Recently, I had a chance to (virtually) interview three of our clients that are actively implementing Tapestry. As I’ve covered previously, Tapestry is one of Epic’s oldest modules, originally developed to manage operations for healthcare payors. Over time, the ways organizations are implementing and utilizing this module has changed rapidly. 

This variance was clear in the three, one-on-one conversations I had in preparation for this piece. For example, two of the organizations I spoke with are adding Tapestry to an existing Epic implementation, and one is implementing it as part of a new install. One organization is standing up a new managed services organization in advance of a risk sharing contract, with the others transitioning to Epic from other software that was previously used to manage their plans. Two of the three organizations are implementing Healthy Planet concurrently with Tapestry. 

Our conversations focused on lessons learned and advice to organizations preparing for their own Tapestry implementation. 

Of course, preparation for any large implementation project should always include: 

• Careful attention to pre-implementation planning of scope, timeline, staffing and other areas of consideration
• Ensuring involvement of user subject matter experts
• Establishing a strong project governance structure
• Other basic tenets of good project management

However, when the implementation at-hand covers Tapestry, there are many additional considerations to include in your planning.

Educate Your Existing Team

Tapestry is a unique Epic module with multiple “sub-modules” that replicate functionality found in other Inpatient and Ambulatory modules (Resolute PB/HB, Prelude and others). These sub-modules leverage many of the master files owned by other application teams. As the Tapestry implementation progresses, cross-team communication is essential to coordinate build efforts and prevent disruption of existing hospital and clinic workflows. Establishing these communication pathways will be much easier if your existing application teams have insight into the payor perspective and understand both the similarities and differences in workflows when managing members in a managed care model versus patients in an acute or outpatient setting. 

Partner with Operations

Building a strong relationship with operations is critical to the success of your Tapestry implementation. Complex workflows, third-party integrations and external data sharing are components of every Tapestry implementation. A strong partnership with operations will enable more accurate understanding of business processes and drivers that will influence the build. The implementation team will need to step into their shoes to create comprehensive workflows and a build that can be seamlessly integrated into business operations. 

Understand Current State Workflows

It is critical to understand existing workflows that will be impacted by the Tapestry install. Every organization has unique processes, requirements and workarounds that have been developed over time to accommodate functional limitations, third-party requirements and employee preferences. It is important to analyze these existing workflows to understand what can be improved using Tapestry and what will need to be replicated or modified to meet external requirements. In addition, operational representation is needed throughout the implementation to ensure that new Tapestry workflows are integrated with operational workflows to meet the business needs of the organization and external partners.

Staff the Right Team

One of the people I spoke with said it best, “Not only do you need to have the right people on the bus, you also need to make sure they are in the right seats.” Tapestry implementation roles vary greatly across the sub-modules with significantly different skillsets required. Most clients choose a blended approach to staffing their implementation team: a core of newly certified analysts with operational experience supported by experienced Epic mentors. This blended approach ensures both business knowledge and Epic expertise on the implementation team. 

One client shared his preferred backgrounds for newly certified members of the implementation team:

• Enrollment and Eligibility: Very technical role requiring a data-driven analyst rather than someone with a business analyst background
• Claims: Complex billing roles that benefit from previous capitation and revenue cycle experience
• Customer Relationship Management: Less technical and appropriate for a junior to mid-level business analyst
• Utilization Management: Requires experience with physician workflows, including orders and insurance referrals
• Healthy Planet: Clinical business analyst with an understanding of the basics of lab and imaging orders, familiar with nurse and physician workflow interactions
• Electronic Data Interchange: Heavy focus on ETL and transferring files
  • Helpful to have a business analyst also identified to capture incoming and outbound file specifications and assist with data validation.
• Contracting: Deep understanding of the business of managed care

Change Control and Governance

Decisions made during the Tapestry implementation will impact business operations and shared master files used by other applications. It is important to include representatives from business operations and existing Epic teams in your Tapestry change control and governance groups. For example, one client interviewed suggested weekly integrated team meetings throughout the implementation to coordinate Tapestry decisions with hospital billing and registration application teams.

Another shared their best practices for governance:

• Interdepartmental governance is key. Include representation from all operational areas and Epic project leadership.
• Document and publish key discussions and decisions. This will be a valuable resource to both the Tapestry implementation team and other application teams.
• Prevent decisions made in silos and conflicts between silos. Establish a clear hierarchy with multiple layers. Smaller module and master file-based workgroups should roll up into high-level groups, such as a health plan operations and a provider-facing group, which then roll up to an executive steering committee.
• Participation needs to be mandatory with representation required from each department or group at every meeting. This includes operational representatives, Tapestry project leadership and Epic IT leadership. Analysts should attend as needed to provide information needed to make decisions.
• Leverage existing IT structures and established policies whenever possible. For example, integrate the Tapestry implementation with existing change control and environment management strategies. 

It is also important to ensure that other IT initiatives, such as upgrades, environment refreshes and concurrent implementations, will not impact the Tapestry implementation timeline.

Preparing for Third-Party Data Integration

Third-party data required for Tapestry implementation and ongoing operations will always be more complicated, harder to receive and require more testing than initially planned. Make sure to allow sufficient lead time in your schedule for exchanging data specifications, data transformation and testing. It is critical to have an agreement in place with third parties to ensure they will be able to support your data requests and accommodate implementation timelines.

To ensure timely and accurate enrollment and eligibility data, receive data directly from payors rather than retrieving from an existing data warehouse. Communicate with third-party payors to ensure that they are able to provide resources to commit to timelines for data files, discuss specifications and assist with any data integrity issues. Delays in receiving enrollment and eligibility data can have significant impacts on your implementation timelines.

In addition to data sharing, most Tapestry implementations require multiple third-party integrations, including: authorization management, claim editing, clearinghouses, remittance management and scanning and optical character recognition (OCR) of paper documents. An additional integration area to consider is telephony integration. Telephony integration enables functionality to open a patient in Epic based upon the incoming phone number of a service call. This integration can be costly, but saves a significant amount of time for incoming CRM calls.

Lessons Learned

In response to the rise of risk-sharing arrangements, managed care contracts, population health and other alternative payment strategies, many organizations are undertaking Tapestry and Healthy Planet implementations. Core project management methodologies, combined with application-specific considerations, will ensure a successful implementation. 

If you’re currently planning an implementation project or need to assemble a high-performing team, Medix Technology can help. Connect with our team of consultants today to learn more about our solutions, and let our experience guide your success.

About the Author:

Jason Kulaga, Practice Director – Healthcare Solutions, joined Medix Technology to focus on leading and growing the consulting and advisory services practice. He is a PMP certified registered nurse with 25 years of experience in healthcare, including 4 years working at Epic in clinical implementation and 15 years overall experience in EHR implementation, project management, delivery oversight and consulting leadership. Jason is primarily focused on mentoring and advising internal consultants and Medix Technology clients on topics including implementation planning, project management, community connect, interoperability, workflow and system optimization, change management, project governance and physician adoption.