Support Tailored to Operational Need
As one of the nation’s largest pediatric medical hospitals with more than 40 clinical departments and over 250 specialized clinical programs prepared to move onto a new EHR platform, Impact Advisors was tasked with “keeping the lights on” within their current EHR environment (access, revenue cycle, and clinical functionality across two different systems).
The Impact Advisors Application Managed Services (AMS) team was engaged to support the health system’s legacy EHR (Epic) environment while a new instance was built by a focused project team. Once a system is labeled “legacy,” it is often perceived to be deprioritized. The goal of Impact Advisors’ AMS team is to maintain (or raise) the reputation of that production system, as end users continue to count on it to serve patients every day. With this imperative in mind, Impact Advisors’ team strove to provide support as seamlessly and efficiently as possible, recognizing that continuity for the end users in their support experience would help drive success through implementation and post-live support.
From the start, communication and interaction among the client and Impact Advisors leadership teams were key to success. Working together, they identified overarching strategic initiatives with specific timeframes, rather than solely focusing on daily ticket resolution. The goals for a successful go-live included reducing the service ticket backlog, deploying change requests before go-live, and adhering to the established 7-day service level agreement (SLA) for responding to support requests.
The support teams were structured by function and focused on scheduling, registration and admission, hospital billing, and patient billing. Rounding out the team was an Epic database administrator to support the technical environment and a team to maintain and develop new reports from the Epic system.
In addition to providing ongoing maintenance support, the Impact Advisors leadership team initiated discussions about applicable strategic projects so workload and resources could be properly allocated. Because the organization was already live on Epic, operations was more inclined to continue with their strategic goals, always striving to use their tools to the best of their ability. The delineation of work was critical, so teams weren’t stretched too thin to be effective. Based on the strategic plan, specific monthly goals for each team were established for the ongoing support work and special projects, including supporting an office move involving 40 departments, and a urology build designed to streamline patient intake and triage. Ongoing communication involved weekly meetings to discuss and resolve issues and monthly report-outs shared with the hospital leadership team.
Our Client Impact
By staying focused on business priorities and outcomes, the Impact Advisors team met the agreed-upon strategic goals and set the client up for a successful transition and post-live support.
Backlog Reduction & SLA
Goal: Reduce the backlog and achieve SLA with minimal ticket transfers from Legacy Epic to New Instance Epic.
At the start of the engagement, the client had a backlog of approximately 1,000 tickets. The challenge was not only to clean up this backlog, but also keep up with incoming requests and incidents. Prior to Impact Advisors’ engagement, the client was averaging a 65-75% SLA adherence. Throughout the year, the team was able to reduce the backlog to zero, and ultimately achieve the target SLA of 90% resolution within 7 days – applicable to over 21,000 tickets. The team transferred only 84 tickets to the new instance of Epic that were to be filed as optimization requests, resulting in a clean Jira queue and fresh start for the team supporting go-live.
Change Deployment & Volume Reduction
Goal: Deploy planned projects and changes in the live environment, and help to decrease volume and minimize change ahead of go-live.
Part of preparing for a move to a new application means minimizing changes and requests for the existing production environment as go-live approaches. This is especially true in an Epic-to-Epic move, where it’s imperative that changes made in the live environment align with the new build and are included in integrated testing. For this reason, Impact Advisors stayed tightly aligned with the client’s build team and was an integral part of their end user communication and freeze “exception” evaluation process. The team met weekly with leadership to report on incoming change requests and incidents and made recommendations regarding strategy
and communication to help reduce volumes. This proved challenging in an Epic-to-Epic move, as the end users were already technically savvy, and the institution prestigious and forward thinking, all within an economic environment that requires constant pushing for revenue cycle performance improvement.
Utilizing Root Cause Analysis to Address Recurring Issues
The legacy support team was tasked with fixing credit card readers that were not working properly, which was an ongoing challenge. Payments became delayed as patients could not pay at the time of service, which impacted patient experience and revenue collection. Additionally, the organization wanted to shore up the issue before the Epic go-live so the internal support team wouldn’t face an additional burden. The Impact Advisors team began to track and dig into the previous ticket
data. This included documenting the number of issues, the computers impacted, the locations involved, and the resolution for each ticket. The team also consulted with the organization’s Production Support and Networking teams to review their previous efforts and determine what was effective in fixing issues with the credit card devices. Teams from Epic and Instamed, the payment processing software used, were brought in next to address how their systems could be affecting the payment process. With all teams involved, Impact Advisors took a trial-and-error approach to finding the root cause of the problem. By utilizing a holistic root cause analysis
approach to addressing the malfunctioning credit card devices, the number of tickets decreased by over 50% from January to May.
Looking Ahead
Having built trust and a repository of knowledge that would be valuable to the client through go-live and beyond, the Impact Advisors legacy support team was retained to continue support after go-live with a focus on KTLO tickets. As of three months post-live, the team has worked down the go-live tickets from over 600 to approximately 250. The historical knowledge possessed by the team enables them to work tickets efficiently and position the client well for their upcoming first upgrade and optimization wave.