The trauma of going live with a new electronic health record system is written all over Vanderbilt University Medical Center's preparation plans.
Vanderbilt is already reducing patient appointments at its more than 120 clinics and outpatient sites during the week of Nov. 2, when physicians and staff will start working in the new Epic Systems Corp. system, said Dr. Kevin Johnson, Vanderbilt's EHR project leader.
The Nashville-based academic health system also intends to beef up staffing in its emergency rooms that week, Johnson said, as patients who can't secure clinic and outpatient appointments will likely show up at the ER for care.
And 1,000 third-party consultants and trainers will be fanning out across Vanderbilt's entire system—to the three hospitals on the city's west end, across Tennessee and into southern Kentucky—to be on the ground to assist employees during the first two weeks of the conversion, he said.
Hospital systems change EHRs infrequently—often after several years—to take advantage of new technology and help their clinicians and staff run their operations more effectively. But it is a daunting and expensive task that, if executed poorly, can cost millions of dollars to repair and executives their jobs.
"It's like changing a jet engine midflight," said Johnson, a pediatrics professor who is the medical center's senior vice president for health IT and chief informatics officer.
The medical center, which legally split from the university last May, has been preparing employees for the switch to Epic since it publicly announced the plan in December 2015.
The long runway to launch is crucial, Johnson said. As much training on the system as possible will be completed before going live, he said.
And literally hundreds of staff and clinicians have been involved in the planning and communication of the rollout so that every possible wrinkle can be ironed out before launch day.
Vanderbilt has $214 million budgeted for the conversion and untold more dollars at risk if it leads to a bigger-than-anticipated drop in patient volumes.
An EHR is the electronic nervous system of a hospital or clinic, allowing staff to onboard patients, track care, view clinical workflow and bill for services.
UMass Memorial Health Care is going live with its own Epic rollout later this year. Already, the preparation is hitting the bottom line.
The four-hospital academic medical center saw EHR expenses mount to $26.1 million in fiscal 2016, eroding operating income to $40.7 million for the year with big additional spending on tap for the launch.
The upfront costs are worth it because if employees hate the system and can't get used to it, going back to refine processes and software is exorbitant, said Vince Vickers, healthcare technology leader at KPMG, which is a major consultant to health systems on EHR installs. KPMG shepherds through 25 to 30 EHR installs annually.
Vickers said the biggest complaint he hears comes from physicians who often find that the workflows they're introduced to in a new system strike them as not intuitive.
That's why it's critical that physicians have a voice in system design and get plenty of upfront training. In fact, services for an EHR install tend to be two to three times the actual cost of the software and hardware of the system, Vickers said.
If there's dissatisfaction with the system, "the cost to go back and 'optimize' it is exponential," he said.
Vanderbilt won't be accused of failing to communicate its goals to staff.
From the initial announcement, Vanderbilt has explained the reasons behind the conversion. Vanderbilt today uses a hybrid system featuring homegrown and McKesson-built functions, Johnson said.
The McKesson part of the system is older and won't be updated by the company beyond March 2018, thus the need to switch.
The new Epic system is being tailored for Vanderbilt's needs, Johnson said. But it remains standard enough to receive frequent company upgrades, while allowing clinicians and researchers to use a modern software system that won't feel foreign if they have to work with others outside of Vanderbilt, he said.
To undertake the rollout, 1,000 employees have been directly involved in vetting the technology, preparing their departments, organizing training and constantly communicating the path ahead.
Vanderbilt recently encouraged employees to familiarize themselves with the new system at interactive events called "space stations." Formal training on the system for 15,000 employees begins Aug. 21 for most users, with "super users" starting training two weeks earlier.
Moody's Investors Service estimates that the cost of the new EHR and any patient dislocation caused by the staff learning curve will cause Vanderbilt's operating cash flow margin to dip to 6.1% in fiscal 2018. That compares with a solid 7.7% it has been running throughout the system's fiscal 2017.
Clunky hospital EHR rollouts also can be deleterious to careers.
Last year, MD Anderson Cancer Center in Houston said its Epic implementation sparked a revenue decline and a $405 million, or 77%, drop in adjusted income in the 10 months that ended June 30.
MD Anderson President Ronald DePinho resigned his post this March under a financial cloud, saying he could have done a better job administratively and communicating with staff.
MD Anderson and Vanderbilt are about the same size, with the former posting revenue of $4 billion in fiscal 2016 and Vanderbilt tracking to record revenue of about $3.8 billion in fiscal 2017.
Vanderbilt is calling the overnight switch in all locations from the old EHR to the new Epic system "the Big Bang."
Staff determined that rolling out different functionality in phases or office-by-office would just prolong the learning curve, Johnson said. Deloitte is Vanderbilt's main consultant on the project. To prepare physicians for the conversion, other physicians will be training them ahead of time on the system, Johnson said.
Patient volumes will be down the first week of the rollout, predominantly in outpatient settings, as Vanderbilt intentionally reduces throughput so staff can adjust to the system on the fly.
Johnson believes employees and clinicians will be so well-prepared ahead of launch that they'll get patient volumes back up to speed after that tumultuous first week.
Vanderbilt plans to videotape the launch at multiple locations and study the film to learn how it can improve processes—a benefit it received by benchmarking launches at other hospital systems, Johnson said.