![]() ![]() The temptation to add additional features or functionality or even sites during the transition process was often high, but beyond the scope of what we decided we could accommodate at go-live. Third, we focused on implementation of core functionality, while avoiding scope creep. This including evaluating people who need to be trained and end-user devices that needed to be replaced. Second, we took pains to ensure we budgeted realistically making sure that the total cost of ownership of the project accounted for every possible system that was being replaced. We set out to minimize turnover and maximize training of the existing teams, so that our personnel felt they each had a purpose and a role where they could be appropriately involved in the project. The first of these strategies was to invest in our information technology teams. These mitigation strategies are summarized in Fig. Reviewing the literature, we identified six major areas where go lives typically fail and put in place plans to mitigate potential risk. Many facilities that have gone through an install of this magnitude have reported system significant challenges leading up to and through go-live. In preparation for the transition, VUMC evaluated a variety of technical challenges, integration and workflow considerations. The project began with an effort to build a brand new version of Epic, configured for VUMC that took into account many of the innovative informatics work that had previously been implemented. More than 2000 people were made available for “at the elbow support” on the go-live date, as VUMC simultaneously brought the system up at 3 large acute care facilities, 125 different physical locations, involving more than 60,000 end user devices running 25 different Epic applications. Finally, VUMC identified more than 1100 subject matter experts who each provided unique input into the project. They functioned throughout the project as key advisors to the system build team. Additionally, VUMC created a new model called “core design advisors.” These advisors were a group of physicians that had been trained to use Epic and were intimately familiar with a variety of specialty areas across VUMC. There were more than 300 team members involved in the project planning, including approximately 100 consultants hired to assist with system implementation. The transition involved accommodating more than 16,000 end users and leveraging more than 450 design sessions to ultimately develop 700 workflows comprising over 14,000 individual build tasks that needed to be done during the 30 month transition period. 1 summarizes the overall scale of this migration. This would in turn allow VUMC to enter into a more sustainable support model and ensure the medical center was able to continue to use certified electronic health record technology as required by U.S. To make this transition a success, VUMC recognized a need to simultaneously move away from its home grown culture and internally developed systems to processes that were more in keeping with industry standards. Plans were made to implement all of Epic in a “big bang” model with a go-live date of November 2nd 2017. In 2015, Vanderbilt made a decision to transition to the electronic health record (EHR) system developed by Epic Systems Corporation (Verona, Wisconsin) for all of its core clinical information system needs – including ambulatory, inpatient, billing, and provider order entry. Anchored by a 1000-bed general medical and surgical facility, VUMC provides nearly 2000,000 patient visits each year at 120 clinic and outpatient sites with its staff of 19,600 individuals. The Vanderbilt University Medical Center (VUMC), in Nashville, Tennessee is among the nation’s premier teaching hospitals serving a large geographic area that includes Middle Tennessee, southern Kentucky and northern Alabama. ![]()
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