FQHC Implements Epic EHR through Community Connect

All Care Health Center (All Care) is an Iowa FQHC that provides quality medical and dental care, mental health and social services, and a pharmacy for patients. As part of a strategic cooperation with the Iowa Primary Care Association (IPCA) and other partner organizations, All Care, along with several other Iowa clinics, would be transitioning to a new Epic electronic health record system provided through a Community Connect agreement with a third-party, centrally-hosted collaborative.

The move was intended to help care teams better manage and connect patient care, streamline clinical workflows, and improve the health of rural and medically underserved communities nationwide. Like many small clinics, All Care was used to outsourcing most of its EHR support functions to its previous vendor. Its leadership was unfamiliar with Epic, and the organization lacked the expertise and resources internally to manage an IT project of this scale. IPCA and the host collaborative would provide significant support for the implementation, but there would likely be more to be done internally than All Care was accustomed to or staffed for. Furthermore, the implementation was scheduled to take place amid the relaunch of a clinical quality performance improvement initiative—an additional challenge for resource availability but a good opportunity to redefine and standardize workflows and processes in line with Epic and their own best practices.

To position the organization for success, All Care engaged Impact Advisors to project manage the implementation and transition in an aggressive timeline.

Governance, Planning & Contract Negotiation

Impact Advisors’ project manager reported to All Care executive leadership and was responsible for ensuring the project met goals and objectives. To start, the project manager established best practice project governance to prioritize, resource, and decide what changes should be made to the EHR to support clinical, operational, and financial needs at the organization.

The host’s collaborative model allows members to have the power of Epic without the full EHR support workforce of a stand-alone Epic customer; however, All Care would need its own dedicated resources in key areas who would be upskilled in their roles during the implementation and beyond. These individuals (provider builders, reporting specialists, revenue cycle leaders, and EHR support analysts) would handle all maintenance, break/fix, regulatory changes, improvement projects, and innovation work that touches Epic. Some would also serve as trainers and at-the-elbow support after go-live. Helping leadership decide who and how many would serve in these roles was an important part of planning.

The project manager also provided experience-based insight on service level agreements and contracts, advocating and negotiating on behalf of All Care and saving the organization thousands of dollars through scope reductions. For example, All Care successfully lobbied to have Dragon removed from scope, because they already had the software and would have ended up paying for two licenses. Another negotiation resulted in All Care retaining their current and preferred third-party biller.

Discovery

Receiving Epic via a Community Connect implementation can be challenging. The host in this case has hundreds of client implementations they are managing, each with a different scope and unique environment. While this host’s Epic installations are highly prescriptive, the volume of resources involved can lead to inconsistencies in direction. For organizations that are unfamiliar with the software, Epic can feel like a completely different language. The project manager served as a liaison between All Care leadership and the host’s implementation team, helping interpret “discovery” requests related to EHR planning and transition and assisting with retrieval of the information.

Implementation

The project manager provided oversight and support to All Care’s locations throughout the phases of implementation, including key areas of organizational and operational readiness, go-live planning, training and workflow design, cutover, and post-live support. Tasks included:

• Monitoring and updating scheduling, clinical, and revenue cycle workflow processes.
• Managing third-party interfaces (Quest Lab, GL, etc.).
• Providing oversight to legacy system hosting responsibilities, including interface development, data conversion, and archiving.
• Supporting All Care IT resources as they carried out Epic build activities.
• Ensuring effective communication and coordination among the various individual workstreams.
• Communicating project status, key issues, and risks to senior leadership and facilitating critical issue resolution.
• Assisting with interviewing and training Superuser candidates.
• Defining internal best practices/standards and understanding the host’s required KPIs and metrics.
• Helping All Care understand Epic standard dashboards and reports that can be used to monitor performance on everything from registration times to lab errors to revenue cycle performance.

Results

Nearly 30 days post-go-live, All Care reported low ticket volume and improvements across several key metrics, including Charge Lag, Charge Days in Review, Claim Acceptance Rate, Claim Edit Days, Days in A/R, and Registration Time.

Other results included:

• The project manager set up a Care Everywhere Master Agreement with the host and all the health systems in the area to enable interoperability and the implementation of the patient portal, a key priority for executive leadership and the Board.
• As an Epic expert with multiple certifications, the project manager was able to help train staff to do the build that the host required they do efficiently and in less time than anticipated.
• The project manager helped All Care governance develop agility for defining and institutionalizing standard work using Epic, which would help ensure long-term success.

Keys to Success

Leadership and core project team turnover, including replacement of the host’s project manager mid-project, presented challenges, though not insurmountable ones. The executive sponsor played an essential role of being closely involved and active in removing barriers to progress. She kept staff focused and disciplined on the project as a key priority.

Having an experienced Epic Implementation project manager is also critical to success. When engaged early, the project manager can help set expectations, quell anxiety about change, cite historical precedence, and use methods of change management and communication that are proven effective. ■