EHR Optimization: How to Keep Improving After Go Live

Phil Sobol: Cory Lane has been serving as the IT manager at Oakleaf Surgical Hospital and Altoona, Wisconsin, and is transitioning into her new role as director of operations at Oakleaf. She began her career in clinical informatics and has used MEDITECH for almost a decade. Welcome to the podcast Cory! 

Cory Lane: Thank you. I'm glad to be here.  

Sobol: So, we always love to start these off with just a little bit of sharing. So, if you would not mind telling our listening audience, a little bit about yourself and your journey in healthcare IT, and maybe just touch on a little bit about Oakleaf and Surgery Partners and your roles there.  

Lane: Sure. Absolutely, thank you. I appreciate the opportunity to speak with you. I am originally from Southern Wisconsin. I went to college, up here in Eau Claire, Wisconsin. I came out of college and 

I had a degree in speech pathology of all things and ended up getting a job as the receptionist at Oakleaf Surgical Hospital and I have never left. 

I have enjoyed every single role I have had here in this hospital and organization. It is a physician owned the hospital and takes amazing care of both its patients and employees. I am honored to be a part of the executive team as I start my new role.  

So, I was a part of very briefly our original EHR implementation in 2011, just from a business office perspective and then transitioned, like you said, Phil into informatics. And I was the Informatics manager, and IT manager since 2015. So, we had MEDITECH 6X and then we just transitioned to expanse. 

Sobol: That is a fantastic advertisement for why people should come to work at Oakleaf. 

Lane: Yes, it is a great place. 

Sobol: That is excellent. So, Oakleaf specializes right? In things such as outpatient surgery and certainly, when it comes to patient care and operational efficiencies, that is absolutely critical.

Lane: Yes, that is correct.  

Sobol: So, maybe if you would not mind, walk us through some of those operational must haves that an organization like yours just needs when it comes to technology and when it comes to EHR.  

Lane: Yeah, absolutely. It is critical. We found that we maxed out on our prior system in that we needed more from it. We needed to be able to provide our physicians with more information in their documentation. We had a very hybrid system. We were some electronic in some paper based and that in itself caused some inefficiencies. And so, we are scanning things in and then promptly printing them back out for health care. And we wanted to make sure that we could sustain for the future and maybe save some paper along the way.  

So, that was a huge importance for us, to provide documentation, and just the flow of that clinical information as the patient comes from. The start of the stay all the way through discharge and beyond, and that the physicians and nurses alike had access to information in a in an efficient way. 

Sobol: That makes great sense. So, you touched a little bit on it, how you recently gone through a project completing of the Medicaid Expanse Implementation and had the privilege of talking with Ann Hargrave Thomas, your CEO there.  

Lane: Oh, yes. 

Sobol: Yeah, on a previous podcast, and she talked a little bit about the collaboration between Oakleaf and Surgery Partners in CereCore and we work together really from that assessment phase through the go-live. And so, from your perspective, maybe a little different perspective than Ann had, what was top of mind was such a big technology change for you?  

Lane: All 3 parties were very much needed so everything had their role and, we hear at the local level and on site had the vision, right? We knew what we wanted, we knew what our shortfalls were, and we knew what we wanted to improve on. 

Our CereCore partners all came in with great knowledge. We ended up having three project managers, CereCore one, Surgery Partners one, and then myself. In the beginning, you are all just trying to figure out your way and who fits where. But ultimately, they were all needed because every single aspect of it had the right attention. And from an IT perspective, Surgery Partners definitely brings their a-game when it comes to that and the resources that they have on our IT side were instrumental. And, the amount of access we had with them, and we had with our CereCore partners both on the technical side and on the professional services side was ultimately why we were successful.  

Sobol: So, I think what you stated cannot be overlooked. So many times, people go. Oh, well, we have a project manager.  

Lane: Yes. Yep. 

Sobol: And I think sometimes folks lose or do not have the quite understanding of how complex these projects really are, how many people are touched, how many folks are influenced, and have a say.  

And, organizations do themselves a bit of a disservice when they do not resource them properly; not only for the folks with their hands on the keyboards, but also, as you stated in that project management arena.  

Lane: Yeah.  

Sobol: Because herding all of the proverbial cats is a tough thing to do. 

Lane: Right, especially when you throw in third party vendors, all the testings, and everything that goes along with that. 

Sobol: Yes.  

Lane: Everyone was very attentive, had their role, and herded their cats. And, it worked out really well.  

Sobol: That is great.  

Lane: There were some things we did not notice at the beginning and ended up having to shift resources and then add resources. But everyone was on it and that is what was ultimately important. 

Sobol: Oh, that is great. So, you are now alive, and it has been how long now?  

Lane: Oh, gosh. I think we signed our contract with Expanse at the very end of 2021. 

Sobol: Okay. Yep.  

Lane: So, and for us, it was certainly we were very close to signing when COVID hit. So, this is a long time coming for us. 

