BMAL 504 GROUP PROJECT OUTLINE UVA HEALTH SYSTEM.pdf

GROUP PROJECT OUTLINE: UVA HEALTH SYSTEM

Group Project

University of Virginia Health System Epic Phase 2

Ballance/Heck/Lemieux/Bailey/McIntyre/Newberne

Liberty University

BMAL 504 – Leading Organizational Change

UVA HEALTH SYSTEM 2

The University of Virginia Epic Phase 2

Description of the Organization

The University of Virginia Health System (UVAHS) is a teaching hospital located in

Charlottesville, Virginia. The health system employees over 7000 clinical and support staff

Description of Change Process

In 2009, the UVA Health System began the implementation process of its electronic

health record (ERH), Epic Systems. The implementation was called Epic Phase 1 and included

clinical applications. Dr. Marshall Ruffin served as the Chief Technology Officer and among his

all inpatient departments went live. Many of the original project team continue to support the live

system. Over the years, UVA Health System customized Epic to provide physician satisfaction

and to make it work with the legacy Siemens financial application.

Epic’s financial applications include patient scheduling, registration, medical coding,

hospital and professional billing, and claims. Although the option was available to install Epic's

financial system in 2009, senior leadership decided against this due to the high customization of

the current financial system and the fear of increased Accounts Receivable (AR) if systems were

changed. However, in recent years, Epic’s financial applications have proven to decrease AR

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days by speeding up insurance payments, automation of medical coding, and consolidation of

patient billing (Revenue Cycle, 2016). UVA Health System has decided to move forward with

sun setting legacy systems and move forward with Epic’s revenue cycle applications. This will

mean a fully integrated system.

special clinical workflows. In 2013, work began to bring UVA’s instance of Epic back to

foundation. This was the first steps to preparing for implementation of the revenue cycle

applications of Epic.

UVAHS’s Chief Executive Officer (CEO), Pamela Sutton-Wallace presented to the

University of Virginia Board of Visitors on February 15, 2015. Sutton-Wallace stated to install

full suite of applications was installed for $300 million (Lewis, 2012).

In August 2015, UVAHS began the project to implement Epic's financial system. This

project is called Epic Phase 2, and the project team does not report to the same management team

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a team lead and a manager. The team leads major function is to direct the workload and

complete a smaller amount of the application build. Team leads spend an average of 25 hours a

week in meetings, and are not salaried employees so they are not allowed to work more than 40

hours a week. The rest of the team is made up of former operational member and new hires who

on this process. The certification exam is limited to three attempts and as part of the

employment contract, if the team member does not pass on the third attempt, they will no longer

work on the project. The various teams have lost several analyst due to not passing the exam on

the third attempt and this has meant another round of recruiting.

As the project officially kicks off, many decision are required to be made that involve

the project. In January 2016, UVAHS and University Physicians Group (UPG), the professional

billing, make the joint decision to move forward with PFB as a measure to have patient friendly

billing and increase patient satisfaction. This decision comes three months behind schedule.

After the PFB decision is made, UPG and UVAHS have other incremental decision such as legal

parameters for late payment of bills and collection of bills that must be decided upon jointly.

The Epic Phase 1 and Phase 2 managers have different leadership styles. The phase 1

managers prefer to control and assign work to their team. The managers on Phase 2 allow their

teams to prioritize their work and the manager only intervene when help is needed. Epic Phase 1

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and Phase 2 teams must work together since the system is being integrated. The phase 1 team is

responsible for maintaining the current procedure records for the live system. All new procedure

records must be built as part of the revenue cycle integration. These new procedure records will

allow hospital charges to generate. This means the phase 1 team is heavily involved in the phase

process and how patient self-pay balances will be applied are still outstanding. The project

sponsors felt the slow decision process has put the project at risk and have asked Epic to

determine the cost of undoing the build already completed for PFB, and the cost to split out the

billing office. The sponsors presented this information to the Chief Financial Officer, Larry

Fitzgerald on Friday, June, 10, 2016. The same day, before the close of business, the

whether to go SBO [PFB] or not. A meeting was held early today to discuss. This

email is to confirm that the senior leaders have decided to stay the course and do SBO

[PFB]. We will begin working on the mitigation plan for our late decisions so we can dig

out of this hole (Parkin, 2016).

