For the past few years, health systems across the country have been stuck in constant implementation mode, and Chesapeake Regional Medical Center is no exception. So when the organization made the decision to migrate to Epic, leadership decided to leverage the expertise of a seasoned user, which would enable Chesapeake “focus on innovation instead of just putting in systems.” In this interview, Deans talks about his team’s Epic rollout strategy, their big plans with big data, and their “dynamic” multi-year business plan. He also discusses his leadership style, why it’s important to strive for perfect, and why anyone who isn’t nervous about ICD-10 is either “very impressive or naïve.”
- About Chesapeake Regional
- Migrating to Epic
- Flexibility with go-live — “We’re not trying to meet a date for the sake of meeting a date.”
- Epic Connect model with Good Help Inc.
- Biweekly meetings – “We want to be nimble.”
- Focus on workflow and process improvement
- “Don’t let perfect be the enemy of good.”
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It’s a date that we’ve put out there as a target. I think our intent and goal is to go live when it’s time, it’s appropriate, and we’re ready to go live. We’re not trying to meet a date for the sake of meeting the date.
Putting in systems is painful. It’s burdensome. It’s cumbersome. It’s exciting as well, but it detracts from some of the business focus.
Our executive suite and the board really value technology as an investment, not necessarily as an expense, and there is a pretty big differentiation there. We understand that it’s one of the keys to business success in our industry.
We wanted to be a little more nimble than that, so that’s where the biweekly model comes into play. We can react pretty quickly.
Even though I’d say, much to our chagrin, we’re seasoned pros with implementation, this really is a different model for us that we’re rather accepting of and pretty excited about.
Gamble: Hi Ken, thank you so much for taking the time to speak with us today.
Deans: Thanks for having me.
Gamble: Sure. To get things started, can you talk a little bit about Chesapeake Regional — what you have in terms of the hospitals and some of the other services, and where you’re located?
Deans: Chesapeake is in the lower southeastern corner of the state of Virginia. We are an independent health system. We’re actually what’s known as in the Commonwealth of Virginia as a hospital authority. That means our organization was created through an act by the state legislature nearly 40 years ago now. And so our board of trustees is a little bit unique in that it is appointed by the city council from the City of Chesapeake. So we have a quasi-government touch point from that perspective, but from there down, the organization is its own full 401c3 nonprofit organization. We’re located here in Chesapeake, a coastal community consisting of a medical group and a core hospital with all the typical services you would find surrounding a medical center — home care, hospice, nursing care, etc. We’re a really robust, family-friendly, very community-oriented nonprofit organization here in the Commonwealth of Virginia.
Gamble: How many beds in the hospital?
Deans: 310 beds.
Gamble: As far as seasonal volume, does that impact you at all?
Deans: Believe it or not, not so much. We are a co-owner of a hospital down in the outer banks area of North Carolina, which is owned by a close neighbor, Vidant Health. That organization really is in a travel area, so they do see a fair amount of seasonal volume. But for our organization, we have a pretty constant volume. We certainly have some seasonal volumes like most organizations have, but none due to tourism. We’re pretty constant there. There are a lot of other healthcare entities within our region, and we have a pretty large medical staff that’s just under 700 credentialed physicians. So we stay pretty busy, actually.
Gamble: In terms of the clinical application environment, Chesapeake is in the process of going to Epic, correct?
Deans: Correct. We’ve been with our current vendor, our core vendor, for about 6-7 years now, and in some areas of the organization, that partner has been around for 10-15 years. But we are one of the few within our region, and frankly almost within the Commonwealth of Virginia, that are not on Epic. And because we have such a large physician population that is practicing at many different entities throughout the region, we feel that it’s really time — Epic has matured to a level where we’re comfortable taking it on, to move it into our organization at this point in time. We’re pretty excited about that.
We have about 8, 9, 10 months of implementation ahead of us. We have a tentative go-live for February 28, 2016. I think we’ll see how we roll out with that date. That’s the date as it stands now, but it’s a date that we’ve put out there as a target. I think our intent and goal is to go live when it’s time, it’s appropriate, and we’re ready to go live. We’re not trying to meet a date for the sake of meeting the date. We have just put that out there as a legitimate real target for us so if we can meet it, we will, but we won’t go live either prematurely or even then if it doesn’t feel right, so to speak.
Gamble: And as far the implementation strategy, how did that work? Did you go ambulatory first?
Deans: The strategy we currently have will be system-wide. It’s akin to what’s known in our industry as the big bang go-live. At this time, we still have ambulatory focused on that same timeframe. As we get a little further into the implementation, we may modify that slightly. Is it 60 days beforehand? Is it 60 days after? I think that’s yet to be determined, but in general, that is the approach, with one caveat. When I say big bang, that is referring to most of the inpatient areas. It is not all of the ancillary systems. For example, laboratory and home care will not be brought up simultaneously. We’ll focus on phase 2 for some of those areas, but the core inpatient system and most of the supporting components, as well as the rev cycle financial side of things and patient access, are all contemplated as part of that.
Gamble: What about training — how are you approaching that? Will you do any type of site visits at other facilities that are using Epic?
