August 10, 2017

Focus on Epic: Extensive planning, preparation set stage for smooth launch

“If you haven’t been part of an Epic Go Live before, it’s a pretty amazing experience,” said Chris Costello, director of the EpicLeap program, referring to the time period when Epic software goes into production for the first time. “It’s borderline magical.”

by Madison Agee

“If you haven’t been part of an Epic Go Live before, it’s a pretty amazing experience,” said Chris Costello, director of the EpicLeap program, referring to the time period when Epic software goes into production for the first time. “It’s borderline magical.”

Costello should know — he’s been a part of five large-scale implementations of Epic software at medical centers all over the country. He brings this wealth of experience to his role as the dedicated leader for the entire EpicLeap program, Vanderbilt University Medical Center’s (VUMC) multi-year project to design, refine and install eStar, its customized version of Epic’s software for large health care institutions.

Regular Go Live Readiness Assessment exercises, which bring together the technical experts who designed the new system with the people who will be using it, have been conducted for the past five months. (photo by Susan Urmy)

The reality is, however, that the majority of Vanderbilt’s faculty and staff have never been part of an Epic Go Live, which means there is likely lingering uncertainty as to what a “Go Live” entails. What will it be like on Nov. 2 when the change occurs? What will employees be doing during the transition? What, if any, impact will it have on patients?

“Our primary goals for Go Live are that we continue to safely deliver patient care and maintain relatively normal operations while everyone uses eStar for the first time in real-life situations,” said Nancy Evans, chief information officer for Vanderbilt hospitals.

Evans leads the Go Live preparation efforts in partnership with Erin Tickle, R.N., director of shared governance. Together they oversee a massive, coordinated effort of teams across the Medical Center.

“A successful Go Live will be the result of multiple workstreams, months of planning, and the contributions of hundreds of people from areas all over VUMC,” Evans said.

For example, the team has conducted regular Go Live Readiness Assessments, which started five months before Go Live and have taken place every 30 days. These events have brought together technical people who designed the software and operational representatives who will use eStar in everyday settings, to provide an area-by-area readiness “scorecard.” Technical dress rehearsals are underway, during which all the hardware that will be connected to eStar, including printers and armband scanners, is tested. These technical events will be complemented by operational dress rehearsals, opportunities for selected areas to practice using eStar in their own environments.

Operational dress rehearsals are led by a dedicated operational readiness team, which has been working to socialize more than 500 new and updated workflows with operational owners, identify internal super users, hold events on critical changes and communicate impacts to different stakeholders.

Preparing data for Go Live

One of the earliest activities around Go Live preparation was the work involved in planning the import of much of the data from software that would be deactivated as part of the transition. Historical patient data, such as diagnoses, test results, medication lists, family histories and allergies, needed to be available in eStar, so that clinicians could make informed care decisions.

Other information, such as future patient appointments and auto-reminders that clinicians set up for themselves, would also have to be carried into eStar.

The team had to determine how many years of this data to move into eStar, as well as the specific method and timeline for loading it.

“In most cases, we’re bringing over ten years of patient data,” said Rachel Lassiter, an information technology senior analyst who helps coordinate the data backload and conversion effort. “That data has to be verified, so we’re relying on Vanderbilt nurses and other clinicians to help check it for accuracy.”

The actual conversion of most data will take place as close to Nov. 2 as possible, which will help preserve accuracy, though some data, such as that related to research studies, will be converted earlier in the fall. Items such as the status of patients in VUMC beds during the transition will be converted during the actual cutover process.

Making the actual software change

This cutover process — during which legacy systems are brought down and eStar is brought up — merited extensive planning on its own. This effort demanded a specific sequence of tasks to govern the transition, which is scheduled to take place in the very early morning hours of Nov. 2. The process is much more elaborate than a single button push some people may have been imagining, requiring literally hundreds of unique steps.

“While some cutover activities start as early as September, most of the steps start around 7 a.m. on Nov. 1 and end approximately 24 hours later on Nov. 2, which is when most users will begin to use eStar for the first time,” Evans said.

In that interim overnight time frame, Vanderbilt will still have to care for the patients in its hospitals and keep its emergency departments open and running. Clinicians who are in the hospital that evening will work under system downtime procedures, for which they will be well-prepared with education and direction starting several weeks beforehand. They will also help carry out some of the cutover activities, such as attaching new armbands with eStar-coded data on patients.

Addressing issues, providing support

The detailed planning and preparation for Go Live — not to mention the extensive testing performed on eStar — will help deliver a fairly seamless transition, one that will be largely invisible to patients. Still, the team expects a number of technical issues to arise, ones that can only come up during real-life situations.

“It’s not unusual at a Go Live for there to be thousands of trouble tickets and phone calls to the call center,” said Costello, reassuring that most of these tickets will be for minor issues.

To address these issues, the team will deploy hands-on support, made up of super users, who work at Vanderbilt and received special training, and external Epic experts, who will arrive shortly before Go Live and stay until eStar is stable. This 2,000-person army will be embedded in each unit or department and serve to answer questions, walk employees through steps within eStar, and enter and prioritize tickets.

Answering the call of these trouble tickets will be a fully staffed Go Live Command Center that will operate around the clock. One of the Command Center’s primary responsibilities will be to sort through the thousands of tickets, triage the most critical items, address the underlying issues and report back to the on-the-ground employees with status updates.

“We’re purposefully going live on a Thursday morning, because it will give us two full days of identifying problems from around the entire Medical Center — inpatient and outpatient,” Costello said.

“If we went live on a weekend, we wouldn’t have any idea what issues our clinics were experiencing until Monday. This way, we have two days to uncover issues and then the entire weekend to work on fixing the most critical ones.”

As the volume of trouble tickets goes down, and Vanderbilt employees become more confident in using eStar as part of their everyday work life, the intense support around Go Live support can then decrease. Contracted at-the-elbow support can disappear (though super users will remain as long as they are part of that unit), the Command Center can reduce its staffing numbers, and life around VUMC can return to business as usual.