What comes after the Epic go-live? 6 questions with MD Anderson CIO Chris Belmont

Houston-based University of Texas MD Anderson Cancer Center is one of the latest health systems to go live on Epic's EHR. After selecting the software in November 2013, the health system flipped the switch March 4.

It was the second time Chris Belmont, vice president and CIO of MD Anderson, led an organization through an Epic EHR implementation — he oversaw the Epic go-live at New Orleans-based Ochsner Health System starting in 2010 when he was system vice president and CIO.

With two successful go-lives under his belt, Mr. Belmont has a seasoned and unique perspective on these enterprisewide projects. He spoke with Becker's Hospital Review about MD Anderson's go-live, the financial fluctuations of a project of this scale and lessons for other healthcare leaders embarking on similar projects.

Editor's note: Interview has been lightly edited for length and clarity.

Question: About three months have passed since MD Anderson Cancer Center went live on its Epic EHR. How have the past three months gone?

Chris Belmont: They've gone very well, very predictable. It's the second time I've done an Epic implementation at a large institution. It's scary how so many of the events are predictable, it's almost like déjà vu. You have to go through certain phases and experiences and adjust to the new norm.

We're about 90 days in, and the easy wins are over. Now what we're going through is figuring out how this settles into the normal business. Our volumes are back up, everybody's live. Patients are being scheduled in the new system and aren't just appointments we carried over from the previous world. How do I readjust my day that I've been doing for the last decade? How do I rewire myself to do things? And that'll probably continue here for a few months. That doesn't mean that patients won't be seen, that productivity is off or that we won't perform well financially. It's just that we've disrupted the day-to-day flow and how we do work.

Q: What has been the biggest challenge post go-live? How are you mitigating this?

CB: The biggest challenge is fatigue. We've been at this journey for three years. We introduced a tremendous amount of change in one weekend. The team that got us here and the operations group, the institution in general was sprinting toward this go-live data. Now that we're live, we still have a lot of work. People are trying to get back to their day job and kind of recover from this.

Another challenge is managing the noise level, and what I consider noise is the misinformation. Employees will make a couple of comments not based on fact, but it's the grapevine effect. By the time it makes it around to the project team or the president, it kind of has taken on a life of its own. Someone might say, 'Boy, it took me two hours to have my transfusion done.' By the time it makes it back around, it's, 'Epic caused us to be two hours late for a transfusion,' but in reality it might have been a delay in getting lab results back. People make assumptions, and it's easy to blame the system because that's the most obviously change that occurred. Managing he noise level and boiling it down to what's real is kind of our biggest challenge.

Also, remember, we went live in March with Epic. We also did a Cerner lab upgrade in December. In October of last year we did ICD-10. We have introduced significant change over the last year here. While Epic was the last major project in that chain, we have seeing a great deal of confusion and at the same time trying to treat a tremendous number of cancer patients.

Q: For the seven-month period ended March 31, MD Anderson recorded adjusted income of $122.9 million, a 56.6 percent drop compared to the previous year, but this was expected as a result of the Epic project. How does a healthcare organization plan and prepare for these financial fluctuations that come along with EHR implementations?

CB: Our dip was much less than expected. One of the mistakes we made is we…thought [the drop] would be a little more gradual. It occurred very quickly in the February and March timeframe as our physicians went to training. We aggressively reduced schedules. Just like every other institution, you're supposed to cut back on patient volumes. Unfortunately at MD Anderson when you're in cancer treatment, you can't just skip treatment in March. In a lot of areas, we cut back as much as 50 percent. If you extrapolate that, it should be a reduction of 50 percent of your revenue, and we didn't have anything near that.

We went live in a naturally slow time here — we did that intentionally. During that week, it's within two weeks of spring break in Houston, a time which would be a naturally slower point.

All those influences came into it, and then climbing back out and getting back up at full speed, we are very close. Last month's financials haven't come out, but the preliminaries look positive. You just plan for it. We budgeted for it. We managed any change.

Q: Looking forward, what does MD Anderson's post-implementation strategy look like to ensure clinical productivity, operational efficiencies and leveling finances?

CB: For three years we've been in implementation mode. How do we get out of implementation mode and into service mode? How do we put the term 'Epic' in the rearview mirror and see it as a tool in the toolbox to optimize operations? How do we transition ourselves to be more of a service provider and less of an implementer? It's a big shift, and our organization has to recognize it. From here forward, [information services] will slide back into more of a support role, but not too far back.

We also have quite a few modules from the Epic platform we did not implement intentionally. We felt we were going to introduce too much change. Some of the mobile apps will be coming out in the next month. We're also going to be looking at the ability to do more patient self-service around check in, check out and registration through the portal.

Q: How is MD Anderson evaluating ROI? What metrics are you looking at to measure outcomes?

CB: The first thing we've noticed is the transparency and the access to information. We saw in one of our areas long wait times. Looking back, we've always had them, but now they're a little bit longer than expected. Because we had total access to information, we've been able to rally around that and reduce those wait times because we knew where the bottleneck was. In the past, that information was spread out over three, four or five systems. Now we have it at our fingertips in real time.

We're also safer. One of the things we implemented was a barcode medication administration check, which we didn't have fully deployed prior. Medical errors are more transparent, and there's better visibility into near misses. In a self-reporting world, that's more difficult. If it's safer, we can start focusing on quality.

As far as direct measurements go, we should have increased charge capture and reduced duplicate services being done. On the revenue cycle side, we should see things like reduced denials, much shorter accounts receivable timelines. That's how we're going to measure it.

Q: Having overseen two Epic implementations now, what advice would you offer other healthcare leaders embarking on a similar implementation project?

CB: Get your customers involved early and often. Make sure you do everything you can to prevent this from being a software implementation project and more of an organizational transformation project. One way to do that is not to dwell so much on the software but to dwell on the processes and desired outcomes. That was one of the reasons we were so successful. Our operations team just stepped up and owned it. They never pointed fingers and never came back and said the software is broken. They said this is what we have to do to take care of our patients.

The other thing is if you're doing Epic, follow the script. Their methodology works. I've seen it work twice, and it gets better each time. Don't try to buck the system, don't try to reengineer it. 

More articles on Epic:

Judy Faulkner ranks No. 3 on Forbes' 'America's Richest Self-Made Women' list 
An Epic go-live, the opioid crisis and more: Mass General's CNO weighs in 
St. Luke's completes Epic go-live on time, under budget 

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