A highly customized EHR in need of costly updates challenged the new CIO at Oklahoma Heart Hospital to evaluate the technology stack he inherited and chart a new course at this award-winning healthcare organization. The OHH story is one of analytics and efficiency offering important lessons for healthcare CIOs considering a major technology transition on an ambitious timeline.
In a recent episode of The CereCore Podcast, David Miles, CIO of Oklahoma Heart Hospital (OHH), and Jim Wetzel, the facility’s director of clinical systems, shared valuable insights from their recent Epic implementation – an implementation that was completed in just 11 months (earlier than the 12-month goal established at the onset of the project).
Stream the episode for the full conversation.
It Started with a Decision to Change
Upon his arrival as the new CIO, David Miles initiated an evaluation of the OHH vendor partnerships to inform the IT strategy at an organization where the EHR (Cerner Millennium) had been in use for twenty years. He discovered the organization faced challenges scaling and supporting their highly customized EMR. An evaluation of maintenance costs revealed an unsustainable need for specialized expertise to continue with their current EHR, and the journey to an Epic EHR began.
Keys to Success
The OHH team assessed all of their applications, but started with their EMR given its number of users and potential for impact as the system with the most users across the organization. These were some principles they used to guide their decisions.
1. Keep it Simple: Miles emphasizes sticking to features and functionalities that will actually be used, avoiding over-customization.
“If you were to ask me what does the key IT decision-making process look like, I would tell you keep it simple. Stick to the features and functionalities that your organization is going to use because there's bells and whistles in everything. A lot of them you won't use. So stick to the ones that you're going to use. Make your buy decision based off what's already in the product, not what they're promising you is going to be there,” said Miles.
2. Standardization: Ensuring all strategic business units operate uniformly is crucial for system effectiveness.
“The resounding thing that we heard, even just prior to making the decision, was less clicks, more revenue,” Jim noted as he emphasized the importance of clearly defining success for major projects. For their Epic implementation, maintaining efficiency without added staff or costs was a primary goal.
3. Efficiency Focus: Success was measured by maintaining operational efficiency without adding staff or costs.
“Over the 20 years we've been an organization, again, part of the success of OHH has always been our ability to react to changes in regulatory posture from the government, changes in consumer behavior, changes in the way our physicians and staff provide care, medical technology, advancements that shift procedures from in to out, things like that. So part of our success has been our ability to respond to those quickly via enhancement in our EMR. At one point we had a group of 10 application developers that were doing nothing but writing custom code for EMR. But, again, that comes with consequences,” stated Miles.
4. Interface considerations: OHH completed the implementation in just 11 months, demonstrating that an aggressive timeline can be achieved with proper planning and execution even when numerous interfaces complicate the project.
“For all the nights that I tossed and turned worried about how we were going to connect 128 different interfaces and make them all work, I do have to give a ton of credit to the project team that CereCore put together for us. The interaction that Jim and others from Epic had with that group of people. We literally, I mean, I can't think of one major interface issue we had,” said Miles.
5. Stakeholder Engagement: Building consensus among leaders, including the CFO, was important to OHH success. In their case, the CFO championed the value of the integrated revenue cycle in Epic and was a strong proponent from early on.
“This [Epic implementation] to me was the great reset. We ran on an EMR system for 22 years. We developed lots of bad habits and lots of good things, too. We had lots of success. But for me, this was the point at which we could say, okay, where were the problems? Can we mitigate them with this project, this implementation? And can we have a better path forward? And I think we did that. We quantified that stuff up front and we measured it along the way and even sent a synopsis recently off to some of the senior leaders to say, this is what we actually accomplished besides that new interface that you're looking at,” said Jim Wetzel.
For more information, listen to the podcast where you’ll learn about challenges and surprises during the implementation, post-implementation focus areas for OHH, and the OHH team’s advice for healthcare leaders.