When people hear that a health system completed a major EHR rollout three years ahead of schedule, it’s going to raise a few eyebrows. But it’s precisely what Dave Garrett and his team were able to accomplish at Novant Health, which went from having 90 billing systems and a dozen EHRs to one consolidated system. The strategy? Start with small waves, gain confidence, then go bigger. The keys to success? Governance, executive buy-in, and super-users. It may sound simple, but it required a great deal of trust and collaboration. In this interview, Garrett talks about what it takes to complete an enterprise-wide transformation, and how they’re working to achieve the goal of “one patient, one record, one remarkable experience.”
- “It’s all about the patient”
- Creating repeatable rollout model
- Hitting metrics — “We had money coming in the door within 7 days.”
- Super users “carrying the flag”
- Pay it forward, pay it backward
- Epic MyChart — Zero to 300K users in 2.5 years
- Transforming care at the bedside
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We rallied together with executive leadership and the physicians in the community around the fact that it was all patient centered and it was all about the patient. That’s really what enabled us to go forward.
It feels like each wave is the same, but we know that there are going to be a lot of similarities and there are also going to be differences.
They’ve really carried the flag. They’ve become the experts. They’re on site providing a lot of elbow-to-elbow support, and then they stay in that facility when we leave.
That’s transforming care and transforming care around the patient. It’s phenomenal. It’s just so exciting to go down that path. And that’s starting to open up other doors and opportunities for us.
Garrett: Our governance process includes some guiding principles, with the first and foremost guiding principle being it’s all about the patient. Everything has to be about the patient. When we looked at being on one electronic health record, it was really all about the patient. Quite honestly, it was a little bit of a challenge at first because everyone had their favorite one-off system, whether it be their emergency department system, radiology system or cardiology system— you name it. Everyone had their favorite system. And we rallied together with the executive leadership and the physicians in the community around the fact that it was all patient centered and it was all about the patient. That’s really what enabled us to go forward.
We created a lot of teams across all of our markets — our three-state market. We pulled in all the acute care facilities and created teams, but not only during the evaluation process. They all participated in the evaluation process and the selection process but also in the build. When we worked with Epic, we included them in the build so we would have one system build, and then multiple rollouts that would be a consistent rollout that would be a repeatable model. We created waves of rollouts, just like we did with the ambulatory. So after about 18 months of training our employees and building the system, we went live with our first facility. We took a little longer to do the build because it was a build across 14 acute care facilities. Just imagine mustering 14 facilities together to create a system build — but that’s what we did.
On the first wave, the initial wave rollout we did was back in October at Novant Health Presbyterian Medical Center, and that went extremely well. There were a lot of lessons learned, as we would expect, but I’ll tell you, a lot of the statistics and metrics that we had established we were hitting very, very early on — things like the number of physicians using computerized provider order management (CPOM). We had set a goal of 90 percent and on day one we were up in the upper 80s and moved it right on to the 90s. Right now we’re sitting at about 94 to 95 percent amongst the physicians within Presbyterian Medical Center.
We actually were able to draw up bills on the third business day, which was phenomenal, and we actually had money coming in the door within seven days. It was pretty phenomenal. There were a lot of other statistics that we captured; basically, by all measures, it was extremely successful. As a matter of fact, we were doing site visits with potential Epic customers. The first one was 70 days after go-live, which is usually unheard of. You don’t want people stepping into your organization only 70 days into a go-live, but we were pretty confident. We always were.So that was the initial wave.
Our next wave is actually getting ready to go live March 22, and that will include three more facilities here in the Charlotte market — Novant Health Matthews Medical Center, Novant Health Huntersville Medical Center, and Novant Health Charlotte Orthopedic Hospital. In addition to that, we’ve added our ambulatory surgery centers. There are several of those in the market, as well as our first joint venture activity, which is going live March 22. So it’s an ambulatory surgery center where we have a joint venture with the local Charlotte Eyes, Ears, Nose and Throat Association surgery center. So that’s quite a few things getting ready to happen here in less than two weeks.
And then our next wave after that in August of this year, where we go up into the Winston-Salem market and hit our largest facility, Novant Health Forsyth Medical Center, as well as three other medical centers in that particular market. And then after that we’ll be rolling up to the rest of our facilities across North Carolina, and then moving into Virginia. Then by the middle of 2015, I’ll say the summer of 2015, we will be up and running on all 15 acute care facilities on Dimensions.
Gamble: That’s really fast considering the number of facilities. Do you find that it’s similar to ambulatory in that once you have the first wave and you’re able to work out some of those kinks, you can use that model with the other waves?
