Health system’s Epic, Infor best-in-suite approach helps fix interoperability challenges
Earlier this decade, Faith Regional Health Services, a health system based in Norfolk, Nebraska, was using a number of different applications in its health IT setup.
On the inpatient side, Faith Regional was using the Soarian electronic health record first developed by Siemens with a different system in its emergency department called ePowerDoc. In its clinics, it was using a NextGen EHR. On the financial side, meanwhile, the health system was using Cerner’s MedSeries 4 as well as Kronos for HR and payroll.
“Our clinicians weren’t necessarily happy with the EHR platforms that we were using,” said Brian Sterud, chief information officer at Faith Regional Health Services. “However, we were under contract for some time. We looked at implementing the Soarian Financials package a few years back to replace Med Series 4 as it was an antiquated product with little support and a diminishing user base.”
But in 2014 it was announced that Cerner was acquiring Siemens’ health IT business, which included Soarian. While Cerner had committed to a number of years where it would continue to develop the product, Faith Regional Health Services felt it was the right time to evaluate a change.
"As many others have learned, there are changes to workflows that must be learned to optimize the system and ensure that it is used properly to care for patients."
Brian Sterud, Faith Regional Health Services
“This acquisition prompted us to take a look at a suite that would cover our continuum of care,” Sterud explained. “We evaluated the major EHR vendors and selected the Epic product. Leaving Cerner on the clinical side also prompted us to evaluate our financial systems as well. The Med Series 4 product was unique, in that it served as our revenue cycle product as well as our financial package for AP/GL/supply chain, among other features.”
Faith Regional Health Services evaluated and ultimately selected the Infor suite of products that would provide these features as well as a breadth of human resources and payroll functions, he said. This allowed the health system to migrate away from Med Series 4 as well as Kronos, he added.
“These legacy systems did not allow for an elegant solution for our patients,” Sterud said. “The patient portal was a bit disjointed and not necessarily user friendly. We were not able to view detailed bills online and initiate payment. The disparate systems also created multiple bills for our patients. On the financial side, we were lacking many of the modern reporting and analytics capabilities. Many processes for our financial teams were based on manual processes and spreadsheets.”
The Epic and Infor systems, which went live this fall, brought a few solutions to bear for Faith Regional Health Services.
“The Epic solution offered us the ability to have a single EHR and patient database for the entire continuum of care,” Sterud explained. “This results in fewer bills for patients, fewer registrations and a best-in-class patient portal and smartphone app. Epic also offered the ability to better interact with our most common referral patterns and resulted in better patient care due to the ability for all caregivers to share and interact with the patient record.”
Infor enabled the health system to modernize many aspects of its operations, including advanced reporting and analytics capabilities.
“The supply chain functionality brought us forward decades compared to our legacy solution,” Sterud remarked. “Specific enhancements would be inventory management and bar coding solutions that allow for just-in-time inventory and advanced analytics. On the finance side, we are able to move our accounts payables process to an electronic approval as well as electronic approvals for purchase orders.”
In terms of workforce management, the health system’s departments were excited about the advanced scheduling features like shift trades, self-scheduling and other features, he added.
There are many electronic health records systems in the health IT marketplace today. Some of the vendors of these EHRs include Allscripts, athenahealth, Cerner, eClinicalWorks, Epic, Greenway Health, HCS, Meditech, Netsmart and NextGen Healthcare.
MEETING THE CHALLENGE
Faith Regional Health Services clinicians have adapted to the Epic system much more quickly than anticipated.
“As many others have learned, there are changes to workflows that must be learned to optimize the system and ensure that it is used properly to care for patients,” Sterud commented. “We had a robust training program and good feedback throughout our testing processes. We had great support from our partners and contracted with top notch, ‘at the elbow’ support.”
IT staff worked hard on all of the interfaces and integrations with other information systems. While their solution was a best-of-suite approach, there still were other systems that were impacted downstream.
“One example is integration with radiology systems,” Sterud said. “We use INFINITT for our PACS and significant testing was necessary to make sure that all images and results flow properly throughout the workflow. Another example is the integration with our Philips monitoring systems for vital signs monitoring.”
Sterud said that throughout the transition from legacy systems to the overarching Epic and Infor systems, staff learned a couple of lessons, including the importance of training and the importance of workflows.
“These go hand in hand as they work together to provide a successful solution,” he stated. “In Epic, like many solutions, you need to follow the correct processes or the software doesn’t work in the way it was intended. This goes hand in hand with training. It is critically important to make sure your users are trained properly so they follow the correct workflows within the software. Deviations from the proper way to follow a workflow create many negative outcomes.”
Faith Regional Health Services created a workgroup that met daily to track where the health system was having issues with workflows. This effort was spearheaded by Connie Rupp, the chief nursing officer.
“This is a slight, but very important, distinction from reported ‘problems,’“ he said. “Our leaders recognized there were instances where we were not getting the intended results. However, they realized this was due to our teams not following the proper workflows rather than the system being ‘broken.’ This accountability allowed us to quickly acknowledge where we needed to make changes and control our own destiny, rather than pointing a finger at a system misconfiguration.”
This also built credibility with the vendor – its staff understood when the health system reported an issue that it had most likely done its homework and validated it was an actual issue, he added.
ADVICE FOR OTHERS
“I’m a huge proponent of bundling services to allow for better integration and to reduce the overall administrative overhead,” Sterud advised. “I believe that the integration outweighs many possible disadvantages. For example, if you selected the best possible module for each intended function, then you would have the best of breed.”
However, the ability for the systems to properly integrate is difficult, he contended.
“Even if possible, there is a considerable amount of effort needed to make this type of integration occur,” he explained. “Thus, while a best-of-suite may have modules that are not the top-rated for that function, the overall suite provides better results due to the integration and the ability for the modules to interact and share data efficiently.”