Why EHR Optimization Is Worth The Effort And Budget

Phil Sobol: Welcome to the CereCore podcast, where we focus on the intersection of health care and IT, from practical conversations to strategic thought leadership. Let's unpack the decisions, challenges, and journey of those whose purpose it is to deliver technology that improves health care in their communities.  

Well, welcome, everyone, to the CereCore podcast. Today, we have a panel of guests with us. We'll start off with Bob Gronberg. He's the Assistant Vice President of MEDITECH Professional Services at CereCore. Bob has more than 30 years of hospital-based healthcare IT, software vendor, and leadership experience, and has been instrumental in helping clients maximize their often underutilized MEDITECH platforms for clinicians and physicians.  

John Walsh is a manager in our MEDITECH professional services practice, and he began as a senior consultant specializing in implementations and revenue cycle optimizations with us. He has over 15 years of subject matter expertise working with MEDITECH Magic, Client Server, 6.0, 6.1, and Expanse, and is proficient in MEDITECH applications from registration to MIS and their impact on hospital operations. 

 Last but not least, we have Stephanie Murray, who's the Senior Director of Epic Services and oversees the professional staffing and advisory services within our Epic practice here at CereCore. She has more than 15 years in the healthcare IT industry and brings a vast variety of experiences working in healthcare operations, with an EMR vendor, and with consulting firms.  

Welcome to you-all. You know, we always like to start these out with just getting to know you all just a little bit better. And so, you know, if you wouldn't mind, we'll start with Bob and go to John and then Stephanie, you know, just tell us a little bit about your work, you know, how you ended up in healthcare IT and some of those experiences that you've had with, you know, the evolution that really has been, you know, the EHR software packages throughout the years.
 
Bob Gronberg: Sure. Thanks, Phil. This is Bob Gronberg. I love that you said thirty years we're fast approaching forty years so I have earned every gray hair in this beard. Started off in came from a family that was very much involved in healthcare and so that coupled with the fact that I had a love of computers at the time and an aptitude for programming kind of drove me into what was then called data processing in small hospitals and took the opportunity in my career to rise to the level of IT director and CIO at some point.  

I had the opportunity to jump out and do consulting and actually spent probably half of my career in a consulting role of one shape or another. I also had the opportunity to work as a vice president of professional services and then strategy for a small software company also working in the healthcare space. So I've been involved in a lot of different aspects of healthcare IT over the years. and really enjoy the work. It's an ever-changing landscape from a regulatory perspective, from a technology perspective, from a people resource perspective, and over the last 20 years, the change in the focus of Senior leadership involvement of IT in strategic planning and in the strategic direction setting for organizations has been a great opportunity for us, for consultants, for really adopting the tools. So happy to be here. 

Phil Sobol: Excellent. Thanks, Bob. John. 

John Walsh: Thank you, Phil. Yeah, so my journey actually started. I graduated college. I had a friend that worked at MEDITECH and I reached out to him, so he referred me to MEDITECH and at MEDITECH, I was part of the implementation team where I traveled around the United States and Canada implementing all the administrative applications. So going back, my first site was a client server site. And then my second site, they're like, you're going to a magic install. And I had no clue what magic was. I had never even seen it. So I kind of caught off guard by that. And then eventually I went on to 6x and to 6.1 and to Expanse. After MEDITECH, my goal was to work for a large hospital corporation. So I moved to a corporation within the Boston area where I worked for about three years in their IT department. And then from there, I thought I was kind of ready to take that leap into consulting. So I've been with CereCore for almost 12 years consulting and managing a staff of 10 folks. But one of the things that I think is interesting is I've got the experience and perspective from MEDITECH, from being the client, and from the consulting world, which I think has been amazing, and I can see it from every angle when I'm doing these different installs and assessments. 

Phil Sobol: Absolutely. Thank you, John. Stephanie. 

Stephanie Murray: Hi, I'm Stephanie Murray. My journey also started at a software company. Unlike others, I did not go to school for anything software related. Mostly my degrees are in sociology, philosophy, criminal justice. And I applied to an ad that said, do you like to break stuff? Not knowing it was for quality assurance at a software company. So fast forward, I was hired at Epic actually in the implementation space. So started there. And then after that, I moved into consulting, also worked at a healthcare organization as well. So been in consulting for a little bit more than a decade, doing different roles, implementation, quality assurance, training. One of the things I keep thinking I'm going to get out and then something always draws me back into healthcare IT. I think just watching the evolution of of the systems over the years is fascinating, especially in the data landscape where I used to install people from paper and now they're going from system to system or they're optimizing their system. So it's a never ending journey. 

