How to get two steps ahead of clinical integration issues [13-min. video]

It takes 10,000 hours of practice to become an expert in something, says Malcolm Gladwell. If that’s true, consultant Sheri Long is almost certainly an expert at clinical informatics.

With more than two decades of health IT work under her belt, she can often sense an EHR issue before it happens. When it comes to clinical integration, she says, there’s nothing like experience to help you dig up a problem that will arise a few months down the road.

In this video, Sheri sits down with Senior Practice Director Josh Kalscheur to talk through “lessons learned” on integrating clinicals and revenue cycle. If you’d prefer to read rather than watch, the transcript is below.



Josh Kalscheur: Hi! Josh Kalscheur here, Practice Director over our Advisory Services team at Nordic. I wanted to spend a little bit of time this afternoon talking with Sheri Long, one of our Advisory Services consultants, about her work in clinical readiness with one of our clients. We do a lot of large-scale big bang enterprise implementations.

Sheri's working on an install where they're already live on the clinicals side of the house and are installing revenue cycle as well, so I thought it would be interesting to hear a bit about what you're doing and how that may look different and unique for a lot of folks.

Sheri Long: Sure.

Josh Kalscheur: I'm wondering if you could share a bit about yourself and the project that you're working on.

Sheri Long: Yes. I came into this academic medical center as a clinical project manager. It involved a lot of work with governance and structure and trying to get groups together on the clinical side to talk with the other aspects of the revenue side.

Then it morphed into clinical integration, and it eventually changed into support for the CMO, the CMIO, and the nursing and ancillary service leaders, which is very characteristic of this type of install.

It's interesting to me, because in a big bang, everybody knows to examine everything. When you layer in [the addition of revenue], or if you’re putting clinical over revenue, people think, “Okay, it's almost there, we're just going to add this stuff to it.” But in reality, you have to go back and look at every single workflow and everything that you did in the beginning. You have to re-energize structural things like governance and operational readiness and communication plans.

Sheri-Long.jpgThen you have to go to the bedside workflows and figure out all the [workflows] you have to re-examine to determine the impact of what you're implementing. With this customer, we're adding revenue, but we're also adding OpTime and Beaker, as well as Home Health. There's a little bit of a workflow change because the operating room affects the nursing units. There's a difference with pathology, and there's a difference with other things.

You have to go back and make people pretend it's a big bang and identify all those workflows and then step through them all to determine the impact.

It's been a bit of a challenge. It's harder, because the initial thought and the approach to it is not always the same. People think it might be a little bit easier, but I don't think it is.

Josh Kalscheur: It's interesting to hear you say that. Do you notice that organizations tend to be resistant to seeing it as a whole-scale project when they have to review existing workflows, or do they just require additional advice and oversight and direction to be able to understand them?

Sheri Long: I think a little bit of both. I’ve found that the biggest challenge is, when a site goes up the very first time with phase one, it's the first time that they've had to support through the help desk with all the end users and all the workflows that are now in Epic, so they're very busy doing that.

What they don't do is maintain base things like documenting current state workflows. The workflows change from when they went live, and they are modified as they optimize and they add practices, and they do a lot of that.

They leave those things behind, so when they come in with phase two, you go to pull up a workflow and realize we haven't been doing that in a while. Now we have no documentation. There's little pieces that you have to go back and re-institute. Sometimes the communication or the operational readiness plan resources have left the system.

It’s about re-examining everything and figuring out how it fits into this new approach. They do tend to think it's going to be a lot easier, and they find out very quickly that they have to run and punt and go with it. It's tough for them sometimes.

Josh Kalscheur: In your experience, Sheri, do you have to re-engage with clinicians or with the operations staff that are not involved in the project? Or do you work through the existing project team to reach out to those different individuals to get them engaged?

Sheri Long: A little bit of both. The role I try to play is safety net. As they're doing the things that make sense and are intuitive, I'm looking on the periphery and at all the integration points to think, “What are we not thinking of? What department? What workflow? What end user? What security has to change? What particular department has been having difficulty?” We want to come up with a solution for it. Can we do it with the tools that we're adding?

There's a lot of the stuff on the periphery that I pay attention to, while the project is paying attention to the things that they know to do. We support them in that and prompt for other items as they go along. It’s about making them feel comfortable that nothing will be forgotten. I see myself in that role. It feels comfortable that way.

Josh Kalscheur: In your experience, do you often have folks on the project team who report to you? Or do you operate independently and work across a number of teams?

Sheri Long: Since I've been consulting, I don't have anybody that reports to me. Eventually, I've had people ask me if I could help lead. A lot of it is cross-training. A lot of it is giving them information about clinical aspects. If they're new to Epic, it’s explaining how Epic works, so that when they're trying to make a decision about communications or readiness, trying to fill a role, or trying to think about a workflow, I do a bit of knowledge transfer that helps make that much more accurate.

It's about supporting what they tend to know to do, so a little bit of both. Often they'll say, “Would you just help this particular group of people?”

