How to Plan for MEDITECH Expanse: Tips from 40+ Hospital Implementations

Every hospital EHR implementation has different requirements and considerations due to the uniqueness of the hospital services. Through implementing MEDITECH Expanse in over 40 hospitals, I have developed this list of key lessons learned that will help any hospital gain a head start preparing for MEDITECH Expanse. 

Prepare for the Project 

The initial start of Expanse discussions until “go live” day can go by in a blink of an eye. The beginning of a project is always a bit slower as teams are being established and workflows are being defined. The last few months are the busiest as training is in full swing and sites prepare for go live. 

For this reason, I highly recommend taking advantage of months prior to the project kickoff and those early project months to gather information about your specific hospital(s) that will help guide the scope of the project.  

Gather information to help you prepare, beginning with these important areas: 

• Third party vendor integration list with signed contracts (vital sign monitors, fetal monitors, imagining, anesthesia, etc.) 
• Compile list of build requirements for each department (nursing, respiratory, physical therapy, occupational therapy, speech therapy, infusion clinics, medications that need assessments and reassessments, paper documentation that should move electronic, care plans, surgery procedures, surgery preferences card, imagining exams, order sets, quality measures, etc.) 
• List of charges within each module or department 
• Identify the departments that will use each application 
• Define project resources and ensure resources are allocated to cover each service line 
• Establish access to file sharing and communication platform used hospital wide (email, file sharing and collaboration tools like SharePoint, Teams, WebEx) 

Determining the above information as early as possible will set your project up for a successful, organized implementation. This will define the scope of each department and the resources needed to optimally build the system for a department. 

Outlining the specific department needs will help drive your project resource list so you can ensure you have the right staffing level assigned to each area. For example, one PCS resource may not be able to handle the workload if your hospital has a robust build for labor & delivery, med surg, ICU, respiratory therapy, occupational therapy, infusion clinic, etc.  

Build Tracking Tools 

This may sound simple, but using a build tracking tool may have one of the largest impacts to an EHR implementation. 

MEDITECH provides some project timeline tracking tools, which are a great start. In addition, CereCore has incorporated more granular project management tools that include prerequisites, build percentages, outstanding task and deadlines, as it aligns all MEDITECH applications and vendor needs.  

In my experience, Expanse project core teams have found great value in this detailed level of tracking. This has improved organization and created a clear overview of the project to-do list including where the project stands as milestones approach.  

Lessons Learned and Project Plan/Considerations

MEDITECH delivers great evidence based standard content in Expanse. This is an excellent foundation for an updated EHR. Content including assessments, queries, and data elements items were always heavy lift areas that take more time to review, and customization maybe needed to meet the requirements of your hospital.  

Below are the areas that need more time, energy and focus to review and optimize. Many healthcare systems overlook the larger effort needed in the beginning of their projects.  This leads to dissatisfaction and poor usability post-live.  

I have worked on many “Post LIVE Optimization” projects with the goal to improve workflows and build components that never got the detailed attention needed during the initial implementation. This list is aimed to ensure your hospital has the most optimized system prior to live which will reduce changes needed post live. 

1. Review care order set and care plans 

Zynx Health is the required vendor for order set and care plan content. Here are a few things to know:

• The delivery of care plan content into MEDITECH from Zynx creates duplicates. The positive side of this is there are robust care plans to choose from in Expanse.
  

Consideration: To prepare for optimizing care plans, identify a resource who will review care plans, problems, outcomes, and interventions to determine what needs to be inactived and identify any additional care plans to build. 

• The Zynx AuthorSpace order set website and MEDITECH do not interface. While it may have in the past, this actually solves many issues that the interface caused prior.  

Consideration: Without the interface, Zynx and MEDITECH order sets do need to be dual maintained if your hospital chooses to utilize the Zynx AuthorSpace website to its full capacity. While collaboration between IT, pharmacy and physician champions is needed throughout the Expanse project, it is a great tool to communicate build recommendations and edits. It is also an incredible tool for downtime order set forms. 

2. Review standard content and allocate adequate time for resource approvals 

• Reviewing and editing PCS intervention standard content is a large lift requiring many hours of attention from each department that will be utilizing PCS. This is often underestimated in the resources and timeline of projects.  

