In 2013, Houston Methodist decided to implement Epic, an integrated electronic health record (EHR) as part of our mission to deliver unparalleled safety, quality, service and innovation. Our investment was big ─ $293 million over three years.
This spend would bring 8 hospitals, 150 ambulatory clinics and 7 emergency care centers up on Epic. You might imagine that most of our budgeted dollars were targeted for technology costs. Not so much. Less than 20% of our budget involved software and hardware expenses.
What dominated our budget? People costs consumed our budget at 72 percent, in comparison to software and hardware costs which stood at 10 percent and 9 percent respectively. As we analyzed our spend and our Senior Vice President of Finance declared, “I get it now, this is a people project.”
Bottom line: Successfully orchestrating an Epic electronic health record project is more about the people than the technology. Organizations don’t change, people do. By focusing on our people we achieved Epic success because it was owned by the entire organization and not by just IT.
Before you greenlight Epic at your hospital, meet with your board of directors and sign that contract, make sure you review these four operating performance principles for success.
1. Build your Team with the Right Mix
Identifying the right mix of talented individuals was a key to our success. A multi-disciplinary, internal job fair helped us staff up with 226 dedicated project team members. This included individuals from across the system in nursing, patient access, HIM, physicians, therapies, the OR, the PACU, the ICU, ED, marketing, legal, internal audit, business practice, IT and administrative leadership.
We met our team composition goal of 70 percent internal candidates, which we later combined with external hires and some contractors, plus 30 from Epic Corporate and 10 implementation advisors. In addition to the project team, we also budgeted for resources and other costs associated with the Go-Live events. We supplemented our project team with 60 trainers at peak and 350 activation support members for our Go-Lives. Having a majority-Houston Methodist based team was a strategic advantage for us. This meant we already had cultural buy-in for our I CARE values of integrity, compassion, accountability, respect and excellence along with our mission to deliver unparalleled safety, quality, service and innovation.
Over the project’s duration, we retained all of our IT leadership on a fast-paced project noted for plenty of job stress and other disruptors. This leadership continuity ensured we had consistent focus on important implementation activities to create, test and customize Epic for Houston Methodist. Our people were at the heart of the project and their expertise was instrumental in ushering in a new era at Houston Methodist.
2. Partner with the People
We understood going in that partnering with clinical operations would be a critical success factor. A network of 800 subject matter experts (SMEs) and 200 physicians contributed an estimated 40,000 SME hours to set new standards and policies. We adopted a multi-phase roll out of Epic instead of a big bang approach and structured our ambulatory Go-Lives in three phases in 2016. In May 2016, we brought our flagship inpatient hospital in the Texas Medical Center up on Epic and waited nine months before taking the first of six community hospitals live in two groups while opening one new hospital. This staggered launch approach helped us understand the world our clinical operations leaders lived in while allowing the project team to remain nimble, adjust accordingly and become problem-solvers whenever issues presented.
We valued the feedback we received from clinical leaders during pre-Go-Live exercises, just as much as we did in the Go-Live command centers, and they became an extension of our team. These clinical leaders enjoyed joint ownership over decision-making and co-presented with us during our Go-Live Readiness Assessment meetings held at various intervals. During Go-Live, we dispatched senior executives in business SWAT teams. These leaders rounded daily to obtain first-hand clinician experiences and to provide immediate attention and issue resolution. Excellent team communication heightened awareness of issues which we resolved before the next Go-Lives.
Carefully monitoring service line and clinic administrator meetings gave us first-hand insight into their concerns. We staged ambulatory “Outpost” teams in centralized areas on these hospital campuses. If the rate of adoption can be assumed from low call volumes, we frequently met that goal within two weeks of a command center presence. Finally, when we found workflows that worked in theory, but not necessarily in practice, we adjusted where we could to improve subsequent Go-live success.
3. Safeguard Operations Activity to Protect the Revenue
Implementing an EHR can be costly and the graveyard is littered with organizations that either didn’t emphasize the planning process, tried to do Epic on the cheap or failed to understand the importance of the relationship between clinician workflows and generating charges. For Houston Methodist, Epic success meant ensuring 100 percent adoption, safeguarding operations activity by limiting volume impact and protecting the revenue by returning to baseline projections as quickly as possible.
Realistically, you can’t anticipate every issue you’ll face until your clinicians are working in the live environment. While we required full training compliance from over 15,000 staff and more than 5,000 physicians, we recognized our operational partners needed time to work in Epic to fully appreciate where there might be issues. For this reason, our SWAT teams reviewed every related workflow charge for high-revenue generating departments. We tackled the less complicated financial issues first, and then progressed to the more complicated ones. Once we course corrected, we provided additional educational opportunities, plus plenty of at-the-elbow support.
We’re proud our preparation led to us never having to move a Go-Live date. Operating revenue post Go-Live can be challenging for some organizations, but not for Houston Methodist. We’re projected to come in $16 million under budget and Epic helped us capture revenue previously lost due to inefficient processes. As a testament to how well our team worked together, our charges at the flagship hospital returned to baseline within two weeks. At the end of our first year of implementation, we received an 8 out of 10 Gold Stars from Epic Corporation, the one of the highest designations for a first-time implementation for their clients. Houston Methodist excelled at physician productivity, operating margin success, population health, patient engagement, value from data, nursing productivity, community and quality and safety.
4. Embrace the Change
Stephen Covey is famous for saying, “Begin with the end in mind.” We were single-minded in our goal to have “the Best Epic Implementation Ever.” We listened well to other organizations who preceded us on this journey and to their lessons learned and have been appreciative of their shared knowledge. Change is hard, managing change is harder still and making change work to your advantage is the hardest of all. When we organized our project team, we included a team of communicators and change managers because we knew that projects with change management embedded are six times more successful.
I’m a firm believer in the power of change management and completed two Prosci certification courses which leverages the ADKAR methodology. I knew that a project of Epic’s magnitude impacting 20,000 people required embedding change management strategies from the very beginning into the project. Our change management and communications consultants trained everyone on the project team in change management, followed by our executive leaders or sponsors of the change. We stressed active and visible sponsorship as the number one indicator of success. We held kick off events and asked our people to commit to Epic by signing specially-designed commitment banners. Coaching middle management in role play scenarios and change strategies was extremely helpful because we knew employees wanted to hear about changes impacting their roles from their direct line leaders. By combining these efforts with targeted communications, we increased awareness of sponsor events and gave our leaders roadmaps.
Our investment paid off. Our leaders were highly engaged and supportive of the change. Our leaders/coaches were prepared to help their people adjust to the change. Our people were informed, well-trained and ready for the new system. In the end, we enjoyed tremendous leadership and staff engagement, participation and ownership of the workflows, which ensured quicker adoption.
Steps for Epic Success
You may think that technology budgeting for bringing Epic’s electronic health record online at your hospital, however, my experience at Houston Methodist during a three-year, multi-phase roll-out convinces me otherwise. What’s important to remember when you’re planning an Epic project is that people are at the heart of any successful rollout. Incorporating change management principles helped us to assemble a strong project team who partnered with clinical operations every step of the way to customize Epic for Houston Methodist. We successfully completed our Go-Live at our flagship campus, Houston Methodist Hospital, in May 2016. At the end of 2016, we had a strong operating performance with 3% greater equivalent admissions and beat our operating budget by 15%!
In addition, active and visible executive sponsor, physician and staff engagement ensured that our entire organization had “skin in the game” and invested in these success outcomes. The key organizing principles of focusing on people, partnering with clinical operations leaders to better understand their world, safeguard operations activity and their revenue impact and embedding change management had a cascading effect for making our Epic journey an exceptional one.
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