How to Transition from MEDITECH Legacy EHR to Expanse

For the past 40 years, MEDITECH Magic has been a stable, cost-effective electronic health record solution for healthcare organizations. But, Magic is an aging technology that eventually will represent more compromises than value: potential security risk, lack of performance, limited integration capabilities, and so on. Now is the time for healthcare information technology (HIT) leaders to begin planning for their next EHR technology.  

Several healthcare industry pressures are driving an EHR platform change.  

1. HCA Healthcare, one of MEDITECH’s largest customers, is beginning to implement MEDITECH Expanse, an effort slated for the next 5 years, touching approximately 160 hospitals. This will be a significant change in the MEDITECH Magic customer base.  
 
2. Only regulatory and patient safety changes are made in Magic. Future investment in Magic is unlikely and impractical. For example, Surveillance in Magic has not been enhanced since the initial package delivered a few years ago. Magic customers could anticipate incentives to upgrade. 
 
3. Healthcare operations, care providers and patients need more from an EHR than Magic can provide. The capabilities were good for its time, but now the EHR needs to be integrated across the care continuum from acute to ambulatory.  
 
Today’s clinical team and providers expect the EHR to have web-based user interfaces and efficient workflows. Clinicians and physicians want business Intelligence (BI) and near real-time decision support to help aid their clinical judgement process. What’s more, several clients report having a modern EHR platform can be a recruiting differentiator for providers. Patients expect a consumer-like experience and want online access to their health information and more.  

4. The IT staff who helped implement and maintain Magic are aging out of the workforce or perhaps retiring. Even if the Magic platform was not on borrowed time, those knowledgeable IT professionals are hard to find, especially in rural areas where Magic is still the predominant EHR solution. There is a risk in waiting too long to upgrade, especially when it comes to capturing the institutional knowledge that your long-term EHR experts will have to share throughout the implementation process. 

A starting point checklist: Moving from legacy MEDITECH to Expanse (or most any other version or EHR platform) 

HIT leaders needing to move from Magic to Expanse will need to develop a thorough plan to avoid unnecessary costs and disruptions to hospital operations. While there are always unforeseen variables that might be out of your control, here is a checklist to get you started: 

Evaluate your options 

Decide whether or not your healthcare organization should evaluate other EHRs or continue with MEDITECH and move to Expanse.  
 
Research which EHR infrastructure hosting model will be the best fit for your organization. The options include self-hosting or on-premises hosting, hybrid cloud, and software as a service (SaaS). Compare these options in The Buyer’s Guide to MEDITECH Hosting.

With MEDITECH Expanse, you would need to weigh the pros and cons of virtualizing from the licensed version of the application or subscribing to MEDITECH as a Service (MaaS). Factors to weigh include hospital size, IT resource expertise and bandwidth, and need to customize your instance. 

Finding a trusted partner with clear expectations defined in the contract is vital for your healthcare organization. Unfortunately, we have heard too many stories of customers who were trying to function under poorly defined Service Level Agreements (SLAs), were shocked by unexpected costs, or were burdened with responsibilities because they did not fully understand the infrastructure and hosting agreement.

Be realistic about your timeline.  

A well thought out and planned buying process can take 12 months or more. Rushing an implementation puts your organization at grave risk. We can cite dozens of examples of how a failed implementation sunk a healthcare organization and the executive team.  
 
If your organization is evaluating EHR options and partners, then the RFP process can take six months (maybe longer), depending on how detailed your request is and what is in scope.  

You’ll need to participate in demos, potentially site visits, reference calls and contract negotiations. Plus, you will need to go through your internal budget and board approvals.

Consider engaging a reputable firm to help with that EHR selection process.  

Since the EHR is the backbone of your HIT, this decision should be deliberate and thoughtful. For many, such a decision is often made only once or twice in a career.  

CereCore is EHR agnostic, because we provide IT services for each of the leading EHR platforms. Find a healthcare IT partner who can help you from an advisory perspective through the EHR selection and with negotiating terms. 

We have advised numerous health systems through the EHR selection process, and we do so through the lens of our 30+ years of healthcare operations and EHR implementations background. Let's talk and see how we can help you navigate this significant technology investment, too. 

Request a Current state and risks assessment.   

Understand the cost  

The cost model to operate today’s modern EHR like Expanse is very different from MEDITECH Magic or other legacy EHRs. Modern EHRs require more computing power, more servers, more integration, more support—really more of everything. That's why it is really in the best interest of your healthcare organization, your care providers and your patients to get advice from an experienced MEDITECH implementation services partner who can help you determine what you really need to have a successful to go-live.  

Contact your MEDITECH representative early in your planning and evaluation phase to get a comprehensive understanding of what it might cost to move to Expanse.  

Engage a HIT partner and perform a total cost of ownership (TCO) assessment.  
 
Before you decide on an EHR infrastructure hosting model, or invest in new hardware, let our experienced healthcare hosting team who are specialists in MEDITECH solutions and support help you complete a comprehensive MEDITECH hosting TCO.

