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MassTLC Inside the Four Walls with Dr. George Brenckle


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UMASS Memorial Medical Center in Central Massachusetts has recently undergone an IT transformation. The massive overhaul of its core IT systems was both a technology change and a cultural change across the organization. Dr. George Brenckle, CIO at the Center and co-chair of MassTLC’s healthcare community, presented at a MassTLC member roundtable discussion what it took to remove and replace its core IT systems and the ensuing impact of changing the technology, the processes and the culture to enable better care.

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MassTLC Inside the Four Walls with Dr. George Brenckle

  1. 1. * Healthcare Reform – Meaningful Use* Decreasing Volumes* Increasing Financial Pressures* Increasing Reporting Needs* Replacing the Core Information System * Used for 25 Years * Yeah, It kinda feels like this….
  2. 2. *  Soarian Conversion January 14, 2012
  3. 3. *  7 Hospital System (5 campuses)*  Clinical Partner to UMass Medical School*  13,500 employees*  3,000 registered nurses*  Approximately 1,700 physicians*  1,111 beds*  $2.2b in Annual Revenue*  ~70,000 inpatient visits*  ~1,600,000 outpatient visits *  3
  4. 4. * Only Academic Medical Center (AMC) in Massachusetts without a clinical Electronic Medical Record (EMR) and Computerized Provider Order Entry (CPOE)* Only AMC in the country running Meditech as its core information system * Clinical and Financial limitations of the system * Focused on back-end remediation vs. front-end data capture * We knew we had to upgrade/replace our core system* Under pressure to move quickly – short time to implement change * 
  5. 5. * Initiate Enterprise Master Patient Index* GE Centricity (IDX) *  Ambulatory Scheduling and Physician Billing* Allscripts * Ambulatory EHR* Siemens Soarian * Hospital/Acute Care EHR and Hospital Billing *  Pharmacy* GE Imagecast (RIS) Philips PACS* Meditech Laboratory * 
  6. 6. Forward Advantage     PCI o c      Metri Laboratory PCHIS Cycle IDX TSI PACS Power Scribe Cardiology R4 Ob  US IBEX ED* 
  7. 7. PACS R4 ED IBEX Ob  US*                                                          G  M  B               Lab TSI Meditech Bizcom    M o dbMotion EMPI IDX PCI
  8. 8. Current Information Systems as of January 2012 Private Medical HealthAlliance Practice Hospital Clinton HospitalWing Memorial Hospital Hahnemann Memorial Marlborough University Hospital Medical Group Private Medical Practice Private Medical Siemens Soarian Practice / Affiliate Hospitals Meditech Allscripts / IDX Health Alliance has been running a separate instance of Soarian since 2005 8
  9. 9. *  HIM Repository and Remote Coding/Abstracting*  Transition of Care Automation*  Ambulatory Meaningful Use ($10M)*  Combining E-Mail Systems*  Wireless Device Expansion*  Virtual Desktop/Device Independence*  Single Sign-On*  Application Linking/Switching*  Single Patient ID/IDX Active Registration*  Soarian/IDX 2-Way Interface*  ePSI Financial Planning System*  Ambulatory Dashboard*  eICU Expansion*  Salar Inpatient Physician Documantation*  MedCPU/ NLP * 
  10. 10. * The Conversion * Replacement of the core system used for 25 years * Largest Soarian implementation to date * Multi-entity implementation * Financials AND Clinicals – touched EVERY process at once * Significant changes in practice/workflow * “Big Bang” conversion of 5 campuses * Over 20,000 users converted * 3.9 million patient records converted * 300,000 scheduled future appointments moved * 284 new interfaces built and implemented * Introduced Virtual Desktop Technology, Wallaroos, Workstations on Wheels * 
  11. 11. * Conversion Week * 4 Hospital Operation Command Centers * 7 Soarian Support Centers * Open 3-4 weeks 24/7* The First Three Weeks * 300,000 results into Soarian * 250,000 non-med orders * 17,000 hours working on Soarian within IT * 
  12. 12. 1/15/12 6:00 am 1/15/12 6:00 am Interface Soarian Backloads Financials Live 1/14/12 4:00 pm Patient Access Complete Interface Conversions Complete 1/14/12 11:00 am Meditech Conversion Complete1/14/12 12:00 am 1/23/12 7:00 am Memorial andConversions beginHospitals on 1/20/12 7:00 am University Campuses LiveDowntime University NursingProcedures 1/19/12 7:00 am Campus Live Documentation Orders Memorial Campus Live Orders 1/18/12 7:00 am Clinton and Marlborough Hospitals Live 1/17/12 8:00 am Soarian Clinicals *  Business Offices Live Revenue Management
  13. 13. * Unforeseen * 4 Power Failures in our Soarian Support Center * Network Switch Failure on Lakeside A * Lower Census did not materialize* We should have foreseen…… * Security Issues * Effect of SSO (Single Sign-On) introduction with Soarian * Problems with Role-Based Access * Limitations of Siemens Security Tool * Downtime backlog * Design of downtime forms based on issues with backload * 
