National Consulting Firm Takes Innovative Approachto Help Fletcher Allen Succeed onLarge-Scale Epic EHR Upgrade

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In 2013, Fletcher Allen embarked on a large-scale upgrade of its existing Epic Systems EHR called PRISM (Patient Record and Information Systems Management), which it first installed in 2009. The hospital chose to transition from its highly customized existing system to an EHR that more resembled the Epic model system in order to more easily add enhancements and improve functionality and to provide users with a more streamlined and intuitive experience. “It was almost more of re-install than it was an upgrade,” noted Chuck Podesta, Fletcher Allen’s chief information officer (CIO).

The CIO’s main concerns were achieving a successful outcome and identifying components of the upgrade that could benefit from the expertise of an outside consultant. The Fletcher Allen team recognized early in the planning process that they would need significant help training and supporting staff on the updated version of PRISM. The four-person in-house PRISM training team was simply too small to retrain the thousands of users on all the new features – especially given that the training would need to be done quickly and on a 24/7 schedule in order

to reach the large number of overnight staff and other employees with non-traditional schedules.

A different approach: Integrative Insource ConsultingTM

Facing an upgrade of this magnitude, Fletcher Allen sought to create a long-term partnership with an organization that had significant experience working on large-scale electronic health record (EHR) rollouts, as well as a proven ability to bring qualified resources to meet the needs and demands of such projects. They also needed this partner to help grow their in-house Epic expertise and decrease their dependence on outside consultants. MBA HealthGroup worked directly with leadership at Fletcher Allen to devise a strategy that would not only ensure a successful upgrade, but also contribute to building the hospital’s internal Epic training team.

Fletcher Allen and MBA developed what they refer to as the Integrative Insource ConsultingTM model – a strategic partnership program customized to meet Fletcher Allen’s needs. This strategy involved bringing in the right

consultants from MBA and giving Fletcher Allen the opportunity to hire some of those consultants at the end of the engagement to bolster the hospital’s in-house expertise. That meant not just selecting experienced consultants with tremendous expertise, but also identifying specifi c professionals who would work well with the Fletcher Allen team as they essentially embedded themselves in the hospital for several months—and perhaps beyond.

MBA excelled in this area. “We creatively thought about how to work with a consulting fi rm so that at the end of the process the consultants could potentially become Fletcher Allen employees,” said Debra Dulac, director of PRISM for Fletcher Allen. “That allowed us to see if they would be a good fi t before hiring, and that approach really set MBA apart and it set the stage for the ultimate success of the initiative.”

Fletcher Allen’s Podesta agreed: “MBA’s consulting arm is impressive – they work with great people and have a deep bench of professionals. They were able to do so much in terms of fi nding great people to help us and really complement our eff orts. In the end, they did a great job understanding our culture and then bringing in the best and most appropriate people to help us so the project would be a success. Having the ability to hire the MBA consultants as permanent trainers also was appealing.”

Once engaged, a team of MBA consultants worked closely with Fletcher Allen’s in-house training team, nursing educators, clinicians and operations staff to fully understand the hospital’s culture and workfl ows. That insight enabled the MBA team to examine existing processes, modify test scripts and provide curriculums for the training classes that centered on how each type of staff member – including physicians, nurses and ancillary staff – would actually use the new upgraded version of PRISM, with a particular emphasis on explaining the new features and functionality. “Their deep knowledge of the Epic system as well as the way we wanted to use it was instrumental in delivering eff ective training,” said Podesta.

Results and evaluationsThe end result: In just under seven weeks, MBA and Fletcher Allen trained approximately 2,900 employees on the new system – including 1,350

IP nurses, more than 700 providers and nearly 200 ambulatory super users.

What’s more, the Fletcher Allen staff had overwhelmingly positive responses to the training initiatives – rating all aspects of the training at least a 4.1 out of 5 (Figures 1 and 2). Perhaps most impressive: The physicians who received training gave the classes an overall rating of 4.6 out of 5. “That’s just staggering to me,” marveled Podesta. “Physicians are some of our toughest critics, so that rating was just off the charts.”

The bottom line, said Podesta: “We’re seeing great things from a patient care standpoint. Our nurses and doctors tell me that they feel well-trained on the new system and they’re using it to be more productive and do their jobs better.”

Best practices for a fl awless upgradeThe Fletcher Allen team points to fi ve key best practices that MBA implemented that ultimately drove those strong results:

1. On-demand resources. MBA worked around the clock to off er training opportunities on site, as well as via e-learning channels and other outlets to fi t the staff ’s needs, schedules and preferences.

2. A refl ective and active learning environment.The MBA trainers were adept at presenting

“Th ey did a great job understanding our culture and then bringing in the best and most appropriate people to help us so the project would be a success.”