Don’t skip this analysis because determining which hosting and infrastructure model needs will best fit your organization will inform your budget for the EHR transition. Whichever path you choose, it is a huge decision. There are quite a few “gotchas” that can be costly to your organization and your reputation as a HIT leader.  

Prepare for the transition to a new EHR 

Once you have determined you are moving from a legacy MEDITECH application to Expanse (or other EHR), there is plenty of work that can be done to prepare for an install. 

Identify what success looks like. Gather KPIs from each department so you know what is important to them and can measure success.

Embrace the change. Implementing a new EHR means the same old model and approach probably will not work for you and your staff this time. Standardization is great and should be a goal, but cookie cutter approaches seldom work in the real world.  
 
Choose an implementation partner who will engage with your team and talk through options and recommendations rather than dictate a path.

Establish a baseline that you can measure against at different points in time post go-live to ensure you are hitting your goals or at least trending in the right direction.

Take an inventory of reports and identify what truly is needed for go-live.

Start to clean up your master patient index (MPI).

Contact third party vendors early in the EHR transition process. Moving from one version to another will have consequences so it is best for all involved to notify vendors of your plan, what needs to be relicensed or what services will be needed in the future.

Develop a communication plan to help educate and inform constituents as to what is coming and why it will benefit them. Early communication about why this EHR change will help them will help create a connection to the larger purpose—it’s much more than an IT project. 

Establish effective project governance 

What governance should you make sure you have in place? How do you make sure you have the right people involved across clinical and hospital operations? Here’s what we tell clients: 

Define your governance teams: roster of participants, roles and responsibilities, and set expectations. 

Some of the common components of project governance include executive sponsorship, core teams, governance teams, and advisory groups. 

Executive sponsorship. An EHR implementation project is not an IT project but a clinical IT project. Having an executive sponsor who has a clinical background will help ensure clinicians have an advocate who keeps patient safety and clinician satisfaction top of mind.   

Core teams. The brunt of the EHR implementation project work is done by core teams and they are focused on applications and workflows. As applications become more integrated, core teams have started organizing around work streams and workflow instead of a specific application.   

Governance teams. Governance teams should help your organization navigate project planning, roles and responsibilities, decision making process, communication processes, and more. For example, are we going to use similar data to what we had in the old system? Are we going to rewrite how this works or what it integrates with? How could this department benefit from workflow changes?  

Advisory groups. Communication is important to engage physician, clinical and financial advisory groups so that the EHR can be designed and implemented in such a way that it supports their needs. Each specialty may have a slightly different approach to workflows and using the system. Be sure the right people are involved and empowered to drive decisions. 

Steering committees. Typically, the steering committee focuses their attention on things like the budget, project scope and overall timeline, appropriate evaluation criteria. They are also usually the team responsible for monitoring key performance indicators and metrics, and they need regular involvement in the EHR implementation project.   

Explain to stakeholders and participants why project governance is important.  

Project governance helps stakeholders—from executive leadership to clinical department managers, revenue cycle experts, HR and others—understand what's going on, have ownership and responsibility for specific parts of the project that will affect them, facilitate decision making, and resolve conflicts.  

Create a governance meeting schedule that makes the most of everyone’s time.  

Governance meetings ebb and flow, often held frequently at the beginning of the project, tapering off during the throes of the project and ramping up again before go-live.  

The more effective and relevant the governance meetings the more likely your project governance will be effective, too. When governance council meetings are canceled, executives or other decision makers don’t attend, the governance framework will crumble, and the project will suffer. 

Bottom line 

• When project governance isn’t strong, experienced, or healthy (lack of leadership, communication or staffing), then we often see projects begin to run into delays or they don’t achieve the original scope and goals.
  
• You don’t know what you don’t know. Many senior leaders go through one or maybe a handful of large scale EHR implementations. You’ll want to ensure you have an airtight budget that won’t find you going back to the CFO for more money. (It could damage your reputation or blemish your career.)
  
• Investment in an EHR is a long-term commitment. An EHR transition and implementation will take longer than you think. Start planning, getting ready, and learning all you can now. 

More resources 

eBooks on MEDITECH

• The Buyer's Guide to MEDITECH Hosting
• MEDITECH Expanse Ambulatory: Move Your Organization Closer to a Single EHR
• The Path to MEDITECH Expanse: Why Your Organization Needs a Single EHR

eBook on Staffing. Not sure how to manage the staffing conundrum of an EHR transition? Managed services and contact staffing could help. Dive into the pros and cons: Managed Services Versus Staffing Decision Guide.

Physician interview about MEDITECH Expanse implementation. Stream this episode on The CereCore Podcast—A Physician's Perspective: How Healthcare IT Bridges Gaps and Helps Patient Care.

MEDITECH Resource Library. Find demos and videos that can help you see MEDITECH features in action from our Provider’s Medical Center (PMC) sandbox environment. 

Advisory services. Tap into advisory services from system selection to negotiation know-how and fractional leadership.