Dartmouth-Hitchcock (D-H) is a nonprofit health system, with hospitals and clinics throughout New Hampshire and Vermont. Across its many locations, D-H receives 1.7 million outpatient visits and 31,000 emergency visits, and performs 20,000 surgeries annually.
When the Affordable Care Act (ACA) was signed into law in 2010, most of the conversation focused on health insurance. But for Dartmouth-Hitchcock, and other healthcare providers, the regulations in the act amounted to a new—and pressing—to-do list requiring a complete overhaul of day-to-day interactions with patients. That's because the ACA's sweeping reforms called for a sharp reduction in administrative costs, driven by a mandate to move patients' records from paper to electronic. For D-H, these regulations and the looming federal deadlines meant a workflow shift: Good-bye to paper, and good-bye to fragmented systems dealing with point-of-care service and record-keeping.
To meet ACA requirements, D-H settled on the Epic system, an enterprise-level electronic health record (EHR) suite of applications. Choosing an EHR was just the first step— installation and implementation was a whole other project. It's difficult to understate the enormity of this transition to Epic's software: While any upgrade or new software is typically accompanied by some level of user confusion and expected bugs, Epic would need to be implemented in multiple locations and serve a range of patient needs from routine well-visits to ongoing cancer treatment. Service disruptions would go far beyond inconvenience, or a negative impact on the bottom line—they were potentially perilous to patient care. Adding to the difficulty of the transition was the timing: Epic’s launch of 14 new applications was scheduled to occur in a single day: April 2, 2011.
Even a problem-free launch would require significant support. Bill Weyrick, Director, Information Systems User Support, knew there was no question that implementing Epic, and overhauling the existing patient record-keeping system, would lead to a dramatic post-launch spike in incident volume, and a close examination of D-H’s information services environment revealed that it would not be able to handle an influx of support requests.
“Cherwell enables us to manage our systems to provide the best possible patient care. Cherwell doesn't touch the patients directly, but its indirect touch is incredibly important. With strong support operations, we provide better patient care, secure in knowing that we're adhering to regulatory requirements like HIPAA and managing our end devices better through asset tracking and management.”
Bill Weyrick - Director, Information Systems User Support
“Deeply fragmented" is the best way to describe D-H's information systems environment during this time period: There were 12 incident management systems using an assortment of products from FileMaker Pro to SharePoint to Excel, as well as two regional help desks, each running a different service management system. There was no capacity to roll up incidents into problems, to escalate issues, or to communicate across teams; the environment was completely incapable of supporting Epic’s launch, much less day-to-day operations. “Up to that point,” recalls Weyrick, “we had been siloed with vertical solutions for each team for service management. To support the Epic suite, we needed an enterprise-class service management system.”
The hunt for the right service management system began in early 2010, and by summer, D-H signed a contract for Cherwell Service Management. Cherwell met D-H’s major criteria, including:
With an ITSM vendor secured, D-H could begin to lay the groundwork for Epic’s implementation, staying on schedule for adherence with federal regulations.
Prior to the looming go-live date, D-H was eager to affirm if Cherwell was capable of supporting a major launch. Willow, Epic’s pharmacy system, was the perfect test case. D-H used Cherwell Service Management, which was branded Dartmouth-Hitchcock Service Management (DHSM), as the incident management solution for this small yet vital launch.
The trial run in December 2010 went incredibly well; Weyrick describes the integration as seamless. “Cherwell’s technology and adherence to standards proved out for our whole implementation cycle," he says. With this test hurdle cleared, preparations began for the next massive go-live date, including the establishment of a call center. Weyrick describes Cherwell’s product as “extremely intuitive,” with two team members doing the majority of the implementation after just a week of training.
Cherwell was a supportive partner throughout launch preparation, as requirements were gathered and the technology was configured. “Cherwell was very helpful and flexible with our licensing for the massive go-live, which we knew would involve a spike in tickets,” says Weyrick. With a temporary boost in licenses to support the anticipated volumes, D-H confidently established a 100-person command center, with 20 teams of five people providing round-the-clock coverage for the weekend of the Epic launch.
The launch was a triumph, with Cherwell's support enabling it to occur on schedule and without disruption to patient care. While the days following Epic’s arrival on April 2, 2011 were as busy as anticipated, by mid-April, the call center was disbanded. Within a few months, D-H returned to pre-launch levels of support. Since then, DHSM has capably handled day-to-day support of Epic and other systems relied upon by D-H staff to deliver patient care. Since D-H adopted Cherwell Service Management, the IS team has serviced 550,000 tickets and nearly 26,000 change requests, the CMDB has grown to 60,000 records, and two million emails have been processed.
D-H is steadily replacing outdated service management systems in other departments outside of IS with Cherwell. “Just about anyone that receives calls and creates requests from those calls is a natural fit for Cherwell Service Management,” says Weyrick. From the department of continuing education, which uses DHSM to track class requests from nurses and physicians, to the security department, which manages parking and ID card requests, DHSM is used far beyond the traditional boundaries of IT.
In addition to its utility to departments throughout D-H’s health system, Cherwell Service Management has also transformed communications. Removing siloed teams has “fostered and expanded communications,” says Elias Hunt, a Senior Systems Manager. “It’s resulted in a lot of conversations between groups that didn’t used to occur, or occurred in water-cooler conversations, and weren’t forthcoming, open, or growing.” Weyrick also points out that Cherwell is helping D-H on one of its biggest initiatives: transitioning from a fee-for-service model to a population model. For this to work, D-H needs to see a high volume of patients, so D-H is building affiliations with other hospitals at a rapid rate. “One of our first steps when we assimilate another organizations is to extend Cherwell out to them,” says Weyrick, since experience has shown D-H that Cherwell is essential for both launch and day-to-day support of Epic's solution.
Implementing Cherwell Service Management at Dartmouth-Hitchcock allowed the healthcare institution to support a necessary but intimidatingly complicated launch—but Cherwell's benefits have extended beyond short-term support. Cherwell has improved operations and communications far beyond the IT, and is now an integral partner, hand-in-hand with Epic, as D-H maps out future expansion plans and assesses the challenging healthcare landscape.
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