Lessons Learned from a Virtual EHR Go-Live: Q&A with CIO Brett Mello

By Candace Stuart

Cayuga Medical Center in Ithaca, N.Y., decided to proceed with their EHR implementation amid COVID-19 challenges by switching to a virtual go-live. In this Q&A, Brett Mello, assistant vice president and CIO at Cayuga Health Center, describes processes, strategies and lessons learned. 

Q: When had you started planning your EHR implementation and at what point did you decide you needed to make your go-live be virtual?

B.M: We began our project to upgrade from Meditech 6.08 to Expanse (6.16) in 2018 with a planned go-live in May of 2019. Some unexpected needs arose in our organization during this time which ended up pushing our project out another year. As we began 2020 and our glide path to go-live, COVID hit, disrupting our staff and direct, onsite access to consulting. 

Demand for IT services to address COVID-related response activity exploded and our IT resources were immediately stretched thin. We had several decisions to make … postpone again and risk losing momentum on the work and preparations being done, risk incurring additional costs with Meditech and consulting, and adversely impact dependent, high value projects. There was also morale to consider – IT staff who have worked very hard for a long time to get everything that was required done and the collective breath holding with the hospital staff who were also preparing for impending changes. 

Alternatively, we could push forward and adapt to the new normal of remote work and collaboration and work even harder in order to support not just our upgrade but all the rapidly emerging COVID projects that required things to be done at “COVID speed” (a term coined to characterize the rate at which we had to turn around new project/tasks). We obviously chose the latter.

Q: What did you do in advance to facilitate the virtual go-live?

B.M.: Like many others across the globe, we ramped up our use of teleconferencing and quickly deployed Microsoft Teams to facilitate real-time collaboration across the organization. This worked surprisingly well. So well, in fact, that we became even more efficient because meetings and discussions could be done on the fly. No waiting to schedule conference rooms. 

And the new COVID environment of high alert put everyone in a constant state of readiness. Different combinations of people could be assembled in minutes versus weeks. We also found it easier to manage Meditech resources and consultants remotely since we didn’t have to coordinate physical workspaces or help them navigate our facilities like we would if they were onsite.

Q: Did you run into any unanticipated challenges? If so, how did you resolve them?

B.M.: Other than competing demands on our resources, not really. Everyone pulled together and, out of necessity, decisions were made fast.

Q: Did you discover there are advantages to a virtual go-live compared to on-site?

B.M.: COVID activities blur this a bit as our entire organization was functioning at a different level but I think virtual go-lives, like many other things that have changed this year, will quite possibly become a new standard.

Q.: What did you learn from this experience that will inform any future IT projects?

B.M.: IT governance and how demands on us are prioritized will need to continue to improve. IT can do some really amazing things but we can’t do it all. As senior leadership, we’ll need to assess demand versus capacity a bit more closely and be OK with putting more things in the parking lot in favor of addressing fewer but higher value initiatives. Additionally, we’ll be continuing our journey to move more infrastructure virtual, both onsite and in the cloud, with the goal of faster scalability and better redundancy/availability.

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