An organization’s decision to extend their instance of Epic to outside practices and/or facilities, known as Connect, offers many advantages to patients, providers and organizations. Used appropriately, the functionalities extended enhance the providers’ understanding of a patient’s clinical results, history and charts. In turn, this enhances the patient experience with an overall better, more comprehensive treatment and understanding of that patient’s particular problems. A goal of ‘one patient, one medical record’ is more attainable and sustainable and should lead to better outcomes. Additionally, communication and relationships between organizations and their medical community providers is improved. It is not difficult to understand why an organization may decide to offer a Connect product to their community.
On the surface, the implementation planning sounds easy. After all, the organization offering their EHR has already done the ‘heavy lifting’ of building workflows and determining best practices. Oftentimes, the overall mindset in these projects initially is to treat an implementation the same way the project team would treat an internal implementation (e.g., a new department or service line).
As with any implementation, there will always be lessons learned. There are some key areas of potential risk to your ‘customers’ overall satisfaction with a Connect implementation. These items can be easily addressed prior to contracting and can ultimately alleviate or bypass future pain points for both your customers and your project team. Although not comprehensive, below are some recurring challenges that can be experienced in Connect projects. Organizations should ensure they have a clearly defined and communicated strategy around them.
- Everyone is special – Determine your customization thresholds. Just as your organization is different than another in your city or region, your Connect partner is likely different from you. When extending your instance of the EHR, you need to clearly and frequently communicate to your recipients what, if any, customization you will support in their EHR with you. Customization in build is not just limited to clinical workflows but can include interfaces, third party vendor relationships, user security templates, billing/claims workflows and clearinghouses, scheduling templates and reports/reporting, among other items. Any items or areas in which your organization is willing to step away from in an established build and workflow, needs to be clearly defined for all so your Connect partner is aware of what is or isn’t possible and your project team has set parameters. Keep in mind that the more customization of the build you allow (vs. standardization), the more complex and costly your maintenance of that build will be long-term.
- No one likes to be ignored – Determine what level of participation your Connect partners will have in your governance and/or clinical content decisions. The quickest way to antagonize your Connect partners is to make them feel ignored. Clinicians, particularly specialty clinicians, will have preferences and suggestions to the clinical content and workflows you have extended to them. Your organization should strongly consider inviting representation of these partners into your governance and/or clinical content infrastructures. Such a strategy not only leverages additional resources to enable better patient care, it also serves to start shifting your organization’s internal culture to include consideration of outside providers and facilities in their deliberations.
- You may need a culture shift. When you sign on your first Connect partner, your organization is no longer just “your” organization. From that moment forward, everyone from your leadership down needs to be aware that changes to workflows and content in Epic build could now impact your partners, and therefore those entities need to be included in any consideration of such changes. This is particularly important for the Epic team, as they are the ones responsible for your build, as well as any system upgrades and updates. You also may need to incorporate your Connect partners into any communication and/or training protocols you currently use around changes and upgrades in your system.
- What are your long-term strategies around your Connect partners? How will problems be reported and resolved with your partners? We have seen a variety of solutions to these questions with our clients. Many organizations use their normal help desk operating procedures (call in a ticket, ticket is reviewed & prioritized using organization standards, ticket is assigned and worked by Epic team), but some organizations utilize a dedicated team and phone number for their Connect partners’ requests and problems. Another long-term consideration is new employee on-boarding at your Connect partners since your organization remains subject to your Epic agreement, which includes training requirements prior to access. You should review who/how that training is to be provided and how a partner communicates the need for training. As a corollary, how is your organization to be told of employee terminations for security inactivation?
- What is the exit strategy? Unfortunately, Connect partnerships do not always work out. This may be due to practice closure or provider dissatisfaction. To protect both your organization and any of your potential Connect partners, it is strongly recommended to ensure you have an off-boarding protocol clearly laid out and communicated prior to contracting. This protocol should include the steps of how a partner initiates off-boarding activities, what the reasonable expectation of deliverables after off-boarding will be (i.e., how does the partner access the patient medical record once they are off-boarded?) and the projected timeline of an off-boarding.
Each of these items is underscored by the underlying theme of communication. Wherever you land on decision points in your Connect implementations means little if these decisions are not shared clearly and frequently with your partners, your organization and your project team.
Connect projects are exciting opportunities for any organization to better care for patients, both in-house and in the community. Just be sure to look at the entire picture before beginning these partnerships so you can ensure your partners will be successful using your EHR.
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