Managing a Legacy Team in an EHR Transition: …...14 EHR Upgrade Team= 64 Team Members Additions: • 1 Project Manager • 5 EHR Analysts • 2 Periop Analysts • 3 Report Analysts

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Managing a Legacy Team in an EHR Transition: Success & SerendipitySession #75

February 21, 2017

Penny Black, Director

Houston Methodist Hospital

Alan Perkins, Associate Principal

The Chartis Group

2

Speaker Introduction

Penny Black Alan Perkins

Director

Houston Methodist

Hospital

Associate Principal,

Informatics and

Technology Practice

The Chartis Group

3

Conflict of Interest

Penny Black and Alan Perkins:

Have no real or apparent conflicts of interest to report.

*All images and graphs are property of The Chartis Group

4

Agenda

Preparation: Upgrading the Legacy EHR

Transition: Managing a Legacy Team &

Supplementing Clinical IT Leadership

New Reality and Lessons Learned

5

Learning Objectives

• Identify potential pitfalls in staffing a

major EHR project

• Define key principles for maintaining

employee satisfaction on legacy teams

• Analyze successful strategies for

integrating employee and contract labor

into a cohesive team

• Develop a staffing plan which supports

an effective leadership strategy

6

Realizing Benefits for the Value of Health IT

Our system will enhance our ability to provide

high quality evidence-based care in a safe

environment and will enable us to quantify our

care and deliver metrics in a meaningful way.

Our system will highlight the Houston Methodist experience

by connecting our patients and families with clinicians,

physicians, and employees.

7

Legacy Systems: Mission Critical

Today(and for the next 2 years) Tomorrow

8

About Houston Methodist

Houston Methodist comprises a leading academic medical center in the Texas Medical Center and six

community hospitals serving the Greater Houston area.

2,550

Total Beds> 4,000 Physicians

1,983

Beds in Service

36

Residency Programs

18,000+ Employees260

Residents

467

Employed Physicians

$3.1B

(FY’14)

Total Revenue

9

Houston Methodist ICARE ValuesHouston Methodist employees recognize and support the organization’s values, reinforce positive

behaviors, and celebrate the contributions of those who exemplify our values.

Integrity Compassion Accountability Respect Excellence

We are honest

and ethical in all

we say and do.

We embrace the

whole person and

respond to emotional,

ethical, and spiritual

concerns as well as

physical needs.

We hold ourselves

accountable for our

actions.

We treat every

individual as a

person of

worth, dignity,

and value.

We strive to be the

best at what we do

and a model for

others to emulate.

10

Start with the End in MindGoals:

• Replace existing “Best of Breed” applications

• Utilize HMH employees (IT and Clinical) for implementation team

• Ensure resources maintain HMH employment

– Implementation team transitions

– Legacy team placement post sunset

• Maintain “Legacy” team to maintain current systems

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Agenda





12


Upgrade EHR to most current version

– Final version to sunset (3 year plan)

Meaningful Use readiness considerations

Upgrade additional ancillary systems

Hire consultants to supplement team

Goals

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Our Initial Team=51 Team Members

• 1 Director

• 1 Systems

Architect

• 2 Managers

• 5 Lead Analysts

• 8 Report Writers

• 5 Periop Analysts

• 3 Pharmacy

Analysts

• 8 EMR Build

Analysts

• 13 Clinical

Coordinators

• 3 Trainers

• 2 Support Analysts

Director

ManagerManagerSystems Architect

Lead Trainer

Trainer 1

Trainer 2

Trainer 3

Support 1

Support 2

Lead Coordinator

Coordinator 1

Coordinator 2

Coordinator3

Coordinator 4

Coordinator 5

Coordinator 6

Coordinator 7

Coordinator 8

Coordinator 9

Coordinator 10

Coordinator 11

Coordinator 12

Team Lead 1

Pharmacy Lead

Senior Rx

Pharm Tech

Analyst 1

Analyst 2

Analyst 3

Analyst 4

Analyst 5

Analyst 6

Analyst 7

Analyst 8

Lead Periop

Periop 1

Periop 2

Periop 3

Periop 4

Periop 5

Lead Report Writer

Report 1

Report 2

Report 3

Report 4

Report 5

Report 6

Report 7

Report 8

Coordinator 13


14

EHR Upgrade Team=64 Team Members

Additions:

