Professor of Radiology, Mayo Clinic College of Medicine and Chair of Clinical Systems Oversight Subcommittee, Mayo Clinic, Dr. Patrick H. Luetmer shared in an email interview with Healthcare IT News some key takeaways behind the success of the Plummer project. The massive EHR rollout project at Mayo Clinic was named in honour of Dr. Henry Plummer who developed a patient-centred health record at Mayo in 1907.

Mayo Clinic has achieved a historic milestone with the final Epic implementation in Florida and Arizona in October 2018. With that, all Mayo locations are now on a single, integrated electronic health record and revenue cycle management system. Could you tell us about your involvement in the Epic implementation across Mayo Clinic’s 90 hospitals and clinics, which started in July 2017? 

The Mayo Clinic journey to a single, integrated electronic health record and revenue cycle management system, a key component of a long term strategic practice convergence plan, began with an EHR task force in 2009/2010 which focused on interoperability with a two vendor, three EHR system.  The journey accelerated in the Spring of 2013 when we learnt that the EHR vendor supporting our Rochester destination practice was planning to end support of our Rochester legacy EHR. 

I was the physician responsible for governance of our Rochester EHR and I played an active role in assessing the readiness of Mayo Clinic to pursue a converged single EHR. In the October 2013, we received Board of Governors endorsement and launched an EHR vendor assessment.  I played an active role in the RFI/RFP process and site visits.  In February 2015, we received Board of Trustees approval confirming selection of Epic as our vendor partner and we launched the Plummer project with a four phase implementation strategy beginning with “big bang” conversions of all of our Wisconsin Mayo Clinic Health System (MCHS) sites followed by our Minnesota MCHS sites, then our Rochester Destination practice and finally our Florida and Arizona destination practices. 

During the project, I served on the Plummer project steering group as well as provided governance of the legacy Rochester EHR through the Rochester go live in May 2018. I now serve as chair of our enterprise clinical systems oversight committee which is responsible for the ongoing governance of our converged EHR and well as departmental clinical systems.

During the organisation-wide movement to Epic, what do you think were the key factors in the successful implementation of the Epic EHR in a relatively short amount of time?

Key project success factors included:

• Extensive practice convergence in the years prior to project kickoff. Many enterprise practice groups were actively working to converge to a single high value practice and the lack of a single converged EHR was recognized as a barrier to convergence. The Plummer project was viewed as part of a solution to allow convergence, not as the sole driver of convergence. Those areas most actively engaged in practice convergence prior to the project tended to do the best with the project.
• Utilisation of a formal change management program with comprehensive activity for all levels of staff was critical as every staff member experienced significant workflow changes.
• A talented core implementation team with limited turnover
• Appropriate project resourcing, clear strategic priority of organisation, full engagement of leadership at all levels and sites.  It was evident to all in the organisation that this was a top practice priority for three successive years.
• Strong support and collaboration from Epic. 
• A formal lessons learned process with rigorously tracked follow-up allowed project improvements which enhanced each successive implementation.
• Rigorous tracking of co-dependent projects and careful management of a separate team to support legacy systems ensured system stability prior to and during cutover and go lives.

What tips or advice would you give to healthcare organisations looking to carry out a system-wide implementation of a new EHR?

A new EHR will impact the workflow of every physician, nurse and allied health care provider. The success of the project will depend on the adoption of the system by these providers and their full engagement is critical.  They need to understand and endorse the need for change. They need to be actively involved in system configuration, workflow analysis, training and personalization and ongoing refinement of the system.

As a trained radiologist yourself, what were some of the improvements to workflows with the implementation of Epic?

Our legacy environment relied on interoperability of interfaced systems with disparate legacy databases. The Epic Radiant module provides a radiology specific view of the single Epic database. This provides a substantial advantage. Radiology order details, exam protocol and technologist note details, provider notes, labs and patient correspondence are just a click away. 

Care Everywhere allows the radiologist to quickly review reports from prior exams performed at other health care organizations. The Radiant RIS driven workflow allows prioritization of the reading list by a “reading priority score.” A cumulative weighted score including factors such as ordering priority (stat vs routine), patient class (such as intensive care unit, emergency department, outpatient), exam indication (such as stroke or trauma), patient clinical status (hypotension, other clinical or lab elements) time elapsed since end exam and time to next appointment can be calculated to present the radiologist with the most important case to review next. 

Critical test result management is enabled within the RIS workflow simplifying both provider notification and documentation of critical test result communications. As an academic radiologist, feedback to trainees on preliminary reports has been enabled within the RIS workflow improving both quality and timeliness of trainee education.

Dr. Luetmer will be at the HIMSS Singapore eHealth & Health 2.0 Summit on April 24 2019 to share about the key lessons learnt from the massive EHR rollout.

In particular, he will emphasise the importance of rigorous tracking of co-dependent projects and careful management of a separate team to support legacy systems prior to go lives.

Keen to explore more about the lessons learnt from the Plummer Project? Sign up here to enjoy early bird rates for the upcoming HIMSS Singapore eHealth & Health 2.0 Summit held from April 23-24 2019!