St. Luke's University Health Network goes live on Epic: 4 questions with Revenue Cycle VP Richard Madison

In January 2016, Bethlehem, Pa.-based St. Luke's University Health Network commenced its systemwide go-live on an Epic EMR for inpatient records.

The goal was to bring the health network's six hospitals — each of which operated on a disparate EMR system — onto a single platform to improve clinical, operational and revenue cycle inefficiencies. After selecting Epic, St. Luke's tapped Navigant McKinnis, a Chicago-based consulting firm, to implement the EMR system.

St. Luke's completed the EMR go-live May 2016, on time and under budget. St. Luke's reported it achieved cash neutrality within 12 weeks of the go-live and indicated its claims acceptance rate had increased from 65 percent to 98 percent in eight weeks.

"Those financial outcomes were impressive out of the gate, and they've been sustained through the 19 months we've been live with the Epic system," Richard Madison, vice president of revenue cycle at St. Luke's, told Becker's Hospital Review in May.

Mr. Madison spoke with Becker's Hospital Review about how St. Luke's scheduled its go-live and what outcomes he's noted during St. Luke's first year on Epic.

Editor's note: Responses have been lightly edited for length and clarity.

Question: How many EMR systems was St. Luke's using prior to the Epic go-live?

Richard Madison: The product we were supporting was a McKesson Horizon product, Star, from circa 1980. The Star McKesson product was in five hospitals, which were not connected and were not integrated. They were on separate workflows in separate databases, so we were dealing with five different EMRs, if you will. Our New Jersey facility was using a Siemens Invision product, so was not integrated at all with the rest of the organization. They were separate, and they really stood out there on their own.

Q: How did you decide to implement Epic across St. Luke's in one go-live, rather than a gradual rollout?

RM: We did the "big bang" across all six hospitals, New Jersey and Pennsylvania facilities, clinical and financial applications. We were actually going to do it in two phases — one bringing the smaller hospitals up and working out the kinks and then bringing up the bigger facilities. But this was going back to fall 2015, when we also had ICD-10 coming up right in the middle of those two phases. The one thing we really wanted to focus on was minimizing any type of detriment to our cash flow.

Prior to ICD-10, there were objections that we would incur cash flow problems because of third-party denials, or delays from coding, et cetera, so we put together several financial models that looked at the expected impact of going live with a two-phase approach ... We realized how, using the big-bang approach, we could maximize the resources in a go-live scenario. At the end of the day, it seemed appropriate for us to get past the ICD-10 issue and then, after that, bring up the organization in a big-bang situation.

Q: How did St. Luke's prepare staff for the Epic implementation?

RM: We're very fortunate that just prior to going live we moved to a new building, which accommodated centralized Epic trainings. We brought employees in for training over a two-to-three-month period prior to going live, going through significant hands-on training with the Epic application. We also first went live on the inpatient hospital side and are currently going through a go-live now for the ambulatory network applications. For that process, we identified "physician champions" in all service line levels to be spokespeople for the Epic system.

Q: Were there any changes in clinical workflow after the Epic implementation?

RM: There have been significant efficiencies in both clinical and operational workflows, in emergency department and lab turnaround times, and we eliminated the use of traditional dictation and transcription, to name just a few things. I obtained this information from our clinical informatics folks, who were very much a part of the implementation of the system and are currently working with all of our clinical areas to ensure they're using it right. They said transitioning the network to an integrated system allowed us to standardize our inpatient clinical workflows. From a six-hospital perspective, we now have standard workflows for inpatient processes like clinical content review.

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