Go-live gone wrong
Are there lessons to be had from a Maine hospital's rollout troubles?July 31, 2013
Though it seems that much of the healthcare industry is finally on board with making the transition from paper to digital records, the transformation comes with a high price. Much anticipated, and sometimes hyped, electronic health record system rollouts cost millions of dollars and often end up causing chaos, frustration, even firings at hospitals across the country.
Case in point: Maine Medical Center in Portland, Maine, a 600-bed hospital that is home to the celebrated Barbara Bush Children’s Hospital, and a part of the MaineHealth network.
Maine Med’s go-live last December of its estimated $160 million Epic EHR system seemed at first to go off without a hitch. But four months later, the hospital network’s CIO, Barry Blumenfeld, MD, was out of a job, and, in an April 24 letter to employees, Maine Medical Center President and CEO Richard W. Petersen announced a hiring freeze, a travel freeze – and a delay in the further rollout of the EHR throughout the rest of MaineHealth.
"This is being done to concentrate and focus our information systems resources to finding solutions to our revenue capture issues," Petersen wrote.
The letter, obtained by Healthcare IT News, cited a $13.4 million operating loss the hospital sustained over six months of its fiscal year. Petersen cited as contributing to the loss a decline in patient volumes, the increasing number of patients who can't afford to pay for their care – and the launch of the electronic health record system.
"The launch of the shared electronic health record has had some unintended financial consequences," Petersen wrote."While there have been many advantages in the implementation of SeHR, in some cases, we've been unable to accurately charge for the services we provide. This lack of charge capture is hurting our financial picture."
A Maine Medical Center nurse told Healthcare IT News the charge capture issue was a serious one.
"From what I've been told, for six weeks caesarean sections weren't charged. Big things. Surgeries weren't charged – big things and little things," she said.
"Since Epic's gone live, essentially, the Epic people failed to mention – and certainly, 100 percent failed to teach – that the nurses and the doctors were supposed to be somehow charging people for everything that we do," she added. "I guess we didn't know that Epic was supposed to be charging as we went along. Let's say I document that I put in an IV in – there goes a charge right there. That's how they get charged for that. The nurse puts in the IV, and then they put in the computer that they've done that. There's supposed to be a charge for that. So I guess, early after go-live, finance people were saying, 'Something's wrong; we're not charging.' But we didn't realize that we were the ones who were supposed to be charging, and we actually weren't taught how to charge. Not only that, but we weren't taught what was important to charge. We were basically taught how to navigate the right screens."
Now the clinicians are supposed to be charging, the nurse said, but they have not been taught anything different. "We haven't been brought back into a classroom and told this is how you're supposed to be doing it," she said. "We were never told that we would be responsible for putting those charges through."
'We have to pass at this time'
To follow up on the news story about MaineHealth's troubles, which Healthcare IT News posted on its website May 2, we contacted the communications department at Maine Medical Center May 3 and asked to arrange an interview with then Chief Information Officer Barry Blumenfeld, MD.
The response via email: "Barry has left the organization. We have an interim CIO ... let me see if he's available." A series of emails followed back and forth. Maine Medical Center asked for the questions in order to find the right person for the interview. Healthcare IT News supplied them. The emails from Maine Med ended with this one, on May 30:
"Sorry, but we have to pass at this time, as our team is really focusing on follow-up work related to the rollout. Can we check-in later this summer to see if that would be better timing? Thanks, and sorry to take so long with a response."
On May 22, we emailed Blumenfeld directly to ask for an interview. "I would love to speak with you," he wrote. "I've thought (about) my experiences and believe that I have some things to say that would be of value to your audience. However, I'd like to let MaineHealth know that I will be talking with you before I do it. I’ve sent them a note giving them the heads up and asking if they have any specific concerns – and will let you know just as soon as I hear back."
A day later, Blumenfeld said in an email he would have to pass on the interview.
Epic, meanwhile, also declined an interview request. A spokesperson told Healthcare IT News that, "Only MaineHealth can share information about their system.
"Since each system is configured for their needs, many things are customized."
Not alone to decline
Maine Medical Center was not alone in taking a pass on an interview about its rollout. At 885-bed Wake Forest Baptist Medical Center in Winston-Salem, N.C., a media contact said, "We are not facilitating media interviews at this time."
Sheila Sanders, Wake Forest's CIO, planned to resign at the end of May, according to a May 17 article in the Winston-Salem Journal.
"The health system has struggled with the implementation of Epic, a new electronic medical records system," the Journal reported. "However, health system officials said Sanders' resignation was not related to Epic and that Sanders is relocating to Florida to spend more time with family."
Partners HealthCare in Boston, an eight-hospital system with some elite names – Massachusetts General and Brigham & Women's, to name two – made its plans for an Epic rollout known last year. But it too declined a June 3 request for an interview with Healthcare IT News, saying: "Given that we are so very early in our effort, we are going to pass on this opportunity. At this point in this very early stage, we would be unable to effectively answer these questions. We are years away from go-live dates. Thanks for thinking of us, and do not hesitate to check in, as we get further along in our process."
The Winston-Salem Journal reported that Wake Forest had launched another round of "multi-million dollar" cost-cutting measures that would last through at least June 30, the end of its 2012-13 fiscal year, related to "fixing Epic revenue issues."
Those measures include attempts at volunteer employee furloughs and hour-and-wage reductions, a hiring freeze, a reduction in employer retirement contributions, and elimination of executive incentive bonuses for 2013.
The Journal added that Wake Forest Baptist cited $8 million in "other Epic-related implementation expense" that it listed among “business-cycle disruptions (that) have had a greater-than-anticipated impact on volumes and productivity." Also listed was $26.6 million in lost margin "due to interim volume disruptions during initial go-live and post go-live optimization."
Wake Forest Baptist attributes some of its operating loss in its current fiscal year to projected revenue that has been delayed related to problems rolling out Epic, particularly with billing, procedure coding and collections.
Detroit-based Henry Ford Health System, meanwhile, reported total revenues of $4.46 billion in 2012, an increase of $490 million from the $3.97 billion total revenues in 2011. Overall, however, Henry Ford reported $53.1 million net income for 2012, as compared to $62.9 million in 2011 – a decrease of 15 percent.
"The net income decrease is related to two factors," Henry Ford's Chief Financial Officer James Connelly noted in an April 25 news release. "The first is an increase in uncompensated care in 2012 for the health system. Second, Henry Ford is making a significant investment in state-of-the-art information technology in our clinical, business and insurance operations, which positions us well for healthcare reform."