  14. 14. * Spread support resources throughout hospital * Eliminated Single Sign On with Soarian * Established a Security “swat” team * Relaxed Role-based access requirements * Staged phased introduction to orders and documentation* 
  15. 15. * Training * Planning and executing initial training program * Flashes during transition* Downtime Planning * Dedicated Activation Project Manager * Engaged Emergency Preparedness Coordinator* Support Centers * Definition, logistics, scheduling, metrics/dashboard tools * Communications with Operational Command Centers * Flexible and scalable during the transition* MPI Conversion* Integration cutover* Meditech conversion* Room Renumbering deployment * 
  16. 16. * Operational and clinical buy-in * Created Applications for Operations Committee (SKTT) * Communications: *  More vehicles, more frequently *  Transparency * Using the experience gained by HealthAlliance* Timeline * Engage activation manager and operations sooner * Live date changes (10/1/11, 12/1/11, 1/14/12) constrained transition planning * Testing: more workflow and reports * Incorporate QA and reports development team in future design* Technology * Mock cutover * Simulation testing * 
  17. 17. * Consider pilot go-live then big bang* Staging a rapid roll-out* Assign a dedicated communications manager *  Link support center network *  Provide ability to leverage more tools (blogs, Twitter, Facebook, etc.)* SWEEPS work; will keep for subsequent activations* Do not underestimate the space and other accommodations needed for you support staff* Can not overemphasize training and training* Establish a formal coaching program *  Formal commitment; long term* Invest in temporary support staff *  Internal and external *  More training sooner *  Plan to include internal staff in testing efforts as an education opportunity * 
  18. 18. •  Discuss Lessons Learned•  Share the discussion between technical and clinical•  Provide successes and challenges Organizational Culture and Governance •  There is no magic here •  The key tenets of successful implementations remain Technical Clinical •  Planning Build Adoption •  Communication •  Detailed Workflow •  Testing •  Training •  Support * 
  19. 19. * Replacing Meditech rather then implementing a “new” approach * Long term Meditech client * Customized the application significantly *  PDI *  Provider Dictionary *  Patient instructions *  Bulletin Board *  Reports * Workflow was primarily paper *  Little standardized work *  Complicated areas *  Dialysis *  ED *  Outpatient * 
  20. 20. *  "Thank you, thank you. I will get you a huge bag of chocolate! I am so happy now I have access to the forms and reports I need and they work since the folks in the support center spent time with me…”*  "I cant believe how much easier Soarian has made my job…”*  “This system is much more user friendly than Meditech”*  “Slowly learning and I will be an expert soon”*  "Dont quote me but this is kind of fun"*  “…We love this! We get credit for what we do!"*  “I never thought Id say this but this is easier.”*  "You know what I like about Soarian? The target behaviors page. Boom.- there it is!"*  “…love it love it love it took 4 hour class, left crying but it turns out Soarian is really easy to use and intuitive” *  20
  21. 21. * Stabilization and Enhancement* Allscripts Expansion * Order Entry/Results Verification * Population Health Management * Patient Portal* Wing Memorial * Soarian & Allscripts* Electronic (Bar Coded) Med Administration* Computerized Provider Order Entry * 
  22. 22. *  *  No definitive formulation – each attempt at creating a solution changes understanding of the problem *  No stopping rule – since you cant define, you can’t tell when it is resolved. Problem solving ends when resources are depleted. *  Solutions are not true/false but good/bad – no unambiguous set of criteria for solution – what is “good enough” *  No immediate or ultimate test of a solution – impossible to know how all consequences will play out *  Every implemented solution has consequences – you can’t reverse, it’s one way…. *  No well described set of potential solutions – all stakeholders have differing views of acceptable solutions *  Every problem is essentially unique – no “classes” of solutions *  Every problem can be considered a symptom of another problem – interlocking issues and constraints that change over time *  Causes can be explained in numerous ways – many stakeholders with varying and changing ideas about the problem, its cause and potential solutions *  Planner/designer has no right to be wrong – scientific method does not apply * 
  23. 23. *