• 1 Project Manager

• 5 EHR Analysts

• 2 Periop Analysts

• 3 Report Analysts

• 2 Support Analysts

Director

ManagerManagerSystems Architect

Lead Trainer

Trainer 1

Trainer 2

Trainer 3

Support 1

Support 2

Lead Coordinator

Coordinator 1

Coordinator 2

Coordinator3

Coordinator 4

Coordinator 5

Coordinator 6

Coordinator 7

Coordinator 8

Coordinator 9

Coordinator 10

Coordinator 11

Coordinator 12

Team Lead 1

Pharmacy Lead

Senior Rx

Pharm Tech

Analyst 1

Analyst 2

Analyst 3

Analyst 4

Analyst 5

Analyst 6

Analyst 7

Analyst 8

Lead Periop

Periop 1

Periop 2

Periop 3

Periop 4

Periop 5

Lead Report Writer

Report 1

Report 2

Report 3

Report 4

Report 5

Report 6

Report 7

Report 8

Support 3

Support 4

Analyst 9

Analyst 10

Analyst 11

Analyst 12

Analyst 13

Periop 6

Periop 7

Report 9

Report 10

Report 11

Project Manager

Coordinator 13


15

Key Success Factors


Plan the work, work the plan, and embrace…

• Change management and communications

• Extensive training plan

• Super users

• Detailed planning, testing, and mock go-lives

• Command center logistics and processes

16

Agenda





17

Transition: Managing a Legacy Team

Keep core systems running and maintained

Limit interruptions for EHR implementation team

Goals

Keep legacy team turnover low and engagement

and satisfaction high

Implement new governance model

Limit requests to appliance core measures, quality,

patient safety or critical business needs

Ensure streamlined teams meet customer needs

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Core Clinical (Legacy) Team 2014

Day five, post upgradeTeam Members

Director

Trainer 1Coordinator 8Senior RxPeriop 5Report 7

Trainer 2

Trainer 3

Support 1

Support 2

Coordinator 9

Coordinator 10

Coordinator 11

Coordinator 12

Report 8

Support 3

Support 4

Analyst 9

Analyst 10

Analyst 11

Analyst 12

Analyst 13

Periop 6

Periop 7Report 9

Report 10

Report 11

Coordinator 13

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New Implementation Team - 2014Project Executive

Exec Admin

Project Director

Clinical Director

Epic SystemsDirector Clinical

Systems

App Mgr. ClinDoc/

Stork/LTAC/ASAP

App Mgr.Orders/

Willow/Beacon

Director

Physician

Initiatives

Director

Revenue Cycle

Resource

Resource

Resource

Resource

Resource

Resource

Resource

Resource

Resource

Resource

Resource

Resource

Resource

Resource

Resource

ClinDoc

Resource Resource

Resource Resource

Resource Resource

Stork

ASAP

Resource

Resource Resource

Resource Resource

Resource Resource

Resource Resource

Resource

Resource

Resource

Resource

Resource

Resource

Resource

Resource

Resource Resource

Resource

Orders

Willow

Beacon

Open FTE

Contractor / Staff Aug

(In FTE position)

