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.
- About Riverwood HC
- Partnering with Allina to implement Epic
- Heavy focus on workflow design
- Using Allina’s blueprint — “They have it pretty much down to a science.”
- 2 keys to adoption: Communication & recognition
- “It was a lot of work.”
- The new CEO’s “desire to get to a single EHR.”
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That started with our new CEO asking questions as to why we had two EHR systems: one for ambulatory side and one for our hospital-based side, because he strongly believed that both should be integrated, and that is true. An integrated EHR for hospital and ambulatory is considerably more effective and more efficient than trying to run two of them with interfaces.
It was a lot of work. People were really burning the wick at both ends, and they were tired and a little bit frustrated on occasions because of the workload and the short timeframe, but we endured. And in general, people are pretty happy right now.
They made a much stronger effort to pull in departments that were affected by their workflow, and then they would discuss the problems of the current workflow and come up with a new workflow design that would satisfy not only kind of the main department, but also those that are affected by downstream workflow as well.
They were frustrated with the existing hospital-based EHR and the lack of integration between the ambulatory side and the hospital side. So there was definitely acceptance and willingness to make the move based on some of the issues that we have had between the hospital and ambulatory from a continuity of care perspective.
Gamble: Hi Daryl, thank you so much for taking some time to speak with healthsystemCIO.com.
Kallevig: No problem. It’s a pleasure.
Gamble: To give our readers and listeners some background, can you talk about Riverwood Healthcare Center — what you have in the way of hospital beds, clinics, and where you’re located?
Kallevig: Riverwood Healthcare Center is a critical access facility. We have 25 med surgical beds, four ICU beds and then we have three OB suites. We are located in north central Minnesota, pretty much straight west of Duluth, about 85 miles. We’re pretty close to the center of the state in the northern third of Minnesota.
Gamble: Are you are considered a standalone, or do you have any affiliations with other organizations?
Kallevig: We are a standalone critical access facility. I did forget to mention that we do have three clinics as well, one is attached right here in Aitkin with the hospital, and then we have two clinics, one located in McGregor, which is about 20 miles to the east of us, and then one in Garrison, which is about 20 miles to the south of us, right on the northwestern edge of Mille Lacs Lake.
Gamble: And at this point, are there any affiliations or partnerships with other hospitals?
Kallevig: We are a standalone facility, but we do have an affiliation with Allina Health out of Minneapolis. We are termed as one of their non-owned affiliates and what that means to us is we just went live with a new EHR that Allina Health is providing for us. It’s an Epic ambulatory and hospital-based replacement that we pursued, moving away from Meditech and eClinicalWorks.
Gamble: So, that’s a service that they extend out to other hospitals in the interest of being able to let information flow a little bit better between facilities?
Kallevig: Correct. And as far as transfers out of our facility for specialty care, be it cardiology or neurology or various things specialties that we don’t have here, a lot of those go to the Minneapolis area, and they specifically go to Allina-based hospitals. And so, a large amount of our transfer-out traffic is to Allina, and then they host the Epic application for us. We just went live on that April 1 of this year, so we’re just a little over a month into it now.
Gamble: Yeah, that’s very new. So you’re just about a little bit over a month after go-live. How are things going at that point? I know that’s a big question.
Kallevig: I always kind of want to knock on wood here, but extremely well. As far as the implementation of Excellian, which is what they brand name Epic for all their affiliates; our go-live was April 1, and we relatively had no system issues. There are some workflow things. We went through a workflow design process for pretty much every area that went live, and there were some issues. There were some unanticipated things where we were going back and modifying the workflow in some departments to better accommodate the use of Epic within those departments. But from our go-live, we still haven’t hit 100 issues yet, which is extremely good, and they all seem to be workflow process-related issues.
Gamble: Right, so the types of things you would expect in everyday actual usage of a new system?
Gamble: What was the planning phase like as far as going to this new system?
Kallevig: Well, that started with our new CEO coming in essentially asking questions as to why we had two EHR systems: one for ambulatory side and one for our hospital-based side, because he strongly believed that both should be integrated, and that is true. An integrated EHR for hospital and ambulatory is considerably more effective and more efficient than trying to run two of them with interfaces, because there are always gaps in those types of integration attempts.
We started talking with a couple of large Epic sites within Minnesota and we essentially decided on Allina primarily because of our transfers — medical transfers and specialty transfers that occur. They seemed the logical choice. We went down that road with a nine-month implementation plan, and so we went full-bore with that starting back in August of 2015 with our kickoffs and implemented April 1.
Gamble: That’s fairly fast, especially for Epic, which we always hear does require a huge amount of planning and just the change management aspect of a new system. And how was that something that you worked with?
Kallevig: The change management side?
Kallevig: Well, this is all part of the implementation process that Allina uses in implementing affiliates. They’ve done quite a number of these affiliate implementations, so they have the implementation pretty much down to a science almost. And so that part of it was very, very scripted. We did a lot of communications to all of the Riverwood staff in relation to Epic or Excellian coming in. From an administrative level, all of us were really doing a lot of communications to the Riverwood staff, providing what the expectations were, all of our timeframes, our progress to date.
We actually had newsletters we prepared that went out for sure every month, and then as we got a little bit closer to go-live, they would go out every two weeks, explaining statuses, progress, various types of things related to the implementation. And we gave accolades in various areas, what kind of achievements they’ve made and so we really tried to focus on the positive side of that.
It was a lot of work. People were really burning the wick at both ends, and they were tired and a little bit frustrated on occasions because of the workload and the short timeframe, but we endured. And in general, people are pretty happy right now that it’s over and there are relatively few issues outside of some of those workflow process issues that I had talked about.
Gamble: Right. When you have a roadmap to go by, that’s something that certainly does help, but workflow of course can be unique depending on the organization and the individuals. What are some of the processes for handling the requests that come in or just the challenges that they’re experiencing from a workflow perspective?
Kallevig: Those workflow teams essentially just got back together. Sometimes the workflow teams did work a little bit in a silo and some of this is cross-department types of workflow that are affected, so they made a much stronger effort to pull in departments that were affected by their workflow, and then they would discuss the problems and issues of the current workflow and come up with a new workflow design that would satisfy not only kind of the main department, but also those that are affected by downstream workflow as well. And we are still working on some of those.
Gamble: You mentioned that a lot of this started with the new CEO. How long has the new CEO been there?
Kallevig: Let’s see, as of this year, he will have been here three years, so he started in July of 2013.
Gamble: It’s interesting when you have somebody new who comes in and asks a question that really makes a lot of sense as far as the two EHRs, but we know that this is never a short simple answer. So was that a tough situation or was is it a matter of just communicating and talking about where the organization stands and where it needed to go?
Kallevig: It was a desire to get to a single EHR. We did have a fairly high level of dissatisfaction in our hospital-based EHR and with things being difficult for our providers, our hospitalists, and rounders that we use within the facility. They were frustrated with the existing hospital-based EHR and the lack of integration between the ambulatory side of our organization and the hospital side. So there was definitely acceptance and willingness to make the move based on some of the issues and ongoing issues that we have had between the hospital and ambulatory from a continuity of care perspective and being able to transition easily between the ambulatory setting and the hospital setting.