Sobol: Yes, I know it feels good to go-live, but as we all know, going live is just the beginning of the next journey for an organization.  

Lane: Yep, absolutely.  

Sobol: So, maybe we can talk a little bit about that. I think in the context of journeys and, you start with implementations and then ongoing journeys and the term, I think partnership, right? 

Lane: Yep. 

Sobol: The partnership term gets thrown around a lot, and as part of this process there was a group of partners. We have mentioned Oakleaf, Surgery Partners, you graciously mentioned CereCore, and MEDITECH.  

Lane: Yep. 

Sobol: And, you cannot forget the vendor as well and that from a software perspective. So, maybe talk a little bit about kind of the value of that, not only in the context of the implementation. But then also from an ongoing standpoint. 

Lane: Absolutely, as I stated before, just from the implementation side of it, everybody brought a different angle. But I think, once the implementation, then some people move on to other projects and I do know that Surgery Partners and us here on site, we still have a lot of work to do. We do not want to take our foot off the gas, because we had an amazing and successful implementation. 

But we all know that every plan needs a relook and things we thought would work wonderfully maybe do not. So, I think we are committed now, along with Surgery Partners to optimize with MEDITECH as well and make sure that everything is just doing what we intended and thought it would do. And when it is not, we certainly do not want to ignore that. So, our patient's safety is of utmost concern, and we look at everything under that lens. So, we are reviewing workflows, our nurses are totally engaged, and everyone from our clinical staff, right up through our CEO have been completely engaged. That is what made us successful. 

Sobol: That top to bottom engagement is so critical.  

Lane: Mm. Hmm. So critical.  

Sobol: When everyone's bought in, and they truly understand the why, and they understand the importance. It is honestly just amazing what transformation can occur.  

Lane: Yes.  

Sobol: That is so neat to see. And so, I am sure you have had opportunity now post go-live to kind of hear some feedback, right?  

Lane: Yeah.  

Sobol: From the user community, from the clinical staff, obviously that flows into some of that optimization work. You talked about. 

Lane: Yeah, absolutely. 

Sobol: Are there any kind of early results, or maybe comments from clinical staff, that make them say, oh, my goodness? Now we have X and oh, by the way, now, my juices flowing, now, what about this, right? 

Lane: Yep, absolutely. I think our staff and the different subject matter leaders of the different modules spent so much time in training, in testing, and in simulating. And so, all that time is what paid off in the end. So, then on go-live day, we were not running around. Well, do not get me wrong, I do not want to paint a picture that was not real, but it really went very smoothly.  

And I chalk it up to that to all the hard work that everyone put in upfront and in the training. Now, that we are post live and going through that, we have a documentation committee that our clinical staff is very involved in with our informatics team and this is where we bring changes that maybe pre-op is bringing to us potentially could affect what happens on our med search floor. And so, we try to be very thoughtful about those discussions and decisions and make sure that we look at those downstream effects to ensure we make the right choices in all of our optimization phases, and it is exciting.  

Then people are, like you said, their juices are going like, oh, this is great. We have got so many trackers and things we could not do before throughout the hospital that are helping our clinicians. 

Sobol: I think a lot of times people get that kind of project and go-live fatigue.  

Lane: Yeah.  

Sobol: And so, you mentioned, you have got this process now in place where you are gathering that feedback and that documentation that cross collaboration. Do you have any sort of insights for folks as far as, hey, maybe how that should be set up, what the cadence of that should look like? Because I do think that sometimes people just tend to experience that let down and then they may miss the next meeting, then life catches up, and so on and so forth. Right? And then all of a sudden that trajectory that you were on, it starts to plateau a little bit.  

Lane: Yes, you are exactly right.  

Sobol: So, maybe you can give some guidance for our audience as far as, how you help avoid that and put together some of the incentives to keep that momentum moving.

Lane: Yeah, I think it is about empowering the people, the end users to speak up, and let them know that we do not take it personally. Right? Just because I built it does not mean that I am offended when it does not work. So, trying to create a sort of welcoming environment to share frustrations, concerns, and just being open and honest that this is all a part of what we expected. This is not surprising that this or that maybe did not work the way we thought, and we knew that was going to happen. We want people to feel comfortable with coming and sharing their ideas with their peers and troubleshooting together.  

We have found great value in that and, not realizing the impact of something someone in pre-op is doing and how someone later down the flow of the patient actually uses that information, which makes all of us understand the why behind what we are doing. And ultimately the quality and the diligence kicks in once you understand that. So, I think it is just really important to work with the end users, give them that voice, and the forum in which to share. And then, come up with solutions as well. 

Sobol: Yes, one of the things you touched on, and it sounds like just from leadership through your teams, is it just has the utmost respect for each other. I think that that plays in large part as well, because then all of a sudden folks feel that freedom to have the conversation and they do not take things personally when oh, yep. I had made that decision. 

