Having gained experience leading an EHR transition to Epic at Deaconess Health System in Indiana, Diane Hunt, M.D., chief health information officer, recently oversaw the switch from Meditech to Epic at Mount Nittany Health System in State College, Pa. Only two and a half weeks after go-live, Hunt sat down with Healthcare Innovation to discuss what led to a smooth change management process. 

Healthcare Innovation: Were there some lessons you learned at Deaconess Health System about managing this type of EHR transition that you've brought to this project at Mount Nittany?

Hunt: We did several transitions to Epic at Deaconess. We were in sort of a mergers and acquisitions phase during my time there, so over my eight or nine years at Deaconess, we learned a lot about the importance of governance and clinician engagement from day one.

HCI: Were you involved in the decision to switch to Epic at Mount Nittany, or was that decision already made before they brought you on?

Hunt: The medical staff and board had been pushing heavily for that transition prior to me coming here, so that was a big portion of my decision to come here, and I suspect that's probably part of the reason why Mount Nittany chose me to come here.

HCI: Mount Nittany is a smaller community health system with only one hospital yet it chose to implement Epic independently. Could you talk about some of the strategic considerations behind that?

Hunt: There was a strong desire to move to Epic, but there was also the possibility of utilizing the Community Connect program, where we could have partnered with a bigger health system to use their version of Epic. I think the thing that was a little bit unusual for an organization of Mount Nittany’s size is that we did elect to go it alone. I think we wanted to have the ability for the community here to really drive the utilization of the tool, so using something like a Community Connect relationship really would not allow us to be the decision maker for how the build is done and how we can expand it to our community. So we felt like that was a pretty important piece of the puzzle for us.

HCI: Are we seeing more small community health systems deploying Epic now than we did several years ago?

HCI: As a chief health information officer, what would you describe as a couple of the top challenges leading a transition like this?

Hunt: It's interesting. When I came here to Mount Nittany, what I thought would be the top challenges ultimately ended up not being the biggest issues. Culture is huge, and I have been so surprised, and honestly just delighted by the culture here at Mount Nittany. Everyone really has been behind the project, and it really has turned into a health system project, as opposed to an IT project, and that's not common in my experience. 

I felt like there would be a lot more issues with governance and operational leadership, and making decisions about workflows, and people not really being interested. That was not an issue on our end at all. And in fact, we had to turn super-users away because so many people were interested. 

Where we saw our biggest challenge was around bringing data over from our legacy system. As more organizations are moving away from those legacy systems, it's hard to find experts to help with that data conversion, so we really are still battling some issues with that data coming over.

HCI: What happens with the patient portal? Do patients have to sign up again?

Hunt: Yes, it’s a completely new software system. We are blessed to have a very strong marketing department, and they have been really well engaged with the project overall, so they had a massive plan around MyChart and reaching out to our community and our patients. We are two and a half weeks in, and I think we're at a 45% MyChart engagement rate, which is just phenomenal at this point. We're making sure that we're talking about MyChart at all the entries into the health system as well, so that's been a pretty smooth process for us.

HCI: Could you talk about how you make sure that the communication is flowing and the responsibility shared between the CIO, CMO, the chief nursing officer and others?

Hunt: When I got here, I started talking about governance, and that was a little bit of a foreign concept for the organization. We really hammered that in from day one, and once we signed the Epic contract, we developed project principles, and we created the governance structure. We had well over 80 work groups. Every work group included operational end users. We had clinicians, we had IT staff, and all of those staff members that you mentioned were involved at all levels of governance. We had the individual work groups that would talk about the admission workflow, or what happens when a patient codes in the ED, and then that would flow up to our clinical work groups, which were primarily clinicians, so the doctors then would hear about the decisions that were made, and that would flow up to our executive steering committee, so everybody sat at different levels within the organization.

We really want our end-users who are doing the workflows to make the decisions, so we had our overlying project principles, but we expected that those people who were in the trenches were making the decisions. It was a really empowering process to be a part of, for sure.

HCI: Could you talk about some of the things that are available in Epic that are going to allow new things to happen — maybe with a focus on some of the AI tools?

