with a quick download, users can have the latest operating system. But in healthcare, updating IT isn't so easy.

Healthcare is an industry marked by regulation, and health technology must keep up with these policy changes. Updates are released much less frequently, and it can take weeks for hospital staff to become acquainted with even the smallest of tweaks.

However, Children's Hospital of Philadelphia recently updated its Epic software from the 2015 to 2017 release without a hitch.

"These are 'all hands' events for the information services and EHR teams, and a big deal for the clinical operations side as well," Bimal Desai, MD, the hospital's assistant vice president and chief health informatics officer, told Becker's Hospital Review. "Impressively, this was our smoothest upgrade ever."

Although hospital IT departments understand the patient safety benefits of an EHR update, they often dread this arduous process. Not only does this feat require extensive planning, it also means system downtime when physicians can't use the EHR, a potentially overwhelming amount of problem tickets and calls to the support desk, not to mention possible patient frustration with the interim chaos.

Children's Hospital has been an Epic client since late 2000 and has updated the software multiple times, providing ample opportunity for Dr. Desai and his team to master the task. He said the recent update saw the shortest downtime, the shortest time spent reconciling orders and the fewest service desk tickets.

With years of Epic upgrade experience under its belt, Dr. Desai said the hospital owes its success to both the vendor and the hospital's implementation of improved processes, which he equates those of a NASCAR pit crew.

"Every member of the crew has a role, everyone knows where to stand, what to do," Dr. Desai said. "They can swap out all four tires and fix up the car in a matter of seconds. What makes it harder for us is the car doesn't stop moving: there is no option where we can stop the hospital for hours while the [information systems] teams conduct a software upgrade."

EHR vendors are also getting better at releasing updates that don't crash legacy systems, Dr. Desai said. When a vendor is working on a software upgrade that must be able to function on older hardware, they must spend hours testing it to avoid "regressions," when an updated software system fails to perform the same as it did before the changes.

Brett Rehm, vice president of technical services at Epic, told Becker's these updates can take hospitals anywhere from three to six months to install, but more than one year to devise. Historically, his team releases a major version about once every 12 to 18 months, but now that customers are seeking access to new features sooner, Epic plans to release a new version every quarter.

"We've heard a lot of feedback from organizations that want to have access to the features even faster," Mr. Rehm said. "We will be doing these versions every quarter and putting them out and helping organizations upgrade so they can get everything much faster to their end users."

Epic assists nearly 236 different organizations each year with updating their systems. To do so, Mr. Rehm explained his teams collaborate with hospital staffers to customize the updates to best fit each organization's unique needs. Hospitals' information systems teams work closely with analysts, informaticists and trainers, as well as physicians and other end-users from each department, to identify the new features they want or need to comply with changing regulations.

After the updates are developed, the new systems undergo a series of technical simulations so the hospitals can estimate how long the downtime will be and plan for the change.

"It's a ballet — I wasn't joking when I said these upgrades must be choreographed," Dr. Desai said.

The latest release, Epic 2018 — introduced in February — includes many enhanced features to improve patient access, clinical outcomes, physician productivity and organizational success. Some of these tools include:

1. On-demand video visits

2. Prescription drug monitoring program integration and alerts to possible opioid dependencies

3. A "Search Everywhere" function that lets users comb through all of a hospital's information

4. Extended benchmarking to show hospitals how they compare with their peers  

5. An "Images Everywhere" tool so end users can see images from other healthcare organizations

Epic not only uses insight from individual healthcare organizations to craft its updates, but it turns to the industry to see what agents are driving improvements. "Artificial intelligence and machine learning are big topics and [we are] trying to figure out … how to take advantage of these new technologies and options to drive healthcare forward for everybody," Mr. Rehm said.

The best way to approach an upgrade, according to Dr. Desai, is to be "prepared, test, rehearse and choreograph every part of the event." To ensure these updates don't have the potential to negatively affect patient care, Dr. Desai notes they are often scheduled in the middle of the night when admissions are low and on the weekends, when the ambulatory facilities are closed. During the upgrade, the hospital follows its downtime procedures and reconciles charts as soon as the EHR is back online, and it dedicates a special team to this task so physicians and nurses can focus their energy on caring for patients.

Whether a hospital is voluntarily updating its EHR or refreshing it to meet new government mandates, the EHR vendor plays just as important role as the hospital staff in ensuring the smoothest transition. Both parties must collaborate extensively, plan every detail and trust each other to achieve a stress-free EHR upgrade.

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