National Consulting Firm Takes

Innovative Approach
to Help Fletcher Allen Succeed on
Large-Scale Epic EHR Upgrade
In 2013, Fletcher Allen embarked on a large-scale
upgrade of its existing Epic Systems EHR called
PRISM (Patient Record and Information Systems
Management), which it first installed in 2009.
The hospital chose to transition from its highly
customized existing system to an EHR that more
resembled the Epic model system in order to
more easily add enhancements and improve
functionality and to provide users with a more
streamlined and intuitive experience. It was
almost more of re-install than it was an upgrade,
noted Chuck Podesta, Fletcher Allens chief
information officer (CIO).
The CIOs main concerns were achieving a
successful outcome and identifying components
of the upgrade that could benefit from the
expertise of an outside consultant. The Fletcher
Allen team recognized early in the planning
process that they would need significant help
training and supporting staff on the updated
version of PRISM. The four-person in-house PRISM
training team was simply too small to retrain
the thousands of users on all the new features
especially given that the training would need to
be done quickly and on a 24/7 schedule in order

to reach the large number of overnight staff and

other employees with non-traditional schedules.

A different approach: Integrative

Insource ConsultingTM

Facing an upgrade of this magnitude, Fletcher

Allen sought to create a long-term partnership
with an organization that had significant
experience working on large-scale electronic
health record (EHR) rollouts, as well as a proven
ability to bring qualified resources to meet the
needs and demands of such projects. They also
needed this partner to help grow their in-house
Epic expertise and decrease their dependence on
outside consultants. MBA HealthGroup worked
directly with leadership at Fletcher Allen to devise
a strategy that would not only ensure a successful
upgrade, but also contribute to building the
hospitals internal Epic training team.
Fletcher Allen and MBA developed what they
refer to as the Integrative Insource ConsultingTM
model a strategic partnership program
customized to meet Fletcher Allens needs.
This strategy involved bringing in the right

Produced in partnership with

consultants from MBA and giving Fletcher Allen

the opportunity to hire some of those consultants
at the end of the engagement to bolster the
hospitals in-house expertise. That meant not
just selecting experienced consultants with
tremendous expertise, but also identifying specific
professionals who would work well with the
Fletcher Allen team as they essentially embedded
themselves in the hospital for several months
and perhaps beyond.
MBA excelled in this area. We creatively thought
about how to work with a consulting firm so that
at the end of the process the consultants could
potentially become Fletcher Allen employees, said
Debra Dulac, director of PRISM for Fletcher Allen.
That allowed us to see if they would be a good
fit before hiring, and that approach really set MBA
apart and it set the stage for the ultimate success
of the initiative.
Fletcher Allens Podesta agreed: MBAs consulting
arm is impressive they work with great people
and have a deep bench of professionals. They
were able to do so much in terms of finding
great people to help us and really complement
our efforts. In the end, they did a great job
understanding our culture and then bringing in
the best and most appropriate people to help
us so the project would be a success. Having the
ability to hire the MBA consultants as permanent
trainers also was appealing.
Once engaged, a team of MBA consultants worked
closely with Fletcher Allens in-house training
team, nursing educators, clinicians and operations
staff to fully understand the hospitals culture and
workflows. That insight enabled the MBA team to
examine existing processes, modify test scripts
and provide curriculums for the training classes
that centered on how each type of staff member
including physicians, nurses and ancillary staff
would actually use the new upgraded version of
PRISM, with a particular emphasis on explaining
the new features and functionality. Their deep
knowledge of the Epic system as well as the way
we wanted to use it was instrumental in delivering
effective training, said Podesta.

Results and evaluations

The end result: In just under seven weeks, MBA

and Fletcher Allen trained approximately 2,900
employees on the new system including 1,350

They did a great job understanding our

culture and then bringing in the best and
most appropriate people to help us so the
project would be a success.
Chuck Podesta, CIO Fletcher Allen
IP nurses, more than 700 providers and nearly 200
ambulatory super users.
Whats more, the Fletcher Allen staff had
overwhelmingly positive responses to the training
initiatives rating all aspects of the training at
least a 4.1 out of 5 (Figures 1 and 2). Perhaps most
impressive: The physicians who received training
gave the classes an overall rating of 4.6 out of 5.
Thats just staggering to me, marveled Podesta.
Physicians are some of our toughest critics, so
that rating was just off the charts.
The bottom line, said Podesta: Were seeing great
things from a patient care standpoint. Our nurses
and doctors tell me that they feel well-trained on
the new system and theyre using it to be more
productive and do their jobs better.