– Chuck Podesta, CIO Fletcher Allen

“Th ey did a great job understanding our “Th ey did a great job understanding our

Fletcher Allen is a Level 1 trauma center and Vermont’s only academic medical center. With more than 500 beds, Fletcher Allen serves approximately 1 million patients in Vermont and the northern New York area. The hospital employs 7,000, including 500 physicians, making Fletcher Allen the largest private employer in Vermont. It also has appeared on U.S. News & World Report’s Most Connected Hospitals list of the nation’s leading hospitals in the adoption of electronic medical records.

information about the upgrade in ways in that made the staff feel comfortable and open to learning new concepts that might not come easily the first time around. This approach can be crucial in healthcare environments, where physicians and other professionals often get defensive when getting trained on new technology they may not understand immediately. “The director of our nursing education and research commented on how committed, dedicated and engaged the trainers were in the classes,” noted Dulac. A major part of creating that positive environment was the trainers’ ability to actively listen to attendees’ questions and concerns, and customize the lessons around core issues of importance to the various groups. “The trainers didn’t just present a static agenda. They focused on getting the staff to learn and retain the information that mattered most to them and tailoring the teaching to the specific people in front of them,” said Dulac. “Their engaging style created a lot of buzz within the organization. It got people actually excited to go to the classes and learn the new system.”

3. A partnership-based approach. Rather than take a “go it alone” approach, MBA partnered with Fletcher Allen’s nursing educators who work in patient care areas. Teaming up in the classroom allowed the MBA trainers to present the crucial IT information while giving attendees direct access to in-house staff who could answer their specific questions about clinical workflow issues that were unique to Fletcher Allen. “That team-based approach fit in with how we work here, and it fostered a sense of camaraderie in the classroom that elevated the training to a higher level,” said Dulac.

4. Training by workflow, not function. The best classroom training or e-learning in the world will not matter much if the information is not used. MBA emphasized how to implement the new features of the upgraded system “on the ground” by centering the training on actual workflow processes. Their success in this area was evident the first day after the new system went live. “The go-live was essentially a non-event. People came in on Monday and went to work with little to no problems,” said Podesta. “We had a help desk ready to field questions and complaints, but we ended up having no more calls than we’d get on a typical day.”

5. Ongoing check-in and follow-up. MBA engaged in regular dialogue with Fletcher Allen to assess on an ongoing basis how the consultants were doing and how the staff was responding to the training. That proactive approach helped head off any potential roadblocks that could have slowed down the learning process or prevented Fletcher Allen

Inpatient Providers Ambulatory Providers

The trainers were knowledgeable 4.6 4.8

The topics covered were relevant to my practice 4.6 4.5

The materials provided are useful 4.5 4.5

The class was well paced 4.3 4.7

The training was a good use of my time 4.1 4.5

Figure 1. Fletcher Allen provider evaluations of training(1=Strongly Disagree; 5=Strongly Agree)

About MBAMBA HealthGroup is one of the fastest growing healthcare consulting fi rms in the U.S. They work with healthcare organizations to solve their most intimidating challenges and deliver innovative solutions and the best client experience in the industry. Their consultants focus on HIT Strategy, large Epic and Allscripts EHR implementation, training, andoptimization, ICD-10 Readiness, ACO Strategy, RCM Optimization,Meaningful Use and Patient Engagement services.www.mbahealthgroup.com

Produced in partnership with www.himssmedia.com ©2013

Figure 2. Fletcher Allen inpatient evaluations of training(1=Strongly Disagree; 5=Strongly Agree)

993 respondents

“Th e training feedback we received represents the outstanding hard work, dedication, user-focus, and professionalism of the PRISM training team and the Fletcher Allen leadership that promoted and supported this all-out training eff ort.”

– Karen Baron, PRISM Supervisor of Training & Support

from meeting its goals on time. “MBA was great at communicating with us from day one, and that was crucial to the success of the upgrade and staying on track,” said Dulac.

In the end, the benefi ts that MBA delivered have encouraged Fletcher Allen to look for more opportunities to work together going forward. “We see MBA as a true long-term partner,” said Dulac. Podesta concurred: “Given the expertise and resources that MBA brings to the table I can confi dently say that they can help us with any need that might come up – be it Epic-related or not. In MBA, we know we have a great partner that we can go to for anything.”

“Th is has been a truly remarkable result for training.”

– Adam Buckley, MD, Chief Medical Information Offi cer Fletcher Allen

The trainers were easy to understand 4.8

The trainers were knowledgeable 4.8

The trainers answered my questions 4.8

The materials were clear andeasy to follow

4.7

The materials covered the tasksI will perform in PRISM

4.6

The class was well paced 4.6

I feel confi dent that I’ll be able to do my job in PRISM after the upgrade

4.5