Strategic Project Governance at Covenant Health System Leads to Successful 5.6 Implementation (2/05/2009)

Since orchestrating a major software implementation can pose a challenge for any single hospital facility, the stakes are especially high for large hospital networks like Covenant Health System (Lubbock, TX). The biggest health care organization in west Texas has recently gone LIVE with the core products of MEDITECH's 5.6 Release across its four hospitals. "You must think long-term and balance the risk with potential rewards," advises Jim Reid, CIO, on choosing to undertake an implementation project of this breadth. "We needed to build a solid foundation for the future of our large organization, and after years of working within a somewhat comfortable yet limiting best-of-breed environment, we believed an integrated system like MEDITECH's could help us achieve our goals for increasing patient safety and care quality." Given their success, Covenant Health System illustrates how keen project governance during a large scale software installation can positively impact a health care organization of any size and ultimately, provide better care to patients. MEDITECH recently sat down with Reid and Tiffany Lemmen, Perot Systems project manager, who played a significant role in both the planning and implementation processes. They discussed how their implementation and training plan was rolled out to the organization's 5,000 employees, as well as how MEDITECH's 5.6 Release supports the organization's long-term objectives. MEDITECH: What were the major factors behind Covenant Health System's decision to transition from a best-of-breed environment and choose MEDITECH? Reid: Several years ago, when the leadership at Covenant Health System was considering replacing our best-of-breed I.T. solution with an integrated one, we had the benefit of first hand experience influencing the decision. Covenant is a member of St. Joseph Health System (SJHS) in Eureka, California, a long-term MEDITECH customer whose Care ReDesign project has significantly improved care quality and safety at their health care facilities. We were impressed by the commitment between SJHS and MEDITECH, and the success SJHS has achieved as a direct result of their relationship. Their positive experience using MEDITECH's Health Care Information System, coupled with our own research on MEDITECH's integrated HCIS, heavily influenced our decision to adopt an integrated strategy, specifically with MEDITECH as our vendor partner. MEDITECH: From a leadership perspective, how did Covenant prepare for the impact an integrated approach might have on your facility after so many years of working within a best-of-breed setup? Reid: We knew the implementation would change a lot of fundamentals and that it would require a great deal of business preparation on the front end. Functional needs and work processes would need to adapt to our new, integrated approach. We spent a lot of time beforehand studying this complex change and the effect it might have on our facilities. We wanted to do a standardized, phased implementation across facilities. With six hospitals in west Texas plus 10 affiliated hospitals, we were looking to do one implementation, not 16. Since departments that previously worked in silos would have to begin making interdisciplinary decisions, we developed very specific implementation plans for each area. We had to establish clear guidelines on decisions management teams would be permitted to make for their own facilities. We then assigned ambassadors (superusers) who would lead the various floors through their implementations. MEDITECH: Managing a massive implementation across five hospital facilities is impressive yet challenging. Were there any MEDITECH tools you found to be especially supportive of your governance efforts? Reid: Because we have multiple affiliated MEDITECH hospitals, we determined the Corporate Management System module (CMS) would allow us to maintain and standardize systems and processes across the entire continuum of care. Doing so would allow us to save time in the building process and provide us with system consistency. CMS allowed Covenant to standardize dictionary entries and monitor the entire system from any location within the network. MEDITECH: Similarly, training 5,000 employees across the five facilities was a tall order. What strategies did you use? Lemmen: Training over 5,000 doctors, nurses, clinicians, and administrative support staff members was a significant endeavor and proved challenging for the hospital. Preparing nurses and physicians for new technologies can be difficult. There was a level of anxiety and resistance in the beginning. However, because we explained how utilizing 5.6 would improve outcomes, enhance patient satisfaction and safety, increase clarity, and aid in working efficiently with fewer errors, training went a lot more smoothly and easily than anticipated and clinicians were eager to start the transition. Reid: Our strategic plan focused on getting everyone on board and engaged. As such, Covenant introduced and defined clear rules and roles which enhanced the process for everyone involved. Our governance team—or core team—defined a communication plan with physicians, clinicians, and end-users, and identified the direction of the initiative and what was expected in terms of specific clinician responsibilities. We provided demonstrations and training and developed implementation plans for each clinical area. Lemmen: Ambassadors were stationed in functional areas on the floor for additional support and guidance. They provided front-line support to staff members before, during, and after go-LIVE. We were prepared to deal with any issues that arose because we had the necessary support and help available at all times. MEDITECH: What was the biggest challenge you encountered during implementation? Reid: Somewhat ironically, the biggest challenge we faced was learning how to transition our clinicians and staff members to an integrated system, since they were so used to our previous solution which lacked integrated, interdepartmental components. MEDITECH: How are staff members adapting to the new technology now? Reid: Even though we have only been LIVE since July, 2008, staff members are becoming accustomed to the solution and most see it as a positive tool aimed at assisting them in their day-to-day care delivery. Information and results are available immediately and since patient information can be accessed in any department throughout our facility, clinicians are able to document and access records seamlessly from all locations. This is leading to better and safer care for all our patients. Recently during an executive meeting, folks from our Customer Service team praised the system, saying the technology will help to improve patient satisfaction scores. I was pleasantly surprised by the feedback. MEDITECH: Is there anything you would have done differently with the training? Lemmen: Even with all the preparation and training provided to staff, additional training is indispensable for some. Because of different learning styles and needs, adjustments to training were necessary in some cases. Extra attention and consideration is always going to be a win-win for any health care organization, provided the resources are available. For upcoming product implementations, we are already planning on adding more training and support. MEDITECH: How is the newly installed software affecting clinicians? Reid: Staff members are already discovering the advantages MEDITECH's software brings. Within a few short months of implementation, we are experiencing significant improvements in system optimization and productivity, day-to-day operations, data sharing, and in our financial areas. We are seeing more and more positive clinical changes and benefits each week and because of the integration. Also, we are working on achieving a better understanding of how to keep track of our business. Using MEDITECH, we are gaining tighter control of revenue as it flows through the system. MEDITECH: Where are you now in your project timetable, and what will you be installing next? Reid: Covenant has been able to achieve an important piece of its strategic implementation plan, but there is still much more to come. We are currently focusing on leveraging the MEDITECH system as the foundation for more advanced clinical functionality. We hope that by incorporating and utilizing more functionality within the MEDITECH system, we will be able to continue moving forward. In terms of advanced clinical functionality, we are LIVE with the Emergency Department Tracker and hope to complete the entire Emergency Department implementation very soon. We plan to implement Physician Care Manager, Bedside Verification, and Oncology in the near future. We also plan to devote resources to training physicians on the Enterprise Medical Record. MEDITECH: What advice do you have for other health care organizations who may be embarking on a similar project? Reid: Achieving an implementation project as large and diverse as Covenant's can be a realistic goal for any health care organization, as long as the time, dedication, and preparation efforts are put forth. As we continue moving forward, fostering our partnership with MEDITECH is very important to us. We look forward to continuing our good dialogue with MEDITECH as we strive to achieve the full value of our HCIS.