RWJBarnabas Health forges ahead with remote Epic implementation
Since the merger of Barnabas Health and the RWJ Health System in 2016, RWJBarnabas Health, New Jersey’s largest health system, had been carefully planning for a migration from multiple electronic health record systems to a single, universal EHR that would work seamlessly across all facilities.
The selection of the universal EHR from Epic was made in 2019 with the initiative formally commencing in January 2020. The project, which the health system calls Epic Together, has multiple phases, leading up to installation of the EHR throughout the health system.
Before COVID-19, RWJBarnabas Health was at a critical juncture: the build phase of the EHR strategy, where subject matter experts assembled in discipline-specific workgroups and councils, which were convened to make decisions about scoping, functionality, workflow and configuration of the system.
At the start of the pandemic, more than 3,300 SMEs from the health system – nurses, physicians, pharmacists, medical school staff at Rutgers University and a myriad of other stakeholders – composed 62 SME workgroups and councils.
“Once COVID-19 began to spread throughout New Jersey, the health system’s primary focus shifted to site readiness to handle the pandemic within our state and health system,” said Robert T. Adamson, senior vice president and operational project director, Epic implementation, at RWJBarnabas Health. “This meant that many of the SMEs in our workgroups and councils would be needed for COVID-19 site readiness and no longer available for workgroup and council activities.”
"When evaluating whether to keep a large project active during emergency situations, consider pausing parts of the project in lieu of a binary question of full project pause or not."
Robert T. Adamson, RWJBarnabas Health
The challenge for the Epic Together project was the interdependence of decisions coming from SME workgroups and councils, which are translated into tasks for the EHR build team to configure the Epic system.
In addition to potential lack of SME availability, the EHR build team would begin exclusively working remotely with an estimated 40% reduction in productivity. With COVID-19 site readiness the priority of the health system and the build team working remotely exclusively, a decision needed to be made whether to continue keeping the Epic Together project active.
The proposal that the health system developed is called “Epic Together Strategic Pause.”
“The Epic Together project leadership team would evaluate the 62 subject-matter-expert workgroups and councils for COVID-19 impact,” Adamson explained. “Each workgroup and council would be assigned a score of one to three. A score of one represented normal availability; two, reduced capacity; and three, a full pause in the activity of the workgroup and council.”
As an example, he said, “the emergency department SMEs would likely be unavailable, but access and revenue likely would be able to continue to be engaged with the EHR build team.”
This process would give the EHR build team leadership insight into SME availability. By completing this exercise, the leadership team could determine if there would be enough SMEs available to perform decisions so that the EHR build team would have enough tasks to remain active and advance the project.
Next, migrate the EHR build team from a centralized office base to a fully remote work environment. The EHR build team leadership team would perform a needs assessment of equipment, communication and collaboration tools the team would need to maximize productivity.
The EHR build leadership team would evaluate all pending tasks that would need to be performed over the entire build timeline. The team then could reorganize the tasks, such as those that are independent of having SME evaluation.
Then, evaluate the EHR build team for nurse clinicians that could be re-deployed back to clinical practice to strengthen the acute care facilities’ COVID-19 site readiness. After the evaluation was completed, the EHR build team and the health system’s senior management could determine whether to halt the entire project or move to a strategic pause.
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MEETING THE CHALLENGE
“The Epic Together project leadership team is comprised of myself, the IT project leader, the CIO and our EHR build leaders council, whose responsibilities were for applications systems in ancillary, clinical, medical group, access and revenue, digital, data analytics, and project support, along with leaders from the project management office, training and change management, and communications,” Adamson explained.
“Epic and implementation partner Impact Advisors leadership collaborated with the Epic Together leadership team to develop and execute the Epic Together Strategic Pause Initiative,” he said.
The Epic Together project leadership team completed the evaluation and strategically paused 13 of the 62 SME operational workgroups and councils. The entire EHR build team and health system senior management were informed on a weekly basis of the status of the workgroup and council using a communication tool called an SBAR, which stands for Situation, Background, Assessment and Recommendation.
“The entire EHR build team converted to a remote work environment, bringing all their equipment from the centralized office to their home environment,” Adamson said. “The IT team ensured enough capacity and licensing for remote access to the health system’s network. In addition, they implemented the collaboration tool Microsoft Teams so that communication among all the stakeholders was ensured to maximize efficiency and productivity.”
The EHR build leadership team established metrics and held regular team meetings via video conferencing to set weekly goals for each application team. The EHR build-leadership team evaluated all pending tasks that would need to be performed over the entire build timeline. The team then could reorganize the tasks such as ones independent of having SME evaluation first, and revisit SME-dependent tasks after the workgroups and councils were reactivated.
“The EHR build team redeployed all nurses, 10% of the team, back to the acute care facilities to enhance COVID-19 site readiness,” Adamson said. “Their roles on the EHR build team were absorbed by the team that remained.”
Throughout the project, RWJBarnabas Health has been tracking tasks within the project management tool. Each week, staff count the number of tasks completed. Since the implementation of this strategy, the average weekly tasks completed has consistently increased.
From December through March, the average weekly tasks each month rose from 33 to 180, then to 496. By halfway through April the average was 521, and by the beginning of May the average was 811.
Each month, each week, RWJBarnabas Health became better and better at implementing this new strategy: Finding the right tasks that staff could complete and getting them done effectively. During the best week, in April, staff completed 1,309 tasks.
“Using the strategic pause, we reversed the prediction and concern that productivity would fall by 40% due to the pandemic, instead increasing productivity by 43%,” Adamson stated.
ADVICE FOR OTHERS
“When evaluating whether to keep a large project active during emergency situations, consider pausing parts of the project in lieu of a binary question of full project pause or not,” Adamson advised. “In order to activate the project, consider strategic activation instead of full activation at normal cadence. Activation can occur with less frequency ensuring that the project continues to move forward.”