Phil Sobol: Indeed, indeed. Well, thank you very much and just privileged to have each and every one of you on today. So, you know, today's topic is really top of mind for virtually every health care leader and organization, and that is EHR optimization.  

You know, as we all know, the EHR platform has been in many instances, one of the largest, if not the largest investment that hospitals and health systems have made, you know, over the past several years. And certainly, you know, getting the most out of that investment is always top of mind. And so, you know, as we started thinking about that, you know, we started thinking about some of the, you know, the big, big, opportunities--optimization touches a lot of different areas, right? It's like, how are the workflows? Is it efficient? You know, are we moving everything through so that, you know, the revenue cycle is working properly and all of that sort of stuff. So, you know, if you wouldn't mind, you know, each take a moment to just talk to the audience about, you know, some of those strategic sort of approaches that you know the leaders whether they be quite frankly in the IT space or not are taking to tackle some of these challenges associated with their EHR system. 

Bob Gronberg: So Phil it's Bob, I'll start here. What's interesting and I was thinking about an analogy for this particular podcast. A lot of organizations, particularly in the wake of meaningful use and all the money that was made available to both large and small facilities and organizations to advance or improve their information management systems, many of those were electronic, there was an awful lot of energy put into finding the right tools, putting the right tools in the right drawer within the tool cabinet, and making sure you had all of those components. And also understanding what you needed to replace, what were the foundational things that you couldn't not have in this new system.  

And so when you go through a large-scale EHR or EPR implementation, as you're marching through the timeline and checking off the milestones and going through the various gates that a project actually has, you start to then really focus on those foundational items. And invariably, in every project that I've been involved in, and it's been dozens and dozens over the years, you get to a point probably about a third of the way through the timeline when you start to focus on those items that maybe haven't gone quite as well in the implementation. Maybe you're running late. Maybe the build is not where it needs to be. And you redirect focus and you redirect time, energy, resources to getting those things completed. In many cases, scope starts to get scaled back. Again, every one of these projects has broad scope, stretch goals, et cetera, that are trying to leverage all of the advanced technology within the package that they're installing. But invariably, you tend to get down to a point where you need to get the base level functionality up and running.  

Where a lot of organizations fall down is that they don't adequately plan for that second phase, that follow-up phase, that optimization phase, which may happen three months, six months, or a year later, where you're looking at what you didn't bring up. Can you bring it back? Can you bring it up now? Is this an opportunity? Do you have the funding? Do you have the organizational capacity to do that? as well as maybe the tool that you implemented and the way you implemented, say, a lab system isn't quite working well, as well as it should, with the most optimum workflows in the microbiology area, and are there opportunities to tune that?  

And so that's an area where we find a lot of our customers are today. They brought up, whether it be MEDITECH or Epic or any of the competitors, and it was this full court press to get this thing up and running. But they narrowed scope at the end, and they never really have come back to look at what they have in tune or optimized. 

John Walsh: I guess, Phil, this is John, just to add to that. No matter what release of MEDITECH sites are on, leadership is really trying to see what can be done to get the most out of their current system. So we've done assessments from Magic sites, the client server, all the way up to Expanse. And one of the things that we see as a leadership team is there's facilities with lots of turnover. So there's really a lack of education. There's lack of experience with MEDITECH. There's no, um, history behind why decisions were made, so we could ask, hey, why was this set up this way? And they're like, I don't know that the person has left. So that's one of the things we really have to kind of hone in on and say, OK, let's figure out how your system is set up and how we can make it more streamlined, like you said, more safe for the patient, easier for the end user to use, just figure out exactly how to help them as a partner is the goal. 

Phil Sobol: That's a great point. 

Stephanie Murray: I think to add to that as well, I think regardless of what system you're on or what system you're talking about, change management is a huge piece. You can optimize all day long, but if you don't tell users what you're doing or how they have to use the system in a new way or even train them, if it's a significant change, they're still going to keep doing the same thing they've always been doing the same way they've always been doing it. So I think to help with that as well, a consistent change management cycle is key. That helps users understand when to expect changes, how to digest those changes, how to adopt those changes. So having that consistent cycle so that users get used to the cadence of different optimization efforts or even of maintenance concerns will really help from both a short-term understanding and a long-term goal as well. 

