When Jeff Pearson stepped into the CIO role at Trinity Mother Frances, Epic changes were in the air. The organization had started its journey toward an integrated system by selecting Epic, and now it was time to get down to business. Walking into a situation like that, according to Pearson, required a great deal of confidence — both in his own abilities, and in the senior leadership team. In this interview, he talks about what it was like to take the helm during such a “hectic” time, why Trinity opted to go big bang instead of using a phased approach, and the enormous benefits of having physicians who are very much engaged. Pearson also discusses the need for CIOs to be able to talk tech and business, and why he believes in the power of scarcity.
- About Trinity Mother Frances
- Big bang in hospitals & clinics
- Pushing back go-live — “We wanted to test out all of our scenarios.”
- Metrics for determining success
- Managing productivity loss — “Our folks stepped up.”
- Epic’s role in MU attestation
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It definitely had its own learning curve. It’s not very often that an Epic hospital moves to a different Epic implementation.
Epic had made some recommendations on how much testing you needed to do, but we really wanted to test out all of our scenarios, and just felt at the time we weren’t at a good glide path to complete that and feel comfortable with it.
I won’t lie and tell you it was as easy for them and that they didn’t work long hours and have a lot of frustration in that month to do that. But they did not have more than an expected productivity drop in that area.
We certainly had some folks we had to coach and mentor through that, but it was not something where we had to be in front of hundreds of physicians and constantly reminding them to make that goal, so that helped us a lot.
Gamble: Hi Jeff, thanks so much for taking the time to speak with us today.
Pearson: My pleasure, Kate.
Gamble: To get us started, can you give us a little bit of information about Trinity Mother Frances — how many hospitals you have, what you have in the way of ambulatory, things like that?
Pearson: I don’t know how many of your readers know where Tyler, Texas, is but it’s about 90 miles east of Dallas. We have about 100,000 people in the city limits and a couple 100,000 in the metro area. It’s in East Texas, the Rose Capital of the World, and it’s been a great little community for me and my family the last couple of years. Ultimately, the hospital system serves about 1.2 million people in a 27-county area, mainly the counties east of Dallas, between Dallas and Shreveport, Louisiana.
We have three hospital campuses. We have the main Tyler campus and then we have two critical access hospitals — one about an hour north of Tyler in Winnsboro, Texas, and another about 45 minutes south in Jacksonville, Texas. Those are 25-bed hospitals. On the Tyler campus, we have our main 400-bed hospital, which was opened in 1937 by the Sisters of the Holy Family of Nazareth. Interesting fact — it was opened a day earlier than originally planned because of a disaster in New London, Texas, in which a school had a natural gas explosion and killed hundreds of kids. It was right about the time they were planning to open the hospital and it opened a day early to deal with the victims of that disaster.
It’s got some other components to that main hospital. We have a 51-bed long-term acute care hospital that is a partnership we have. It’s embedded inside the hospital to serve the needs for folks who need a longer stay. And we recently added a 72-bed state-of-the-art heart hospital. It was built in 2012, and it’s the area’s first free-standing heart hospital. And then in addition, in the city of Tyler, we have a partnership with HealthSouth on a 74-bed rehab hospital. They are not on the same systems as we are, but it is part of our organization.
As far as clinics go, back in 1995, Mother Frances Hospital merged with what was then known as the Trinity Clinic, which was Tyler’s largest multispecialty clinic back then, and formed an integrated system. That Trinity Clinic has grown now to over 350 physicians and mid-levels, so that’s about 40 specialties in 36 clinic locations. We also have in that group a pretty substantial basis in hospital services. We have radiologists, hospitalists, anesthesiologists and intensivists. Our emergency room physicians come from our Trinity Clinic, as well as our neonatologists. We’re not a closed campus but we staff much of the hospital with our Trinity Clinic folks, and we have an extensive primary care network and specialty network in town as well.
