A pharmacist by training, Lisa Stump admits that she never would’ve pictured herself in IT leadership. But after playing a key role in implementing an early CPOE system, she discovered her passion for “providing the right information to the people who can make the right decisions for patients,” and she’s never looked back. In this interview, Stump talks about why a largescale implementation is never really finished, the fascinating dichotomy of being an Epic client while also working with startup companies, and why she believes Yale New Haven’s focus on innovation will help recruit top IT talent. She also discusses her team’s groundbreaking work with patient engagement, the new skill sets that will be required as analytics and security bigger larger priorities, and why she ignores the word “interim.”
- About Yale New Haven HS
- Epic in the hospitals & medical practices since 2013
- “Complexities” of going big bang with Beaker
- Preventing operational disruption — “That took a lot of careful planning.”
- Lab leadership stepping up
- “Boots on the ground support” with super users & consultants
- Getting the most out of Epic
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It wasn’t just a simple implementation. We did a lot of consolidation effort at the same time, so all of that added a high degree of complexity to both the initial planning and build, but also the post-live monitoring plans, because we no longer had a one-to-one relationship between the tests that existed in our legacy system.
We had expected areas where we needed to tweak some of the build once we came live, but it was incredibly smooth overall, particularly considering the complexity of the consolidation that we undertook and the geographic spread of the organizations we were supporting.
The opportunity to select and build the team specifically around that project was an incredible opportunity to really bring in the right skill sets and the right soft talents that we needed to really see a project like that through.
The initial implementation from our hospitals ended at that point, but we will always be evolving the tools to meet the needs of our customers, our consumers and our clinicians.
Gamble: Hi Lisa, thanks so much for taking some time to speak with us today.
Stump: I’m happy to, thanks.
Gamble: A good place to start is to get some basic information about Yale New Haven Health System — what you have in terms of hospitals and ambulatory, and where you’re located, things like that.
Stump: We are a health system of three hospitals that encompasses 2,200 inpatient beds. Our hospitals are in New Haven, Bridgeport and Greenwich, Connecticut, and our system also includes a physician medical group with a few hundred physicians, supporting ambulatory practices across the state of Connecticut. In total, the health system has more than 6,000 physicians, and that includes our 600-member multispecialty foundation. We now have over 20,000 employees across the state of Connecticut. The enterprise delivers 109,000 inpatient discharges and over a million and a half outpatient encounters every year.
It’s important to note that the health system also operates in partnership with the Yale School of Medicine and its 1,500 physician specialty practice, so we really have a diverse group of physicians and specialties spanning the state of Connecticut and even into the surrounding states.
Gamble: As far as the IT staff for Yale New Haven Health, what’s the approximate size?
Stump: We’re about a 600-member IT staff supporting that entire enterprise, which includes the school of medicine and the health system.
Gamble: Okay. And I know the health system is using Epic — is that in all the hospitals and clinics at this point?
Stump: It is. We completed — although I say that a little bit tongue-in-cheek — the first stage of our implementation, so all the hospitals and the medical practices were completely implemented by 2013. And then in the years since as the health system has continued to grow, we deployed Epic as new practices come into the health system and as new organizations have come into the health system, or as we’ve had interest in additional modules. Beaker was a good example of that.
Gamble: So it was fairly recent that you went live with Epic Beaker?
Stump: Yes, we just completed that implementation at the end of July.
Gamble: And that was done across the board?
Stump: We did. We did that as a big bang implementation consolidating three different laboratory information systems at each of our hospitals now into a single Beaker instance for with the health system.
Gamble: Obviously the goal is to get everyone on that same system, but what were some of the challenges in doing it the way you did and going big bang?
Stump: One of our biggest concerns was around what could be operational disruption; supporting three hospitals in three different cities was a strain on the team in terms of support for the laboratory operations and the ordering clinicians and end-users out on the floors. The complexity in our go-live, though, was compounded by the fact that we chose to consolidate our laboratory test naming conventions as well as pricing around some of the laboratory tests across the organizations, and so it wasn’t just a simple implementation. We did a lot of consolidation effort at the same time, so all of that added a high degree of complexity to both the initial planning and build, but also the post-live monitoring plans, because we no longer had a one-to-one relationship between the tests that existed in our legacy system and the tests that were now created in the new Beaker environment.
That took a lot careful planning to create crosswalks and ensure that we didn’t have either an operational disruption, with clinicians who could no longer find the test they wanted to order, or financial disruption. We needed to be able to test volumes and ensure that that was all flowing correctly. So our timeline was initially anticipated to be a few months shorter, but we thought it would be in the best interest of the organization to do all of that consolidation and spread the timeline to the end of July.
