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Today on This Week Health.

You can't anticipate everything. I think it's, you know, motherhood and apple pie when you first sit down and come up with this amazing project plan. Then you get into weeds and it's like, well, wait a minute we don't work like that.

Take the whole example that I gave of the centralized versus decentralized scheduling, scheduling is scheduling. What's the big deal that I do in one spot or multiple spots? Well, it turned out to be a big deal. Welcome to Town Hall, a show hosted by leaders on the front lines with interviews of people making things happen in healthcare with technology. My name is Bill Russell, the creator of This Week Health, a set of channels and events dedicated to keeping health IT staff current and engaged.

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Hi, everyone. I'm Carla Rizzolano. I'm the CIO at Rocky Mountain Human Services. Welcome to one more Town Hall episode of This Week Health. Today, have the pleasure to introduce our guest, Lotz Polk. Lotz is the VP and CIO at National Jewish. Hi, Lotz. Thank you for sharing the space with us.

Can you start by telling us about yourself and your role at National

Jewish? Well, good morning, Carla, and thank you for inviting me to join you this morning. As far as my background, I have a Bachelor's in Business Information Systems from Colorado State University, and I hold an MBA from the University of Colorado.

I am a Colorado native, which There are far and few of us around these days, and I've lived basically on the front range my entire life. As far as some more of my background, I've worked for the U. S. Department of Agriculture. It's probably my most interesting job in that I helped track diseased cattle.

I've worked for the military health care system as civil service, I've worked for Centura Health and Exempla Health, which is now, absorbed into Intermountain Health, and now at National Jewish. I serve as the CIO, as you said, and I just passed my 14 year anniversary.

Oh, very nice. I'm excited to hear that you're from Colorado.

I didn't know that because you're one of those lucky ones that were born and raised here and get to stay here in this beautiful state. So that is great. Great to hear that. And then you have served, I didn't know about your background that you've done all that before you started into healthcare.

That's

yeah.

Those are interesting. You can tell me

all about it later. So, well, I tell people, yeah, I've been in healthcare and, tracking disease cattle was part of that healthcare experience, you know. it is.

It is how you started. You're right. It's truly how everything started. So, I know that you have a ton of projects, because when you and I were kind of brainstorming, there's a lot of stuff going on, and there's a lot of stuff going for every organization, but one of the projects that we wanted to talk about is your Community Connect Connection.

project that you work in collaboration with Intermountain Health. And I understand that one of the hospitals for Intermountain is one of your main partners at St. Joseph's Hospital. Let's talk a little bit about what is your collaboration with them and then we can transition into talking about your project with them.

Sure, so several years ago, National Jewish and St. Joseph Hospital formed this joint operating agreement to support each other and augmenting each other's services in multiple areas. As an example. We now jointly manage our pulmonary and cardiovascular services at the 2 locations.

You know, We jointly manage those together. It's great. St. Joseph is only a few miles from here. So, our clinicians can move back and forth between the 2 facilities fairly easily. 1 of the goals identified in the agreement was for National Jewish to implement EPIC. Since they already had it to better facilitate the sharing of our, patient information as our patients move back and forth between the two facilities.

thE transition to Epic was originally planned to occur in 2020, and of course with the pandemic that got backburnered. And just in June of 21, the two organizations agreed to start working on a project together. And so

you talk about, and that's important to know, right? So you started this product a few years ago and I was reading about some of the things that you've done.

And obviously, this is not your first EMR implementation. So that's interesting, right? I'm sure that you learned every time you do something like this, you'll learn something different, but. I know that, I mean, we talk about the collaboration and be able to be able to exchange information, to provide continuity of care for those patients.

But what else were you looking into as success drivers when you were talking about your implementation? Like, what else? I mean, a lot of things happened after COVID, right? We're trying to figure it out, optimizing resources and, multiple things, but why don't you tell me about a little bit more about what else were you guys looking

into?

I think one of the big challenges that we were faced with is that we're actually using 5 different clinical systems prior to going to EPIC. We're using an inpatient registration and billing system, scheduling system, the Allscripts ambulatory EHR. Along with an oncology EMR and an oncology practice management system.

And while we had built interfaces between all those systems, of course, an interface is not the same thing as being on the same system. So there was some information that was not shared between the 2 systems and therefore our clinicians would have to navigate into multiple.

very much. Systems to kind of get the complete picture of what was going on with our patient or, diagnoses and recommended procedures, et cetera. So, our 2 main drivers were to transition to an integrated EHR, obviously, and 1, which we provide seamless care to the patients we have in common with St.

Joseph. So, that kind of set the foundation for the entire thing. Back in the early days of setting up that joint operating agreement so prior to the design and build, so now, back to 2021 when we've sat down at the table and rolled up the sleeves, started working on it we came up with a number of principles and priorities to define success for the implementation of the project.