Resource

Resource

Resource

Resource

Resource

Resource

Resource

Resource

Resource

PMO

Mgr Appl Tech

Mgr

Integration

Resource

Resource

Resource

Resource

Resource

Resource

Resource

Resource

Resource

Resource

Resource

Resource

Resource

Resource

Technical Apps

Integration

Ambulatory Mgr

Resource

Resource

Resource

Resource

Resource

Resource

Resource

Resource

Resource

Resource

Resource

Resolute Billing

Mgr

Resource

Resource

Resource

ResourceResource

Resource

Resource

Resource

ResourceResource

Resource

Resource

Resource

Resource

Resource

Ambulatory

Resolute Hosp Billing

Infrastructure

Mgr

Resource

Resource

Resource

Resource

Resource

Resource

Resource

Infrastructure

Resource

Resolute Phys Billing

Resource

Resource

Resource

Resource

App Mgr Radiant/

OpTime-Anes/Cupid

ResourceResource

ResourceResource

Resour

ce

Resource Resource

OpTime/Anesthesia

Resource Resource

Resource

Resource Resource

ResourceResourc

e

Resource

Resource Resource

Resource Resource

Resource Resource

Radiant

Cupid

Nurse

Champion

Resource

Resource

Resource

Director CM/

Comm/Edu

Resource Resource

ResourceResource

Resource Resource

Resource

Resource

Resource

Resource

Resource

Resource

Resource

Resource

Resource

Resource

Resource

Resource

Resource

Resource

ResourceResource

Resource

Resource

n

Training Mgr

Resource Resource

Resource

Instructional Designers

Change Mgt/Comm

Resource

Resource

Resource

Resource

Resource

Patient Mgmt

Mgr

Resource

Resource

Resource

Resource

Resource

Resource

Resource

Resource

Resource

ResourceResource

Resource

ResourceResource

Resource

Resource

Resource

Resource

Resource

Resource

ADT/Prelude

CadenceHIM

Director

Patient Access

Reporting Mgr

Reporting

Resource Resource

Resource

Resource

Resource

Resource

Resource

Resource

Resource

ResourceResource

Resourc

eResource

ResourceResource

Resource

Resource

Resource

Resource

Resource

Resource

Resource

Resource

Resource

Testing Manager

Testing

Resource

Resource

Resource

Resource

Resource

Resource

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Compassion Strategy – Critical Core

• Strong leadership support

• Created retention bonus

• Continued internal promotions

• Celebrated successes

• Created work close to home options and remote work alternatives

• Eliminated primary pager responsibility

• Continued management support

We embrace the whole person and respond to emotional, ethical, and spiritual concerns as well

as physical needs.

21


Excellence Strategy – Critical Core

• Implemented new governance model

• Applied new work management model

• Taught Clinical Coordinators configuration

• Completed cross training between EHR and Periop.

• Eliminated “on call” physician training; published schedule

We strive to be the best at what we do and a model for others to emulate.

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Respect Strategy – Critical Core Consultants

• Initial participation in employee outings

• Option to work remote exclusively

• Occasional one-on-one with director

• Transparency with SOWs and budget plans

• Created opportunities for additional training and certifications

We treat every individual as a person of worth, dignity, and value.

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Transition 1: Critical Core Team 2016


Director

Trainer 1Coordinator 8Senior RxPeriop 5Report 7

Trainer 2

Trainer 3

Support 1

Support 2

Coordinator 9

Coordinator 10

Coordinator 11

Coordinator 12

Report 8

Support 3

Support 4

Analyst 9

Analyst 10

Analyst 11

Analyst 12

Analyst 13

Periop 6

Periop 7Report 9

Report 10

Report 11

Coordinator 13

Director

Trainer 1Coordinator 8Analyst 9Periop LeadReport 7

Trainer 2

Support 1

Support 2

Coordinator 9

Coordinator 10

Coordinator 11

Coordinator 12

Report 8

Support 3

Analyst 10

Analyst 11

Analyst 12

Analyst 13

Periop 6

Periop 7

Report 9

Report 10

Report 11

Coordinator 13

Senior Rx

Analyst 11Periop 5

2015 = 28 2016 = 27

Five successful core team transitions

to implementation team positions

One employee transition

to clinical area

One consultant

resignation

Addition of consultants to

backfill employee transitions

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Employee Engagement – Success

4.59

Tier 2

Tier 3

4.79

2013Teams reporting to Penny Black

2015

Teams reporting to Penny Black

Employee

Satisfaction

Scores


2016

Teams reporting to Penny Black

Tier 3

Tier 2

Tier 1 Tier 1

4.67

Tier 2

Tier 3

Tier 1

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Employee Engagement – Benefits

• Willing to go above and beyond,

exerting additional effort

• Energetic and enthusiastic

• Loyal to the organization –

more likely to stay

• Proud of the organization and

willing to recommend as a place to

work and to receive care

• More satisfied employees overall

Sense of belonging

Confidence HMH will

be successful

Work unit members

are honest/ethical

Key Drivers

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Key Success Factors –What Makes This Work?

Leadership commitment to employees that no individuals

will be left behind

Carefully choose 3rd party resources who compliment

and blend in to the team

Allow time for team bonding and knowledge transfer

Share organization value system and align values where possible

Trust and accountability

Flexibility


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Transition: Supplementing IT Leadership Team

Ensure that existing core IT systems remain

Productive and effective for business and

clinical operations

Goal

Current with regulatory and health reform requirements

Supportive of ongoing operational performance

improvements

Benefits

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• Engage a consulting partner

firm to provide experienced management

resources to oversee core operations

(multiple leadership positions)

• Engaged partner firm to provide

experienced leads and project

managers to supplement PMO resources

Logistics

Houston Methodist IT Leadership

Consulting Partner IT Leadership

Retains HR-related responsibilities

(annual reviews, promotions)

Retains financial authority

(approval of invoices, budget approval)

Provides feedback for the consultants’

annual review process

Function seamlessly as part

of the Houston Methodist IT

leadership team

Manage onboarding and oversight

of other third party staff resources

Approach

Transition: Supplementing IT CL Team

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Key Success Factors –What Makes This Work?

