Valley Health’s Epic Journey
May 18, 2015
Hugh Stubblefield
In the 4th Quarter of 2011, Valley Health began exploring
options to replace its Electronic Health Record system.
In May 2014, we went live with Epic.
This is the story of our “Epic” Journey.
Electronic Health Record
 Electronic Health Record (EHR) - A Digital Version of
a Patient's Paper Chart
 Includes All Actions Performed for the Patient:
Registration, Documentation, Orders, Medications,
Test Results (i.e. Radiology, Lab), Billing, etc.
 Epic is the EHR Software Valley Health Implemented
Introduction to Valley Health
 Valley Health:
 Winchester Medical Center
 Warren Memorial Hospital
 Shenandoah Memorial Hospital
 War Memorial Hospital
 Hampshire Memorial Hospital
 Page Memorial Hospital
 3 Urgent Care Centers
 3 Long Term Care Facilities
Introduction to Valley Health
 Valley Health includes:
 2 Acute Care Hospitals
 Level 2 Trauma Center
 Neonatal Intensive Care Unit (NICU)
 4 Critical Access Hospitals
Introduction to Valley Health
 In 2013:
 610 Licensed Beds
 166 Long Term Care Beds
 33,391 Admissions
 204,404 Emergency Room / Urgent Care Visits
 4,840 Employees
 500+ Medical Staff (Physicians, Physician Assistants,
Nurse Practitioners)
EHR
 Series
 Patient Accounting, Registration, Billing System
 AS400
 Older Coding Technology
 Many Modifications, Unstandardized
 Clinicals
 One Vendor (Mostly)
 Un-integrated – IT Built All Interfaces Between
Clinicals, Series and Other Systems
 Vendor – Discontinuing Support of Products
Heath Care Regulations –
Environment
 Healthcare Reform
 Meaningful Use


Stage 1 in 2012
Preparing for Stage 2 (July 2014)
 ICD10 – Delayed initially, expected in October 2014
 Accountable Care
EHR Replacement Goals
 Healthcare Reform Capabilities
 Streamline Throughput – Unified Database
 Improve Data Integrity
 Improve Operational Efficiency
 Improve Clinical Outcomes
 Improve Revenue Cycle
 Improve Patient Experience
Vendor Selection
 2012 Formed EHR Selection Task Force
 30 Representatives


Cross-Functional Backgrounds
Employed and Community Physicians
 Engaged Kurt Salmon Consulting to Assist
 Experience in the Market
 Marketplace Education
 Organized the Effort
 Initial Evaluation Narrowed to 4 Vendors
 High Level Demos
 KLAS Ratings
 Vendor Fair
Vendor Fair
 August 2012 – 2 Days of Demos from Each Vendor
 Specialized Focus Groups from All Valley Health
Stakeholder Groups:
 Ambulatory
 Revenue Cycle
 Physicians
 ER
 Home Health
 Etc.
 Each Group Tasked with Completing a Standardized
Evaluation Form with Recommendations
Vendor Fair
L&D Classroom A
North Tower - Mall Level
ED Classroom
North Tower - Mall Level
Lab Conf Rm
North Tower Annex - 2nd
L&D Classroom B
North Tower - Mall Level
8:00 AM
Executive Briefing
Taskforce Committee
Day in Life Group1
ER Inpatient OR Ancillaries
Home-Health
Day in the Life Group2
ER Inpatient OR Ancillaries
Home-Health
Ambulatory Group1
Physician Office
VPE EMR UCC VPE Admin
9:00 AM
Ambulatory Group1
Physician Office
VPE EMR UCC VPE Admin
Executive Briefing
Taskforce Committee
Day in Life Group1
ER Inpatient OR Ancillaries
Home-Health
Day in the Life Group2
ER Inpatient OR Ancillaries
Home-Health
10:00 AM
Day in the Life Group2
ER Inpatient OR Ancillaries
Home-Health
Ambulatory Group1
Physician Office
VPE EMR UCC VPE Admin
Executive Briefing
Taskforce Committee
Day in Life Group1
ER Inpatient OR Ancillaries
Home-Health
11:00 AM
Day in Life Group1
ER Inpatient OR Ancillaries
Home-Health
Day in the Life Group2
ER Inpatient OR Ancillaries
Home-Health
Ambulatory Group1
Physician Office
VPE EMR UCC VPE Admin
Executive Briefing
Taskforce Committee
Room
Vendor Decision
 270+ Employees and Physicians Attended
 Based on Evaluation Responses, Narrowed Candidates
to 2 Vendors
 Further Review of RFP and Total Cost of Ownership
Estimates Indicated Finalist for Further Evaluation:
EPIC
Due Diligence
 Formed Workgroups for each Area:
 Clinicals (Inpatients and Ambulatory)
 Ancillary Departments (Lab, Radiology, etc.)
 Patient Access / Revenue Cycle
 Post-Acute Work Group (Rehab, Long Term Care, etc.)
 Analytics
 Technical
Due Diligence
 Site Visits:
 Bon Secours
 Inova
 Carillion Clinic
 Anne Arundel
 Others
 Reference Calls
 Professional Organizations (HIMSS, etc.)
 Demos (Remote and On-site)
 Colleagues / Peers
 Internet – Blogs, Reviews, Articles
Recommendation
 January 2013 – EHR Task Force Recommended
Purchasing and Implementing Epic software
 May 2013 – Final Approval to Move Ahead by the Valley
Health Board of Directors
How ?
 Cost
 Recommended Duration: 18-24 Months
 Staffing
 Expertise
 Project Team Space
Alliance with Inova – Region
Connect
 Epic Region Connect Program – Larger Healthcare





