MUSE Site Visit: Lessons Learned from Kalispell Regional Healthcare MEDITECH 6.15 Project
On August 11, Cornerstone Advisor’s client Kalispell Regional Health (KRH) held the MUSE event “Kalispell Regional Healthcare MEDITECH 6.15 Project: Lessons Learned” in Kalispell, MT. The day-long event was attended by interested participants from Indiana, Illinois, Missouri, Minnesota, Idaho, Kansas, Wyoming, and many areas across Montana. These participants represented sites live with 6.1, in the process of implementation, and some looking toward a future move to the 6.1 platform.
The Kalispell team shared triumphs, challenges, and advice for implementation and optimization.
The morning kicked off with an introductory session by Melanie Swenson, Director of Health Information. Melanie spoke of the success for KRH in reaching their goal of One Patient, One Record, One Balance through the MEDITECH 6.1 implementation. She described some of the areas that presented the biggest challenges for KRH at Go-LIVE, such as role-based access, how they’ve approached the resolution of the issues and advice for how to avoid similar pitfalls. Melanie shared the current state of roll-out in the Ambulatory environment with Web Ambulatory and next phases in expanding the functionality MEDITECH 6.1 offers with applications like Critical Care and integration with Home Care. She also spoke about partnering with MEDITECH as an early adopter for remote monitoring through the portal.
Lori Myers, Hospital Applications Supervisor and Clinical Lead for the project, followed with a presentation on some key setup considerations for the “backbone” build of the system. Included in her discussion were:
- Creating the facilities structure and importance of getting it right the first time. The complexity of the KRH organization, including three Critical Access Hospitals (CAH) in the project, no initial clear path for clinic facility set-up, and the need to factor in future growth presented challenges.
- Corporate Management Software (CMS)- the inclusion of the CMS tool in the implementation required thorough and on-going governance to respond to the evolving understanding of its effect on the multiple HCISes while trying to maintain independence and meet the goals of the multiple hospitals. The KRH implementation was faced with a unique balance between the current implementation and the ability to leverage CMS for future expansion of the enterprise.
Doug Riley, Applications Supervisor for Ambulatory, presented coordination for key pieces of the implementation impacting AMB Go-LIVE including conversions, Chart Abstracting, and Chart Prep for the clinics. He presented the available conversions, the ones KRH included in the implementation for AMB, and the mix of options used at KRH to prepare the clinics with the information needed to treat patients on Day One. Doug finished his session with words of advice for future sites including preparation, planning, and the hindsight of how helpful the historical LAB conversion would have been for the KRH clinics.
Corrine Kastner, Integration Supervisor, and Angela Tollerson, Integration Analyst, teamed up to present integration and reporting topics. Corrine described the impact of implementing a new interface engine in parallel with the MEDITECH project.
- The new considerations for interfaces and reporting in the 6.1 release with the flow of data between NPR and M-AT applications
- The positive experience with having MEDITECH NMI resources on-site for the Go-LIVE
- The advantages gained in new NMI interfaces replacing previously used third party interfaces
Angela provided a demonstration of what KRH has gained with the implementation of the Business and Clinical Analytics tools. She shared a live demonstration of the capabilities for data display using the ED Dashboard developed at KRH. Next she demonstrated the capabilities of the Visual Insight integration for custom reporting and dashboards.
The morning sessions finished with Jim Joyner, Applications Supervisor for Revenue Cycle and Finance. He presented the KRH experience with the Financials and Revenue Cycle applications implementation. Jim discussed the gains for KRH with the new M-AT functionality for Patient Accounting with the flexibility of the various desktops that come standard with the 6.1 revenue cycle content for workflow support and monitoring and improved look-up options. He described the impact of redesigning the Chart of Accounts on the integration and dependencies of other application builds. Jim shared examples of the decisions made related to dictionary migration versus rebuild and the opportunities KRH seized to start fresh with cleaner dictionary content. Also discussed was the importance of the Charge Reconciliation Team developed for the project. The group initially met almost daily, now meet much less frequently, as issues have been resolved through the groups focus on charge capture and flow.