In this case, I'm doing a lot of work with the CMIO and the physician leadership group and their integration with nursing and ancillary services, which is a key aspect to any type of additional go-lives for systems.

Josh.jpgJosh Kalscheur: Can you dive into that a little bit more? I'd love to hear more about the work you're doing with that group, and some examples of how you've helped them or provided some additional perspective or direction.

Sheri Long: Sure. When I first came, I was immediately asked if I could help them figure out what's changing. You have these clinical applications, and you're adding a couple more – plus all of revenue, which includes patient movement. It’s a revenue functionality within a clinical workflow, so there's a lot of integration that has to happen.

People think, “Well, we're adding that, but what does it mean? What does it mean to me every day?”

I help them come up with a methodology that describes what's new, what's impacted, and what's changing. It's a way to approach a lot of different types of projects that are going up in phases.

After we finished that document, it was the basis for a lot of the communication plan. It was the basis for some of the operational readiness. They were able to use that information and put it into messaging for target audiences to help them get going on the deliverables needed to move forward in the phase of the project.

Josh Kalscheur: In your role, help me to understand how you interact with the Epic team as well. Are you mainly interacting with ACs and AMs? Are you focusing more on the leadership space? What does that relationship look like for you?

Sheri Long: It seems to focus more on the leadership space. Specifically, I have a clinical lead on the project that I work directly with. We meet every week. We keep each other informed. We identify areas where we need to help. Often I reach out to the Epic partner and say, "This is what I've seen," which gives them information to say, "Here's where we need to support these particular applications with the different ACs."

Or it may be that Epic might need to solution this, because I don't think operations has the knowledge or the skillset yet to do that. It gives them a little bit more insight.

On the other side of that, Epic often comes to me to see if I can help support something that they need to get done that needs a little bit more cross-training from the analysts. We work together to drive the outputs that we need to go onto the next stage of the project, and to make sure that they’re accurate.

There's a lot of reviewing things, double-checking for people, reporting out, and letting each other know the process that we see on our side, to make sure that we're working synergistically. It’s very beneficial.

Josh Kalscheur: In regards to your current project, do you have an example of where the work you’ve done has helped avoid a negative outcome, or a situation where you had the foresight and expertise to steer the ship in a different direction?

Sheri Long: For me, it's lessons learned. When you are involved in so many different projects, you accumulate a lot of lessons learned. When you see something fail again and again, you know where to look. I'd like to say it's just magic, and I know everything about it, but it's just because I've already got the scars from it. I'm able to really look at that and say, "Let's go check this particular workflow," or "These end users are often forgotten."

There are many different examples, but for me, it's about knowing where failures can occur and really understanding the dynamics of a particular institution and their demographics, the way that they practice.

As a nurse, I can tell where they're going to have difficulty, and I hone in on it and dig for stuff. If nothing's there, then I move on. If there is, we've uncovered it, and we can solution it.

It means looking across the whole project and trying to apply everything that I've learned from all of the different implementations and see if there's anything I can use that would benefit that particular customer.

Josh Kalscheur: What advice would you give to an organization or a consultant working on a similar project, where either revenue cycle's being implemented after clinicals, or clinicals are being implemented after revenue cycle? From your experience, what’s a thing that if you haven’t checked or done or thought about, you should do that now?

Sheri Long: I see it again and again: People want to say there's revenue and there's clinical, there's ambulatory and there's inpatient, there's phase one of the project and now we're into phase two. There's a point where you can't really distinguish things like that. You have to talk about workflow. You have to talk about integrated workflow and patient through-put – through a department, through an office, through the hospital itself, from the doctor's office to the hospital and back, into home health.

You need to look at it from a holistic perspective. I recommend that they take themselves away from those individual silos of thought and look at a patient experience as they move across the care continuum for that particular hospital and ambulatory offices.

Every once in a while, they'll catch something and say, "I didn't think about that part of it." It’s about physically moving or making contact to ensure that I can go on to the next step. We've caught some really good stuff that way. For me as a nurse, that always gives the best perspective.

Josh Kalscheur: I appreciate that perspective a lot. I’ve heard that some organizations will have their senior leadership team walk through workflows as if they were a patient.

I've even heard of organizations that have gone so far as to get in the patient garb and sit in the beds and move from unit to unit. That can be one of the most profound experiences of understanding.

Sheri Long: It is.

Josh Kalscheur: Here's the system and the patient that I've been pulling apart this whole time, and now here's how that comes together and where it really matters.

Sheri Long: It is. It's really effective. Sometimes it's good to have people that have been there, done that, at their side when they have that experience. You're able to point out things or have them pay attention to very odd stuff that, with a small tweak, can make the patient's experience that much greater. If they have a little bit of guidance and support as they go through that, I find that it makes for a much better outcome in the long run.

Josh Kalscheur: Great. Well, this has been fantastic chatting with you a little bit, Sheri.

Sheri Long: Thanks for having me.

Josh Kalscheur: I appreciate your time and certainly hope that you've been able to share some tidbits of information that are helpful to some other organizations or some of our other consultants out there.

Sheri Long: I hope so.

Topics: Advisory