I have consulted with several healthcare organizations as they navigate big changes: transitioning from one EHR platform to another, merging or partnering with other hospitals to expand their health system, bringing up new service lines, clinics and partners. The ripple effect of these changes often means changes in healthcare technology, staffing and IT investment.
Much planning and preparation goes into go-live so it’s essential to discuss changes and events you’ll encounter before, during and after go-live.
Cutover: The day before go-live
Let’s talk about cutover planning. Cutover is usually the day before the go-live. This is also when we get the production system ready for our go-live day by ensuring that basic patient data is available for staff when we “turn on” the system for our end users.
Cutover day checklist
When you are moving from another EHR into the Epic system, a number of things need to occur on cutover day:
- Admit patients into the Epic production environment
- Enter demographics and insurance information using the information from your legacy system.
- Ensure they are admitted into the correct rooms and beds.
- Enter height, weight and allergies
- Transcribe active orders into the production environment
- Medications
- Orders such as diet, labs, radiology tests, activity, therapy orders (PT, OT, SLP, Respiratory), and any other orders (for example, code status – how are you going to handle this one?)
- I recommend creating a crosswalk from your legacy EHR to the naming convention in Epic. Providing this crosswalk will assist your cutover staff greatly.
Questions to help determine essential data for EHR cutover
The first decision that needs to be made is what essential information should be entered into the EHR. A number of factors go into this decision:
- What is the minimal amount of information that is needed in order for clinicians to do their jobs when the system comes up? Collaboration between your clinical staff leaders and lead analysts and project managers should be able to determine this list.
- How much time do you have to complete this entry and how many people do you have available? Obviously, the larger number of people available will improve how much data can be entered and how long it will take. You will also need to have census predictions to factor into these measurements.
- Who will be responsible for entering patient information and in what order? Usually Grand Central (admitting) end users will admit patients, then nursing will enter height/weight/allergies, and then physicians or pharmacists (or both) will enter medication orders and possibly nursing or physicians will enter any remaining orders.
For example, I need to have a patient admitted into Epic before I can place orders. Then I need to have allergies and height/weight entered before medication orders are entered due to many med orders being based on height/weight. But, you will still need to decide what’s next. Are you going to have pharmacists enter all medication orders or are you having a group of physicians enter in orders? Is nursing going to be entering in orders?
Make time for a cutover “dry run”
Epic does provide some great tools in Galaxy™ to help you map out how many people are needed based on the time it takes for entry of orders and complete admissions. I recommend scheduling some dry runs of your cutover. This experience will give you great information and help you figure out some of the hurdles that you will hit when running your cutover.
Dry run checklist
- Security issues. Does everyone have the ability to see and enter the information?
- Build needs. Many organizations build cutover navigators in Epic to help expedite documenting the needed items.
- Experience will improve entry times. When you are doing this dry run exercise, many users are touching Epic for the first time and spending this time during the dry run will help users complete tasks needed on the actual cutover day. You can use the dry run to help you estimate an average entry time for the following:
- Height/Weight/Allergies
- Medications
- All other orders
- Legacy data. How are you going to handle providing legacy data for entry into Epic? Will you print out all information? Will you have two screens and have up both systems?
- Cutover support location. Where are you going to hold your cutover event? Do you need more computers? Do you need more printers?
- Communication processes. How are you going to communicate that groups of patients have been admitted and now they can start height/weight/allergies? How are you going to know when to start medication entry or other order entry?
- Updating Epic. How often will you be updating the Epic system during your cutover day?
- Physicians will make rounds, discharge patients, admit patients and write new orders. How often will you check and update Epic?
- What order will you enter patients into the system? Often it is recommended to complete units with the least amounts of orders and expected admits/discharges first and then end with your critical care areas and emergency room.
Tap into resources
While there is a lot to do for an Epic go-live, good planning can greatly reduce anxiety and prepare your staff for this transition. If you are in the midst of technology changes, we have resources and advisory services here to help. Contact us to get started and learn more.