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Part 2

Definition of the Project

Electronic records are one of the most recently developed forms when it comes to

recording patients’ documentation (Brooks & Grotz, 2010). That is why the UVAHS needs to

easier, and patients are ensured of privacy. The focus is patient centered, and Epic allows

UVAHS to provide for patient safety as well as an integrated system. The health systems need to

not make any mistakes, and these Epic Systems will help prevent this.. Epic Phase 1 deals with

all of the patients’ documentation, where Epic Phase 2 is all about having a more friendly

approach to make sure the safety of the client, and insure the financial stability the system will

for this type of work, and make sure everyone is up to date with all the technology that goes

along with the Epic Systems.

Diagnosis of Current Situation

When it comes to a system such as the Epic Systems, efficiency should be at the top of

the list. The more efficient the job, employees, and system is the more successful it should be. To

make sure this is a successful implementation, the UVAHS needs to know that there will be

bumps in the road. By planning for risk at all phases of the project, the project will move more

smoothly. This way when parts of the process do not work, everyone can be ready to fix the

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situations at hand. When it comes to Epic Phase 1 and Epic Phase 2, both teams will need to

work together to get the job done. The current organizational structure has both teams working

with different goals which set different priorities for each team. Another difficult situation is the

cost to training people to work with the Epic systems is pricey, and many people do not pass the

efficiently, so they can pass the first go round. Also there can be glitches in the computer

program. There needs to be some type of back up to make sure all records can be found if any

glitches do happen.

Epic- Electronic Health Records- Pros/Cons

(Ziabek, Wickus, & Mathiason, 2001). Epic systems in the undisputed leader in EHR’s, and is

positioned to continue their dominance due to legislation that cemented Epic systems, while

making it all but impossible for smaller companies to break into the field with innovated

improvements (Glenn, 2013). Therefore, Epic continues to recruit big name hospitals, like the

UVAHS that continue to spend millions of dollars implementing its expensive system (Glenn,

2013). Consequently, Epic has been described as the most expensive project implemented in the

history of the UVAHS (Strong, 2010). In fact, implementing the system was due to cost the UVA

Health System a total of $122 million over a seven year period (Strong, 2010). No doubt the

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UVAHS has benefited from its implementation, but critics have continued to complain about it

costs and other liabilities.

In fact, many healthcare executives are starting to question if Epic health systems are

worth the cost of implementation (Moukheiber, 2012). Moreover, some critics contend that

with the increased spending due to Obama Care and decreased Medicare reimbursement

(Moukheiber, 2012). Moreover, with 40% of the United States population health records stored

on Epic; the company is poised to either improve its market share or limit the technological

advancements in the field of electronic health records (Glenn, 2013).

Epic is the company that makes the software that physicians and hospitals use to track the

startup and maintenance costs (Silow-Carroll, Edwards, & Rodin, 2012). However, others

contend that with the passage of the Health Information Technology for Economic and Clinical

Health (HITECH) Act that authorize incentive payments from the Medicaid and Medicare

programs makes EHR’s more affordable (Silow-Carroll et al., 2012). In addition, some hospitals

report that EHR’s save lives by preventing drug interactions, and other errors due to physician

error in ordering, filling, and administering drugs (Silow-Carroll et al., 2012). However, others

contend that Epic’s EHR’s are difficult to use, because entering information is time consuming

and detracts doctors from patient care responsibilities (Boulton, 2016). However, nurses and

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other healthcare professionals proclaim that Epic system make their job more efficient because

they do not have to search for charts or solicit doctors for written orders (O’Brien, 2006).

In addition, one of the main complaints of Epic systems is that it’s a closed system that

does not with other EHR systems (Glenn, 2013). Critics contend that Epic’s closed system could

EHR’s which could be detrimental to the bottom line of hospitals due to incentives programs

built written into HITECH Act (Cleveland, 2015).

All in all the research reveals that Epic systems are serviceable but there is work to be

done due to usability and interoperability problems (Cleveland, 2015). However, efficiencies in

chart review, note transcription, billing, medical clerk ordering, and patient scheduling were

knowledge and skills of the new program they will need in order to have the ability to navigate it

correctly. As each employee is well rounded in their knowledge of the new system they will be

well prepared for any potential issues that may arise as the new system is set in motion. As there

are two different phases to implementing these systems it will be important the staff is well

informed and they know what to expect. There will need to be weekly training sessions set aside

for all staff to familiarize them with the new systems before they are implemented. Due to the

intensity of the test individuals must take and the passing success rate there will need to be some

sort of incentive to motive staff. It is imperative that enough staff are trained and accredited to be