Survive Splitting an EHR into Private and Public Entities Xenapp/Hyperspace,BLOB,CareEverywhere •

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  • Survive Splitting an EHR into Private and Public Entities

    March 3, 2016 — 2:30PM - 3:30PM PT

    Marcus Hobgood, Chief Information Officer, University Health System

  • Marcus Hobgood Has no real or apparent conflicts of interest to report. Marcus Hobgood Chief Information Officer University Health System marcus.hobgood@uhssystem.com https://www.linkedin.com/pub/marcus-hobgood/b6/304/aa1

    Marcus D. Hobgood, is University Health System Chief Information Officer and former Chief Information Officer of LSU Health Science Center Shreveport. As the state director of the LSU Health electronic health record project, Mr. Hobgood led LSU Health to became the first state run public health system to successfully implement a fully electronic health record system. Mr. Hobgood has over 15 years in healthcare information technology experience, is a member of the American College of HealthCare Executives, a HIMSS Analytics member, the Gartner CIO program, and a member of the Cyber Information Technology Advisory Board.

    Conflict of Interest

    mailto:marcus.hobgood@uhssystem.com https://www.linkedin.com/pub/marcus-hobgood/b6/304/aa1

  • • Introduction to University Health • Challenge presented by privatization of the LSU System • University Health’s mission • DRIVE Cost out of EHR platform (Initiative and Vision) • Summary Post Privatization

    Agenda

  • • Describe how to successfully manage an organization through a major bifurcation of two hospitals

    • Discuss how to create operational efficiency and EHR responsiveness despite a major transformation

    • Identify steps needed to ensure improved performance after a major transformation

    Learning Objectives

  • University Health System’s goals were to: 1. realize savings 2. increase satisfaction 3. expand patient engagement

    http://www.himss.org/ValueSuite

    Goals

  • Dividing One Epic System Serving Five Hospitals into Two Epic Systems Serving Two Hospitals Each

    Mission: Impossible

  • University Health System is a northern Louisiana healthcare network, consisting of two hospitals, University Health Shreveport and University Health Conway in Monroe. Specialty Services and Centers of Excellence: Level 1 Trauma Center Regional Burn Center Feist-Weiller Cancer Center St. Jude Affiliate Clinic Children’s Hospital Center for Excellence for Arthritis and Rheumatology Facts:

    Shreveport Conway

    • Licensed Beds 459 247

    • Inpatient Admissions 20,902 6,648

    • Births 1,501 949

    • Emergency Visits 60,425 35,618

    • Outpatient Visits 362,308 105,662

    • Medical Staff 307 45

    • Residents 539

    University Health System

  • University Health was once a part of the LSU Health state hospital system that included 10 hospitals. From Shreveport to New Orleans, our charity hospitals have provided care for its citizens for over 200 years. Of the 10 hospitals, 5 joined together as the first state hospital system to implement Epic for EHR. The first “go live” was in November 2011 and the last in March 2013.

    University Health History

  • • Due to deep cuts in the state budget, our governor made the decision to privatize the Louisiana public hospital system.

    • This made it possible for the hospitals to continue providing patient services.

    Mandatory Privatization

  • Our Mission

  • • One EHR, 10 hospitals • Started with the Shreveport hospital, Nov 2011, 5th one done 2013 • Change of plans. State wanted no hospitals, started looking for organizations interested in buying • 2014 started plan to split Epic. Children’s bought NO, BRFF bought EAC/SHV, HPL closed and LAK still state • Completed in May 2015.

    Our Mission

  • • The plan was new compute, SAN and Virtualization • One team was working on deciding hardware and getting ready to start GenIO testing on new SAN • My cache dba team, Epic TC(Sarah) and server TS(Jeff) and i were coming up with a plan on how

    we could do this split. • Epic doesn’t have a lot of “split” project plans laying around so we did took a normal GoLive project

    plan and tried to pick out the items that we knew we would have to do. • This was our existing setup that was supporting the 5 hospitals for the state(LSU). • We also have REL,RELBLD,VLD for upgrade purposes. • We had to take this and create two completely separate instances.

