We often hear about the disadvantages of being a small, rural organization: smaller budgets, challenges recruiting top IT talent, and sometimes, a poor telecommunications infrastructure. What often gets lost in the shuffle are the benefits, one of which is being able to know every staff member, which can help leaders to better understand what keeps everything ticking, says Daryl Kallevig. In this interview, he talks about partnering with Allina Health to implement Epic, the workflow redesign required when switching EHRs, and strategy he used to communicate with his team during the rollout process. Kallevig also talks about why patient engagement is critical for rural facilities, what his team is doing stay “on top of our game,” and his interesting career path.
Chapter 2
- Big-bang with Epic — “We believed the organization was ready.”
- Anticipating revenue hits
- Managing frustrations with an EHR switch — “Change is difficult, but we had to address it.”
- Revation’s call center app
- Patient satisfaction — “We have to make sure we’re on top of our game.”
- Cons of being a rural organization
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Bold Statements
We believed the organization was ready to make that big of a move rather than try to piece-meal the go-lives or transition go-lives at various times. We decided that a big bang was the best way to go, and it worked out very well.
We did anticipate that revenue would drop a little bit, but we’ve exceeded those expectations and we’ve been getting bills out the door pretty much on time. We actually had a good revenue month for the month of April, and that’s really telling.
They definitely understood the ultimate goal, but still, change is difficult for people, regardless of what position they’re in.
We not only take into account internal recommendations and ideas, but also those of our patients as well. It’s pretty frustrating if you get transferred from one area to another multiple times and never really reach the person you want to talk to or need to talk to. That’s one of the things that we tried to accomplish with the Revation solutions.
We have a pretty fixed patient base within the county of Aitkin. And so we have to make sure that we’re at the top of our game and trying to do things right so some of these larger systems don’t come in and pull patients away from us.
Gamble: Did both acute and ambulatory go live at the same time?
Kallevig: Yes, it was a big bang implementation. And that included our two outlying clinics too, so all three clinics, the hospital, and all of the hospital-based departments all went live at the same time.
Gamble: Looking back now, do you feel that going big bang was the right way to go?
Kallevig: Yes. It would have been difficult, I believe, if we did not do it all at the same time.
Gamble: But certainly each way has its challenges.
Kallevig: It does. We believed the organization was ready to make that big of a move rather than try to piece-meal the go-lives or transition go-lives at various times. We decided that a big bang was the best way to go, and it worked out very well for us. I myself cannot complain at all.
Gamble: I suppose if it were the wrong decision, you’d already know by now.
Kallevig: Yes, and actually, even from a revenue stream. For the go-live, we did cut back on physician schedules and appointments by 50 percent the first week, and then if they were ready to expand their schedules, they could do that upon their choice after the first week of go-live. Many of them did that; within three weeks, we were back up to full capacity for patient appointments and essentially, we were back in full operational mode in three weeks.
From a revenue stream perspective, it turned out really well, too. We did anticipate that revenue would drop a little bit, but we’ve exceeded those expectations and we’ve been getting bills out the door pretty much on time. We actually had a good revenue month for the month of April, and that’s really a telling sign too that things did go well.
Gamble: Yeah, definitely. That’s about as good as you can hope for, and having physicians have the option to go back as soon as a week seems like it makes sense because different offices and facilities are going to adjust differently.
Kallevig: When I started here back in February of 2011, they had already made the decision on an ambulatory EHRs, so back in May of 2012, we implemented the eClinicalWorks application on the ambulatory side. The prior one was just causing a lot of frustration and we had some data integrity issues as well. The incentive was to get out of that, and so I jumped right into that when I started. Our new wanted to get to a single EHR, so we planned that out and proceeded down that road.
Gamble: Okay, so it was a couple years that eClinicalWorks was being used?
Kallevig: It was three years.
Gamble: With the physicians, was there some frustration about them having to switch to another system or for the most part, did they understand the ultimate goal?
Kallevig: They definitely understood the ultimate goal, but still, change is difficult for people, regardless of what position they’re in. So we had to go through that — and I wouldn’t call it a battle, but we had to address that from even a physician perspective, because it was still recent in their memory as far as our past go-live, which again went very well, and it was a good application. So from an ambulatory clinic side, we did not realize a whole lot of improvements by going from eClinicalWorks to Epic, but they are very similar from a functionality standpoint. It’s just that how they do it was different.
Gamble: Okay, so a lot going on there on that side obviously. I also wanted to talk about the unified communications system you have — what the goals there, and what you hope to accomplish with this?
Kallevig: Unified communications is something we have been doing that for a bunch of years. Revation is the solution that we used for unified communications; I think we’ve been in that agreement for probably seven to eight years now, and we’ve kind of evolved through that over the course of the last few years here in the way it’s being used.
Predominantly, it is our call center application that manages all of our calls for patient appointments, changes to appointments, or cancellations. And then we’ve expanded its use to include our prescription refill nurse if patients call in relation to billing questions, medical record requests, and messages for our physicians so that those calls are routed to the correct person the first time they call. That’s done using an automated attendant at the front end of the call, and then they just select option 1 to 5 depending on who they want to talk to at that time.
Gamble: It’s certainly obvious as to why there’s a need for unified communications when you’re talking about the amount of information that’s passed back and forth and the channels it has to go through. How do you stay on top of that strategy? You said it has evolved, so is it really based on the clinicians and their changing needs?
Kallevig: To a certain extent, yes, and then some from patient suggestions and things like that. We not only take into account internal recommendations and ideas, but also those of our patients as well. It’s pretty frustrating if you get transferred from one area to another multiple times and never really reach the person you want to talk to or need to talk to. That’s one of the things that we tried to accomplish with the Revation solutions, and it’s done really a pretty good job for us.
Gamble: That’s an interesting thing you bring up, because I’ve read some articles about patient experience and how much of a priority it has to be, especially when you’re talking about revenue and being able to hold on to patients and really treat them like customers. It’s an interesting shift that hospitals are having to go through?
Kallevig: We have been attempting to do that in the healthcare field for many years, sometimes not really successfully. But there are facilities that do it really well, and I liked to think we’re one of those. We can always stand improvements, but things are working pretty well at this point.
One of my biggest issues is being a critical access facility out in the rural area of Minnesota, number one, it’s hard to recruit staff. Number two, primarily because of the remoteness — not that it’s that remote; there are areas in other states like Montana that are a lot more remote than we are — we have a pretty fixed patient base within the county of Aitkin. And so we have to make sure that we’re at the top of our game and trying to do things right so some of these larger systems don’t come in and pull patients away from us. We have to maintain that presence within the community and be leaders in the community so that we can maintain our patient dedication or dedication to the facility from our patients.
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