I would say first and foremost whenever. Possible. We would adopt the Epic Foundation and or Intermountain health Epic standard build and workflow for maintainability and to, and ensure quality and seamless patient information flow. We needed to maintain these standards where possible.

Second. We focused on detailed attention and effort on our unique and mission critical functions that we have here at National Jewish , where workflow in an existing build that didn't exist within Intermountain Health we made a conscious decision, to, to deviate from the EPIC recommended standard where it's required.

So, therefore, we made sure we documented all of this and with. Very thoughtful in the collaborative detail effort to build that between National Jewish and Intermountain. Third, we identified several priorities for decision making when challenged with incongruencies between our critical workflows and the standard build.

We always maintained our dedication to the national Jewish Health secret sauce, if you will both operationally and. Financial efficiencies, improving the care team experience, and a focus on information for reporting and analytics and optimizing the patient centered experience. So those were the 3 drivers that we adhere to during the whole design build process.

Yeah, and it's interesting to hear that you were consolidating 5 different systems. So that in itself represents a challenge. And obviously, like, every, you know, implementation, everybody wants kind of like their own Customization, but it's important to going back to what you said keep it standard as much as you can.

So that way you don't have to, you know, the maintenance becomes a lot easier and the data integrity becomes a lot easier, which nowadays is extremely important. And as you were going through this implementation, of course, you didn't know COVID was going to happen, right? So I'm sure there were other benefits.

As a result of this implementation, because, as I was mentioning before during COVID, obviously, we had a lot of staffing challenges. People really had to take care of the patient, and they didn't have time to document, and I cannot imagine going through a new implementation. during this time. So how did that look for you?

And what were some of those benefits that you saw that you were not planning for, right? Because obviously you didn't know this was going to happen, but I'm sure there were other things that you were able to accomplish with this new system and be able to provide

again, some additional tools to the providers, to the clinicians what is your take on that?

So, tough question to answer the decision was made to implement EPIC with St. Joseph or Intermountain Health, prior to the pandemic. And, so the scoping exercise and the amount of resources that it would take and the timeline, that was kind of More defined pre-pandemic staffing levels, right?

So during the pandemic and post pandemic, I think a lot of institutions were suffering from, loss of employees and employee turnover and stuff like that. So, that all of a sudden the implementation and the design and build didn't match the timeline because of lack of resources.

So, and given our. Partnership with St. Joseph, we knew that we would greatly improve the flow of information to and from the two hospitals, and that would enhance our patient experience. And, prior to this implementation, we had, staff that would make sure documentation, generated here would transfer over to the St.Joseph you know, and we used every mechanism known, courier, faxing, direct messaging, all that kind of stuff. But, not one of those solutions provided all the information, on the patient to transfer over to St. Joseph or back to here. You had to use a combination of the three to get the whole thing over.

And I would say lastly, given our usage of the 5 disparate systems, we knew we'd gain remarkable, administrative operational efficiencies by, by going over to Epic. And, with the loss of staffing and everything. By being able to shrink, where documentation was occurring we gained those efficiencies.

Now, not to say that, staffing is still, challenging in some areas as it is but, I'm glad we are where we are post pandemic as opposed to using those 5 systems pre-pandemic   📍 welcome to This Week Health, where every morning is an opportunity to transform your day with the power of health IT knowledge. Dive into our diverse podcasts on Spotify or Apple Music. Featuring shows like Today and Keynote, bringing you insights from the forefront of healthcare technology. But there's more.

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📍  Yeah, and

so. You mentioned there were benefits associated because of staffing, but also challenges associated because of staffing.

How do you manage overcoming some of those changes with the staff? I mean, this is a major project luckily this is not the first time you've done it, nor, But still, I'm assuming it makes it a little bit more challenging, because like you said, you had your model, then you come back and it really doesn't match.

There were impacts, the timeline was impacted. Absolutely. Is there anything else? I mean, how do you, again, how do you manage all this challenges or overcome staffing component?

Right? Yeah, I think at the end of the day what's amazing about the National Jewish team is, that, that can do attitude and, sucking it up and people put in tremendous number of hours, to not only run the clinic, or their clinical area, but also help in the build.

So all of a sudden, what happened as well is that we then started depending on fewer people than we had originally planned on to help us design the whole thing. And, one person then , became the subject matter expert in several clinical areas. Now, the, unintended consequence of that was that it was easier for this group of people to understand how the whole system was going to work in that, you had fewer people to kind of aggregate all the information into one, thought process as to.

How is it going to work? I think some of the other challenges, that we faced was that for example, conversion of appointments because of who we are, and that we see patients over long periods of time, years, really we had more appointments in our old system Epic, you know, the standard project template, project Management Template anticipated that we would require, converting into EPIC. So we ended up enlisting large numbers of staff, that had spent an entire weekend and many days after that to manually transfer future appointments into EPIC that couldn't be automatically converted.