Gamble: Okay. So you’re really covering all the bases.
Pearson: Yeah. It was appealing to me when the position became available that it was an integrated system that was really trying to form a co-management model with physicians through a dyad. I think it led to some great quality achievements and some of the awards we’ve won here. Three of the last four years we’ve won the Truven award, which is the Top 100 Hospitals designation. And the new heart hospital that I mentioned, despite its young age, has been designated by Truven as a Top 50 Cardiovascular Hospital as well. We’re also very proud of our ‘A’ rating by Leap Frog.
Gamble: It sounds like that’s the direction a lot of health systems are trying to go to, as far as reaching all those different levels of care and having that integrated system like you said.
Pearson: I think they really appreciate the level of integration we’ve now achieved with our Epic system bridging across these clinical locations in the hospitals in a way that our previous systems couldn’t.
Gamble: Epic is in place in all of the hospitals at this point?
Pearson: That’s right. They’ve been in place in all of the hospitals since 2012. Winnsboro actually went live in March of 2013. The Mother Frances Hospital in Winnsboro was actually a Texas Health Resources Hospital. It was acquired by Trinity Mother Frances in 2010. They had already been live on Epic with THR, and then when we acquired them, we continued to get the services from THR. They continued to run Epic under the THR umbrella for a few years until we had our Epic implementation live, and then we transitioned them from THR’s Epic to our Epic in March of 2013.
Gamble: I imagine that of the transitions that a hospital has to go through, that’s probably not as problematic as some of them.
Pearson: No, although it definitely had its own learning curve. It’s not very often that an Epic hospital moves to a different Epic implementation. But there were some workflow differences. We brought some additional services into play, including registration. THR doesn’t use Epic for revenue cycle or registration. At the time, I believe they didn’t at the time use it for radiology, and they weren’t using barcode medication administration in that hospital. When we went live there, all those services were new introductions, but the main inpatient documentation and computerized order entry was the same.
Gamble: To give some background, when did you start at Trinity?
Pearson: I joined around the first of April 2012. At that point we were already in the midst of our Epic go-live planning, but were not yet live, and I was able to be here for the actual implementation work.
Gamble: How far along was it when you took over?
Pearson: Trinity Mother Frances signed the contract with Epic in April of 2011. They had formed the team and certified the team by October of 2011, and began our design build validation work. The goal at the time was for us to do about a nine-month implementation of our revenue cycle and by July of 2012, to do all the revenue cycle and some of the clinics and then transition into the rest of the clinics in August, and then have our hospitals go live by December of 2012. That would be a little over a year on a hospital side.
When I arrived in April, we were at the point where design build validation had completed and we were finalizing our end-user device purchases and our training work was getting kicked off. But at this point, where we really were concerned was the level of our testing, specifically our integrated testing and especially our claims testing as it related to revenue cycle. Epic had made some recommendations on how much testing you needed to do, but we really wanted to test out all of our scenarios, and just felt at the time we weren’t at a good glide path to complete that and feel comfortable with it with the time table.
And so in May, we made the decision to postpone the revenue cycle go-live and the clinics go‑live until September 30, 2012. At that point, we really had tightened our window, and with the goal of still trying to make significant progress on Meaningful Use in that year, we decided to do all of the clinics in a big bang on that date instead of having the opportunity to do one or two and then learn from that, and then do the rest.We did all of the revenue cycle, all the clinics on September 30,and then we did the hospitals in December 8. We really only had a two-month window remaining after we did the first go-live to finish preparing for the hospitals. Of course meanwhile, we were doing go-live support and we were dealing with aftermath and issues and so forth. That was very hectic fall of 2012 for sure.
Gamble: I can imagine. How did that go, as far as doing all the clinics big bang and not, like you said, doing a few and being able to see how that went and see if you could make any changes? How did that turn out?