Phil Sobol: Now, you're absolutely right. You all kind of touched on it where it's you get these large implementation projects and they are they are quite large and they're quite overwhelming and at some point. Organizations run out of steam and they just like, all right, we just got to get to go live. We just got to get to go live and. In many instances, the discipline begins to slip. Documentation begins to slip. And all of a sudden, decisions, like you mentioned, get made. And ooh, we don't remember why, but that was the decision because it wasn't documented. And then you're right. It becomes a point where you went to the board with a particular budget. And that was the budget. And now we're live. And OK, great.  

That's how systems used to happen 30 years ago, maybe. But in the modern platforms, that's just not how it is. There are almost living, breathing entities that have to have some care and feeding that are always moving the organization forward. And so it kind of leads me to my next question, which is, OK, an organization has gone through one of these sort of implementations. They're tired. They're now six months later. They're now a year later. They're now two years later and they don't feel like they're getting the most out of the system. And a lot of times, who gets to hear those complaints from the user base?  

It's IT. So IT hears this, and they say, OK, yes, we can fix that. It's going to take some resources. It's going to take some investment. It's going to take all of that. And they've got to make the pitch to the CFO. And we see it time and time again where CFO speaks a very different language than CIO. You know, and so I'd love to kind of hear your, some of your takes and perspectives, you know, from history. I know many of you have worked in hospitals, you know, as well as from the consultant side of things, you know, just what are some of the things that, you know, a CIO, you know, IT director, whoever it might be, needs to do in preparation for that conversation, you know, to go ask for the funds.  

What is it that they need to be prepared for? Is it just a one-time thing, or are there some things that they should have been doing all along when it comes to communication, cadence, etc., to make those conversations potentially even easier going forward? 

Bob Gronberg: Phil, this is Bob. A couple of things. One, for those that are listening that are contemplating going down the path of large-scale EHR implementation or replacement project. It's important to set the goal and set the perspective and expectations correctly, in that once the implementation is done, it's not put it on the shelf and forget about it, right? Make it one of the books on the shelf. It's about the fact, and you mentioned this, it's a living, breathing thing. There will continually be changes. Again, as I mentioned earlier, you know, the technology is changing, the regulatory environment is changing, medicine as a whole and the way it's practiced by the clinicians changes, and the system needs to be an enabling tool for that. So setting that up front actually helps.  

If you find yourself on the backside of an implementation, maybe a year, year and a half out, and you've got your end user base grumbling, it's prudent to bring in an outside perspective, right? Bring in an organization that can come in and take a look at what you have running. Are you using the tools efficiently? Are you using them correctly? Have your end users started to create bad habits, workarounds that aren't known or sanctioned? And document that. And then what we've done, recently in a number of organizations is just that, and come in and then sort of prioritize and categorize the findings, right? Some of these things have broad impact. Some of them have an immediate ROI, if it's a charging-related thing, or the way in which charges for a particular type of patient in a particular specialty are being attached to patient records, those kinds of things. Others are more about improving efficiencies in improving the way in which the clinicians in particular, physicians and clinicians are using the tools.  

If you can save a minute here and a minute there and start doing the math and calculate the number of physicians or clinicians that do that task, times the patients, times the days, it starts to turn into real money. So there are lots of things that need to happen, but having that independent view of what it is you have up and running, you know, just brings a different perspective, and it sort of makes it devoid of emotion, and it, you know, it's an audit of a fashion. Definitely a good step. 

John Walsh: Yeah, this is John. I guess to add on to that to kind of give some outline of how these assessments work from a CereCore perspective, So what we do is we typically assemble a team based off of the needs of the facility. So if they say, hey, we're struggling with revenue cycle advanced clinicals, we'll bring out specific consultants that have that knowledge or subject matter experts. And we're lucky enough to usually review their system in advance of these meetings so we can tell what might be a problem, what they might be struggling with. But then I always like to make sure we meet with IT individually to get their side of the story, see what they're struggling with, what they would like to see done, and then also talk for the department. So hear their voice and say, okay, what are you guys struggling with?  