Best practices for a flawless upgrade

The Fletcher Allen team points to five key best
practices that MBA implemented that ultimately
drove those strong results:

1. On-demand resources. MBA worked around

the clock to offer training opportunities on site,
as well as via e-learning channels and other
outlets to fit the staff s needs, schedules and
preferences.
2. A reflective and active learning environment.
The MBA trainers were adept at presenting

information about the upgrade in ways in that

made the staff feel comfortable and open to
learning new concepts that might not come
easily the first time around. This approach
can be crucial in healthcare environments,
where physicians and other professionals
often get defensive when getting trained on
new technology they may not understand
immediately. The director of our nursing
education and research commented on how
committed, dedicated and engaged the trainers
were in the classes, noted Dulac.
A major part of creating that positive
environment was the trainers ability to actively
listen to attendees questions and concerns, and
customize the lessons around core issues of
importance to the various groups. The trainers
didnt just present a static agenda. They focused
on getting the staff to learn and retain the
information that mattered most to them and
tailoring the teaching to the specific people in
front of them, said Dulac. Their engaging style
created a lot of buzz within the organization. It
got people actually excited to go to the classes
and learn the new system.
3. A
 partnership-based approach. Rather than
take a go it alone approach, MBA partnered
with Fletcher Allens nursing educators who
work in patient care areas. Teaming up in
the classroom allowed the MBA trainers to
present the crucial IT information while giving
attendees direct access to in-house staff who
could answer their specific questions about
clinical workflow issues that were unique to
Fletcher Allen. That team-based approach fit in
with how we work here, and it fostered a sense
of camaraderie in the classroom that elevated
the training to a higher level, said Dulac.

Fletcher Allen is a Level 1 trauma center

and Vermonts only academic medical
center. With more than 500 beds,
Fletcher Allen serves approximately
1 million patients in Vermont and the
northern New York area. The hospital
employs 7,000, including 500 physicians,
making Fletcher Allen the largest
private employer in Vermont. It also has
appeared on U.S. News & World Reports
Most Connected Hospitals list of the
nations leading hospitals in the adoption
of electronic medical records.
4. Training by workflow, not function. The best
classroom training or e-learning in the world
will not matter much if the information is not
used. MBA emphasized how to implement the
new features of the upgraded system on the
ground by centering the training on actual
workflow processes. Their success in this area
was evident the first day after the new system
went live. The go-live was essentially a nonevent. People came in on Monday and went to
work with little to no problems, said Podesta.
We had a help desk ready to field questions
and complaints, but we ended up having no
more calls than wed get on a typical day.
5. Ongoing check-in and follow-up. MBA
engaged in regular dialogue with Fletcher
Allen to assess on an ongoing basis how the
consultants were doing and how the staff was
responding to the training. That proactive
approach helped head off any potential
roadblocks that could have slowed down the
learning process or prevented Fletcher Allen

Figure 1. Fletcher Allen provider evaluations of training

(1=Strongly Disagree; 5=Strongly Agree)

The trainers were knowledgeable

Inpatient Providers

Ambulatory Providers

4.6

4.8

The topics covered were relevant to my practice

4.6

4.5

The materials provided are useful

4.5

4.5

The class was well paced

4.3

4.7

The training was a good use of my time

4.1

4.5

from meeting its goals on time. MBA was great

at communicating with us from day one, and
that was crucial to the success of the upgrade
and staying on track, said Dulac.
In the end, the benefits that MBA delivered have
encouraged Fletcher Allen to look for more
opportunities to work together going forward.
We see MBA as a true long-term partner, said
Dulac. Podesta concurred: Given the expertise
and resources that MBA brings to the table I can
confidently say that they can help us with any
need that might come up be it Epic-related or
not. In MBA, we know we have a great partner
that we can go to for anything.

Figure 2. Fletcher Allen inpatient

evaluations of training

This has been a truly remarkable

result for training.
Adam Buckley, MD, Chief Medical
Information Ocer Fletcher Allen

(1=Strongly Disagree; 5=Strongly Agree)

The trainers were easy to understand

4.8

The trainers were knowledgeable

4.8

The trainers answered my questions

4.8

The materials were clear and

easy to follow

4.7

The materials covered the tasks

I will perform in PRISM

4.6

The class was well paced

4.6

I feel confident that Ill be able to do

my job in PRISM after the upgrade

4.5

The training feedback we received

represents the outstanding hard
work, dedication, user-focus, and
professionalism of the PRISM training
team and the Fletcher Allen leadership
that promoted and supported this all-out
training eort.
Karen Baron, PRISM Supervisor of
Training & Support

993 respondents

About MBA
MBA HealthGroup is one of the fastest growing healthcare consulting
firms in the U.S. They work with healthcare organizations to solve their
most intimidating challenges and deliver innovative solutions and the
best client experience in the industry. Their consultants focus on HIT
Strategy, large Epic and Allscripts EHR implementation, training, and
optimization, ICD-10 Readiness, ACO Strategy, RCM Optimization,
Meaningful Use and Patient Engagement services.
www.mbahealthgroup.com

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www.himssmedia.com

2013