Initially the scheduling extravaganza, as they call it, was going to be to transfer 100 percent of the appointments over. There were so many appointments that we had to, spin off a subgroup to figure out how to manually convert some of our appointments. And of course, the mapping wasn't a perfect match.

So, some percentage and, let's just say it was 60 percent or 70 percent of our appointments, Could get transferred through an automatic, unload and load process, leaving that, 30, 40 percent that had to be manually entered into the system. So, that was huge, resource usage that we weren't anticipating at the beginning of the project

yeah,

yeah, you made it happen. You made it happen. That's the important thing. And, when you think about your implementation process, there's a lot of planning going on and you try to think about all the possible components or workflows, your multiple systems.

I mean, obviously the appointment component, there's things that come up, but. if you were to do it all over again, or if you were to make a recommendation to other organizations that are thinking about going through the same journey, what would you say to them? , what were some of those lessons learned that you would share with, with the other, with other organizations?

Again, to answer that question, I think I need to go back a little bit and identify that we're National Jewish is really a complex ambulatory clinic with some inpatient patients here but a piece of the. Foundational implementation of EPIC is the facility structure, for example, and it drives how data will be presented throughout the patient's journey, both clinically and administratively, and in following EPIC's implementation project plan, there wasn't nearly enough time for us to properly or adequately understand and design the facility structure for our organization.

Intermountain Health was there with us side by side and, helping provide the details, but it really came down to us because we're the ones who know, our architecture, our facility architecture to actually sit down and do the design. So, the design period for the facility structure took much longer than anticipated.

So I think, if you're going to be a Community Connect client and, work with a larger healthcare system, some of the initial work that I think needs to go into it before you sit down and, kick off the project is to think through and discuss with your partner, how do we operate?

Versus how you operate, what's your standard build? Will that facility structure fit here? What's unique about the Community Connect client compared to the hosting system that will require changes in that facility structure? I think the 2nd issue that we came across was the design of the clinic and appointment registration workflow.

Is your partner utilization a decentralized scheduling model while you're a centralized model? And that's what happened to us is Intermountain more of a decentralized scheduling and we're very centralized. I think part of our patient care experience is, . People come from out of state and from all over the world, really, to come here, so they have a limited amount of time.

So, you don't schedule a cardiology appointment and then after the results come out, oh, let's get you over to the pulmonologist. Instead, we. We compress your schedule here, so maybe a out of state patient flies in for a week, for example, but we need to line up and anticipate what all the appointments are needed.

So many times, the patient then fills out a pretty extensive questionnaire and a clinician will review that And maybe even with phone calls with patients, then determine the course, that patient is going to follow all here. So we'll fire off and schedule, 12, 14, 16 appointments in a, 3 day period, for example and.

So, that's all done in a centralized location to make sure, A becomes, comes before B and B before C , make sure there's no conflicts, like, can't do some tasks if you you know, had a barium swallow, for example, well, you'd better not do you know, a CT after that. So, the order of exams was important as well.

So, understanding, are you centralized, decentralized, how is that going to work? How does that impact the hosting organization, really needs to be thought through. Other things like Epic uses tools that can be leveraged to automate the transfer of problems, meds, and allergies coming from an old system to a new system.

And we didn't take that path as we decided each patient's list of issues needed to be evaluated. and entered from scratch. This actually ended up being a huge expense that we didn't anticipate. And where I'm going is, you know, maybe, some of the allergies were, oh, I sneeze every time I come into my front door of my house.

Well, is that really an allergy? You know, So we made a conscious decision. Let's, get rid of the, the, the crap out of the old system and start fresh with quality data. And we didn't anticipate that. From a technical perspective, for example, another challenge we came across as a Community Connect client is that our virtualization hardware was not necessarily compatible with our hosted vendor, you know, hosting Intermountains virtualization hardware.

And unfortunately, this didn't show up until we actually went live. Initial testing before you actually had the volume of users on the system didn't demonstrate the issue we had. So we actually had to take a pause there and work through an entire weekend to figure out and tune the two virtualization environments so that they were more compatible.

then everything was fine after that. But, another one of those. Thanks. Oh, didn't see that one coming. There are many others, but let me close this question out by saying that our organization was very accustomed to building new functionality in our Allscripts EMR continually.

And by becoming a Community Connect client, we're going through a, a culture shift that we are now dependent on our hosting partners for a lot of the build. And not all changes can be made. As this could impact the entire Community Connect environment and the hosted environment and affect all hospitals and clinics on the system.

So, some changes we can't even do. Some changes are implementable and just in our small So, some Service area, within EPIC. So it only impacts us. So if there are larger changes Intermountain needs to take these to their, review boards to make sure, everyone's on board with the change.

And, that takes some time to do. Rightfully so. So, you know, some of these constraints can, lengthen the time of implementation. And, knew that going into this, but it's still a, a culture shift on our part.

