Healthcare organizations around the world are either implementing, upgrading or optimizing their EHRs. HCA Healthcare is implementing MEDITECH Expanse and Krischan Krayer, VP of Expanse Implementation & Operations at HCA Healthcare, sat down with Phil Sobol, chief commercial officer at CereCore and host of The CereCore Podcast to discuss automation and its potential to change EHR implementation at HCA Healthcare and the industry. “We're breaking some pretty neat ground [with automation] because in order to do this at our scale, you can't do this all through humans. It is way too big of a lift,” said Krayer.
These massive EHR investments can be one of the most significant investments a healthcare organization will make in decades, one of the most complex technology initiatives within the career of certain leaders, and can impact an organization in ways that few other technologies can. Automation is a solid strategy for scaling IT services and resources whether focused on an EHR implementation or other more day-to-day IT operations.
So, how can we make the EHR implementation process less manual? What are some of the most important things to keep in mind when it comes to maximizing this significant investment? Listen to the full podcast episode as Krischan Krayer discussed ways healthcare organizations can evaluate and use automation for EHR implementations. Get advice on working with stakeholders and teams to educate them on what’s possible with automation. Hear more about EHR adoption trends, insights from his role as a physician advocate and IT “translator” and career advice.
Here are a few highlights and takeaways from Krischan Krayer:
Editor’s note: Excerpts have been edited for brevity and clarity.
How does automation play into an EHR implementation like MEDITECH Expanse?
Automation has been a game changer in transforming manual functions associated with healthcare IT. As HCA Healthcare launched their journey to implement MEDITECH Expanse, they have turned to automation as a tool used by IT teams to accomplish several goals:
- Achieve scale. Krayer explains automation is more than a tool for end users or downstream processes, but automation is helping IT implement at scale. “You can't do this all through humans. It is way too big of a lift. So we dug in deep with many colleagues here at HCA and across the organization—CereCore being a huge partner in that and wonderful talent there.”
- Migrate data from the existing system into the new system. This was an important step that needed to be done in a less manual way and one of the first areas of success using automation for the Expanse implementation.
- Configure workflows. Krayer said the next level of automation revolves around “translating what workflows or old systems were doing, and hence how the new system has to be configured. And so the world of mapping can be automated to some degree. There are smart enough tools nowadays that can really help make that a much easier process for the users so that what they have to do then is validate the final pieces.”
- Testing. Krayer continued, “The world of testing can really come a long way with automation. We're trying to take the pieces that historically have been even more critical thinking and figure out if there is rhyme or reason that it can be automated. Not 100%, but there are plenty of ways where we can take that and figure out what to put into the new system based on what we can pull out of the old legacy systems. Putting the automation lens on ourselves is hugely important.”
What are ways to encourage an automation culture or mindset?
Teams and roles within an organization will react to automation differently over time. A good first step is education.
Krayer shared that they were using the basics of automation to export and import data. “We really started educating our core product and clinical experts on the capabilities of automation and challenging them, how far can you take it? They did not quite think that automation could go far enough for them. We challenged them hard and it took a few cycles. Then they got a group together, had the first couple of breakthroughs, and over the last year they have come tremendously far. They have tools that pretty much read our old EHR, help them map the old lab test to the new lab test so we have the correct mapping. Then they pull the information, the detail of the old lab test out of the old EHR so we can correctly load it into the new one— things like reference ranges and critical values. So we don't have to by hand figure out which ones go where and then manually put them into the new system.”
He added that key stakeholders need to see the potential in automation, be willing to invest in it and serve as advocates. “You need a few of the right technical leaders that can really share and educate on that vision and the actual tools and be that initial rallying cry. And if you don't have that in your organization, you're only going to go so far. We've been fortunate between some help from the CereCore team, but then also several people at HCA that are phenomenally versed and really champions for this work, and that is very important,” said Krayer.
How can leaders help bridge the gap between the provider community and technology? And, how has your approach changed with clinician generational changes?
Listening, talking with providers and clinicians, and walking the halls of hospitals are a must when serving as a translator and connecting the dots between patient care and technology. Over the years healthcare professionals have adapted to the basic change associated with technology. Though he was careful to not over generalize, Krayer has observed some differences in adoption and toleration of change based on the career stage of care providers.
- Early career. Physicians out of residency and nurses out of nursing school seem more comfortable with change because they have been living and working in a fluid environment during their professional training. Krayer said, They're very open-minded. They're still in a learning mode. They’re still trying to establish themselves, and they're comfortable with change.”
- Middle career. Often you encounter healthcare professionals who “really get into a groove professionally. And they are in a stage of their life where they're looking to accomplish something professionally,” said Krayer. “When you show up in the middle of that stage and people are pushing hard to achieve something and you disrupt that, people are much less tolerant of that disruption. Middle of the career-driven professionals at all levels are going to really hold you accountable to making sure that change that you bring some value. And the EHR world has struggled with that. The apparent value we bring right out of the gate is not always right there. We're more like a foundation than we are the shiny interior design.”
- Late career. Krayer has experienced both resistance and tolerance from more seasoned healthcare professionals. He explained, “They'll tap out or they actually become quite tolerant. They're a little bit less in a rush. They're a little bit less worried about how this will add up and impact them. And often you find a lot of good champions.”
What are the most important things to keep in mind to maximize your EHR implementation investment?
Krayer said, “Two elements that make or break is far beyond what you choose with a vendor or other things is the team and the organization you build and the leadership you put in place. Any part of an organization that I've seen be successful within EHR and is pretty vendor-agnostic has been successful with strong leadership and a talented team. You need the right level of talent on that team. It is worth going after the right people. A weak team or a dysfunctional leadership group can botch any vendor out there, and a strong team will make any product out there reasonably functional for our users and our caregivers.”
Listen for more
Stream the full episode to hear more insights and practical advice from Krischan Krayer, VP of Expanse Implementation & Operations at HCA Healthcare.
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