Large EHR implementations: Two critical success factors [video]

When you think about some of the largest EHR implementation projects, stories of missed deadlines and budget overruns probably come to mind. But what about the projects that were on-time and on-budget? What about the go-lives that went by without a hitch? What are the leadership keys to success in those projects?

To learn the answers to those questions, we sat down with Zack Tisch, one of Nordic’s experienced advisors to clients undergoing large EHR implementations.

Zack talks about governance, culture, and a few thoughts on the type of leadership team you want working on your large implementation.

Take a look or read the transcript.

If you’d like to dig a little deeper on the topic, give us a call and we can set up a time to talk.


Large EHR implementations: Two critical success factors




Matt Schaefer: Hello, my name is Matt Schaefer, and I'm the vice president of business line development at Nordic. I'm here with Zack Tisch, one of our executive implementation advisors, to talk about common pitfalls during implementations, and some of the advice that he's seen when embarking on one of these large projects. Zack, tell us a little bit about yourself.

Zack Tisch: Absolutely, I'm very happy to be here Matt. My name's Zack Tisch. I've been working in healthcare IT for about 11 years now, and particularly with Epic software for the majority of that time. I've had primarily implementation leadership roles; helping a number of large integrated delivery networks, academic medical centers, and pediatric organizations. Everything from initial vendor selection and implementation design, strategy staffing, and all the way through build, development, testing, go live, and post-live support and optimization.

Matt Schaefer: Can you tell us a little bit about the role of an exec sponsor in a project and what's important for them to think about and consider?

Zack Tisch: Absolutely. I think that in any large project like this, there is going to be a lot of layers of governance. You're going to need all of your analyst team, obviously. You're going to need project managers. You may have product managers, directors, other levels within there, but ultimately you need a place where the buck stops. Ideally, that's one of your strongest senior leaders. In many cases it's a CIO. It may be the CMIO. In other organizations I've worked with it's been a CFO or a COO. I think ultimately, picking the right person with the right mindset is probably more important than the title, but it is really critical I think to have that one visible leader, a place where the buck stops, a person that can 100% accountability and dedication to the project, and that's really working very closely with the rest of your senior leadership team.

They're probably meeting on a weekly basis, but they still need that one person that's really fully dedicated to the project, that it's their baby, it's what they live and breathe every day. The rest of your leaders still have to run you institution, still have to make sure that you're delivering quality patient care, that you're improving. Most of the organizations that we've worked with, the Epic project is the biggest and most important project they're working on, but it's typically not the only one on the list. Especially with things like meaningful use, and ICD-10, and the ACO models, and a lot of the growth that we're seeing around affiliates and acquisitions of community hospitals and physician practices, and bringing them into your institution's network, there' re always other things going on. It helps to have your executive leadership team overall very plugged into the project, but also divide and conquer a little bit. You have one clear person that the number one thing on their list is that Epic project, and let some of your other leaders help with the other initiatives that may be under way, or the day-to-day running of the business.

Matt Schaefer: When you're starting a project, you're going to have to hire 100 or so analysts to join this project. How do you think about taking on something that large for an institution?

Zack_Tisch_Thumbnail.jpgZack Tisch: Yeah, and it's a real challenge. I mean everything from just onboarding all of these people, training, facilities, where do you house them, and really how do you build the culture of that team? One of the things I kind of look back to when I'm looking at "How do I staff up an implementation?" is really “What's the staffing model look like for healthcare?” I think one of the great things about healthcare is, if you think about a patient that may be going in for a hospitalization, how many different staff members with different roles and expertise interact with that patient? You have everything from your initial registration and maybe scheduling if you have appointments, obviously nursing and physicians are a huge component of your care, pharmacy, you're going to see a number of therapists typically, ancillary providers, you have billing staff that you may interact with on the back end, you have dietary, transportation, and so it takes an army of people with a very varied skill set to help get that patient better and get them back home.

