EHR Migration - 5 Key Takeaways - Year 2 Update

We migrated to Epic as our EHR on November 1, 2021 with great fanfare and even greater expectations. Here we are having completed Year 2 and heading into Year 3 and I thought it would be a great time to recap the experience. Hopefully this helps those of you who are contemplating a move or in mid-transition.

Migrating to a new EHR is not as much about the technology as it is about the people and processes involved in using the technology. When you completely change the technical aspect, you will be changing everything about the way you operate. This is one of the most underestimated and overlooked aspects of a migration.

The existing technology solution is configured to perform tasks in a particular order. It might be optimal, it might be terrible, or it might be workable. Regardless, the new solution will perform tasks in a different order or in a different manner. This requires unlearning the old system and learning the new system, all while still being accountable for managing the day-to-day work of the organization. Add to this the challenge represented by the resulting change that happens to the daily work of each individual.

All change requires we unlearn and relearn, but this kind of change also requires we go back into a beginner status. So, people who have become very adept at their jobs and very comfortable in their proficiency are suddenly tossed into the deep end of a new technology and their perceived (and actual) expertise is diminished or completely destroyed. This leads some individuals to dig in deeply to preserve their sense of balance, expertise, or importance (all reasonable things to want to maintain) and avoid learning the new system as they should. Change management systems do address this issue, but most organizations struggle to really work through this layer of resistance.

There's also a tendency to blame all problems on IT or on the technology. In my experience, we saw that about 20% of the issues were build issues that IT had to correct, either because IT made errors during the build/configuration or because something had gone wrong along the way. The other 80% were because the build didn't meet end users' needs. This means that the end users perhaps misunderstood the build item being discussed and made wrong decisions, maybe they were looking at the new system through the lens of the old, or maybe they simply made mistakes. Ultimately, that matters far less than what the organization does to correct it.

Five key takeaways if you're on a journey to migrate your EHR:

1. Expect there will be build and configuration issues. Have a systematic method in place to address them.

2. Avoid blaming. Don't look in the rearview mirror unless you do need to understand a root cause. This is not an IT issue, it's not an end-user issue, it's not a technology issue. It's a change issue. Frame forward and determine what is needed to resolve the issue, regardless of how it came about.

3. Expect some users will adapt easily, others will dig their heels in. Identify those heel-diggers and provide extra training, support, and explanations around the WHY. Ensure they are required to demonstrate proficiency with the new system over time rather than taking surveys or more training.

4. Organizational leaders need to step up, make tough decisions (sometimes) and avoid falling into the "it's an IT problem" trap. That not only divides the organization, it prevents solution-oriented conversations. Yes, sometimes IT makes mistakes; so do our end users. What's important is who we support each other to find a suitable path forward.

5. Data needs will continue to expand, so spend a lot of focused attention on migrating and expanding your data and reporting capabilities during and after the migration.

Good luck to those of you on this journey. Despite the challenges we faced, we've rounded the corner. We're seeing great results from our move to Epic. We're implementing new, innovative features both within Epic and with integrated third-parties. Our providers are engaged and excited, our end users are (mostly) proficient and regaining their sense of expertise. I'm looking forward to an innovative 2024.