For a year, The Carle Foundation was preparing to bring a new hospital onto its Epic EHR system with the target date of April 1, 2020. COVID-19 threw a wrench into those plans, causing hospital project managers to quickly reconfigure their EHR go-live process.
Instead of relying on EHR vendor staff, hospital staff and consulting firms to facilitate the transition mostly on site, the EHR go-live team created a plan to train hospital staff remotely and provide remote support during the actual go-live at Carle Richland Memorial Hospital.
The Carle Foundation was not alone in its push for a virtual EHR go-live in 2020. Sturdy Memorial Hospital in Attleboro, Mass., transitioned 23 sites virtually from Meditech and GE Healthcare EHR systems to Cerner CommunityWorks, a cloud-based version of Cerner Millennium. And the U.S. Department of Veterans Affairs (VA) relied heavily on remote support for its first Cerner EHR roll out at Mann-Grandstaff VA Medical Center in Spokane, Wash., late last month.
To accomplish a virtual EHR go-live, project managers at all of the healthcare facilities had to implement layers of remote support, which included virtualizing command centers.
Shifting to a virtual EHR go-live
With nearly a year of planning under its belt, David Gorrell, director at The Carle Foundation Hospital, part of The Carle Foundation health system, said the organization was in the home stretch of migrating Carle Richland Memorial Hospital to Epic when COVID-19 caused it to slam on the brakes.
"All workstreams were green, we were ready to go live, then all of a sudden COVID hit," Gorrell said during the CHIME20 Digital Recharge virtual event. "We started doing a lot of whiteboarding exercises, figuring out what could possibly be done."
Gorrell said the project managers included all impacted staff and contractors in the discussion on how to make the go-live happen. In the end, the team came up with a plan and got buy-in from the executive steering committee to quickly move forward using remote methods considering the public health crisis it was facing.
"They saw the critical need to get Richland up on the same EHR system, the same system that our main campus is on, because we didn't know what the pandemic was going to bring," Gorrell said. "We didn't know if we were going to have to use that location for moving patients down there."
Gorrell said project managers, with the assistance of Pivot Point Consulting, came up with a set of guiding principles to facilitate a virtual EHR go-live and "keep staff safe." The plan was to do as much work as possible remotely, keep on-site roles reserved for critical personnel, authorize essential travel only, and find ways for staff members who felt uncomfortable being on site to work from home.
"It was important to know that this was our plan marching forward with this new type of implementation we were going to do," he said.
The VA also had to shift its plan for launching the Cerner EHR at Mann-Grandstaff in October. While some training was done on site in rooms that allowed for proper social distancing, most training was completed virtually through video conference calls, said Laura Kroupa, M.D., chief medical officer for the VA Office of Electronic Health Record Modernization. It's a training method that could have staying power, she said.
"We'll be continuing to look at how we can expand the virtual training because that does seem to be where things are going," Kroupa said during a media briefing on the Oct. 24 EHR go-live. "We also want to assess the effectiveness of that virtual training. We want to make sure that what we're doing is giving our folks the right tools to be able to use the system."
Ready for launch
Gorrell said The Carle Foundation created three levels of support to launch the software and triage any issues or problems that arose.
Level one support was a small team of on-site Pivot Point and hospital IT staff. Level two support was a remote group of principal trainers and subject matter experts, who could be accessed via phone call. Level three support was a virtual command center that addressed issues level two support couldn't answer via submitted tickets.
"The command center was located at our main campus," Gorrell said. "We didn't have any delay in support ... so the structure we put in place was very successful."
Indeed, a critical element of virtual EHR go-lives in 2020 were the virtual command centers. They featured a mix of vendor and hospital IT support staff providing technical support from a remote location to the hospital.
At Sturdy Memorial Hospital, CIO Brian Churchill said when the pandemic hit, going live on a new EHR at 23 sites seemed like an impossibility and ultimately delayed the project from June to October.
When it decided to push forward on its EHR transition, one of the strategies the organization employed was a virtual command center run by ReMedi Health Solutions in Houston. But instead of phone calls, roughly 150 tablets distributed to hospital sites were used to provide a video connection with remote support staff through the ReMedi remote access app. Staff connected to the ReMedi support team through Microsoft Teams.
Brian ChurchillCIO, Sturdy Memorial Hospital
"It was the instance of still being sort of face-to-face," Churchill said. "You're really virtually at the elbow as opposed to just a voice on the phone. The tablet is there, the [support staff] can see the frustration level of the end user and what's going on. That more instant connection -- not having to wait for the problem, then find the number, dial it and wait for the connection -- all that's usually involved goes away."
The VA relied on a mix of small, in-person support teams and virtual command centers for its EHR go-live at Mann-Grandstaff. The combo enabled the VA to tap into staff and Cerner expertise for the launch without having too many people on site.
"We had two different command centers at Mann-Grandstaff," Kroupa said. "One was across the street at the Cerner training center and we had another one at the DoubleTree Hotel in Spokane because we needed more space for social distancing. We also had command centers in Roslyn, [Wash.] and Kansas City. There was virtual support for both the users and for the Cerner associates from those sites as well."
Epic, too, embraced the use of virtual command centers. Dan Sullivan, implementation executive at Epic, said when the pandemic started in March, the EHR vendor had hundreds of implementation projects in the works. As travel ceased and companies began asking employees to work from home, Epic also had to adapt, he said.
The EHR vendor relied heavily on its virtual command center headquartered in Verona, Wis. It's a trend Sullivan believes will continue even after the pandemic, given the vendor's ability to complete and virtually support 700 go-lives this year.
"When you think of a hospital system that's going live with our applications, we're going to have 24/7 support helping them resolve tickets, make improvements to the software, and historically a lot of those staff may have been on site, elbow-to-elbow with their peers," Sullivan said. "With the pandemic, we've shifted a lot of that to happening virtually and that's worked quite well."