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.
- From hybrid systems to an integrated EHR
- Stepping into an Epic rollout — “It didn’t scare me away.”
- Importance of a strong leadership team
- Reshuffling priorities after ICD-10
- MU Stage 1.5
- Success with MyChart
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The people driving for it were our clinic physicians. They really saw the value in having a system that would bridge the hospital, the emergency room, and the clinics, and they had been advocates for it.
I didn’t have a lot of the time you might have going into a new organization familiarizing yourself and learning all of the expectations. I had to go under the principle that this was the main expectation of the organization, and I needed to jump right in.
I felt comfortable that he was representing the clinical side well and had really gotten the project on great footing. Those partnerships remained in place as we worked on the implementation together. You can only do it with that level of comfort.
That’s been seen by a lot of people as a real onerous thing, but we’re definitely working hard on it. I think the fact that we pushed hard for the adoption of the portal in the first place and we had a year and a half to really drive that is putting us in a good place.
Gamble: Were the hospitals on different systems before going to Epic, or was there one system throughout?
Pearson: In the hospitals, at Winnsboro we were already on Epic through Texas Health Resources, but in Jacksonville, the main hospital, and the Tyler Hospital, we had Medipac as our registration system and our billing system — it was kind of our patient management system. Then we used TDS for order management in the hospital. That’s where all the orders were entered in and managed, and the order entry in that was done by nurse, secretaries, and so forth — not by the physicians directly. Ultimately, the patient record in the hospitals was paper. So we transitioned from a paper record to Epic as it related to the clinical documentation of the patients.
In the clinics, we had Vision for professional billing and we had Patriot for scheduling of our patients. For about 10 years preceding Epic, we had been using GE Centricity/Logician EMR, and that was a mixed blessing that the physicians had been using an EMR all along. Certainly they had varying levels of comfort with that system, and some of them had become very advanced in their use of that system.
There was a lot of specific content that had been made for specialties and for primary care where we had to take a step back in some of areas as far as what we were able to achieve. Certainly when you’re doing that many specialties all with a single go-live, there was a lot of content that we strived to get in place but didn’t successfully get all of it in place. So for some folks, they took a step or two forward, but they took a step or two back as well with some of the content.
All in all, I think that system was good. It was a clinical documentation system; it was not a provider-order entry system at the time. It was not something that physicians were using to enter their orders — the staff was doing that. They’d document the orders they wanted to get it in the system in terms of the note, but then somebody on their staff would have to enter the actual orders into the system. So that was a change for them going from the previous system to the new system to do order entry.
Gamble: That’s a pretty significant change you had to deal with at a couple of different places at one time. I can’t imagine it was easy, the whole change management piece.
Pearson: Yeah. Before I had arrived, there had been a conversation about bringing in a new EMR all the way back in 2008 and 2009. It had been brought up at system board retreats, and really, the people driving for it at the time were our clinic physicians. They really saw the value in having a system that would bridge the hospital, the emergency room, and the clinics, and they had been advocates for it. And so when we came in with it, we said, ‘be careful what you wish for because sometimes you get it. Here it is.’ I think given that we were delivering on a promise made to them, they had a good alignment with the effort to make it work for their needs.
Now, we did have to bring in some optimization resources in the spring after the hospital was live and we were turning our attention back to the remaining missing pieces out of our clinics. Where the clinic needs had been stacking up for a while, we brought in some resources to really try and drive for better efficiency, optimization, and some of that content that had been missed, and get as much of that back in as we could.
We’ve done some really interesting work in the summer and fall around additional training for our physicians. This was physician-led training where they could really benefit from the shortcuts that the system allows with setting up preferences and optimizing the notes so that they get less note bloat and more effective notes, and it’s also easier and shorter for them to create while still maintaining all the necessary clinical information. So we’ve been really striving on that front too.
Gamble: Have you had a good amount of interest and participation from the physicians?
Pearson: We had a Physician Advisory Council that had been formed before the go-live. That group had been very involved in the design, build, and validation of the system and through the governance process of the go-live. And it remained in place for some months after the go-live in order to prioritize some of this optimization that needed to be done. We’ve since reinstituted it under the umbrella of our IT Steering Committee just to provide ongoing guidance as it relates to Epic, but also as it relates to other systems. And it really, like I said, helps guide the IT division of the organization.
Gamble: Did you have any hesitation about stepping in during this type of rollout? Epic had been selected, and there was a plan in place and things were starting to roll. Was that a strange time to be taking the helm as CIO?
Pearson: It’s not that different from the role I played at Bon Secours Richmond, where I was previously. I managed the IT organization of the local market and that meant that I guided the legacy systems in the Richmond market — the ongoing ancillary systems from an application standpoint, and also the end-user computing devices and network and so forth. But the enterprise was the one who delivered the datacenter, the help desk, and a lot of the support structures that I got as a managed service, and part of that was also the Epic implementation team.