Hunt: Yes, I’ll start with the AI tools, because I'll tell you, when we started talking about this project 18 months ago, they had a little bit here and there, but not much. I didn't expect that to have as much of an impact as just the software in general. The AI tools have really made a massive impact, and a lot of them were just made available to us just prior to go-live. We’ve been fortunate to be able to implement those as part of the go-live, so “Chart with Art” is the ambient listening. We've got that live. We piloted with 50 of our doctors to start with, and we've actually just opened that up to anyone on the ambulatory side who is interested, because it's been so wildly successful. It's so easy to use, so we're transitioning those users from the Microsoft Nuance Dax product over to the integrated Epic one. 

The inpatient functionality for Chart with Art is going to be available to us in the next week, so our hospitalists and other providers seeing patients in the hospital will have the opportunity to use that ambient listening in the hospitals. 

I think the biggest surprise for me from a clinician standpoint is the ambulatory and inpatient summarization tools. We heard a little bit about it at the User Group Meeting, but oh my goodness, that is so powerful for our doctors who are walking into the room and haven't seen the patient in six months. Those summarization tools have been magnificent for our physicians, and I did not expect that impact. That's probably the thing that we get the biggest feedback about. All of the notes we ingested from Meditech were read through the AI tool as well, so we're able to summarize everything that came from the legacy system, in addition to the information in Epic. So that's been useful right off the bat.

HCI: There are probably other things on the administrative side as well…

Hunt: We are only two and a half weeks in, but the expectation is that a lot of the coding tools will be of assistance with the insurance claims and the prior authorizations. We’re just not there in our workflows yet to be able to measure that success.

HCI: Could you speak about the evolving role of physician leadership in health IT transformation? Are you seeing other clinical informatics leaders step up here?

Hunt: I’ve been doing this work for almost 20 years now. I'm a family physician. I worked for 10 years in a hybrid role, and ultimately moved into informatics full time. I think when clinicians are involved, the projects are just so much more successful. I was reviewing some of our tickets from the go-live. You read the ticket from the technical analyst side, and then you see the response from the operational side, and you say, oh my gosh, somebody needs to translate in the middle. 

I have a group of four physician informaticists who helped us with the project who will stay on and work in informatics. I went to them and said, “Just read some of these tickets. This is where your value is. We need that translator in the middle.” 

I think that the nursing informatics team, our physician super-users, and our physician informaticists are so critical to the success, because it's really hard to translate technical talk and healthcare talk, and figure out where we meet in the middle. I also think that having physician champions engaged in the project really gives us some credibility. We’ve been in the trenches. We understand what their workflows are, and that makes such a difference when they're frustrated, and the workflow just isn't working for them, and no one on the technical team understands how critical it is for the information to be right, for the medication reconciliation to work, for your patient list to work. When things go south, we're going to fix them as quickly as possible, but we're in it with you. 

Back when the Affordable Care Act hit, Cerner was the original EMR that I learned. I can remember going to my colleagues and trying to sell the idea that this is going to save us time, and we're going to get so much data, and we're going to care for patients better. I feel like we're just at the point now where that's really true, where we're starting to see that realized, so for me it's exciting. I have been talking the talk and trusting that we were going to get there, and now I feel like we're finally there with some of the AI tools and some of the data and analytics that we've got available to us at the point of care. So it is an exciting time for me.

HCI: So it's really just been two and a half weeks since go-live? In my experience, people don't usually offer to set up an interview so quickly after an EHR transition go-live….

Hunt: We shut down our command center pretty early on. We weren't working nights anymore. This is by far the best go-live I've ever been a part of, and I attribute that wholly to the culture of this organization. People were really dedicated to making it work and making it a success, and Epic was fantastic with their support model for us, and it just went exceedingly well. Our ticket closure rate is upwards of 85% at this point. Yes, there are problems — a lot of them having to do with that data conversion issue, but we are dealing with workflow questions and those sorts of things that I'm used to not talking about until months two or three of a go-live. That’s how far ahead of the curve we are right now.

HCI: What are some next steps or projects for refinement as you move forward over the next couple months?

Hunt: Optimization obviously is where we go next, and putting together the governance structure to support our optimization. We are looking at that governance that we had pre-go-live and translating that to the post-go-live side of things. We'll have our optimization committees rolling here in the middle of July, and we'll focus on making sure that our end-users are using the system as intended, using all the analytics within Epic, our Signal reports, and our productivity reports to make sure everybody is using the system as we need them to.