And from that, we always have a detailed assessment that kind of walks through each item that we feel could be fixed or made better or streamlined. And we kind of come up with a level of effort to provide to leadership. And why this is needed and what the benefits are that can be given to that CFO to the CIO to the CEO. And as you guys mentioned, I mean, software systems are consistently evolving. So there's always changes that are going into the MEDITECH system, whether it's Epic. So if. Sites aren't aware of those changes. They could make a change and it could cause downstream issues. Or maybe they just don't know something's there that they've wanted to implement for years. So that's what these assessments can kind of bring out with these facilities. 

Phil Sobol: Understood. But I know the different, you know, different EHRs are different and certain vendors do things different ways. You know, Stephanie, I know Epic, you know, seems to do a pretty good job of always assessing and evaluating how their clients are using their platform. So, you know, maybe give us all a little bit of hint as far as, you know, what that looks like, but then, you know, how, you know, what that looks like from an output standpoint, but then --how do they know what to do with that once they get that kind of, I don't know if it's an assessment or report from the vendor itself? 

Stephanie Murray: Yeah, I think that's a good point. Epic offers a slew of tools and recommendations and one unique thing about them and their culture is they're very open to helping customers with those initiatives as well.  

But to your point, Phil, you oftentimes have to go ask for money for those types of things or additional resources. And how do you do that? I think one thing that's always helpful, especially when communicating to the business leaders or to operational leaders, is to remember the goals of the organization and how this technology ask leads to those goals or contributes to the completion of those goals.  

Oftentimes, it's very clear to IT that, oh, if we execute this initiative, we're going to get to the XYZ goal. But that might not be clear to operations. So, it's important to draw those lines of connection. 

Additionally, whether assessment is coming from a consulting firm or advice is coming from a vendor, I think it's important to remind leadership that patients have a choice in healthcare. So if you aren't offering the latest and greatest features or functionality or whatever the case may be, then patients may opt to go somewhere else at an organization that does offer that. Maybe they want texting, maybe they want to be able to pay their bill through a portal, those types of things. So I think that's another thing to keep in mind. And when you're talking to that operational leadership or that organizational leadership to draw that connection that patients have a choice and if you don't offer some of those technology options, then you might fall behind as well. 

Phil Sobol: Yeah, and I think, you know, you've all kind of touched on it a little bit and. You know, I know when it comes to, say, like an implementation, you know, all these all these teams get set up and in many instances, cross-functional teams right across the areas of discipline. I think from a leadership perspective, you know, when you're when you're talking about now, how do you operate and move forward? You know, the concept should still be there. Right?  

You know, the CIO should have regular cadence with the CFO. They should have regular cadence with the CMO. They should, you know, from a collaborative standpoint, so that, you know, they all kind of understand each other. And then as these things arise, they can work together to say, okay, yep, here's what needs to take place. I think we talked a little bit about assessments and some of those things. Bob, you made mention of it. I think you're spot on where sometimes having that outside voice is a great one.  

Sometimes you bring in a firm, they've seen this 10 times, whereas you're just experiencing it for the first time. Or you may think you've got a really good rock-solid plan, but you want a little bit of backup before you go. Because maybe it's going to require board-level approval. And, you know, when you can go and say, hey, listen, yep, we've done our due diligence, you lay it all out, and we've validated it with a third party. So, you know, I think all of those were just spot on and great points.  

You know, I think we've touched on a little bit from an assessment standpoint, you know, as it relates to, you know, trying to identify those areas in an EHR that might be underperforming. And, you know, Bob, I think sometimes you said, hey, listen, sometimes there's quick wins when it comes to things like, you know, charges and, you know, that aren't being captured, so on and so forth. And sometimes they're, you know, a little longer play where it's, you know, a little bit of time savings here, so on and so forth. You know, in all of your experience, and we're going to flip the script and start with Stephanie, what are you seeing as those areas from an optimization standpoint that everybody's looking at right now? 

Stephanie Murray: I think each organization does have an opportunity to be unique. Some organizations are looking to assess things that are problem areas, whereas some organizations are looking to assess something that they need to optimize. Maybe they don't know what resources they need, et cetera.  

I think the thing that probably is consistent is oftentimes I see that organizations ask for an assessment on something that's more surface level or symptom based. So they have a problem and they come to you and they say, I want you to assess this area and I need a solution, which is wonderful. You have every right to ask for that.  

But I often find that assessments then uncover maybe the root cause of what's going on instead of just that symptom level. So the benefit of that is hopefully after an assessment, you get your symptoms addressed, but then you also hopefully get your underlying root cause issue exposed and addressed as well so that both can be handled, whether that's with your own staff or with additional staff, whatever that may be. But usually I see that customers come with a particular thing they want to address, but usually it uncovers something else as well. 