• Similar to PCS, the Emergency Department (EDM) must review chief complaints and assessment standard content. It is important to keep in mind that shared queries and documentation sections are beneficial in trending patient data in your system.  This also requires many hours of department input to ensure all requirements are met. 

• All departments must provide input and approvals of their trackers, status boards or patient list to ensure they have information needed, clearly displaying at a quick glance. It is recommended that leadership from each department sign off on the final build. 

3. Assess level of effort and plan for manual build items 

• Surgical procedures and preference cards are manual build so it is important to consider the number of procedures and preference cards your hospital will use. This will determine the level of effort needed for build.  

• The team will need to determine which drugs will need to include an assessment and reassessment screen displayed on the electronic medication administration record.  This is a manual build, so level of effort can differ depending on the number of drugs that will need be modified.  

Key Benefits of MEDITECH Expanse 

Expanse has had some great improvements over the years and MEDITECH continues to make improvements with every service release and priority pack update. Below is a list of new functionally that hospitals have reported great satisfaction:  

Improved Communication of Patient information

• Widgets are fully customizable screens that can be set to display information pertinent to a specific access group in the chart summary screen, patient summary screen, pre-admission testing home screen and handoff. 
  

• Universal patient medical, surgical social and family history streamlines the patient history to be viewed in one place hospital wide and integrates with MEDITECH ambulatory improving continuity of care
  

• Improved integration of the surgery application to Integrate with all other applications and close all information gaps
  

• Easy communication and surgery scheduling with the surgery electronic authorization and ambulatory-surgical booking requests and auto pre-registration functionality
  

• Pre-Admission Testing Home Screen to track and view patient information and calls 

• Bed board is an electronic admission request process which reduces phone calls and increases electronic communication. Admission order, bed criteria, and bed reservation Information flows to registration, house supervisors and/or the bed management department electronically.   

• The handoff functionality can be used in PCS, EDM and SUR built as a central location to display patient information needed to be viewed quickly during handoff via widgets as well as a place handoff notes can be written including canned text and/or formatted data. 
  

• Universal discharge routine streamlines the discharge process throughout hospitals while allowing them to customize which fields display and can be viewed and/or edited in the discharge based on registration type, patient disposition, and user access.
  

• Patient Portal questionnaires are available to gather patient information via the patient portal 

Improved Electronic Documentation Features

• Physical and occupational therapies can utilize the benefits of physician documentation (easy physician signing) while also using nursing assessment for charge entry. This is all accessible through the PCS application.
  
• Standard content in MEDITECH expanse is robust. Generally, the feedback from hospitals is satisfaction with the delivered content.
  
• Electronic medication (MAR) and blood (TAR) administration 
  
• The Surveillance module has great functionality to monitor patient conditions and integrate with nursing and provider status board via indicators. Read about Expanse Surveillance functionality and how to improve patient monitoring and outcomes. 
• Labor and Delivery Suite can be purchased for additional MEDITECH functionality tailored towards integration of mom and baby’s chart, 3rd party fetal monitoring and NICU care documentation  
• Critical Care Flowsheet can be used to documentation assessments and titrations, all in one flowsheet screen
  
• Automated call lists can be set up in EDM, SUR, and case management based. The process has enhanced with web screen overlays, integration with the SUR Pre-Admission Testing Desktop (PAT) and custom assessments linked
  
• ED triage routine can be customized with the flow and fields available for documentation  

So, get a head start on preparing for your MEDITECH Expanse implementation before the project even kickoffs. This extra preparation will help with the overall satisfaction and success of your Expanse implementation and ensure the project workload is evenly dispersed throughout the core team and project timeline.  

Takeaways and Next Steps 

• Early on, gather as much information as possible from third party vendors to build requirements 
• Define the scope of each department, resources needed and time required.  
• Pay close attention to the review order sets, care plans, standard content and manual build items 
• Evaluate new functionality that could provide satisfaction and operational efficiencies 
• Learn more about the Surveillance module in this blog Surveillance Watchlists: Proactively Monitoring Patients
• Consider an EHR assessment to help you prioritize ways to maximize your investment