Posted by: Jenny Laurello
Andre Jenkins, Cloud computing, EHR implementation, Live chat, UPenn Med, Workflow analysis
From approaches to workflow analysis through the execution of strategic vendor partnerships, Andre Jenkins, entity information officer for the hospital of the University of Pennsylvania, shared his insights on the health system’s electronic health record (EHR) implementation process and provided his expertise as part of this Health IT Exchange Live Chat.
Below is the corresponding transcript from the August 3webcast and chat with Jenkins, where members of the HIT Exchange community had the opportunity to ask their most pressing questions regarding UPenn Med’s successful, system-wide EHR adoption and achievement of meaningful use.
Have a question for UPenn Med’s information technology executives or other members of the health IT community? Visit the HIT Exchange Q&A forum and ask now!
Chat transcript: August 3, 2011
11:31 Jenny Laurello: Good Morning! Welcome to our Health IT Exchange Live Chat with Andre Jenkins, Entity Information Officer for the Hospital at the University of Pennsylvania
11:31 Jenny Laurello: Please enter your questions now. We will then push them live and answer as many as time will allow.
11:34 ErnieCIO: What kind of decisions do you have to run by the governance committee in terms of workflow, or hardware and software purchases? How to you describe your interaction with them?
11:36 Andre Jenkins: Our governance committee actively reviews and discusses all aspects of system selection and implementation. In this way, we ensure that we agree and address all the implementation considerations I discuss in my presentation – i.e., organizational bandwidth, technology infrastructure, IS resources, and project management.
11:37 Awais Hashmi: If you had to make any changes to established workflows to satisfy EHR software regulations, how do you assess your end-users acceptance of it. How did you secure their nod and support?
11:38 Andre Jenkins: Good question. So the key for us has been 1) having our key clinicians (CMO, CMIO, CNO, etc.) be part of our CITG 2) using Penn Medicine’s Blueprint for Quality framework to drive workflow decision. When the clinical needs are primary drivers of the EHR selection, workflow discussions are much easier.
11:40 ErnieCIO: In your presentation you mentioned the infrastructure investment required of this project, including storage. Do you have any plans to employ cloud vendors for a service line or department like radiology to do overflow, or is the plan to just keep expanding the data center?
11:41 Andre Jenkins: So, at this time, we have not seen enough from the cloud computing vendors around privacy and security. We are keeping an active eye on the vendor space, but we think it best to not be early adopters in this venue.
11:42 Patrick Howard: Pertaining to that workflow… did your team map out inpatient workflows, prior to selecting an EHR. Then put forth efforts to update it as you implemented?
11:44 Andre Jenkins: Yes, mapping out workflows is an important preliminary step. Many health systems, including ours, we built from disparate entities over time. Vestigal practices still exist; so it was very helpful for us to map workflows first. We recently did this for consideration of a new OR system.
11:45 ErnieCIO: You mentioned that you used project managers to implement your EMR implementation. What makes a good quality PM – do they have to have clinical experience or are they pure IT people?
11:48 Andre Jenkins: Project managers with clinical experience are always beneficial because of the inherent workflow changes that are part of an EHR implementation. However, finding PMs with clinical experience is often difficult, particularly if building a new project management office. In this case, you can leverage some of your mid-level clinicians to partner with the PM. As a matter of fact, you always want to have the mid-level clinicians involved because clinical users better appreciate that the project is not IS driven but organizationally driven.
11:49 Brian: What are your recommendations for system maintenance? Are you doing it in house? How will you be handing upgrades, patches, etc.?
11:51 Andre Jenkins: We have experience with multiple approaches. Our core application servers are maintained by an IS service vendor. They do all of the OS and virus patching. However, any application-level configuration is either done by our in-house team (Epic) or the vendor (Allscripts). All of these approaches work as long as you manage vendor and staff accordingly.
11:52 Comment From Guest: What is the best practice for EHR implementation?
11:53 Anne Steciw: EHR implementation tutorial: From vendor selection to maintenance
11:53 Steve: Do you interact with your EHR vendors on a regular basis for development needs? Who comprises the team that liaisons with the vendor?
11:56 Andre Jenkins: Yes, we do maintain active discussion with our vendors regarding development needs. It is important to remember that the vendors have been evolving as well with recent mergers and acquisitions. One way to ensure that you get what you want from a system is to actively work with your vendor via forums, executive discussions, conferences, user groups, etc. The good vendors, even the big established ones, are very willing to listen and we use our position as a leading health system to influence the discussion.
11:57 Mike: What kind of training schedule did you have to get employees used to working with the new EHR system?
12:01 Andre Jenkins: Training is a big challenge and oftentimes its breadth is unanticipated. For our recent implementation of electronic clinical documentation here at HUP, we had to train over 1,800 nurses in three months. To do so, we had to consider 1) training space 2) backfill of the staff while training 3) training mediums (e.g., video, classroom, etc.) among other things. The costs can be significant if not considered carefully and training becomes a project in and of itself. However, training is also one of the best predictors of success for your implementation. You must give it priority.
12:02 TheGr8Chalupa: What has been your biggest challenge when implementing your EHR? Were there any road blocks during your implementation that you didn’t plan for or expect?
