Hospital mergers, or as they're often called today, integrations, have long been a part of the healthcare landscape. But as IT systems become more firmly entrenched in hospital clinical and business operations, these mergers pose a whole new set of challenges.
In February 2007, when Riddle Memorial Hospital, a 235-bed stand-alone community hospital in Media, Pa., joined Main Line Health System, Riddle's IS department was already up and running on Kansas City, Mo.-based Cerner for lab, radiology and clinical systems. Main Line, a four-hospital, non-profit health system based in Bryn Mawr, Pa., and 20 miles away from Riddle, was implementing Siemens (Malvern, Pa.) Soarian and had been using Redwood Shores, Calif.-based Oracle's PeopleSoft for many operational functions. With the goal of using the new partnership to make operational performance and business process improvements, thoughtful consideration was needed to evaluate which direction to go, IT-wise.
The hospitals wisely decided not to go it alone. “We were brought in in June 2007 to help identify and organize the goals and actions to deliver the integration in the first year,” says Jacob Kretzing, a senior partner at Greencastle Consulting (Frazier, Pa.)
Karen Thomas, CIO of Main Line, says that with two hospitals' worth of IT opportunities, there were myriad possibilities available. “One of the best practices, and what Main Line and Riddle have done, is prioritized the most important business initiatives and where we start, rather than spending our time doing a lot of one-offs.”
Greencastle immediately established a Program Integration Office to be a single point of coordination and integration for process improvement, project management, and organizational change adoption across the board.
The program integration office proved to be invaluable to the IT departments. “Having Riddle and Main Line prioritize what's most important lines up what the IT staff needs to take on,” says Thomas. Greencastle supports oversight for the integration. “It's coaching and guiding, and being the team leads,” says Kretzing. Each integrated team has counterparts from both Riddle and Main Line.
Dennis Tucker, director of IS at Riddle, says that Greencastle helped organize the integration and keep tabs on the process so it continues to move forward logically. “What we've seen to date has been a rational and realistic approach to assessing and evaluating the opportunities available to us,” he says. All agreed that understanding the value of assets already deployed, and the benefit of retaining the value of those assets wherever possible, was key. And one big asset to consider was the clinical information systems.
CIS don't come cheap, and both Riddle and Main Line were each already invested. For now, the two CIS will co-exist. “We have made a conscious decision to stay on our individual CIS for the short term,” says Thomas. “We have each invested heavily in our solutions and we need to get the value out of our respective commitments.”
Tucker echoes that sentiment. “Both Karen and I will continue to deploy what we had planned to deploy. Our Cerner went live in May 2005 and Mainline has worked very hard implementing Soarian. There's a lot of sweat equity and a lot of dollars invested.”
Thomas says that the current thought is to look at other integration opportunities in the non-clinical arena. And that integration opportunity is PeopleSoft (Oracle, Redwood Shores, Calif.)
The hospital teams had taken inventory of all the applications in both places, and according to Tucker, there were some similarities but a lot of differences. “We had to take a step back and look at what systems were going to provide the most value right out of the gate,” he says. “What came to the surface pretty quickly was PeopleSoft.”
Main Line was already using PeopleSoft for elements of finance, human resources and materials management. “We've been on PeopleSoft since 1999 and it's been a successful support tool. Riddle, at this point in time, does not have a robust HR system,” says Thomas, “so this shared services integration using PeopleSoft is seen as providing a lot of benefits.”
Riddle's general accounting, AP, payroll, HR and materials management were part of an older San Francisco-based McKesson series solution. “PeopleSoft is something that would have been typically out of our price range,” says Tucker. “Mainline already has the licenses, so we decided it makes perfect sense to climb on the infrastructure already set up at Main Line and transition all of our general accounting functions to PeopleSoft.”
The hospitals also plan to bring in an integration partner with PeopleSoft experience. “We're going to need to develop a crosswalk from our existing accounts for things like cost centers so they reflect the same terminology and numbering scheme as the Main Line accounts,” Tucker says.
Once the planning began for the PeopleSoft integration, more opportunities came to light. “Interestingly, from an IT perspective, when you look at the integration of Riddle into the PeopleSoft platform, there are a lot of other systems that come into play,” Thomas says.
Riddle and Main Line are both Kronos (Chelmsford, Mass.) time capture system users and Thomas says going to the same Kronos platform would enable PeopleSoft to be fed by a single system. “That's an important feeder system,” says Thomas. “One of our first steps will be to bring them together on a single platform and consolidate and integrate how we do staff scheduling and time capture so they can feed the same HR and payroll systems.”
And while the PeopleSoft integration forges ahead, other integration opportunities are underway — specifically the lab, when Main Line health laboratory begins processing samples from Riddle.
Riddle uses Cerner lab, while Main Line has Tuscon, Ariz.-based Sunquest. Thomas says Riddle will collect lab specimens that will be run initially through Riddle to get labels, then most of the tests will go over to the Main Line Sunquest system, with seamless integration being the goal. “We're writing an interface that will return the results back to our Cerner system,” says Tucker. “It's going to be retrieved just the way they do it now.” He says the goal is to try and make these business changes as transparent as possible to the clinical staff.
Tucker says that first test will come in July when Riddle begins moving some of the lab tests over to Main Line. “If we do it without some of the physicians recognizing that it's been done, then that's a big win for us.”
Linking Riddle to the Main Line network with a high speed connection has already been accomplished — 20 miles of dark fiber now runs between Riddle and Main Line's data center. Riddle can now communicate with the rest of the Main Line campus. “As we bring Riddle onto PeopleSoft, it will be a centralized database,” says Thomas.
That same high speed link will enable another project coming down the pike — use of the same e-mail platform. Riddle had been using IBM's Lotus Notes (Armonk, N.Y.), and Main Line's e-mail system was Redmond, Wash.-based Microsoft. “That's another area of consolidation,” says Thomas, noting that Riddle is looking forward to going onto Microsoft.
Kretzing says there's another important part of the consolidation — cultural differences. “From a culture perspective, probably the biggest thing is you're going from a community-based, independent hospital into a prominent health system. The way they operate is completely different.” He says the cultural differences are part of the change management process in bringing the two teams together. “We're not trying to shift Riddle to do exactly what Main Line is doing; we're comparing the differences, figuring out are there best practices that we can share or learn, and then coming up with a plan that makes sense for both organizations.”
Thomas is looking forward to the months ahead. “It's an exciting opportunity for Main Line and Riddle, and what I'm excited about is that we have our priorities aligned so we can focus in on the systems integration.”