What should a hospital CIO do when it merges with a significantly bigger healthcare organization? Which issue presents the most difficult challenges? Every CIO has a unique war story. Galen Healthcare Solutions, an IT technical and professional services and solutions company, interviewed several CIOs to discuss their experiences. Here are excerpts from a few of those conversations:
Tim Schoener, VP/CIO of the former Susquehanna Health (now part of the University of Pittsburgh Medical Center)
Schoener is in the mist of a merger with a major Pennsylvania healthcare organization. When I interviewed him, he outlined his organization’s plan for each aspect of the transition. In addition, Schoener provided cogent insights regarding the intricacies involved with a multi-database system, the expenses associated with archival solutions, and the challenges associated with migrating records. These are some of his key insights:
We are currently a Cerner Soarian customer. UPMC’s enterprise model is Cerner and Epic, Cerner on the acute care side and Epic on the ambulatory side. We decided to migrate to the UPMC blended model. Over the past nine months we’ve been focused on an EMR governance process, trying to get our team aligned. We have a lot of interfaces, a lot of integration between the two core systems such as context sharing. Physicians can contextually launch and interoperate from NextGen to Soarian, and vice-versa. We pass some data back and forth—allergies and meds can be shared through a reconciliation process, for example. But we certainly aren’t integrated. That’s why we want to move to a single platform, a single database.
To do so, we must gather feedback from different specialties and departments. I do not want surprises. I want physicians to be prepared, to know what’s going to be available. We have already vetted that out with our primary care docs. Now we’re going to take that to our cardiologists and ask them what they think. Then on to our urologists to allow them to weigh in. Our intent is to take it to each physician specialty to establish a good comfort level, so when the transition occurs, I don’t have physicians’ saying to me ‘no one ever asked me…’ or not being able to provide excellent patient care. It’s going to be critical to the success of our EMR transition to keep our physicians engaged and involved.
Jeff Weil, Chief Information Officer, District Medical Group of Arizona
Weil and his team are immersed in numerous projects, from an integration engine implementation to clinical, business and infrastructure upgrades, as well as the implementation of workflow optimization technologies. Weil talked about population health initiatives and how Technology Leadership approaches have changed; the inexpensive side of data storage; interoperating between different practices with different systems; and how in some cases it is working with records that are literally still in boxes. These are excerpts:
Usually we start from scratch in determining the technology requirements for each one of our partnerships. There will be requirements for clinical documentation as well as practice management. For instance, we do the bulk of the professional billing for the physicians that are at the Maricopa Integrated Health System here in the Phoenix area. As such, when there’s an encounter that happens over there, Maricopa does the facility billing and we (District Medical Group of Arizona) do the professional billing for that physician’s charge. We have an interface with them and their Epic system. All of the clinical work they perform is in MIHS’ Epic system. In terms of own internal systems, for our clinics, we have GE Centricity EMR as well as GE Centricity Business for our practice management system.
With the behavioral health provider partner here in town, we have to bring in the billing information from a different EMR and practice management system into ours, so we always have to get creative in working on integration strategies. Moving into this next fiscal year, we’re investing in our own integration engine, as well as bringing on staff to support that initiative. If you think about it—and I’ll just throw out the normal budgeting number—but every single time we do an interface it may cost $15,000 and take 90 days to develop. Eventually the ROI is going to turn in our favor if we’ve got staff in house to design and develop interfaces on our own.
R. Hal Baker, MD, Senior Vice President, Clinical Improvement and Chief Information Officer, WellSpan Health, York, Pennsylvania
Baker is a CIO and a practicing physician whose organization is finalizing its Epic transition plans. He is particularly focused on having an integrated patient record across the system and creating new workflows to accommodate the 5 hospitals and over 100 practice locations that are all coming together. In our interview, Baker discussed his organization’s community-focused, health data retention practice, his plans for legacy application support, and the value of attention units in the healthcare industry. These are some of his observations:
At first, it was hard to appreciate the value of an integrated medical record, when you had disintegrated paper records at each office. We very quickly started to see the value of an integrated patient record across offices, which highlighted the disconnect that occurs between the two separate records in an inpatient and outpatient setting. As we had other communities join WellSpan we recognized the need to consolidate around a corporate-wide solution. It didn’t make sense to further propagate our non-integrated solution—a different billing system vendor, and a different EHR vendor on the inpatient and outpatient side.
There are three buckets to my mind: there’s the data you need to import into the database; there’s perhaps a subset of that, which is data that you don’t want to import in bulk, but you want the ability to import selectively as needed later on; then there’s the data that you need to have access to for when you need it. For example, I need to go back and look at the past reports from 15 years ago, but I don’t necessarily need to move every pathology report from 15 years ago into the record— rather I need to have access to it from our archive system. Then there’s the metadata that you either may need for population health or business purposes in the future that you haven’t recognized you need. This could be due to requirements from a legal medical auditing perspective or for quality or for billing purpose under statute of limitations for regulations.
Thank you to Galen Healthcare Solutions for sharing these important interviews with today’s thought leaders in our industry. We will be highlighting them throughout the summer, stay tuned. Read our series.