Garrett: We do, and it is very similar. Just as we found with the ambulatory, it feels like each wave is the same, but we know that there are going to be a lot of similarities and there are also going to be differences. For example, our initial wave was just one hospital, Presbyterian Medical Center. Our next wave, which goes live in March, consists of three facilities, so what makes it different now is we’ve got three different locations that will go live instead of one location, as well as adding ambulatory surgery in the joint venture. Our next wave after that its going to be huge — our 900-plus bed facility at Novant Health Forsyth Medical Center along with some other facilities. It will be our largest wave. So that’s also many facilities, and it’s a little bit further away from the core team up in Winston-Salem versus down in Charlotte.
We prepare ourselves for all the similarities, which usually is the easy part. It’s the differences that are tougher to prepare for. We’re pretty comfortable about the way the wave rollouts have worked. We created a pretty solid remarkable, repeatable process, and we involve our end users and administrative, all the way through nursing, physicians, phlebotomists, you made it. We’ve established a lot of super users in each one of our facilities, and they’ve really carried the flag. They’ve become the experts. They’re on site providing a lot of elbow-to-elbow support, and then they stay in that facility when we leave, because they belong to that facility.
We leave them behind so that they’re able to help continue support. We do a pay it forward, pay it backward system where of the super users from one wave will roll into another. One that might be in wave two will participate in advancing wave one to get a little ahead of time. That’s the advantage of having size and accounting to scale is being able to take advantage of those kinds of things.
Gamble: John Hoyt from HIMSS Analytics had a quote where he said that Novant Health used health IT as a linchpin for an enterprise wide transformation. I just wanted to get your thoughts a little bit about that concept of an enterprise-wide transformation and why it’s important to view something like this in that regard.
Garrett: Aside from what I’ve mentioned before about the importance of governance and importance of guiding principles and support and buy-in and guidance from executive leadership as well as physician leadership — that aside, when you start talking about transformation, as John pointed out from a linchpin perspective, you start talking about putting the patient first and putting them in the center of everything. We utilize something from Epic called MyChart, which is really the ability for a patient to have access to their chart and their medical data and medical information. It’s been phenomenally successful for us. We grew from zero about two and a half years ago, to now having close to 300,000 MyChart users that are actually up and using on the system today.
We parlayed the success of that into those patients being able to do online scheduling, where you just don’t go into a block, you literally go online and schedule. And I do this myself now. I don’t even call my doctor’s office. I go to MyChart through my iPhone — I have access to their schedules and I schedule my appointment with my physician. It’s not, fill out a form and you get a block of times and they call you back and say, ‘how about two o’clock, will that work for you?’ No. The way this works is you grab your time and now you’ve got your time and you’re done. You’re scheduled. And it works out really, really well.
Then we parlayed that success into electronic visits where, depending upon what’s wrong with you as a patient, you could actually have an electronic visit where you don’t even go to the physician’s office. You do it all electronically. And then we parlayed that success into video visits. In some cases a video visit is appropriate where you actually see your care provider electronically in real-time. Think of it like FaceTime or Skype or something like where literally in real-time you’re interacting with your care provider. You don’t go in. You don’t do anything. You base it on what’s going on. They can even prescribe medications for you and have it waiting for you at the pharmacy. That’s transforming care and transforming care around the patient. It’s phenomenal. It’s just so exciting to go down that path. And that’s starting to open up other doors and opportunities for us.
Another major area of transformation is on the inpatient side. We’re doing several transformation activities. One of the larger ones is what we call transforming care at the bedside. Our goal is to have providers spending more time at the patient’s bedside, interacting with the patient in a meaningful way versus drawing up forms, running around looking for stuff, trying to track down equipment, you name it. That’s what happens in hospitals. It’s phenomenal — I don’t recall the numbers off the top of my head, but we’ve already increased the amount of time that caregivers spend at the patient’s bedside in a huge way at our Presbyterian Medical Center, because they’re the only ones live right now on Dimensions.
We actually have devices in the rooms. The clinicians are in the rooms with the patient or with the family member and the patient actually pulling up the records and utilizing the system in front of and with the patient. It’s just remarkable. That’s just transforming care — period. And so we really consider it the linchpin, because without that consistency and without the ability to do that across the board, it’s kind of hit or miss. This is no longer hit or miss. This is very deliberate and very focused.We’ve watched our patient satisfaction scores improve now at Novant Health Presbyterian Medical Center after we’ve implemented Dimensions, and quite honestly, we attribute a lot of that to the fact that the clinicians are standing there with the patients, spending more time with the patients, answering their questions, and making sure that they’re comfortable — all the things that are important to a patient.
The clinical quality is phenomenal with physicians and the providers doing order management. Things are done real time. Things are done very, very quickly instead of orders getting handwritten where you have to verify and validate because they can’t read it, or orders getting lost because they were manually written. It’s all in the system and all done interactively. It’s working with pharmacy, being able to deliver the meds quicker — those statistics have all improved and increased. Those are just a couple of examples of what John Hoyt was talking about.
Gamble: True transformation in every sense of the word.