Lane: Yes, when they say I spent two hours on that.  

Sobol: Yep, exactly. It is so easy to do, but in the context of things, you are like, hey, listen yeah, this is new for everybody, and we are doing it all together and so that is certainly wonderful.  

Lane: And when you have that team, I think people are more apt to get creative and think outside the box. And maybe that means we have to change an entire workflow but maybe that is better. We really got to a point where people’s brains were so open and just critically thinking, it was such an amazing thing to see the pride when you see that happen and the teams are all doing that and it is like, wow, this is amazing. You can really see the value of doing this in a way that actually is thoughtful and makes it useful for you.  

Sobol: Mm. Hmm. Well, and I would think that you see the value, not only in the workflows as it pertains to the clinicians, but have you begun seeing how the investments in technology have that same direct impact on the care that you are delivering to the patients. 

Lane: Well, I think we are saving trees, so there is that. Trying to save the enviroment.  

Sobol: That is right, yeah very important.  

Lane: I think, we are seeing how information can flow and now, I am excited to take the next step and dig into a module called business and clinical analytics. Here, we can really dig, and I am hoping from a clinical side to be able to pull out useful data for our clinicians and nurse managers to be able to look at real life information on patients, pain levels, and to be able to make important decisions off of that.  

And also, we brought our anesthesia group electronic from paper and having that information in an electronic way has also been very helpful. So, there are many things that are impactful throughout the hospital and so much more to come. This is just the beginning. 

Sobol: I think you hit the nail on the head it is just the beginning, right? You have to get that foundation of a modern EMR in place so that the workflows are there, the data is there, and then you can leverage that data in the right place, at the right time, and in the right hands. And, hopefully without having them say well, wait a minute, I need a report, and can someone go build that for me?  

Lane: Yes, exactly and no, two months later you might have your information.  

Sobol: Exactly, versus when you actually need it in order to make the decisions that are needed for that patient.  

Lane: Yeah, absolutely.  

Sobol: Fantastic. So, we have talked an awful lot about the projects being large from an EHR perspective, teams getting overwhelmed, and how you have been able to deal with that at Oakleaf. Which I think is fantastic. So, we always love to wrap these up with just kind of some last words of wisdom. Right? 

Lane: Sure, yeah.  

Sobol: And I'll ask the question Cory, maybe in two parts. Right? One, in the context of an EHR implementation or a major project upgrade. But then just in general from an IT perspective, what are those things that come up if you are going through a project? What are those top things, maybe just summarize because you have made some wonderful points, but then going forward, you touched on so much about the organizational components and how IT works with the rest. So, if you could maybe touch on some of those, because I know those are near and dear to our listeners hearts. 

Lane: Yeah, I think, my best word of advice for anyone is to advocate for yourselves. Because we came in with the vision. As I said, the hospital here knew exactly what we wanted and that was not always easy to achieve, and I do not like to take no for an answer. So okay, no that way, then how can I accomplish this in a different way?  

And, that is a lot of work, and it takes a lot of energy, but in the end, you get a product which works for your type of practice, your clinicians, and ultimately your patients. So, we did not like to give up on the details because those are what are important to us.  

And so, as we went through this project, there were times when we said, no, we are going to have to figure this out, or we are going to have to creatively think of a different way to handle this because this is important to us. And, we ultimately always come to the right answer using our partners. Like we talked about earlier, as our advocates as well and working with MEDITECH. 

The other piece that I would talk about is from an IT and a project perspective, but also just it in general in a clinical setting is user experience. It's paying attention to when a clinician walks up to a computer, how easy is it for them to log in? What happens when they badge in, how can we set that up, so that it eases access.  

They are focusing on their patients, and they are not having to try and get the computer and that is something that I take very personally in this process and worked very closely with Surgery Partners. And, I think we still have some work to do, but we have not let that slide and working with our IT partners at Surgery Partners and CereCore, or just to make sure that we have brought in all of this let's make sure that it actually works and then it's not cumbersome. So, that'll be a focus too, as we move forward. 

Sobol: That is fantastic. It is the proverbial, walk a mile in someone else's shoes.  

Lane: Yeah, exactly.  

Sobol: I think, but the industry loves to call it, rounding. Okay, well sure, I guess you can use that term, but I am sure we can probably come up with a better one at some point. It is a little bit more personal. 

Lane: Yeah, I mean, it is definitely worth the attention, and I think it is impactful to those clinicians and anything that we can do to make their lives easier will ultimately reflect down on their patient care.  

Sobol: Absolutely, wonderful. Cory, thank you so much for being with us today and for sharing your insight, wisdom with our audience, and certainly for the partnership that we have been able to build with you and the rest of the team at Oak Leaf. 

Lane: Thank you! Yes, thank you, I really appreciate the opportunity to speak with you. 

Sobol: Excellent  

Lane: Thank you.  

Sobol: Wonderful.