I think from staffing a project, it's kind of that same perspective. You need a lot of different backgrounds on the team, and you want a lot of different experiences as well. You want to ultimately kind of meld it into shared culture and get the same vision and goal, but it is important to have a lot of those different skills in your tool belt. I like to look at first, a mix of kind of old blood and new blood. Who are some of our existing folks, particularly in IT for example? Who are some of our strongest people that support legacy systems, that understand our current workflows, our current infrastructure, and what we're moving from? That's usually a great place to source and to pull some of your strongest people onto the Epic project, and then try to backfill your day to day roles. Really use your expertise and your horsepower to skate where the puck's going, and not to support kind of where you are today.

Matt Schaefer: You mentioned a little bit about project team culture and how that's important. How do you foster a positive culture among this newly created team?

Zack Tisch: I think if you do anything right, particularly the first couple months of your project, I'd say make sure you get the culture right. It's really so important. These projects are so much work, and such a challenge, and so many long nights and weekends to get it across the finish line, that having everybody rallied around the same mission is really what's going to get you there. I think one of the really great things about getting to work with healthcare, and so many wonderful institutions, is there's a lot of material there to get passionate about. The work that our teams are doing, and our customer's teams are doing, truly do have an impact on patient care. They're going to make that experience better. They're going to help people get well faster. They're going to help clinicians identify potential medical problems for their patients faster, and hopefully intervene before that problem turns into a reality, and helping to reduce re-admissions, helping to facilitate better patient-provider communication and get patients more involved in their care.

I think first and foremost the foundation for your culture really should be the mission of your institution. I've gotten to work with a number of great organizations, a large cancer center for example, that's a really great mission to rally around. The team is just so passionate about the work that we're doing. If this can help in any way, the organization's mission to end cancer, that's an easy thing to get excited about. When it's 8:00 and you're in a room with 10 other people trying to figure out some problem that's really challenging, remind yourself of that. I think those are things to embed in your guiding principles, and then also just really embed in the team in a number of different ways. These projects are going to be a ton of work either way, and so you can either have fun and enjoy it, or you can wallow in the challenges. It doesn't change what you need to achieve as a group. I think the more you can get people aligned around that shared mission, and then enjoying their time doing it, enjoying working with their peers, you're going to have a better outcome.

Matt Schaefer: What do you think makes Nordic different from some of the other consulting firms that are out there?

Zack Tisch: I think, first and foremost, really our deep expertise and understanding of the Epic methodology. We have people that have been there and done that, that have a tremendous amount of years of implementation experience, of certifications. Then I think also just our mentality, particularly our advisory consultants. We're not going to just kick up our heels and sit there and give you advice. We're going to roll up our sleeves, get there in the trenches, and help you work through it, teach you how to work through it.

We really try to staff people, I think regardless of the role, if it's an executive advisor, or a project director, or a project manager, or analyst, or a trainer, whatever it may be. We want people that have that expertise that can give you the vision and the strategy, but can also execute the work. I think ultimately that's what really sets us apart. We have a lot of folks that can really play a lot of different roles, that can wear a lot of different hats, that can go from working on a very detailed system design issue with analyst, right into a conversation with your CFO about how to manage legacy A/R, or you're overall financial metrics.

I think having people with all those tools in their Swiss Army Knife, that have passion around healthcare, and IT, and what we do, and that understand that these projects are bigger than them, are bigger than Nordic. It's really about the institution. I think when you go into project with that mindset, and with that expertise, you're able to really build a great partnership and add tremendous value. I think that's what we find with our projects, that our customers really appreciate our dedication and how embedded we are in their team and in their success. The vast majority of our consultants get asked to be extended, end up staying post live to help with optimization, I think because of that attitude and expertise that we bring to the project.

Matt Schaefer: Great. Well Zack, so much for being here and sharing your expertise with us today. It's been a real pleasure.

Zack Tisch: Absolutely, Matt. I really appreciate it. Thank you.

Matt Schaefer: Thanks.


Topics: Implementation, Advisory, EHR project management

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