Phil Sobol: Well, and sometimes they're sneaky about it. And by sneaky, I mean smart. Because you're right, it's easy to come in and say, yes, we need an assessment in this area, knowing that there's probably a political issue behind the scenes between departments or between something like that, that this is going to uncover--bubble up to the surface, and then because it's coming from the outside, from an outside consultant or whatever, it will be seen in a better light and therefore be a much more collaborative solution. So, no, I think that's a fantastic point. John, how about you? 

John Walsh: Yeah, so one of the things I know you mentioned and that Bob discusses is quick wins. Those are one of my favorite things. When we go out to a site, we can do an assessment, go up to a user and say, hey, did you know you could do this? They say, well, I didn't even know that existed or I was told you can't do that. I love those quick wins, something that solves a problem and it takes five minutes to show them, and next thing you know, they're educating other end-users on how to do it. We'll always include those in the reports, but it's just a way to get with that end-user and make them feel comfortable with you and show the knowledge that our team has.  

As far as kind of trends that we've seen, a lot is around worklists and rules. So trying to get data out of the system, trying to get the system to save end users keystrokes, whether it's registrars, clinicians. So we have a lot of work that comes in for worklist rules.  

Advanced reporting is another piece that sites, as Bob mentioned earlier, they sometimes just go live with the bare minimum, but then there's and MEDITECH that can allow them to pull different data and dashboards. So they'll look to implement those or look for our systems to help them install those. The other area that's always a focus is revenue cycle. So if charges aren't dropping correctly, if patients aren't getting automated charges for observation hours, just where can we find additional revenue for clients? That's a big area of focus for us as well.  

And another one is just workflows. So like level of care change, a lot of sites still, I know Stephanie mentioned paper earlier, do a lot of level of care change from ED to in on paper, and they're printing out a message and they're doing all of this crazy stuff. And I'll sit with them and say, Hey, do you know through bed management, you can automate this process and make it 10 times easier on your entire staff. So that's one that's been a real heavy focus on the different assessments that we've done recently. And they can easily be resolved just using standard functionality within MEDITECH.  

And I think lastly, before Bob speaks is, we do see a lot with also education and from these visits, staff augmentation, that maybe they can't find the right resources based off of where their hospital is. So how can we either educate internal staff to get them up to speed? Or how can we put someone in as a placement until they can find someone and then bring that person up to speed on the MEDITECH functionality. That's another focus area. 

Bob Gronberg: One of the things that I know plagues a lot of the customers that we serve --and this has been happening for decades --is because they tend to run smaller IT shops and smaller organizations. They may have rolled out some level of support for certain systems into the operational areas. They tend to not go forward with system updates, software updates on the regular sequence that the vendor might request. I was just having conversations with somebody yesterday where we were part of the team that brought them to the latest and greatest version of MEDITECH Expanse back in May. And there are some 6,000 changes that are yet to be loaded, enhancements, many of them, into their system, and  they are struggling with trying to put together a team to take that on. And the more time that clicks by, the larger that number gets, because the vendor is continually adding new changes and new pieces to the stories and the epics and so on and so forth.  

So that piece has traditionally haunted our customers. And it's not uncommon for us to come in a couple of years after a site's gone live. And as we meet with the various folks in the various departments, clinicians, et cetera, they may voice a particular concern about a workflow or the way the system handles a particular item, and that change may have been made by the vendor six months ago and dropped that code into their test system, but the site has never implemented them. They have never tested it. They have never put the effort and the elbow grease into sort of understanding how that change can be deployed within their organization. So the system goes stale. You know, it's no longer breathing in that living and breathing model. So and that's you know it's about resource commitment it's about understanding that this thing is not a static piece of software it's not shelf ware.  

I'm in again a lot of organizations just struggle with that and don't budget for it and don't understand it don't have the don't have the structure internally to make sure that the clinical and financial and revenue cycle departments are very much involved in understanding what's coming down from the software vendor and what that process is going to look like from an upgrade, whether it's done annually, semi-annually, or with some more frequency. That it needs to be this continual cycle that they go through, ultimately improving the tools in which they use to treat their patients and their community. 