Gamble: And so, things went off fairly well?
Stump: They really did. I was very pleasantly surprised by the lack of operational disruption; that’s a great credit to our laboratory leadership teams and the staff. Their turnaround times, for example, on STAT labs didn’t vary by more than 3 to 5 minutes from their baseline throughout the implementation, so their planning around staffing was incredibly sound. The applications performed very well. We had expected areas where we needed to tweak some of the build once we came live, but it was incredibly smooth overall, particularly considering the complexity of the consolidation that we undertook and the geographic spread of the organizations we were supporting.
Gamble: What did you do to ramp up that support? How were you able to get all the people needed to do that?
Stump: Our IT team was housed centrally in a command center. For the most part, all of them were in that central location. We put small numbers of IT experts at each of the hospitals to ensure we had essentially boots on the ground to support any issues locally, and then we had super users and end-user support. We had our trainers and other members outside of our Beaker team from IT that we trained in the application to go out and support from the physician and nursing perspective as they were interacting with the system. We utilized some consultants, we augmented our staff, where appropriate, with consulting to help with that end-user support, and Epic sent staff out from Wisconsin to support us as well, which was very helpful.
Gamble: I would imagine this was one of the bigger big bangs that they had seen with Beaker?
Stump: It was, because of that added level of complexity. As I said, they had not had all of that consolidation from three or multiple lab systems done concurrently with the Beaker go-live before. Our test volumes and the number of laboratory instruments that needed to be interfaced or integrated with Beaker was larger than their other clients to date, so it was a pretty big and complex undertaking.
Gamble: And at this point now, is it in the phase of making any necessary tweaks that need to be made?
Stump: It really is. I had anticipated probably more issues and more severity of issues, but it’s gone incredibly smoothly. I had to remind myself yesterday that it’s only been a month since we went live, so lots of anticipation and preparation, and now things are running very smoothly, which has been nice. The feedback from the ordering clinicians and from the nurses who are now using the bedside closed loop laboratory verification called Rover has been incredibly positive in terms of its utility compared to the older system. Even the laboratory staff find it to be faster, they see greater granularity of the data, and they contract specimens more tightly, so it’s really been a win both in the lab and for the clinical users.
Gamble: Are there other modules you’re still looking to implement with Epic?
Stump: In the year ahead, I think we’re probably looking at the orthopedics module to support growth in our musculoskeletal services. In the last year, in addition to Beaker, we had also transitioned to Epic’s care management solution — that was back in January, so we continue to look for opportunities to use the fully integrated suite that Epic affords. The dental solution is on our list for the coming year as well. We support a dental clinic in our New Haven Hospital, and so coming on to the Epic module there will give that additional functionality and integration with a broader platform.
Gamble: Now, going back a little bit when Epic was implemented, at that point you were Epic project director with the organization?
Stump: That’s right.
Gamble: So obviously you’re very familiar with that and you had a key part in the implementation. I and in that role, were you really focused a lot on meeting the day-to-day goals with the implementation?
Stump: My job as the project director was really to ensure the quality of the implementation and that all of the timelines and deadlines were met. But I would say the overall quality was key and paramount for me, but certainly delivering that within our timeframe and the budget that we had set. I had the privilege of participating and leading the building of the team. We hired that team essentially from scratch, meaning internal staff that were part of our IT organization prior to the Epic project interviewed for positions on the team, and at the same time, we were recruiting externally from Yale University. But the opportunity to select and build the team specifically around that project was an incredible opportunity to really bring in the right skill sets and the right soft talents that we needed to really see a project like that through. A lot of work effort over a long period of time takes the right kind of people to dedicate to, so that was a great opportunity.
Gamble: And as far as the Epic team, did most people eventually return to their positions?
Stump: For the vast majority, no. We managed the use of consultants, I think, really well during the project. In anticipation that we needed to staff up at various stages of the project, particularly around the larger hospital implementation, we augmented smartly with consultants and were able to then maintain most of the original hires onto the team. I would say probably over the last three years, maybe 10 percent either went on to other organizations—they took their Epic knowledge with them and had career opportunities elsewhere. Some who came to us particularly from the clinical arena decided to go back to bedside care, but the vast majority had stayed with us over time.
Gamble: And that’s key, because it really is a never-ending project.
Stump: It is. And that’s why I said, tongue-in-cheek, the project ended in 2013. The initial implementation from our hospitals ended at that point, but we will always be evolving the tools to meet the needs of our customers, our consumers and our clinicians. So it’s really an exciting area of work.