So while I didn’t have all of that under my experience, I was certainly very involved in the implementation of Epic in those four hospitals. And in fact, that meant I wasn’t coming into something that I didn’t know about. But it was a new organization; I didn’t know all the players. What I had to trust, from the conversations I had during the interview process with the senior leadership, with the CMIO and others, is that it had been well-thought through, and the design was there. They knew it was going to be a challenge, but it seemed to me that the framework had been laid, and that the ownership was there as far as buy-in in the selection process.
It had all the earmarks of having success. It didn’t scare me away. I knew I was going to be able to hit the ground running. I didn’t have a lot of the time you might sometimes have going into a new organization familiarizing yourself and learning all of the expectations. I had to go under the principle that this was the main expectation of the organization, and I needed to jump right in. That was my goal.
Gamble: It certainly did help, of course, having the experience with Epic.
Pearson: Yeah. I need to also point out the hard work of the staff. We had a person who was the long-term IT director of the organization. She had stepped up to become the Epic director over the Epic project. Her name is Becky Western, and she really just had so much of the history in the organization and the relationships necessary and really had gotten a great start on that process. I hadn’t really gotten to know Becky before I arrived, but I knew that about her. The CMIO, Dr. Tom Hargrove, was given executive leadership to the project before I arrived, and in talking with him, I had felt comfortable that he was representing the clinical side well and had really gotten the project on great footing. Those partnerships remained in place as we worked on the implementation together. You can only do it with that level of comfort.
And the third piece of the puzzle with my leadership team is the IT director of our technology side. I tapped one of my colleagues at Bon Secours Richmond who worked for me there to come and take the role as the IT technology director. He arrived a few months after I did, and the fact that he knew what it takes to deploy large numbers of systems to new computers, new printers, new interfaces, and so forth for an Epic implementation really helped the organization. I think it gave them a lot of confidence that they were on the right track and that it was going to meet the needs and it was going to go in quickly and efficiently, and I wasn’t going to be as worried about the possibility of a delay in the implementation simply from a systems’ side. It just really helped to have a great team in place to do it all.
Gamble: Certainly, you need that. Now at this point, what is your main focus — are you still in optimization mode? What’s at the forefront right now?
Pearson: If you’d asked me a few weeks ago, I would have said ICD-10. It’s certainly still a concern and consideration. We had really ramped up efforts to do that, and while I think it was going to be a bit of a stretch to get it all done, we were on-track. As part of that process, we kicked off an implementation of computer-assisted coding, and that’s going to certainly continue. We are grateful that we’re going to have a chance to get that in and really stable well before the ICD-10 deadline comes now, which we weren’t going to have a whole lot of time to really make the most of that under the original timelines.
We had also delayed an upgrade to the Epic system in one of the major upgrades because of ICD-10. We didn’t want to take a risk of having too many missing parts. Now that ICD-10 has been pushed back, certainly we’re going to make a priority that Epic upgrade in the interim to make sure that we’re getting all the new features and functionality, some of which is going to help with ICD-10. But originally it was too risky to try and push it in and get the benefits. So we postponed it, but now we have a chance to sneak that in.
Gamble: So you definitely had to do some reshuffling.
Pearson: Yes. And then the other big thing has been Meaningful Use preparation for stage 2. I think we’re in a really good position. Last week we began our attestation period for eligible providers. As I mentioned before, we had 86% of our eligible providers attest for stage 1, year 1 in the fall of 2012, which means that 2013 was their year 2, and 2014 is their stage 2, year 1. We believe we’ve put all the pieces and the reporting in place to get those folks qualified in stage 2 during this reporting period of April to June to attest in July.
Our hospitals are in the year 2, stage 1. I call that stage 1.5 because it comes with some additional requirements over last year’s attestation with the new 2014 requirements. We believe we’ve put those in place; they’re currently also in an April to June attestation period for the hospitals, and then we will be getting ready for stage 2 attestation in the future for the hospitals. And so getting all those things put in place by April 1 has taken up most of our spring in addition to ICD-10, and we’re hoping that’ll pay off here shortly.
Gamble: Yeah. You said stage 1.5, and that seems pretty accurate. And then when you look to stage 2, obviously there are more considerations. That’s something that I’m sure you have to dedicate a lot of time and resources to in making sure you’re ready to comply with all of that.
Pearson: One of the big concerns there was transitions of care and the whole patient engagement piece. With Epic’s portal, MyChart, we’ve really seen a great uptick in that system. It’s very much liked in the city of Tyler. From our patient base, we have over 25 percent of our patients enrolled and they are using it to request prescription refills and send communications to their doctor to ask questions and get responses. So the requirement there to have 5 percent of each provider’s patients corresponding with them is something that for most providers, we’re already achieving. We’re just going to have to do some work on some of the remainders to meet that objective. That’s been seen by a lot of people as a real onerous thing, but we’re definitely working hard on it. I think the fact that we pushed hard for the adoption of the portal in the first place and we had a year and a half to really drive that is putting us in a good place.