Maximizing Benefits Post-Implementation: Q&A with HCI Group’s Chris Belmont, Part 2
By Candace Stuart, Director, Communications & Public Relations
Chris Belmont, executive vice president of operations and strategy at The HCI Group: A Tech Mahindra Company, shared lessons learned overseeing two Epic go-lives as CIO at Ochsner Health System and MD Anderson Cancer Center in a previous Q&A. In this second Q&A, he discusses post-implementation challenges and opportunities. This has been edited for clarity and length.
Q: Some people may think a go-live is as simple as turning a switch on and then we are all done. How do you deal with that mentality?
A:The executive and leadership teams need to be fully engaged, if not, that is a red flag. At the end of the day, these projects are not about the software or the tools but a new way of doing business. We had turnover in both organizations (Ochsner and MD Anderson) during the 3-5-year lifecycle of the project. Mostly natural turnover, reassignments and retirements. We were lucky that the new nursing officer and COO jumped in with both feet and really owned the outcome. They were true leaders and I would argue were MVPs for our programs.
I was fortunate in both places to have a very strong CMIO. I can’t talk on the right level with physicians like they can. But they also can’t relate to some of my technicians and programmers like I can. We had a strong partnership. Modifying physician and clinician behavior and the level of accountability is best done by one of their peers.
Q: You say this is an organizational transformation and not a software project. Does the post-implementation stage vary by institution?
The easiest part of this project is the software. It is predictable. The hardest part is driving adoption and change. That period after the go-live, while I think it is predictable, it varies in duration. Driving adoption and ownership before the go-live determines how long that post-live hangover lasts. At a minimum it’s six months but could be as much as a year. You need to be aggressive and plan for that period. You need to sprint to the starting line (the go-live) and then the hard work begins. That is when it goes from your build team owning and interacting with the system to everybody in the organization being impacted. These transformational projects impact literally everyone including the support staff. It is now their system and not IT’s. The build team shifts immediately from building to support.
You can never do enough training. It is important to set the user’s expectations. Our analogy is that training doesn’t give you a PhD in Epic but more like a middle school education at best. You know how to navigate. You know what it looks like. The real proficiency comes when the users sit down and build your preferences and understand their new workflow. In these new systems compared to the legacy systems, patient care is a team sport. At Ochsner, we called it friendly fire. If not coordinated, activities in the system could conflict with each other. A nurse could tee up an order for a doc to sign and the doctor may not see it or delete it and the patient flow and care flow are interrupted. You must bring those concepts together at the team level. While the physician is treating you, you must realize that the nurse is participating in this workflow with you. This includes messaging and managing patient messages through the portal and other avenues.
At MD Anderson we were fortunate to have a hospital unit that was being prepared for construction. Because we coordinated with others in the organization, we had the facilities team pause the construction and we turned it into a simulation lab. The rooms were equipped and set up like our clinics and work areas. We had real MD Anderson patients volunteer to come in and we went through simulations of a visit. We had binders set up with very specific scenarios: a leukemia visit, or a clinic visit or surgery visit. We had proctors to observe, document and coach the teams. In many cases, we had an entire physician team come in. We probably touched 60-70% of the staff. They quickly became champions. Some actually requested multiple simulation sessions in order to get it right. All these things benefit the pace of adoption post live.
If you think about the go-live day, it is like winning the air war. I apologize for the analogy. You go in and drop this system into an organization but then you must go in with the troops to deal with individual users. It is similar to hand-to-hand combat. You must find every physician who needs help and help them on a personal level. This is not about saying, ‘If you need help, call us.’ There will be a significant number of quiet strugglers. Epic has some powerful tools now that allow you to locate physicians that may be struggling. If you don’t address this community, they will either burn out and leave, be non-productive, or worse yet, may not provide the best care possible.
Q: Where are you finding most organizations are in their journey?
A: Most are post-hangover stage and realizing the value of the transformation. What we are seeing now is that some organizations have taken their eyes off other systems, things like the ERP system. They deflected resources and funding away from some of those systems, so some are getting long in the tooth. Now they are playing catch-up.
We are seeing a trend in organizations looking at managed services. They are saying, ‘What things are commodities that I can have someone else do? Maybe they can do it better, faster and cheaper than I can do it in house? This may free us to do the innovative more progressive things?’ This is not because of EMR journeys but because of the pressures to control costs, be more agile and fast while being more value-added to organizations. Managed services offer the flexibility and elasticity of resources without having to hire and maintain a large team with a vast array of skills that are ever changing. You can drive out labor costs, for example, by sourcing some of those services in an on-demand or as-a-service model. Many are questioning if they want to be in the data center business anymore, for example. Migrating to the cloud is popular now and helps with dynamic capacity and demand while shifting to a more OpEx financial model.
Typically, most organizations after that one-year post go-live period realize that the transformation was a good experience overall and begin leveraging the new operating model that emerges. CIOs who have led these transformations are often associated as being change agents and a strategic partner in the business. Some CIOs are struggling to get there because they still must keep the lights on and do the technology functions but also be strategic. CHIME references this as ‘CIO 3.0.’ The 3.0 is what CEOs want but some CIOs are struggling to get there. Not because of their skills or desires but often because of the tech debt that they are tasked with maintaining. I see so much change going on right now. These are exciting times. I’m also old enough to have experienced these major shifts over my 35-plus years in the industry. These changes are very exciting.
Q: Is there anything you want to add?
A: Sweat the small stuff but remember this is not a technology play. Technology is the enabler. It also is not the end point. It is a starting point. Constantly look at ways of doing more with the portfolio of talent and tools you have; not just more with Epic but look at all the tools. Don’t miss the opportunity to look at all the data you are collecting through all of these systems. That is how you provide value back to the organization. Give them the insights they need to run the business. Don’t wait to be asked. The CIO has a view of the entire organization from a perspective that most others do not.