Improving Stability and Alignment with MEDITECH Expanse
Cloud-based strategies for managing EHRs typically come with myriad challenges. That’s a given. But what happens when unexpected complications are thrown into the mix?
Chad Skidmore, Vice President of Managed Services, Hosting & Infrastructure, Tegria, described how the international consulting and technology services company recently helped several healthcare organizations (HCOs) leverage cloud technology to overcome herculean challenges as they dealt with extenuating circumstances during the education session, “EHRs to the Cloud: Lessons from the Field,” held at HIMSS22 in Orlando, Florida. Skidmore also offered up several best practices.
In 2019, Beauregard Health System contracted with a major EHR vendor to implement its system, with an initial delivery date of March 11, 2020. At the same time, the DeRidder, Louisiana-based organization partnered with Tegria to help implement the system. On paper, the plan looked routine.
On March 11th, however, the World Health Organization declared a global pandemic due to COVID-19. As a result, HCOs needed to make major adjustments to cope with this unprecedented health crisis. For the Beauregard IT department, the pandemic meant that staff members would have to work remotely. Therefore, they would need to take on the EHR implementation – one of the most demanding undertakings for healthcare IT departments – as they logged in from disparate locations.
“We moved a lot of the training and implementation quickly to various different video platforms, so they could begin to build and implement the system,” Skidmore explained.
As if dealing with a pandemic wasn’t chaotic enough, the region was hit in August 2020 with Hurricane Laura, a Category 4 storm that brought 150-mile-per-hour winds and significant destruction to the area.
“The storm destroyed the entire area and caused extensive power outages,” Skidmore recalled. “People were displaced from their homes in a number of cases. And this all happened right in the middle of our EHR implementation.”
Staff members were able to continue with the build because they could connect from their cellular devices. Many of the staff were working on mobile devices from their vehicles because that was the only source of power to charge a tablet or another device.Chad Skidmore, VP of Managed Services, Hosting & Infrastructure, Tegria
Then in October, while the area was still recovering, Hurricane Delta hit, bringing yet another round of destruction to the already-devastated region. Many homes in the area still did not have power or water, and the hospital was operating without many basic services.
However, because the EHR implementation was occurring in the cloud, Tegria was able to work with IT staff to keep the project moving forward. To accomplish this, Tegria adjusted their schedules, mixing video calls with in-person work to stay on track. In fact, Tegria partnered with the hospital to eventually build more than 80 systems on schedule before going live on January 1, 2021.
“Staff members were able to continue with the build because they could connect from their cellular devices. Many of the staff were working on mobile devices from their vehicles because that was the only source of power to charge a tablet or another device. We also had a number of the staff camping out in RVs,” Skidmore said.
With Tegria providing technical guidance and supporting implementation in the cloud, the health system was able to implement the EHR on time and experience 100% uptime, despite the trying working conditions.
“We had no idea what would come our way. The pandemic, the storms, there was no way to be prepared for any of it,” Meg Jackson, Director of IT at Beauregard, said. “With [Tegria], it was much easier to pick up the pieces after every blow and say, ‘OK, here’s what we need to do to get back on track.’ [Tegria] was there with us to help carve a new path, and their cloud hosting ensured we could always access the system. Without them, I don’t know if we could have been nearly as successful.”
Like many HCOs, Val Verde Regional Medical Center in Del Rio, Texas, was heavily impacted by the COVID-19 pandemic. In fact, by July 2020, the area had a 54% COVID-19 positivity rate.
“The hospital was hit pretty significantly with early COVID cases,” Skidmore noted.
As such, the hospital needed to reclassify a number of rooms, build out isolation units and make changes to billing, Skidmore added.
In addition, Val Verde leaders wanted to quickly implement telehealth and remote monitoring programs to meet patient demand for virtual care. “There were a lot of folks that would defer various procedures and treatments because they were afraid to go to the facility. So we were able to work with them [Val Verde] to … really accelerate the implementation of their telehealth program,” he said. “Because they were using the cloud, we could quickly expand and contract the environment to support some of these programs.”
In fact, Val Verde was able to scale the cloud environment in order to accelerate the rollout of telehealth, remote patient monitoring and other point-of-care solutions from the originally expected two-year time frame to just 30 days.
“Things have gone so smoothly that our team has joked about how much divine intervention there must have been to implement the project’s initial scope and to accelerate and adopt new technologies,” said Keith Willey, CIO at Val Verde Regional Medical Center.
... because the EHR was in the cloud, we were able to work with the EHR vendor ourselves to get medication reports and other data out via other mechanisms so that the healthcare organization could continue to provide care.Chad Skidmore
A healthcare system was hit with a ransomware attack in the middle of the night. “It completely devastated their hospital and shut down all their localized operations. Fortunately, we had their EHR in the cloud. It was unaffected,” Skidmore pointed out. “We were able to disconnect from them to make sure that we protected that EHR environment.”
That was fortunate, as HCOs frequently are slow to get their information systems back up and running after a malicious attack. “It often takes a number of days to engage your remediation teams. Then the teams want to preserve systems for forensics, and that really paralyzes your operation,” he noted. “In this particular example, because the EHR was in the cloud, we were able to work with the EHR vendor ourselves to get medication reports and other data out via other mechanisms so that the healthcare organization could continue to provide care.”
Tegria was tasked with helping a major ambulatory practice implement its EHR on the Microsoft Azure platform in the cloud in less than six months. This deployment was made more daunting because the clinical staff had very little experience with EHR systems.
“We were able to very quickly get that entire test, development and production built out within that Azure environment,” Skidmore said. “This is a decent-sized entity … and we had the benefit of the cloud in terms of rapid deployment without having to build out core infrastructure.”
The organization also required that a number of specific, mandated technologies had to be deployed across all operations. “Many of these [technologies] were unfamiliar to the EHR vendor and some unfamiliar to Microsoft as well. We had to go through the process of vetting and ensuring that those different technologies would be allowed and well supported. We did a lot of that validation work in a highly compressed timeline,” Skidmore pointed out.
By leveraging cloud technology, all of the ambulatory practices within this organization were able to simplify EHR implementation and management, keep digital transformation initiatives moving forward and, most importantly, focus on providing optimal patient care.