D546 Task 2 Employee Transition and EHR Plan Example

Keeping the Specialists, Moving the Records: An Employee Transition Plan and EHR Integration Strategy for a Composite Adult-Pediatric Merger

Student Name

Leavitt School of Health, Western Governors University

D546: Healthcare Policy and Governance, Task 2

Course Instructor

Month Day, Year

Keeping the Specialists, Moving the Records: An Employee Transition Plan and EHR Integration Strategy for a Composite Adult-Pediatric Merger

Purpose

The merger of Northgate Medical Center, a 410-bed adult hospital in a regional system, and Linden Children's Hospital, a 130-bed independent pediatric hospital, will close in six months. Its success depends on two things that are easy to underestimate: keeping the people who make Linden a children's hospital, and bringing Linden's electronic health record (EHR) into the system without putting young patients at risk. This plan sets out an employee transition plan and an EHR integration strategy, each with goals, steps, timeline, responsible leaders and measures, and it builds regulatory and ethical safeguards into both.

Employee Transition Plan: Goals

The plan has three goals. First, retain Linden's clinical workforce, especially pediatric subspecialists, pediatric intensive care nurses and respiratory therapists, whose skills cannot quickly be replaced; the target is to keep voluntary turnover among Linden clinical staff at or below its current 14% in the first two years. Second, integrate administrative functions fairly and transparently, treating employees at both hospitals by the same rules. Third, build a shared culture that keeps Linden's family-centered approach while adopting system standards where they improve care.

Employee Transition Plan: Steps and Timeline

Before closing (months 1 to 6). The joint integration office, led by the system's chief human resources officer and Linden's vice president of people, maps every position at both hospitals into one of three groups: clinical roles, which will not change; administrative roles unique to one hospital, which will continue; and overlapping administrative roles in finance, supply chain, revenue cycle, human resources and information technology, which may be combined. Leaders announce commitments in writing: no reductions in clinical positions for at least 24 months, recognition of all service years and accrued paid time off, and a fair selection process for combined roles with priority for internal candidates. Retention agreements are offered to pediatric subspecialists and to the Linden EHR analysts whose knowledge the integration will depend on.

Day one and the first 100 days. Every employee receives a welcome from both chief executives, a written summary of what is changing and what is not, and a named manager for questions. Managers hold weekly huddles and pass unresolved questions to the integration office, which publishes answers within five days. Benefits are compared, and any Linden employee whose benefits would be reduced keeps their current plan through the next open enrollment.

Months 4 to 12. Combined administrative roles are filled through the published selection process. Employees whose positions are eliminated receive at least 90 days' notice, which exceeds the 60 days required under the federal law on advance notice of mass layoffs (U.S. Department of Labor, n.d.), along with severance, outplacement support and first consideration for open positions in the system. Culture work begins with joint councils for nursing practice and patient experience, co-chaired by one leader from each hospital.

Months 13 to 24. Performance review, pay and benefits are harmonized. The system adopts, rather than overrides, Linden practices that serve families well, such as its family advisory council and child life program.

Employee Transition Plan: Measures

Progress will be tracked monthly and reported to both boards: voluntary turnover among Linden clinical staff (target at or below 14%), vacancy rates for pediatric intensive care nurses, the number of retention agreements accepted, employee engagement survey results at 6 and 18 months compared with baseline, and the number of questions answered within the five-day commitment. Organizational change research emphasizes that people go through a transition, a period of loss and uncertainty, even when the change itself is well designed, and that leaders who acknowledge losses and communicate often help staff move through it (Bridges & Bridges, 2016). These measures show whether that is happening.

EHR Integration Strategy: Options

Northgate uses the system's enterprise EHR. Linden uses a different vendor's EHR with years of pediatric-specific configuration: weight-based dosing, growth charts, immunization forecasting and pediatric early warning scores. Three options were considered. The first is to keep both systems and connect them through the regional health information exchange and interfaces. This is the fastest and least disruptive option, but clinicians would still work in two records, and adolescents moving to adult care would have split histories. The second is to move Linden onto the system's EHR, with a pediatric build designed by Linden clinicians. This gives one record for every patient and lower long-term cost, but it is expensive, demanding and carries safety risks during the transition. The third is to move both hospitals to a new EHR, which would cost the most and disrupt the most for little added benefit.

The recommendation is the second option, carried out over 20 months, with the first option serving as a bridge. A review of EHR-to-EHR transitions found that they are expensive, labor intensive and time consuming, and identified risks including limited access to legacy records, data integrity problems during migration, cybersecurity gaps, workflow changes and insufficient training, all of which can contribute to clinician burnout (Huang et al., 2020). The strategy below is built around those risks.

EHR Integration Strategy: Steps

Governance (months 1 to 3). An EHR integration steering committee is formed, co-chaired by the system's chief medical information officer and Linden's chief of pediatrics, with nursing, pharmacy, HIM, privacy and information security members. A pediatric content committee of Linden physicians, nurses and pharmacists has authority over all pediatric clinical content in the new build.

Interim connection (months 1 to 6). Both hospitals connect to the health information exchange, and Northgate clinicians receive read-only access to Linden records for shared patients, so adolescents and emergency transfers have their history available immediately.

Build and data migration (months 4 to 16). The pediatric build is configured and tested against Linden's existing dosing rules. HIM and informatics decide which data will be converted as structured data, including allergies, active medications, problem lists, immunizations and growth measurements, and which will be kept in a read-only legacy archive. Because pediatric records must be retained for longer than adult records under state law, typically until years after the patient reaches adulthood, the archive must remain accessible for decades. Every converted record is validated by sampling before go-live.

Training and go-live (months 16 to 20). Every Linden user completes role-based training and a proficiency check. Go-live is supported by trained staff on every unit around the clock for two weeks, with downtime procedures and a daily safety huddle to review issues. Medication orders for patients under a set weight receive pharmacist double-checks for the first 30 days.

Regulatory and Ethical Safeguards

Privacy and security run through the strategy. The system completes a new security risk analysis before connecting networks, applies role-based access so that staff see only the records their work requires, reviews access logs for inappropriate viewing of children's and employees' records and requires business associate agreements with any vendor handling data during migration. Families are notified of changes to the patient portal and proxy access for parents, since adolescent confidentiality rules limit what parents can see for some services.

Ethically, patient safety comes before schedule: the steering committee has authority to delay go-live if testing shows unresolved safety issues. Employees are told the truth about which roles will change and when. And the pediatric content committee's authority reflects a commitment made in the merger: that Linden's clinicians, not the system, decide how children are cared for.

Success will be measured by medication safety events per 1,000 doses before and after go-live, the proportion of converted records passing validation, user satisfaction at 90 days and the time to full retirement of the old system. Reports go to both boards each quarter until the integration is complete.

References

Bridges, W., & Bridges, S. (2016). Managing transitions: Making the most of change (4th ed.). Da Capo Lifelong Books.

Huang, C., Koppel, R., McGreevey, J. D., Craven, C. K., & Schreiber, R. (2020). Transitions from one electronic health record to another: Challenges, pitfalls, and recommendations. Applied Clinical Informatics, 11(5), 742-754. https://doi.org/10.1055/s-0040-1718535

U.S. Department of Labor. (n.d.). Plant closings and layoffs. https://www.dol.gov/general/topic/termination/plantclosings