Phil Sobol: Indeed. It's eternal optimization. And, you know, I think there's organizations that have built that discipline into their organizations and they've put structure around it. But there's others that don't know where to begin. And so, you know, this is my, you know, my next question to you, you know, are there some organizations that you've either been a part of or had from a client standpoint that have done it well? Who have had this sort of discipline, rigor, and what did that look like, you know, from a structure standpoint, you know, what did it look like from a culture standpoint? And then on the flip side, for those that are scratching their heads going, yep, we need that, I don't know where to begin. What are some of those first steps that they need to take place? And, you know, maybe it's which, you know, individuals that need to get on board, sort of governance that they need to put in place, et cetera. So, would love some insights to share with, with the audience on, on that. 

Stephanie Murray: Yes, I have been a part or been included in some organizations who have done this well. And I really think it takes a lot of due diligence and understanding current state and figuring out how do you make those adjustments that are needed. I know I mentioned this before, but a consistent process is very important, not just for users to understand when changes are coming, but for an IT department to understand what sort of cadence they need to get on to do that regular maintenance. And although regular maintenance is not flashy, it is very essential to ensuring that you can build on top of that foundation.  

I mean, not just the security patching and those types of things, while that's obviously very important to keep data and patients and all of that safe. But to Bob's point before, you have to have a solid foundation in order to build on top of that, in order to make those more flashy optimizations happen, you have to have a good core system. And to do that, getting on some sort of regular pattern to make those updates is very important because it sets those expectations both from an IT perspective as well as from a user perspective on when you think might be coming or when there might be a periodic downtime so that you can put those updates in.  

And then to your question about what sort of things need to happen typically you have to have some sort of governance program in place to enforce those regular changes and or prioritize them because if you haven't done it well in the past and you do have a backlog you're going to have to prioritize those things because they can't all be done at once. There's never a shortage of work but there's always a shortage of resources um so um It's just important to have that sort of governance structure in place so that you can really do that prioritization and then communicate out what the plan is so that everybody is on the same page and it isn't just an IT initiative. It's very important to get those operational folks involved and as part of that solution. 

Bob Gronberg: And Phil, this is Bob. I want to build on some of the things that Stephanie talked about. So the governance piece in particular, but also project management maturity. So again, a lot of these organizations will have gone through the process of implementing the new EHR. There's a lot of rigor put into that process because it's so large, involves essentially everybody in the organization, and it has large dollar, a large price tag attached to it. But carrying that forward, that whole rigor that was put in place should be carried forward for the optimization, the upgrades, all of the various things.  

One of the tenets of our project management methodology is to ensure that when governance is established, that the executive leadership and departmental leadership are very much involved. Generally, they are accountable for a lot of the things that go on in an implementation project, but they should still be involved and still be just as accountable for the upgrade process in particular. I've seen very successful large organizations and small organizations put together things.  

One term I recall is called a clinical council. So in this case, they had members of leadership from each of the clinical disciplines, both ancillary and nursing, involved in a monthly or every other week meeting where they kind of reviewed what was going on within their organizations, any changes that were coming about, whether it was nursing students coming into the nursing areas because of the time of year, or some regulatory process kicking off, or the fact that there are new changes that are coming from the software vendor. All of that was discussed and prioritized as a team. And what it does is it allows everybody to contribute. It informs everyone about what's coming down. It also provides a great mechanism for setting expectations.  

You have a process, a well-established change control process with appropriate gates at the approval side of that to handle the physician that wants to have his or her things done now and why can't I get all of my stuff done? Independent of the fact that there's a huge backlog of other work it needs to be folded in and that that government structure can manage expectations with the requesting user would be a physician or someone else and make sure that they're involved in that process and everything is done with the right set of eyes in the right amount of of optics. 

John Walsh: This is John. One of the things that I think is the most important is really having the executive teams buy-in. I've been at organizations that would come to just say, well, our mindset is this is just the way we've always done it, so we're going to keep it that way. They're not thinking outside the box, looking for changes that are going to help save them hours of work each day or save them thousands or millions of dollars. They're just set in their ways.  

When you have an executive team that can go and say, here's what our plan is, here's what we're looking to do. If we're going through an upgrade, we're doing it on a regular schedule, and we're going to make sure the team reviews all the changes thoroughly, understands the changes, what the impact is, and then we'll decide on the ones we're going to move forward with.  

