LCMC Health Recognized for Multi-Hospital Transition to Epic EHR

The six-hospital health system in New Orleans has transitioned from six different EHRs to one, saving money and setting the stage for more tech initiatives.

LCMC Health is saving money by consolidating all of its hospitals onto a single platform based on the Epic electronic health record, and now the New Orleans-based, six-hospital health system has its sights set on tech-based initiatives to improve patient care.

HIMSS Analytics recently recognized two of LCMC Health's hospitals, University Medical Center New Orleans and Children's Hospital New Orleans, for reaching Stage 7 of the HIMSS Analytics Electronic Medical Record Adoption Model (EMRAM), the highest validation of EHR adoption bestowed by the HIMSS organization.

The achievement caps the four-year project to migrate LCMC Health's hospitals from six different EHRs to Epic, coming at a time when the health system is in a growth and acquisition phase.

"We are relatively young as a hospital system," says Sherri Mills, LCMC Health's chief nursing informatics officer. The EHR migration was a key factor, she says, in LCMC Health's efforts to coalesce.

Sherri Mills, chief nursing informatics officer at LCMC Health. Photo courtesy LCMC Health.

"We know the HIMSS methodology helps organizations take a good look at how they're leveraging technology for patient safety and quality," she says.

The investment in the Epic transition cost the health system tens of millions of dollars, Mills says, but LCMC Health is coming out ahead financially compared to EHR expenses prior to consolidating.

"Through good application rationalization and consolidation, we actually are saving money," she says.

Children's Hospital New Orleans, for example, was actually documenting patient charts on paper before Epic was installed.

"They did have a way to do order management [electronically], but documentation was still on paper," Mills says.

Among the tasks that had to be satisfied to achieve the HIMSS EMRAM rating, LCMC Health had to demonstrate that its systems were secure, have a downtime contingency plan, and perform failover exercises to that plan. Requirements for the certification also include site visits by an executive from HIMSS Analytics and former or current chief information officers to ensure an unbiased evaluation of the Stage 7 environments.

High compliance over six months required

The HIMSS rating evaluates such aspects of EHRs as barcode scanning of patients and specimens to enhance patient safety and computerized physician order entry (CPOE), and requires hospitals to achieve at least 90% to 95% compliance with those measures over a six-month period.

"In addition to that, they just asked a lot of questions around quality and the interactivity between your systems," Mills says.

She says LCMC Health physicians transitioning onto Epic from other EHRs found order entry to be more complex and a bit more rigid, but the physician notes contained more functionality.

"Physicians have had a more enriched and fulfilling experience because everything is on one database," she says.

Like other health systems, LCMC Health continues to grapple with note bloat.

"It just varies on the particular clinician," Mills says. "We struggle with [messaging], too. How do we make sure that the messages that the doctor receives are particular to the doctor?"

One tactic: route some of those in-basket messages to groups that can handle matters extraneous to physicians, she says.

Coming out of the HIMSS attestation, LCMC Health is focusing on increasing nurse happiness through its Project Joy.

"Daily cares is a nursing flow sheet, everything that you can't figure out where to put it in the chart," Mills says. "We are going through that daily care flow sheet and trying to figure out, should this live here? Should we document this? Is this just extra clicks for the nurse? Is this meaningful documentation? Is it driving a decision?"

This includes going back to the principles of charting by exception, she says.

"A great example is having to answer the question, is a security officer present?" she says. "It had yes and no. People answered no to that question over 100,000 times in a month. Why do we even have no? It's just taking a step back and looking at how we can make things better with fewer clicks."

One challenge during the migration was the need to make training virtual to adapt to conditions during the pandemic.

"We created self-learning modules for all disciplines, every single class," Mills says. "It definitely forced us to develop that a lot more quickly."

Some in-classroom training is now being reintroduced, due to limitations of the virtual modules, she says.

One lesson learned, Mills says, is to find a good partner to help with EHR migration and consolidation.

"Hyland helped us navigate the process," she says of the enterprise content services and management company. "We focused on our projects. What is our story to tell? What is something good that our organization has done, that we would want to broadcast to our community? When you can get clinicians on board to talk about how we're leveraging our technology for better patient quality and safety, and they understand the importance of why we're doing that and celebrating that, that's the key thing."

Also under consideration: Having some of the remaining hospitals attest to Stage 7, or possibly looking instead at alternate HIMSS attestations for ambulatory settings.

"We've struggled a little bit more with measures like CPOE in some of our clinics," Mills says. "It's a good way for us to challenge ourselves to make sure we're using our [EHR] to its highest functionality."