The Check Up: Kevin Shimamoto of Valley Children's Hospital

Kevin Shimamoto, vice president and chief information officer at Valley Children’s Healthcare in Madera, Calif., talks about the opportunities and challenges of doing a virtual go-live for a new electronic health record system during the pandemic.

Pre-pandemic, where were you in the planning cycle for moving to Epic?
This whole project started in 2017, 2018. We had seven EHRs, and the decision was (made) through the medical executives. We were in a Meditech space at the time. … Epic probably had the majority of the installs across America in the pediatric group.

We had just done a long-term (request for proposals). We did a lot of visits in many hospitals, but at the end of the day, it came down to Epic as a choice. We went through the process and the negotiations … and we came up with April 25, 2020, (as the) go-live. It’s a traditional go-live. We went through the process of what Epic’s actual project plan was and how we deploy Epic in a pediatric facility. We had a lot of teams put that together in order to come up the plan, just a normal plan to (go live with) Epic on the ground here at our facility, as well as the consultants that we needed to bring in.

So months—really years—of planning leading to April 2020. COVID hits early in the year. What was the management conversation when evaluating your options?
January hit and … we had heard about COVID (first) in China … and then in Seattle (but we) didn’t think much about it. Fast-forward to March, we’re going, “Oh my goodness, this is big. It’s a pandemic.” Everything pretty much shut down across the world.

Senior executives met and we decided, “OK, what are the pros and cons of doing it now?” One of the pros is that we had the undivided attention of Epic because most of their implementations were shut down.

We had long discussions with Epic, saying, “OK, have you done this before?” The answer was, “Well, sort of” with international go-lives they did it in a remote type of environment. The second thing decided was, “If we don’t do it now, what is this going to do to all the work and planning that we’ve done? We’re almost into the go-live time frame. If we were to stop this and put it on hold until the end of the year, what would be the impact?”

The impact was big because here you have a whole team almost to go-live. And if we didn’t do it, then we have to put everything on hold. And basically we’d restart it from an economic, from a financial (standpoint). And we’d still have the seven EHRs we’re trying to take care of.

How nervous were you about doing a virtual go-live of this magnitude?
(There are) foundational things you’re going to need. One is how can we take care of the end-users remotely. We came up with a plan with our consulting firms, as well as Epic, to do a few things. We have a command center, staffed by our team members. No outside consultants could even come into our facility at the time. And that was part of trying to keep the patients safe. The second thing we decided was, “How do we take care of our end-users during the go-live?” We opened up four different locations … within the hospital. So we had our videoconferencing systems up (24/7). We had our phone systems integrated with our consultants’ as well as Epic’s (so if you have) an issue, those consultants can actually take over those PCs during the issues that they had with either a clinician or a physician. And then we had an intake center for all the (troubleshooting) tickets coming in. It worked wonderfully.

We had a virtual room for people to gather and talk about issues.

We had the right people, right time, right place to make sure that everything was taken care of in that very short period of time.

How would you compare this to a regular go-live?
Some things were better because, even though you’re in a virtual environment … you had a physician who was able to talk to (another) physician right at their PC. They didn’t have to move, they didn’t have to wait. They were right there taking over that particular physician’s PC. And I heard through the (operating rooms), which is a tough one to communicate with, that they were really pleased with how well the communications went. So that part to me was better, because a lot of times you just can’t get it to an OR. You have to gown up, but having a physician-to-physician talk worked well.

Looking back on it, are there things you would have done differently?
You can’t test enough—whether it’s your computers or printers. The connectivity side sometimes wasn’t really good, but it’s going to happen. So you should have a backup plan if Epic went down or one of your consulting groups went down. In this case, knock on wood, that wasn’t an issue. Probably a little more time as far as planning for a go-live. We had to throw it together very quickly. What I can say is the leadership of our organization, as well as Epic, they really opened their arms up and said, “Hey, we can do it. Let us know what we need to do to make it happen.”

And knowing what a pandemic really is, knowing the cause and effect of it. We’re feeling the fatigue right now. We’re still coordinating a lot of things to try to get to a stable, optimized environment. Being on a screen seven, eight hours a day, it’s been a huge change and taking 700 to 900 people from their normal jobs to their homes.

How did you balance fatigue among staff—both in terms of the pandemic and the go-live?
The team that I have is resilient. They buy into the Valley Children’s way (of doing things). Everything is centered around the kids. The patients are our kids. And having that mindset of going through anything, whether it’s implementation upgrades, anything you’re trying to do, how can we make it better for our kids? And that is something that comes from the board down to the employees who try to make things happen here.

If you have that mindset, they go above and beyond. Because at the end, if we can put tools out there for the conditions and the physicians, the medical staff, the better we can be for that patient. And that’s what we focus on. We really focus on patient care and safety and quality.

Do you think virtual go-lives will become more common, even post-pandemic?
It really has opened an opportunity for a lot of organizations across America. I would do this again. One, you save a lot of travel costs. People are getting used to (virtual meetings) now. You weren’t used to it a year ago. Being comfortable in front of a camera is something that you have to learn; it’s not something (that’s) easy for everybody.

I’ve talked to a lot of CIOs, my friends across America. And they said, “You pulled off something that most people or organizations would (not normally) do in a pandemic.” And that is something that I’m very proud to say—that it can be done.