Another piece that I always think is important too is trying to keep your testing live in sync. It's not always done, but it makes it a lot easier to go through these testing events. There's nothing worse than getting access to a system, and they say, oh, you can just test it and test, and test looks nothing like live. So sites that always try to keep those environments in sync or do copies from live to test on a regular basis, definitely, from what I've seen, are more successful in the long run. So I think it's important to keep your system up to date, invest in the education of your staff, and to get that executive buy-in, for sure. 

Phil Sobol: No doubt. Hospitals and health systems that I've ever had the privilege of walking through always have this culture of caring. You know, there is no doubt, right? They're bought into the mission. But I think, you know, you all touched on this. But layering on that kind of culture of continual improvement, right? And that's not just about the standard things, but it's about then empowering your folks to say to, hey, if I see something that can be improved, raise your hand. You know, and then how do you capture that? How do you validate it? How do you work through all that process? But, you know, put a structure in place around it. And encourage your people, you know, to bring these up.  

Because yes, once, and then if you've done your continual maintenance and all of the other things are in place, then you will be in a much better position to then act on these areas that can really have tremendous impact and benefit to the organization. I really appreciate your words of wisdom and guidance there. We're coming to the end, and I always like to open it up just for some last thoughts. Between you all, we're sitting on a few years of experience, hundreds of client engagements in and around these EHR platforms. You know, if there's any just last final words of wisdom that you'd like to share to the listening audience, and then if something's, you know, struck one of our listeners, you know, what should they do about it? And we'll start with Bob. 

Bob Gronberg: So parting words. Know that there's really no end to the implementation process it may scale back it may scale down it may have less resources involved in it but you know as you move beyond your big bang go live or your incremental go live or implementing an EHR and EPR know that there will always be new things coming out and make sure that your organization is well um situated and well briefed for the coming changes and make sure that the budgets are appropriate make sure the resource sourcing is appropriate make sure that the involvement is appropriate.  

I've seen lots of organizations once the large project is completed, the lab folks back away, and the radiology or diagnostic imaging folks back away, and nursing backs away, and they go back to their departments. They need to be active participants. There are opportunities in some organizations to ensure that team members that might have been part of the larger project and have gone back to their home departments. Maybe they are the liaisons back to IT and to the information infrastructure group to make sure that the communication lines that were built stay open and are active. There's nothing worse than seeing something shift back and all of a sudden now, because we're in a live environment or have been for the last six months, that it's all on IT shoulders and it shouldn't be on IT shoulders. IT doesn't necessarily understand the business impact that certain changes, certain needs really bring forth. 

Phil Sobol: Great point. Thanks, Bob. John, any last thoughts? 

John Walsh: Yeah, Phil, so I think at the end of the day, I mean, I can say that I love and I know my team loves to go meet new clients, go to our existing clients that are partners of ours and really unlock the possibilities that the MEDITECH system has to offer. So I feel like if there's something your facility is struggling with and you have questions on, definitely reach out. We can get an appropriate team there, or even just have a quick phone call. But I think it's important to really, like I said, unlock those possibilities that exist within the system. 

Phil Sobol: Stephanie? 

Stephanie Murray: I think my last words of advice would be that even if things feel like basic things to focus on, I would focus on that foundational basics for your organization. Get your communication plan in order, make sure your change management is there, make sure you have consistent maintenance cycles, because then you can build on top of that with optimizations and a little bit more flashy functionality and get your system to that place that patients will enjoy their patient care and providers will enjoy caring for patients within.  

One of the key differentiators about Epic, which we talked about before, is their willingness to help and get involved with customers and things like that. So I would also encourage people to bring in folks that are familiar with Epic terminology and Epic culture, have that understanding so that it isn't another hurdle that you might have to deal with. And so I feel like our folks here at CereCore are very familiar with that and we're equipped to understand all of the terminology and the different pieces of functionality there. So, similar to what John said, feel free to reach out, you know, LinkedIn, website, all the things, even if it's just to chat through some options that you're considering. We're always here to be that partner on your journey to improve your system. 

Phil Sobol: Indeed. Well, thank you all very much. It's been very insightful. Certainly appreciate your leadership throughout our practices and everything that you do on a daily basis for our clients. John, you made mention at the very end, y'all are passionate about getting in there and helping the organizations that we have the privilege of interfacing with just become better to use their systems more efficiently to solve problems that have stumped them for months, heck, in many instances, years, and to guide them along a journey that's gonna be meaningful to them in support of the clinicians that are doing the work that they do every day to take care of patients. So thank you all very much for joining us today and for all your insights.