From downtime to Level 10: A $700M Epic journey

Typically, when a health system is spending $700 million over 10 years, it is building a new hospital. However, for Worcester, Mass.-based UMass Memorial Health, that price tag was for rehauling its IT system and switching to Epic. 

When UMass CFO Sergio Melgar helped the system select Epic in 2017, he knew it would be a "commitment." Now, the health system has successfully unified its EHR platform under one branch and achieved the coveted Epic Gold Stars Level 10 recognition for the use of its EHR.

The Gold Stars program measures how Epic users get the most out of their system’s workflows and efficiencies. According to a UMass, Level 10 puts them in the top 4% of healthcare organizations. 

To learn more about this process, from installation to award-winning, Becker's caught up with Mr. Melgar:

Question: How did you select Epic?

Sergio Melgar: So when we were looking at our IT domain in total, the infrastructure, the software and how providers were using the system, it was clear there was not a lot of satisfaction. In fact, providers in their engagement surveys would rank the IT system at the very lowest of satisfaction; of all of the items they could evaluate, it was seen as the worst part of our system. We had a very complex organization with multiple systems, what was called best-of-breed.

It wasn't able to stay in function every day. There were a lot of downtimes and things wouldn't quite connect. We were looking at new systems. At that time, if you looked at the market, Epic was by far the most expensive option. So it was a challenge. We did a very good job of evaluating the environment and understanding if we go this route and what we are getting ourselves into. Now, the $700 million is what we would consider a full total cost of ownership. It was going to be a commitment over 10 years. We needed to ensure that there was going to be a return on investment because you don't typically undertake an investment of that magnitude unless you are building a new hospital.

We certainly wanted to make sure we were going to have something that was going to deliver a system that could provide for the providers, that we would have better IT infrastructure reliability, improve the satisfaction of our caregivers and perhaps pay for itself. This could be achieved by eliminating other systems that would go away because of the redundancy, better revenue cycle management, or better clinical delivery that would be more efficient over time.

Q: Will the new system play a role in helping to attract and retain clinical talent?

SM: The way a provider now looks at our IT system as opposed to if you go back to 2016 or 2017, they are much more satisfied today. It now is the thing they are most satisfied with. It used to be completely flipped. There have been a lot of good things happening that have changed somebody's mind that way. There is also an efficiency factor that allows the workforce, whether they be clinical, technical, or RCM, to lead to a more efficient work environment where they are more satisfied with the tools they have. They are performing better. 

It becomes a multiple-winner where you have a more satisfying work workforce because the tools are better. They see them as better, more responsive and delivering better results. 

You're seeing a better revenue cycle that is delivering more cash to the organization. That cash allows the organization to make better decisions and take on more initiatives. All of a sudden there's a multiplier effect.

Q: Could you describe the process from implementation to achieving Epic Level 10?

SM: When we went in, we thought this is going to give us the ability to thrive as a system. We had the philosophy of collaboration of integration and really creating systemness. Epic certainly did that. 

Our initial thought was Epic is going to be the best tool to be able make strategic decisions as a system. We were not looking at wanting to be a 10 star. We're looking at whether we can have a system that will do the things we want. We had to modernize our infrastructure. When you do that, you now have a more reliable system, you have less downtime and things like that. 

Now that you now have the software overlaid on top of our more reliable infrastructure, you are now delivering software that's out there and people are using it. Now you have an engaged workforce and you start moving up. When you are getting an eight star, people get excited about reaching nine stars. It feeds on itself and you want to stay current and it is a community effort. This is not from my office saying you must have 10 stars as a goal. 

Our goal was to be attentive; we reached that level because everybody was collaborating and working together. People, on their own initiative, want to maintain this level. In fact, we had an entity merging in a couple of years ago, and we just went live two months ago on this new entity. So I knew this year we were going to have to spend time to go live with them. We were going to have to direct resources towards that. I purposely said to folks that if we're back to a nine-star, I understand that we have other priorities. The fact that we were able to get the 10 stars again and we went live basically in the same timeframe is a phenomenal success. 

Q: How did you work with IT throughout the implementation process?

SM: I am the CFO, so IT reports to me, and finance reports to me. From a leadership perspective, they are at the table together. I actually have a philosophy of people collaborating and working as teams. We brought in clinicians so that they were in the decision room when we decided to go on Epic. You're making the decision. That means when we go to put it together, you have to participate in the process. So that when we get done, this is something we did. This is not something that was done to you and the results we'll live with.

Q: How did you ensure that you didn't go over budget throughout the process?

SM: We have monthly meetings where finance, revenue, and IT are at the table and evaluate where we are. Where are the metrics? Where are the timetables? So, are we on schedule? Are we delivering what we said we were going to deliver? We make adjustments necessary to make sure that's progressing. Six or seven years later, we still have those meetings today; now, it's more about the delivery and whether the results are moving in the right direction.

At the high level, we have an executive IT committee that establishes the priorities for the budget for the year. All these elements that are necessary to keep the clinical and financial IT system going. Some of those clinicians who participated in 2017 and 2018 are still at the table in 2023. We, as a system, created a committee of the board of trustees whose whole task is to oversee the process. So we see it as important that we have a separate committee of the board that has outside and inside people. They give us best practices and oversight and governance to make sure that we are staying current and that we are mindful. They ensure that our achievements and our plans are cutting-edge and that we are mindful of not simply where we are but where the world is going.

Q: What advice would you give to other health systems considering a new EHR install?

SM: I think you have to start with the reality that the journey is not going to be a short one. It will be a big cost. So in order to succeed, you definitely need to collaborate. You need partnerships. You need to have ownership on the part of all the players that are involved. You need to make sure you have executive buy-in and governance buy-in. If there are issues, if there are big decisions that need to be made, you need people to effectively identify where those decisions are.

You have got to know what you are getting yourself into. It is a long journey, and then you're committed because once you're committed, you have paths you are going to follow. Be aware of your successes and failures so that you learn from others.

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