Lessons Learned from Allina’s EMR Implementation

northfield250x130Allina Hospital and Clinics went live in 2007 with Excellian, its landmark electronic medical record (EMR) system. Allina, the largest health system in Minnesota with 11 hospitals and 65 clinics, has achieved its vision of “one patient, one record” with the completion of the project, integrating Epic Systems products at the core with other biomedical, administrative, bed management, and picture archiving and communication systems.

Excellian was implemented on time and within 2.5 percent of its original $250 million budget. The project has been heralded as the first of its kind and as an example for other organizations to follow. And it would seem that Healthcare Information and Management Systems Society (HIMSS) agreed – the organization selected Excellian to receive its prestigious 2007 Davies Award for healthcare organizations.

Kim Pederson, former Allina vice president over the Excellian implementation, who now heads her own consulting firm, KP Healthcare Consultants, shares some tips for hospitals undertaking a similarly challenging implementation.

IT projects are not necessarily always about IT. Pederson’s background was in finance and operations before the project, not IT. She argues that Excellian may appear to be an IT implementation, but was just as much about business and clinical process redesign. “We worked collaboratively with IT, but the implementation was run outside of the IT department,” she says.

Be inclusive. When going through the vendor selection process, Pederson and her team had over 600 people from the Allina system putting together the requirements for the request for proposal (RFP). “We sought input from every area that would be impacted by the implementation,” she says. “That was huge from a buy-in perspective.”

Drive vendor demos using your requirements. By getting crucial stakeholder input for requirements, the Excellian team created their own scenarios to be demonstrated on vendor systems. “We didn’t let the vendors come in and demo the stuff they wanted to demo,” she says. “We had a very specific patient flow and set of requirements we wanted to fulfill. So, we had 700 people look at the prospective applications and rate them on how well they could fulfill Allina’s vision.”

Culture is king. Pederson recommends choosing a vendor that has a similar corporate culture and work style. “That makes a big difference, when you come together and need to start solving problems,” she says.

Manage specifically. With 30 percent of project employees being contractors, Pederson believes that the right management is critical. “I think part of the ability for us to manage costs within the range that we did was that we kept our vendors and consultants to very specific milestones with weekly status reports and specific deliverables. We didn’t put up with anything that wasn’t meeting the requirements.

Keep it simple. Pederson recalls that, in the intensive care departments, end users helped build 27 nursing flow sheets to cover any potential situation. “Once we got live, we had to go back and reduce the number of flow sheets. Around 11 took care of the vast majority, and then we set something up for exceptions.” Thinking of every contingency can often create a system that is too complicated for the clinical staff to use successfully once it’s live.

Expect scope creep. “No matter how carefully you plan as you go through the process, things that you didn’t think of or new requirements are going to crop up,” Pederson says. Close to 80 percent of Excellian’s contingency costs were related to scope creep. Pederson contends that covering well for contingency and running a tight change management process will help weather those unexpected changes.

Take a supporting role. Pederson emphasizes that the implementation team needs to understand that they are really the supporting cast during go-live. The employees on the ground ensure the project’s success. “The people who have to buy into the implementation and make it go are the operations people in the clinical departments.” By partnering with those key individuals and helping them take ownership, go-lives were much easier and sustainable for the hospitals and clinics involved.

Manage expectations. Pederson cautions that it’s easy to oversell when getting user buy-in. “The end users get to the place where they think this system is going to solve every problem that they ever had.” She advocates an open and transparent process before going live to let users know what the system can offer them – as well as what it might not.

Provide the right scaffolding. Not every user is going to be thrilled with an implementation. That can’t be changed. Pederson suggests making sure that the right training classes are in place to make the transition as smooth as possible. “We did basic computer skills training, offered typing classes, and at-the-elbow support. We bent over backwards to help people get where they needed to be to use the system.”

Expect benefits to take time. Pederson says that benefit realization from the Excellian implementation is coming, but slower than originally anticipated. “It’s a lot of change for the clinicians,” she says. “It takes them longer to get over the learning curve than we thought — a year instead of six months. But, as physicians and nurses are getting more facile with the system, that drive towards benefits is coming.”