Absolutely. I feel like that's one of the biggest challenges some of some of the organizations that will go into partnership with somebody else will face because you've been like building your own workflows or customizing the system or making the changes that you need.

And now you have to. Go to somebody else to request those changes and like you said, it's a bigger impact. However, I would say that the wins are probably greater than challenges.

Correct? Absolutely. The wins we've realized from this are, far outweigh those losses.

What are some of those that you'll say people are super excited about?

This completely changed our operational efficiencies or what? do you think are some of the biggest wins that you guys have accomplished?

You know,

Some immediate things. That come to mind probably the big win for us is now having that integrated inpatient and ambulatory EMR that the 5 systems down to 1, you can see everything, in 1 pane of glass and then additionally, the.

That sharing of information as we move patients back and forth between, our facility and St. Joseph's Hospital kind of along that same vein, our integration with our oncology clinics. I mentioned earlier that we had a standalone oncology EMR. Now we're using Beacon in Epic and it's fully integrated with the rest of the patient's record.

So, one stop shop to see everything that's going on with the patient. Additionally, a majority of the procedures we perform are hospital outpatient procedures. That was hard to manage and manipulate in the L scripts, the ambulatory EMR. EPIC was easily configured to support all of our procedures and having, again, having the patient's data integrated into that single pane of glass was the big win.

The general consolidation of the systems, we literally eliminated these 5 systems. So, I would say the other thing too EPIC's Care Everywhere system is amazing with so many health care entities on EPIC, the Care Everywhere module allows our clinicians to see and pull his or her, patient's information from other locations, to help improve the care of that patient in our facility, at that moment in time. We also now have Corio available to the clinicians. Under our old system, we were not leveraging Corio that has been helpful as well. There have been some simple things that have been a huge help too. The ability for clinicians, for example, to personalize their own note templates.

For documentation it's kind of removed one of those pebbles from the shoe of the clinician. So stuff like that, the kind of the small things actually turn out to be, big hits with the clinicians.

Very nice. Very excited for this project for you guys.

Like you mentioned, I believe EPIC. I mean, EPIC has a big footprint in Colorado. A lot of the major hospitals have it, so it just makes it easier for patient caring, continuity of care, and exchange of information. The Corrido is our health information exchange. And we have, I think it's Colorado and, there's another state. Anything else that you want to share with the audience?

I'd say the hardest thing to anticipate are the change orders.

You know, You build a contract, a project plan, you come up with, here's how much it's going to cost to do this, but there were change orders and there's always going to be change orders. The change orders, obviously include costs, so contingency and project funding becomes critical. The change orders that we needed exceeded what we anticipated in our contingency.

So, it would be hard for me to, recommend, how much of a contingency to bake into your, project plan as, every facility is going to be different, but, my, my whole thing was, wow, I underestimated. Anticipated that by about, 30%. So, it is what it is, but be prepared for change orders.

You can't anticipate everything. I think it's, you know, motherhood and apple pie when you first sit down and come up with this amazing project plan. And, everybody thinks it's, this is perfect. Then you get into weeds and it's like, well, wait a minute we don't work like that.

Take the whole example that I gave of the centralized versus decentralized scheduling, that, scheduling is scheduling. What's the big deal that I do in one spot or multiple spots? Well, it turned out to be a big deal. You can't think of everything so.

Add to your contingency. Lesson

learned.

Yeah,

yEah. Well, thank you so much. I really appreciate the time. This are, this is very important for me, something that I feel like it's good to hear just because like you said, you feel like you plan for everything, but at the end of the day, there's things that you're going to miss and there's those components or workflows you have to think about.

And for you especially, right? You're an ambulatory center and then going to a big organization. I mean, that's, that compatibility right there, there's a difference. So, you have to think of all those potential challenges, but you guys adapted and succeed.

So happy for you. And thank you for sharing this time. Again, I appreciate it. And I'm looking forward to hear from, from you and other exciting

projects. Actually, Carla, can I, do you mind if I add one more thing here? Go ahead, please. Include your marketing and communications team from the get go.

We had ours included and they were amazing. They helped us with patient communications, like, okay, this is coming. But, of course, they couched it in terms of. What, you know, the patient doesn't know what EPIC is, but they know what MyChart is, or will know what MyChart is, and that's what's important to them.

So, lots of communication about MyChart, and then internal communications too, here's where we are. This is what's coming. This is how it's going to impact you. So, and that's kind of standard in there. Don't forget your marketing team. It paid off in spades for us.

Awesome.

Thank you for adding that final remark. Sorry about that. No. Hey, it's all the things you can think of that could be helpful, we need to talk about. So thank you for adding that. And again, thank you for the time. And I'll talk to you soon.

All right. Thank you, Carla. Have a good day.

You too.

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