12:03 Andre Jenkins: WORKFLOW! From many years in multiple industries, I think this is true everywhere, but particularly in the hospital world. Peter Drucker referred to this industry as the most complex, and I think this is particularly true when you consider the hospital data model and information you are trying to capture.
12:04 Clara Olander: What is your advice for an EHR vendor trying to make contact with decision makers in regards to purchasing a new EHR system. What gets your attention?
12:07 Andre Jenkins: I like to compare EHR selection to car shopping; I know when looking for a new car what looks and features I want. In a similar vein, your organization has a good sense of what you want. You need to take this and document it thoroughly, then use these requirements to screen your vendors. It is easy to choose a vendor solution based on KLAS reports (much like “no one ever got fired for buying IBM”), but unless your organization carefully considers its needs, you will not guarantee the success of your implementation.
12:07 Scott: What types of user authentication mechanisms have you put in place?
12:09 Andre Jenkins: The best information security works in layers, protecting the network edges (e.g., firewall) and working down to the application layer. With all of our EHRs, we use role-based access that leverages the vendor security mechanisms as well as our own process to identify required HIPAA levels.
12:09 Kim: What kind of workflow analysis tools did you employ during this project?
12:11 Andre Jenkins: Frankly, pen, paper, and Visio diagrams. The biggest key is to get all of the key operational and clinical staff in a room and ask them to describe their day-to-day work. We are constantly surprised by small processes (or sometimes larger ones) that different departments have implemented to ensure care delivery. So discussion is the most valuable tool. How you document afterwards is really personal preference.
12:12 Rahul: What is the total cost of ownership for choosing, implementing and maintaining EHRs? What are the factors going into that assessment?
12:15 Andre Jenkins: It really depends on the scale of implementation. TCO for a community hospital is going to be less than for an urban, academic medical center. Factors to consider include: System license fees; technical infrastructure (network switches, servers, etc.); Training; Staffing (for support teams); Ongoing maintenance fees; Storage costs, particularly for images (radiological or cardiac-related); Ongoing training (for new clinical staff); Upgrade costs
12:15 Peter: How do you build redundancy into your tech infrastructure? Are there challenges for doing so when you work with two or more different vendors?
12:18 Jenny Laurello: Sincerest apologies for the pop up ads, folks. The pitfalls of using a new platform. Please email me your questions at email@example.com if you prefer and we’ll get them answered, where you can view in the transcript after the chat ends.
12:18 Andre Jenkins: Redundancy becomes very important as you transition from paper to electronic documentation. At Penn Medicine, we have used a couple of strategies: Multiple data centers (a small, local one for site bound systems and a larger Tier Three facility managed by an IT service firm), Triple redundancy for communication lines between our data centers and hospitals, Having some vendors host our equipment (e.g., Allscripts, Velocity for our Lawson system), Architecting and building systems that utilize server clusters and high availability databases.
12:20 Robert: Does your in-facility EHR share data with other outside-facility EHRs to create a patient-centric longitudinal health record? … If not, does your EHR, in essence, perform the functionality of an EMR? If so, how do you handle data governance and privacy/security with your data being viewed outside of your facility?
12:22 Andre Jenkins: Not at this time, mostly because our state’s efforts to get an HIE in place have been unsuccessful. I think that the industry is struggling with the on-going business model for HIE, even before we tackle the thornier issues of data governance, privacy, etc. However, because we have Epic as one of our main two EHRs, we are looking into the Epic Everywhere functionality to meet the Meaningful Use requirements.
12:23 Nancy: Are a lot of specialists participating in meaningful use compliance? How does the EHR handle all reporting for specialists?
12:25 Andre Jenkins: At Penn Medicine, yes, the specialists are definitely part of the implementation effort. Our base EHRs (Epic – Ambulatory, Allscripts – inpatient) meet most of the needs for our specialists. In the procedures areas where many of them work on a daily basis, the EHRs are part of their toolset along with the clinical modalities (GE, Philips, etc.)
12:27 Jenny Laurello: For more info and background on PA’s HIT state infrastructure and HIEs, see the transcript from our last Live Chat!
12:28 Jenny Laurello: Please note that the next question will be the last. Please refer to the Health IT Exchange Q&A forum for any additional Qs.
12:29 Awais Hashmi: In transitioning from out- to in-patient care, are the two EHRs able to interact and interoperate well?
12:31 Andre Jenkins: Not as well as we would like. However, we use a single-sign on solution to ease the clinician’s transition between systems. Many have an opinion that to avoid this situation, a one vendor solution is best. However, we found that 1) this may compromise your functionality needs from a care delivery perspective 2) there is a business risk with putting all of your eggs in one basket, so to speak.
12:32 Andre Jenkins: Thanks everyone for your questions. I enjoyed our conversation. Good luck with your implementations!
12:34 Jenny Laurello: Thank you all for your great questions and patience with the platform, folks! And thank YOU, Andre, for all of your help and expertise — always appreciate your valuable time.
12:34 Jenny Laurello: Please refer to the Health IT Exchange Q&A forum for any additional Qs: https://searchhealthit.techtarget.com/healthitexchange/itanswers/