The afternoon kicked off with an overview of the Web Ambulatory implementation considerations, challenges, and optimizations presented by Lori Myers, Applications Supervisor. This included:
- A tie back to an earlier session topic about facility set up and thinking through the build and workflow impacts
- The intuitive navigation with the Web chart layout
- The win for the organization with an integrated ambulatory and acute record
- The flexibility of the display of information using widgets and favorites for templates
- Workload message capabilities, decision-making during the build, and the impact on provider workflow
- Sharing some of the challenges KRH has faced with a still-evolving Web AMB product and delivery of new functionality in priority packs post-live
Lori’s discussion was followed by a lively demo of the Web Ambulatory product by Dr. Jonathan Anderson, key member of the implementation provider advisory group and enthusiastic end user. Dr. Anderson covered topics including:
- Optimal hardware configuration/device use for his workflow
- Challenges for viewing patient information introduced by clinics that had not yet implemented MEDITECH Web AMB (KRH live included only clinics on MPM. Clinics in the system on other vendors for ambulatory EHRs are being rolled out in phases)
- How he is leveraging the functionality of Web AMB to enhance patient care
The clinical applications were presented in an energetic tag-team approach by the Clinical HIT Analysts including Pat Muhlberger, Teri Steffens, Peter Cameron and Justin Pitts. They covered Patient Care Patient Safety (PCPS), Emergency Department Management (EDM), Bedside Med Verification (BMV), Surgical Services (SUR) and Physician Access and Physician Documentation (PAPD).
PCPS/EDM/BMV : Pat and Teri spoke about:
- The opportunities they leveraged to standardize through use of Standard Content the One Query Theory and a multidisciplinary approach to the implementation.
- Embracing rules post-live as a tool to optimize, facilitate decision support and eliminate unnecessary documentation
- Lessons learned about access build and the need to take a broad view of what expanded roles caregivers fulfill
- Advice for future sites implementing to play with the system more and doing thorough workflow assessment and definition
- Cutover planning and Go-live support models to have the right people at the elbow and the analysts available to troubleshoot and fix issues
SUR: Peter spoke about:
- The implementation for SUR from the point of including three facilities, two that used MEDITECH Client Server previously and the other that was converting from a paper system
- The Go-live support planning assumptions and lessons learned
- Consideration for workflows like documentation of medications administered in the OR by Anesthesia or how different users will access the patient record
- The volume of report requests post-live
PAPD: Justin presented:
- The importance of standardizing and defining the documentation build approach early
- How strong physician leadership proved to be an essential and an advantage
- A reminder to go back after testing to verify the output
The final session of the day included Order Management (OM/eRX) and clinical ancillary applications; Laboratory Services(LAB/MIC/PTH/BBK), Imaging and Therapeutic Services (ITS) and Pharmacy (PHA)
Suzanne Catalfomo, Pharmacy Informatics Supervisor, led off by presenting PHA, including:
- The differences in 6.1 compared to C/S despite remaining an NPR application
- The changes to how medications are viewed in OM
- The CMS challenges for multiple HCISes with an all or none option for settings in NPR applications
- The advantage of a fresh start
- Their considerations in build for integration with PCS assessments and flowsheet tools
Shelley Graham, the LAB/MIC/PTH/BBK Team Lead presented:
- How they approached the build to leverage standard content and maintain a shared build for all hospitals
- Encouragement for the use of loaders and utilities
- The importance of maintaining an on-going document to track the build and progress
- The close integration between LAB build and OM
- The importance of training end users well on the collection query options
Lori Myers presented the ITS implementation including:
- How they leveraged Standard Content across multiple HCISes
- The AMB impact on the build and the need to plan and build to integrate performing site and performing provider
- Their win with the ability to build/use one procedure and set up multiple site-specific charge codes
- Looking forward to functionality coming in the next updates for a Tracker for Diagnostic Imaging
Suzanne finished up the day with a presentation on OM/eRX and shared:
- Order Management screen layout, views and capabilities
- The impact of the integration between OM and the ancillary applications, challenges for build with NPR CMS limitations versus M-AT and the importance of timing for ancillary build and the push of orders to OM
- Their Order Set build strategy and coordination with the challenge of tools available only in a Standards ring but the affiliates needing to build in the Target ring
- Order Set build enhancements and challenges in 6.15
- An overview of other routines the OM team was responsible for in the project, including the Clinical Data screens, Dietary ordering, Home Medication Lists and reconciliation and the Discharge and Discharge Transfer routines
- The experience with available patient data conversions for Home Medications and Allergies
Kalispell presented important highlights of a long and detailed path with their implementation of 6.15. The attendees had good questions and Kalispell gave a valuable perspective from a post-live position where they’ve integrated experience and new knowledge into resolution of issues and optimization of the MEDITECH 6.15 products. The event offered reviews of challenges, strategies, wins, and lessons learned that will benefit current and future 6.1 clients.