Choose the right partner!

Quality of interim leadership resources – knowledge,

experience, interpersonal skills

Trust and accountability

Bi-directional transparency

Ability to function effectively in a hybrid leadership

environment with some ambiguity

Flexibility

Transition: Supplementing IT CL Team

30

Agenda





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The New Reality and Lessons Learned

Support the successful go-lives of the new

EHR across the health system

Establish an IT staffing foundation which will

support the needs of clinical IT once the EHR

is fully deployed

Ensure a smooth transition of staff from current

roles to future roles on the consolidated new

EHR/Core team

Goals

32

New System Implementation Timeline


Q4 14 Q1 15 Q2 15 Q3 15 Q4 15 Q1 16 Q2 16 Q3 16 Q4 16 Q1 17 Q2 17 Q3 17

Hospital Go-Live

PO Go-Live

Project

Primary Design Complete

System Build Complete

WFWT

Upgrade

Testing Starts

SPG/PCG 1st Go-Live (3/1)

IP Content Build Complete

SPG/PCG Training

4 Hospital

Training

West Houston, St. Catherine

St. John, Woodlands Go-Lives (3/4)

Willowbrook,

San Jac,

Sugar Land

Go-Live (6/3)

HMH Training

HMH Go-Live (5/22)

SPG/PCG 2nd Go-Live (7/19)

SPG/PCG 3rd Go-Live (11/1) 3 Hospital

Training

3 Hospital “Go-Live” 2/19/17

33

2016 Core Team Projection


Director


Trainer 2

Support 1

Support 2

Coordinator 9

Coordinator 10

Coordinator 11

Coordinator 12

Report 8

Support 3

Analyst 10

Analyst 11

Analyst 12

Analyst 13

Periop 6

Periop 7

Report 9

Report 10

Report 11

Coordinator 13

Senior Rx

Analyst 11Periop 5

2016 =27 Resources

Director


Trainer 2

Support 1

Support 2

Coordinator 9

Coordinator 10

Coordinator 11

Coordinator 12

Report 8

Support 3

Analyst 10

Analyst 11

Analyst 12

Analyst 13

Periop 6Report 9

Coordinator 13

Analyst 11Periop 5

2017 =15 Resources

Change freeze, reduced number

of change requests

Continued successful

core team transitions

Expect third-party

resource attrition

New system

continued rollout

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2017 Reality


Director


Trainer 2

Support 1

Support 2

Coordinator 9

Coordinator 10

Coordinator 11

Coordinator 12

Report 8

Support 3

Analyst 10

Analyst 11

Analyst 12

Analyst 13

Periop 6Report 9

Coordinator 13

Analyst 11Periop 5

2017 =15 Resources

Director

Coordinator 8Analyst 9Periop LeadReport 7

Coordinator 9

Coordinator 10

Coordinator 11

Report 8 Analyst 10

Analyst 11Periop 6Report 9

Analyst 11Periop 5

2017 =4 Consultants

Number of changes requests

significantly reduced

All core team members have

suitable transition plans

Third party resource reduction

occurred organically

Rollouts

continue

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Implementation Complete


Director

Analyst 10Periop 6Report 9

Analyst 10

2017Transition Complete

Significant reduced number

of change requests

All core team members

successfully transitioned

Consultant colleagues will

transfer to new projects

New system fully rolled

out by mid-2017

36

Lessons Learned


Success Serendipity• Managing a legacy team

during a major EHR transition

can be done successfully

• Be true to your

organization’s values

• Work with partner firms

that share your values

• Transparency is essential to

build trust and reduce anxiety

• The prior success of the EHR

upgrade created confidence

inside and outside of IT

• Bringing consulting team

members on board in advance

gave time for them to integrate

• Staff adjusted surprisingly well

to new roles – were able to

“train up” and develop

additional skill sets

37

Realizing Benefits for the Value of Health IT

Our system will enhance our ability to provide

high quality evidence-based care in a safe

environment and will enable us to quantify our

care and deliver metrics in a meaningful way.

Our system will highlight the Houston Methodist experience

by connecting our patients and families with clinicians,

physicians, and employees.

38

Questions

Penny BlackHouston Methodist Hospital

[email protected]

Alan PerkinsThe Chartis Group

[email protected]

Thanks for your participation.

Please complete the online session evaluation.

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Documents

Managing a Legacy Team in an EHR Transition: …...14 EHR Upgrade Team= 64 Team Members Additions: • 1 Project Manager • 5 EHR Analysts • 2 Periop Analysts • 3 Report Analysts