Last fall, during the height of the pandemic, Seattle Children’s Hospital completed an EHR consolidation project, moving from Cerner to Epic clinical modules and accelerating its cloud migration strategy.
Zafar Chaudry, M.D., M.B.A., has been senior vice president and chief information officer at Seattle Children’s since 2017. He said the move to the cloud started about 18 months ago when officials there decided that that the on-premise data centers, in general, would not fit their purposes. “In phase one, we closed all of our on-site data centers and built new environments in a private cloud,” he explained. “We have 800 applications running in our private cloud, in a location where the equipment belongs to us, but the data centers themselves belong to someone else.”
For about 10 years, Seattle Children’s was in the slightly unusual situation of running Cerner as a clinical system and Epic as a revenue cycle system. They had moved to Cerner cloud, but the Epic piece had been running on premises before Chaudry arrived.
During that 10 years, Seattle Children’s had multiple consultancies give them advice on whether they should consolidate to a single platform, but they never really got to a decision because of the cost-prohibitive nature of these clinical systems in general, Chaudry explained. “When I came into the organization, the CEO asked me the same question: Should we consolidate our systems? And I said absolutely.” (He added that the actual cost to do the consolidation ended up being much less than the consultants had predicted.)
But before any decision was made, Chaudry worked to discern how the clinicians felt about the potential shift from Cerner to Epic.
I asked Chaudry if the fact that he is a physician helps give him credibility with clinicians and empathy for the impact of technology on their work. “Absolutely,” he said, “because I've been in their shoes. I was the naysayer, many moons ago, saying, IT is just terrible. It’s helped to be able to speak the language, the medical terminology; it helps to have been in their shoes. I completely understand their pain. But at the same time, whether or not you're dealing with doctors and nurses, every time you include somebody in that decision, you end up making a better decision.”
“With the Epic project, I didn't just come in as a new CIO and put my foot down and say, ‘This is what we're going to do.’ We did a ‘bake-off’ between the two vendors. We gave our workflows to Cerner and Epic and asked them to spend 10 hours in classrooms showing our physicians and nurses how their system would work with our workflows. About 300 clinicians attended those sessions, and then they voted. I was present to watch everything, and the votes were clear. I like to do every project that way.”
Complicating the transition was the fact that it had to be done during the pandemic. “We were the first in the world to deliver training to 13,000 people live via webex,” he said. “We couldn't put anybody in the classroom. Epic said that the way people normally do this is in the classroom, and I said, ‘Well, I'm not going to delay the project, because every month we delay costs us a lot of money.’ So we worked out a way. You could attend the class live from your home. We made sure that people had the right technology at home and we had a new learning management system where videos were recorded and online learning was supplemented.”
In the Epic model, everybody has to pass the final exam for the module that they're trained on, and the first-time pass rate using this virtual training delivery model was about 92 percent, Chaudry said. “For those who didn't make it through the examination the first time, we gave them personalized one-to-one, virtual training to get through. We were pretty pleased with the outcome.”
Besides easing data sharing with all the other Epic customers in the Seattle area through Care Everywhere, a bigger advantage is the integration of all the data from module to module within Epic. Previously they had lots of applications that didn’t necessarily share data easily. “We did a big bang with 23 Epic modules,” Chaudry said. “We actually have more functionality now than we ever had for the last 15 years with that hybrid sort of model.”
For cloud services, Seattle Children’s chose to work with a company called Virtustream whose Healthcare Cloud provides availability service-level agreements up to 99.999 percent at the infrastructure level, or less than 6 minutes of unplanned downtime a year. “We've got a five nines guarantee on our Epic system,” Chaudry said, “and where I've struggled with other cloud vendors is that nobody seems to want to give more than three nines in terms of service guarantees. We are very happy with that agreement.” He noted that that platform allows Seattle Children’s to be more agile and scale up faster in ways that traditionally took too long and were too expensive.
With its xStreamCare Services, Virtustream manages the infrastructure for the hospital’s Epic system as well as many other ancillary and supporting applications.
Currently Seattle Children’s is about 90 percent private cloud and 10 percent public cloud with Microsoft Azure and Amazon Web Services. The next step will involve moving all the third-party applications that are bolted into Epic to the Virtustream cloud, because they will perform better there, Chaudry said. “Some of the big commercial applications, ERPs and all those types of things, will be moved into a public cloud setting,” he added. “I think we will probably end up with 60 percent private cloud and 40 percent public cloud. We can’t go 100 percent public cloud because there are still performance issues. Security is not the big concern, but I think the big public cloud vendors still need to get to a different service level for uptime guarantees for healthcare.”
Chaudry also spoke about some of the longer-term impacts of the pandemic.
“We went from 100 people a day working remotely to 4,500 within 24 hours. We had built the infrastructure; we have a fully virtual desktop infrastructure here,” he said. The organization has decided that about 2,500 of those people will never come back to the office. They will permanently work from home, as the organization adjusts its space to be more hoteling desk space in the future.
On the clinical side they went from 150 telehealth visits per week to currently 15,000 per week. “We have launched telemedicine in the spaces that it suits, including psychiatry, initial visits, follow-up visits, and visits with chronic disease patients,” he said. “That is going very well. We serve four different states in terms of our geographical intake, and we have noticed some equity issues in terms of getting laptops, mobile devices and broadband into people's homes.”
They have responded by putting telehealth kiosks in the community, in their own clinics, where patients can do a walk-in telehealth visit from there. They’ve also been loaning devices that come with a 4G connection to those families that don't have access to the internet. “They're able to consume that telehealth visit and then give us the equipment back,” Chaudry said. “We've tried to handle that inequity to the to the best that we can with the resources we have available.”