Getting ready for an Epic implementation or an upgrade? From facilitating physician access to a patient chart or lab results, data mining for clinical research, integrated claim processing or patient engagement, the benefits that an EHR system like Epic will provide to your organization are many. Yet it is one of the biggest and most complex projects you will ever embark on as a healthcare IT professional. For example, a recent $55million Epic implementation at MidMichigan Health required 160 MidMichigan and Epic staffers working around the clock for over a year. Therefore, considering project complexity, cost and length you should be primarily concerned about on-time and under-budget completion as the primary metrics for implementation success, right? Wrong!
While on time delivery, stability and uptime should be critical considerations, your success will be ultimately measured by adoption and user satisfaction. However, there is plenty of room for IT improvement in this front. Consider that only 34% of doctors were satisfied with their EHR systems in 2014 (American Academy of Family Physicians), and doctors and nurses across the board continue to demand an extreme EHR makeover. Want to avoid chaos and frustration and boost user satisfaction? Plan, test, load test and monitor your EHR systems from a user perspective, for all your users, for all roles. Here are some quick pointers to help you get started.
1) Plan– Take the time to properly define record fields to ensure consistency across all facilities, and discuss common workflows and flows with your users (doctors, nurses, financial personnel, administrative staff, patients…). What functions are used most widely? What is the most frequently accessed information?
2) Map and optimize business processes- Your users want to spend less time interacting with the software and more time elsewhere. Therefore, map and document all user requirements and functions, for each group of users. Could you reduce the number of clicks? Could you improve searching? What is a user more likely to want to do next? What are must-have customizations? Consider how to optimize common workflows into new workflow models.
3) Test, test and re-test again (automate your testing!) All functions and critical end-to-end business processes should be thoroughly tested and validated. Begin functional testing as early as possible, so users can provide feedback on common processes and validate reporting structures. Focus on performance testing as well to oversee application response time, a common end-user frustration pain point. As your implementation progresses, automate your testing to save time and easily verify updates, and thoroughly test and re-test as needed to ensure top quality and performance. Look for a test automation solution where you can easily replicate and automate complete end-to-end user interactions with Epic in the form of testing scripts (e.g. logging , search for a patient record, access latest lab results, add visit information ), which can be later on re-used for load testing and monitoring as well.
4) Load Test. As more users place additional demand on your Epic system, performance could slow down and even bring operations to a halt. Ensure readiness for traffic spikes and demand fluctuations with load testing so you can verify that all critical functions and workflows will work well under peak conditions. Build comprehensive test plans that include realistic scenarios with various load levels and ramp up times, and multiple users concurrently performing different actions. In addition, since Citrix is a trusted solution provider to more than 90% of the largest healthcare organizations make sure that you will be able to replicate and measure REAL user activity using the ACTUAL client connection GUI for each load test. That way the most important metric is measured and analyzed – the end-to-end client side response time, so you can verify that SLAs will be met for all pre-defined levels of load.
5) Proactively monitor your Epic system. Simulate and measure availability and response time for all critical Epic business processes you have documented and tested on a 24x7x365 basis, taking response time measurements end-to-end and for each step. Ideally you should reuse testing scripts for proactive SLA monitoring, so you get alerted at the first sign of trouble, when Epic starts to slow down, before your users are impacted.
6) Continue to listen to your users. Stay aligned with your users’ needs and look for ways to continuously boost user satisfaction. Consider re-defining workflows, planning additional customizations, allocating more hardware resources or organizing more Epic training, and keep all lines of communication with users open by hosting regular meetings. Additionally stay on top of key industry trends (e.g. shortcut key strokes could prove deadly with health records and Epic warns providers who use copy and paste) and periodically review testing and monitoring reports to identify the need for Epic performance optimization.
Want to learn more? Check out CitraTest (test automation) CitraTest VU (load testing) and CitraTest APM (proactive response time monitoring from a user perspective).
Good luck with your Epic implementation!