    Current Environment Strategy

  • • On the left side, was our existing IBM compute and SAN plus UCS blades for NonProd • On the right side, was our new Dell compute and SAN plus the UCS blades for Nonprod • So to start, we created RedHat VMs for our new Prod and TST. Then we took backups and restored to

    create UH PRD and UH TST • We decided that rather than build the new UH POC and have the analysts build there yet, we continued

    to have the analysts build in LSU POC, build for the current live Epic would go on to PRD and be auto DC’d to UH TST. New build was manually DC’d to LSU TST then UH TST

    • Created MST from LSU MST, Ace envs created later

    Technical Practice Migration

  • For cutover Stop shadowing, finish build for UH PRD, Stop the DC from LSU TST TO UH TST

    Cutover / Go-Live

  • • Started May 2014 with hardware discussions • Create a new UH(University Health)domain • Created new VM datacenter • Created new Citrix Farm • All UH users were create new domain IDs • Their EMPs in live Epic were flipped to these new IDs

    Timeline

  • • Created all NonProd Epic servers, Xenapp/Hyperspace,BLOB,CareEverywhere…

    • Jan 13th – had Epic NonProd build trip • At this point we had TST

    Timeline - continued

  • Since our UH Prod env was a shadow of LSU env, we couldn’t connect the Windows client servers except during a cutover practice. The shadow was brought down, env brought live and testing would happen. Feb 25th had the production build trip which included Client, server and interface TS. Configurations on production windows servers were completed. In Mar tested document scanning, barcode scanning and printing April 13 our 3r and final cutover test. Went from taking a day ½ to run clinical scripts to remove LSU inpatients, down to a little over 4 hours After cutover, we changed our test interfaces to point to UH PRD and completed full integrated testing. Since our production interfaces were still live on the LSU instance, we couldn’t test with them.

    Timeline - continued

  • Most interfaces were already divided between the LSU OL engine and the UH Corepoint engine but all connections to Epic flowed thru the CP engine. Had to change Ips for any interfaces going to the new UH production Since we were a new company, we got new AIP number. So all our interfaces went from 747 prefix to 582. Plus we renamed them from LSU_ to UH_ Handful of interfaces that had to be created, Surescripts, MdStaff, GE RIS/Pacs(same interfaces but new RIS/PACs) For the Ris/Pacs there were new servers and thus new Ips. Interfaces had to be connected to the new servers and then there was full integrated testing.

    Interface Split

  • • These are just the highlights of the steps performed during each cutover and then the final GoLive.

    • Along with the Epic split, we were also splitting off and bringing our own instance of GE RIS/PACS. This started at the same time.

    • Stop shadowing

    • Build UH PRD

    • Disable UH employees access to the LSU Epic, LSU employees can continue to work

    • Sarah was doing some configuration of new env, plus licenses

    • Started a script to discharge all LSU inpatients – 4 hours

    Cutover Steps

  • • Currently, our Production, Reporting, and Support instances are hosted on 2 Dell r920s running Red Hat 6.5 and VMWare ESXi v 5.5. The non-prod environments are living on Cisco UCS hosts. For storage we are using Dell Compellent SC8000 w/ all flash array drives. When we first implemented Epic in 2011, Intel was not supported. We went live with IBM Power 770/780 physical servers running AIX 6.1 w/ IBM DS 8300 15K storage. It worked well for the most part but we did see some I/O performance issues.

    • We were the first Epic customer who attempted a simultaneous migration of both servers and storage, going from physical to virtual, AIX to Red Hat Linux as well as splitting the patient database all at one time. Both Epic and Dell had a huge stake in the success of this undertaking and were there throughout the project, providing support on every level, both remotely and onsite.

    Simultaneous Migration

  • Pre-Migration Infrastructure

  • This is the documentation we used – most of which is available on Epic’s UserWeb.

    • Preliminary Hardware Configuration Guide (created for our organization)

    • Cache on Linux on VMware Architecture

    • Operational Database Storage Layout Recommendations

    • Epic’s Operating System Settings and Security Setup and Support Guide

    • Cache 2013.1 Install and Upgrade Setup a