Systems can “Share” their Instance of Epic with a
Smaller System
Proposed to Partner with Inova Health through Region
Connect
Inova Completing Final Epic Implementation in June
2013 - 5 Hospitals
Valley Health Would License Epic through Inova
Utilize Inova’s Build as Much as Possible
Largest Region Connect To Date
Timing
 Epic Recommends 18-24 Months
 Ambulatory Sites Go Live First
 Stagger Hospital Go Lives
 Meaningful Use Stage 2 Scheduled for July 2014
 ICD10 Scheduled for October 2014
 Decided on a “Big Bang” Go Live on 5/30/14 to Meet
Those Regulatory Deadlines
Staffing
 “Beg, Borrow, Steal”
 Valley Health is a Very Functionally Oriented
Organization
 Where Will the Staff Come From?
 IT/Clinical Informatics/Operations
 Backfilled Essential Functions with Consultants
 CTG – Consulting Firm that Assisted Inova with Epic
 Inova Team – Supplement Staff
Certification
 Epic “Builders” Must Be Certified by Epic
 Training
 Project
 Certification Test
 Multiple Certifications for Some Applications
 3 Month Deadline for Each
 First Group went to Training on 6/1/14
Logistics
 Needed Dedicated Space for the Project Team
 Approx. 75 Valley Health Employees
 Approx. 25 CTG Staff
 As needed, 59 Inova Staff
 Training Phase Used Space at Valley Health
 “Requisitioned” Classroom Space and Office Space OnSite
C.O.V.E.
 July 8, 2013 – Signed Lease on 52,741 Sq. Foot Office
Space/ Warehouse in Winchester
 Named C.O.V.E. “Creating One Valley with Epic” after
Naming Contest
 86 Days – Converted Space into 18 Training and
Conference Rooms, 108 Cubicles; 8 Offices, 6
Conference Rooms, Break Rooms, Restrooms
 Capacity to Train 444 People at a Time
 September 2013 - Team Moved to C.O.V.E.
Governance
 Committees – Included All Stakeholder Groups At
Valley Health
 Hospital Operations, Revenue Cycle, Ambulatory,
Nursing, Pharmacy, Analytics, Etc.
 All Provided Review, Approval and Input to the Process
 Oversight Committee
 Final Review of Scope
 Approval of Change Requests
 Review of Progress and Final Escalation Point
Scope
 Big-Bang Go Live:
 4/8/14 - 18 Physician Practices
 5/30/14 - 6 Hospitals, 3 Urgent Care Centers,
Remaining 135 Physician Practices, Specialty Clinics and
Hospital Outpatient Departments
 Modules: Ambulatory, Patient Registration, Patient
Scheduling, Emergency Department, Operating
Room, Anesthesia, Clinical Documentation, Orders,
In-patient Pharmacy, Professional Billing, Hospital
Billing, Claims, Health Information Management,
MyChart
Scope, Cont’d
 Use As Much of the Inova and Epic “Model” Build as
Possible
 Reports – Validate, Revise and Build New if Necessary
 Interfaces – Replace Existing Interfaces and Build New
Ones as Needed