Pearson: All in all, it went okay. We had some significant issues at the very beginning with lab ordering; there were some challenges there with the routing of lab orders. It turned out one of the issues among many was that, in the end, we realized our lab system test environment that we had done all of our testing against didn’t match our lab production environment. We thought it did. And so therefore, some issues came up in the go-live that would have ideally been identified during testing, but because those didn’t match, we didn’t know to expect them. So that was definitely one of our challenges.
And certainly one challenge is trying to get coverage of all of those locations and having at-the-the elbow support and being able to deal with a multitude of issues. Thankfully, for the most part, it was not an issue where we had, this specialty had this issue and that specialty had this issue or we had this location-specific problem. Really, most of it was things that were system-level, and so when we were able to track down the solution, it would solve it for everybody. But the bad news, of course, is as you’re doing it, you are affecting more people and more patients.
In the end, there are a couple of metrics by which I guess you could judge it. We had anticipated some level of productivity drop by our providers. We had budgeted for the first week to be operating at 50 percent productivity, the second week to be operating at 25, percent productivity, and then the remainder of the month to be at 100 percent productivity. If you work that out, what that should entail is over the course of that whole month is about a 17 percent drop in productivity. In the end, looking at the metrics of the number of encounters we did that month as it related to the previous month was only a 7 percent drop in encounters. Our folks stepped up and did the number of encounters. I won’t lie and tell you it was as easy for them and that they didn’t work long hours and have a lot of frustration in that month to do that. But they did not have more than an expected productivity drop in that area.
The other metric to measure it against is Meaningful Use. We had done the go‑live in the hopes that we would be able to attest for these physicians still inside the 2012 calendar year. We went live September 30, and the 90-day attestation period began immediately. I think we had maybe three days before it really had to start in order to meet that goal. We had 86 percent of our eligible providers achieve Meaningful Use in the 2012 year.
I give a lot of credit, of course, to the physicians and how hard they worked to learn the system and to use it. But also I think Epic does a nice job of putting some dashboards in front the physicians at the end of each encounter, letting them know what they still needed to do in order for that encounter to meet the objectives. By giving them that immediate feedback I think they were able to be guided right out of the gate on achieving that. We certainly had some folks we had to coach and mentor through that, but it was not something where we had to be in front of hundreds of physicians and constantly reminding them to make that goal, so that helped us a lot.
Gamble: You must have been really thrilled at that 86 percent, especially since there wasn’t a lot of wiggle room with the 90 days.
Pearson: There were certainly bumps in the road, but they stepped up for sure, and the team did well. And of course we’re doing that while some of our Epic team was turning their attention to the next go-live of the hospitals. And so if we didn’t have that kind of guidance in those dashboards, I think we would have been really struggling to give the mentorship and help that we would have needed.
Gamble: What was the timeline for the hospitals in getting implemented?
Pearson: On December 8, we turned on Epic in the main Tyler campus and the Jacksonville Hospital — not the Winnsboro Hospital, as I mentioned earlier. The main Tyler campus included the long-term acute care hospital that was embedded in the organization. They also went live on Epic; amongst the services they contracted with the hospital like pharmacy and radiology, they contracted with us for our EMR. That was December 8, and then on December 15, the heart hospital opened. The new heart hospital building opened, so they went live on Epic right out of the gate. They did not ever use our Legacy systems.
That was not the original time table. They were going to open in November at one point; they were going to become live on our old system and then have about a month of interim workflows before they went live on Epic. In many ways, I think that the fact that that heart hospital got delayed was a boon to everybody. It certainly was another distraction we really didn’t need in the month of November, but it also meant that they could start from the beginning with the new EMR.
And then to add to the craziness in December, Joint Commission showed up a couple of days after the heart hospital went live and began our survey of all of our hospitals. We were only a week and a half into our Epic implementation. Of course we did successfully pass and get accredited. It was quite a testament to how hard everybody worked. We all learned a new level of stress and what we’re all capable of sustaining and surviving in that implementation.