In mid-January, representatives from Epic visited Vanderbilt University Medical Center, where they rounded on a number of hospital units and outpatient clinics. They used anonymous survey results and spoke directly with clinicians, nurses and other staff members to better understand how well VUMC was doing two months after its transition to eStar.
The event was the first in a series of post-live visits, a regular part of the Epic implementation process. These visits allow Epic to identify specific issues that may be present following a large-scale software implementation, and to make recommendations of areas of focus for the post-Go Live phase, known as Stabilization.
Around the time of the Epic site visit — but before Epic issued its findings and recommendations — the eStar Stabilization Oversight Group was officially formed. Chaired by Paul Sternberg Jr., MD, Chief Patient Experience Officer and Chief Medical Officer, and Marilyn Dubree, MSN, RN, Executive Chief Nursing Officer, the Oversight Group directs a number of workgroups, each tasked with addressing a complex eStar-related issue that requires extensive collaboration from operational, clinical and technical leadership.
Weekly reports on workgroup progress are provided to senior leadership, accompanied by an at-a-glance infographic of key performance indicators, such as wait times for providers in clinics and bar code medication administration scanning usage in the hospitals.
The Oversight Group was reassured that it was focusing on the right priorities when Epic recently finalized the findings and recommendations from its January site visit. Epic’s report contained no real surprises, as the vast majority of the noted issues were identified at Go Live and have action plans for remediation well underway.
In its recommendations, Epic listed four major areas on which it suggested VUMC needed to focus over the next several weeks. These suggested areas aligned with the current efforts underway by many of the 11 stabilization workgroups, as well as other efforts across the Medical Center:
- Tackle issue of InBaskets that are causing widespread frustrations — The issue of InBaskets has been a primary focus since Go Live. It is one of the Oversight Group’s top priorities, and significant progress has already been made.
- Formalize robust governance structure for prioritization, oversight and follow-through — The establishment of the eStar Stabilization Oversight Group was an important first step as the formal post-Go Live governance structure is finalized. This governance structure will soon be announced.
- Address clinician unhappiness and frustration — Clinician dissatisfaction is being mitigated through multiple existing workgroups, including tactics for decentralized and local support, clinic check-in optimization, addressing issues of InBaskets and work queues, and improving communication between IT and the clinical enterprise.
- The final recommendation from Epic’s post-live visit was that VUMC “continue on-site visits to solve issues, deepen understanding of problems and strengthen trust in team.”
While the Oversight Group directs efforts on formalizing the clinician and staff support model, HealthIT recently rolled out a pilot of a program called HUGSS (Helping Users Gain Skills and Satisfaction).
The HUGSS pilot, which kicked off Feb. 26, was created to address a wide range of issues needing immediate attention. Teams of IT support experts visited a small number of targeted clinics to get on-the-ground understanding of eStar- and other IT-related problems and provide on-site remediation and support. Over the course of a week, they addressed the most pressing “break fix” issues and created longer-term plans for those issues that needed additional resources or more time to solve.
The initial pilot, which took place at clinics such as Interventional Pain and the Breast Center at Vanderbilt Health One Hundred Oaks, was enormously successful and received positive feedback from clinic colleagues. The HealthIT team is now leveraging this experience to refine its approach and explore how to scale HUGSS to reach more clinics and areas in need of support. The team looks at data such as number of support requests (i.e., Pegasus tickets) to determine to which clinics and areas to direct resources. As with the 11 stabilization workgroups, the HUGSS program operates under the direction of the eStar Stabilization Oversight Group.
While the Stabilization phase of an Epic implementation can last several months, especially given an academic medical center of Vanderbilt’s size and scope, the combined effort of the HUGSS initiative and the 11 workgroups are helping to advance the timeline. The Oversight Group is hoping that, when Epic returns for its second site visit in April, the findings will reflect the hard work so far.