40 +
 Data Conversion – 5 Years of Patient Demographic and
Clinical Data One Year at a Time
Security
 Epic Security = Role Based
 Replacing Years of Entries
 Review Physician Credentialing and Privileges
 Significant Amount of Validation and Cleanup
 Distributed Security Templates to Each Department
 Completed for Each Employee
 Returned to Security Team for Build
 Security Team Built and Distributed User ID and
Password to Users After Training Completion
Devices
 Epic Recommends 17” Monitors With Dual Monitors
for Non-Clinical Users
 Replaced Nearly All Monitors for Epic Users
 Replaced Laptops in Hospitals
 Specialized Units Required New Devices



Install
Test
Integrate
 Printers – Needed to be Mapped to Departments for
Registration, Orders, Wristbands, etc.
Training
 5,073 People Completed Classroom Training
 600 View - Only Users Completed Web-based Training
 20,863 Total Class Completions
 12 Instructional Designers
 40 Certified Trainers
 900 + Super Users
 Training Was Required for All Users
 No Access without Training
 Average Training Hours Per User= 16

Up to 30 Hours for some
Testing
 Test All Devices, Integration and Printer Mapping
 Test Security – Users
 Over 268 Integrated Test Scripts
 Users, Team Tested
 End to End Integrated Process Testing
 Each Script Required to Pass Twice
Change Control
 S.B.A.R. –
 Situation
 Background
 Assessment
 Options – Required 2
 Recommendation – Prepared by Requestor
 Presented to Oversight Committee
 Reviewed and Voted On
 Changes Documented and Added to Scope Documents
Communication
 External Consultant (Inova Experience) and Internal Marketing
Lead the Team
 Committee Meetings
 Weekly
 Explained Issues, Concerns, Changes, Impacts
 Communicated To Dos, Progress and Status
 Weekly Communications to Organization
 Entity Representatives Met with Team, Communicated Back to
Entity
 E-mail Communications
 Webinars
 Newsletters
GLRA
 Go Live Readiness Assessment
 Every 30 Days Starting at 120 Days from Go Live
 Leadership and Key Stakeholders
 Each Application and Team Presented Status, Issues and
Resolution Plans


Red, Yellow Green Based on Schedule and Go Live Status
Q&A
 Encourages Transparency
 Displays Progress per Session
 120 Day – Very Red, 30 Day – Very Green
 Initial Go vs. No Go Decision after Abbreviated 15 Day GLRA
Status – Progress
 Epic Does Not Follow PMI
 Build Trackers (Spreadsheets)
 Percentages
 Milestones
 Used MS Project for Overall Schedule and Reporting
 Built Communication Plan Around Project Milestones
 Published Percentages Complete to Organization
 Published Weekly Dashboards Highlighting Positives,
Issues and Risks to Oversight Committee
 Very Transparent
Command Center
 WMC Conference Center
 Converted into Space for 100+ Staff
 Help Desk – Record Issues, Team Work Issues Based
on Priority:
 Critical
 High
 Medium
 Low
Cutover and Command Center
Cutover
 May 30 – 6:00 am
 Command Center Staffed
 Monitor Census Files are Synching


Monitor Patient Locations in Both Series and Epic
Track Orders
 Meds – Built in both Current System and Epic Pharmacy
 Labs – Update Lab Orders and Results in both Current System
and Epic
 Downtime at 9:00 pm to Complete and Ensure the
Synch
Go Live
 May 31, 2:07 am Cutover Complete –
 Valley Health CEO On-Site Made the Final Go Live
Decision
 Live on Epic!!!!
 Command Center Open for 30 Days:


24x7 for Two Weeks
12x7 for Two Weeks
 No Critical Issues Reported
 Few High Issues Remained at End of Command Center
What Now?
 2014 Upgrade – 5/9/15
 Live on Version 2010, Inova Delayed 2012 Upgrade for Valley
 Governance (Valley and Inova)
 Relationship
 Issue Prioritization
 Direction and Decisions of Future Modules
 Optimization
 Managing Requests
 Prioritizing Requests
 Staffing
 Correct Size
 Proper Skill Set
Questions?