The Mayo Clinic has started the second phase of its implementation of a $1.5 billion integrated Epic electronic health record and revenue cycle management system, replacing three disparate EHRs that the healthcare provider currently uses.

“The second go live began last Saturday, November 4 and that was Minnesota Health System—so everything in Minnesota and into Northern Iowa, except for Rochester,” says Steve Peters, MD, Mayo Clinic’s chief medical information officer. “It’s going quite well.”

According to Peters, this latest rollout of the new EHR-RCM system includes 11 hospitals, 40 clinics and about 7,500 users. In July, Mayo Clinic Health System started to go live on the Epic system at 27 facilities in Wisconsin—including seven hospitals and 20 clinics, with about 9,000 users—as part of the first phase of the implementation.

Also See: Mayo Clinic starts to roll out $1.5B Epic EHR-RCM system

Peters acknowledges that “there were quite a few lessons learned from the first implementation” and that the Mayo Clinic made modifications to the staffing, support and training to ensure the second go-live went smoothly. As proof, he points to the fact that so far the transition team has received “about half the individual number of service requests or questions,” compared with the first go-live.

About 20,000 employees have been trained to use the new system to date, and ultimately, more than 51,000 Mayo Clinic staff will get training, according to Peters. In addition, Epic is a “single integrated clinical and revenue cycle system” that will replace more than 300 systems, he contends.

“Our plan is for four big implementations over this year and next year,” says Peters, who notes that, in addition to the November 4 go-live, Mayo Clinic’s Rochester headquarters is scheduled to implement the system next May, while Mayo Clinic’s campuses in Arizona and Florida are scheduled to go live in October 2018.

The Rochester campus is “under somewhat of a time constraint because of the sunsetting of the enterprise GE (Centricity) system that we have as a core EHR,” he adds. “Arizona and Florida have a common version of (Cerner) EHR, so we could convert them at the same time.”

Although the implementation will involve three time zones, the technology “makes it possible to do this across the country fairly seamlessly,” Peters contends. “All of that is manageable within the system. It’s worked by bringing people together both in person and with a lot of telecommunication and video conferencing. We have several hundred staff full time on the project.”

The Epic rollout is dubbed the Plummer Project, named after Henry Plummer, MD, who created the world’s first patient-centered, unified health record at Mayo Clinic more than a century ago. Peters makes the case that the organization “has almost no paper records” and in fact hasn’t for several decades. However, he concedes that Mayo’s electronic environment had “diverged in several areas” and was reducing efficiency and its ability to spread best practices.

“The primary driver for this single integrated record is practice convergence—it’s not just an information technology project,” concludes Peters. “That means we’re trying to get Mayo Clinic knowledge, our protocols, our best practices and our order sets available in every site where we take care of patients. With different EHRs and modules, that is harder to do.” He also notes the previous challenges and inefficiencies in maintaining “disparate and smaller revenue cycle systems.”

While the Mayo Clinic is implementing Epic’s MyChart patient portal, Peters says the organization will maintain its patient online services.

“Our own Mayo Clinic portal is going to remain the front end and the visible portal to the patient—then, behind the scenes, we’re bringing in the information, the record and the features of MyChart,” he adds. “The advantage of that is that we can maintain our previous identity management, so it is seamless to the patient—they’re still using their Mayo Clinic portal for access, the results will come from Epic. But we can also then provide additional information that we may want to distribute that’s separate from the EHR itself.”

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