Deans: I should talk a little bit about our selection process in so far as how we’re advancing Epic. Originally, we talked to Epic in the traditional way, what’s known as the Epic Direct model. But we also, in our conversations with them, became aware of what’s known as Epic Connect. And this is a model that’s not dissimilar to a group purchasing power-type scenario where one might consider finding another partner who is already a larger Epic customer and contemplating riding on their back bone and their structure, taking advantage of group purchasing to reduce some of your licensure costs and leveraging some of the their build knowledge and history. And so really, instead of what’s known as Epic Direct, you’d have a connect model where you’re partnering with somebody who’s already done it. So after a lot of thought and analysis and after we spoke to a few entities out there that could potentially offer those to us, we did select the partner and have chosen to go with the Epic Connect Model, and that’s through an entity known as Good Help Inc, which is subsidiary of Bon Secours Health System based out of Richmond, Virginia. They’re really helping guide us through that process.
We’ve been in the business of implementing, it seems, every year, especially since we’ve been in an era of Meaningful Use and constantly adding new capabilities and new systems or modifying systems to support all the new requirements. I really wanted to get out of the business of implementing purely and find a quicker time to market model so we could really focus on innovation instead of just putting in systems. Putting in systems is painful. It’s burdensome. It’s cumbersome. It’s exciting as well, but it detracts from some of the business focus in many instances, and so we felt like this was a quicker way to get the system in, get Epic in, and forego a lot of that “tweaking” that occurs for some period of time with any application, even post-live for several years.
In our model, we will take the Bon Secours build pretty much as it stands today, and then modify those areas that are unique to us. For example, many institutions may have different accrediting bodies, which is the case with us. So there’ll be some modifications there, as you would expect, to support those requirements. But we really felt like it was a model that would save us some expense upfront; what is certainly very important today is protecting the treasury in any healthcare organization across the US, but I think even more importantly, really improving the delivery of the go-live product and leveraging the knowledge of somebody who has already gone through the painstaking process of implementing, modifying, implementing, modifying, etc. Hopefully, we will avoid a good portion of that and just start from precisely where they’re at after nearly a decade of experience.
Gamble: Just as far as that communication with them, is there a specific group on your end who’s tasked with that?
Deans: We definitely have a very strong governance model. It’s not dissimilar I think to what most organizations put in place anytime they undergo a significant implementation such as this. It includes starting at the very top of the hierarchy. I’m very fortunate to have really strong board support for technology. I think our executive suite and the board really value technology as an investment, not necessarily as an expense, and there is a pretty big differentiation there. We understand that it’s one of the keys to business success in our industry, and so I think we have that strong support at the very top levels.
Then when you move down from that, we have a traditional IT governance model, which would include a steering committee that’s comprised of the entire executive team, as well as other key stakeholders. These key stakeholders come from the next layer of the model, which includes a series of just under a dozen work groups which really as the entities responsible for the implementation across the house. This includes the rev cycle team. This includes a physician advisory council. You go through each discipline and there’s a work group surrounding that. There’s specifically a go-live work group and a work group that provides training and education for the house. Each of the chairs and co-chairs for those sub committees are also permanent members of the steering committee.
The body of work really happens at that work group level throughout the organization, but we really feel it’s important to have that collective steering committee meeting biweekly to be there just to support these work groups, or break down any barriers that may exist. When there are big hairy decisions that have to be made, they’re there to really dialogue over those and come to a decision pretty promptly. I mentioned that the steering group will meet biweekly, that’s with some intent. Traditionally with some organizations, you’ll have these higher level entities meeting monthly. In some case, I’ve even seen quarterly where you have a really large, multifaceted implementation.
In our interest, we felt we wanted to be a little more nimble than that, so that’s where the biweekly model comes into play. We can react pretty quickly, and if there are ad hoc things that come up, we also have the luxury of the executive team already meeting weekly. So whomever of us needs to bring something to the collective body or the team, we have that avenue as well.
Gamble: I would think the strategy to use Good Help played well with the users, just as far knowing that they’re dealing with people who were in the same spot and can deal with some of the tougher questions or maybe even be a little more honest.
Deans: I would say the organization as a whole and the individuals within it — all of us as employees — are quite excited and quite enamored. Because we’ve done implementations before; it’s not as if we are a small organization that’s coming from paper to the electronic world. We’ve been electronic for quite a while, a couple of decades here at this organization, with multiple different partners over those years for that. We’re very aware of all the latest and greatest requirements. We’ve done most of our Meaningful Use attestations and have stayed on track with that. We’re early out of the gate, even pre-Meaningful Use, and focusing on some of our advanced capabilities such as electronic order entry. The organization knows what an implementation is all about. I think this was an excitement to have a little bit of extra insight to a new partner that we’ve never worked with before in exactly how that application in those systems work and how they work they together, how they interoperate.
I think this implementation is a little bit different than probably those we’ve done in the past. Your typical install or implementation involves not just workflow analysis, but building screen customization, interactions in between, multidisciplinary areas. We feel pretty excited in that most of that will come, to a large degree, pre-built for us, so we’re spending most of our implementation in fact focusing on workflow and process improvement. You always do this to some degree, but there never seems to be enough time. That old mantra, ‘don’t let perfect be the enemy of good’ — we’ve been there before. We’ll say, ‘we’ll catch those post go-live and post implementation.’ We’re pretty excited. This time, we have an opportunity to capture most of that upfront and with the new technology. Part of it is learning what our capabilities are with the new software versus the traditional model. Even though I’d say, much to our chagrin, we’re seasoned pros with implementation, this really is a different model for us that we’re rather accepting of and pretty excited about.
Gamble: Yeah, and moving closer to that optimization mode and like you said being able to focus on innovation and not just the ongoing implementation that never ends.
Deans: Yeah, precisely. That’s it.