A growing number of hospitals are now beginning their second cycle of EMR implementations. But migrating from one vendor to another can be daunting. Healthcare Informatics editor Daphne Lawrence recently talked with Jonathan Thompson, a vice president at Minneapolis-based Healthia Consulting, about his experience with migrations, and his recommendations for an easier transition.
DL: Is switching enterprise systems something you’re seeing more of these days?
JT: There are several folks moving from a legacy enterprise to a brand new EMR--they put the last screw in one implementation and statt another. It’s happening with different vendors.
DL: So when you’re migrating from one enterprise system to another, how far out should you start your planning?
JT: The question every CIO should ask themselves first is, “What’s driving the decision?” Because that defines where you start. Why has the decision been made and what’s the benefit realization? What are the real issues behind it? Is it around, clinical, financial or organizational goals? Reaching out to community docs? I think functionality is a key driver — certainly from a clinical standpoint.
In particular, integrated EMRs have different benefits. If it’s a clinical or financial or organizational goal to expand into the community, you really have to define what’s your key driver. Some we’re working for right now have the community physician at the top of the list because of the relaxation of the Stark laws. So that’s really driving them to adjust their strategy in this area.
DL: So where do you start?
JT: If you’re a hospital concerned about keeping market share in the community and getting referrals by physician groups, that’s going to drive where you start and what your key priorities are. So you will start with your affiliated ambulatory strategy.
DL: How do you achieve lift-off?
JT: Key foundational items you have to have in place are high level planning around your timeline and scope. The high level planning is the high-level IT organization and the new vendor of choice and some of the current vendor. All three are stakeholders in the transition. The CIO ultimately has accountability for it, but certainly in that IT organization, there will be an IT project director who has accountability for it. With the legacy discussion in that planning, there is ownership from the legacy application standpoint and the new vendor. All three have accountability in that planning discussion. You can’t implement the new without understanding where we’re at with the old.
Ultimately the plan needs to be owned and driven by the CIO and the IT organization, with involvement from the operational stakeholders as well. The vendors are advisors and partners in the migration. There is opportunity to leverage third party knowledge (consultants) that have knowledge of both systems. But the ownership really resides within the hospital.
DL: What needs to be on the table early in the game?
JT: There are key issues that need to be discussed early on in the process and one of those is change management. That’s one topic that’s bubbled up in every migration I’ve done, and that’s “how do you get the IT organization and also the operational folks, physician groups and revenue cycle people, bought in and up to speed on why are we doing this and how are we doing this?” Get the communication messages consistent and relevant to the point of project from the very start throughout the lifecycle of it.
Another key topic is the structure. You need to align the organization differently when you’re doing a migration. The organization needs to take into consideration the support of legacy applications and the implementation of the new applications. There’s a significant need to keep the engine running on the current train and keep this parallel track running. At some point the engineers hop over to the new train and you’re on a different path. But you’ve got to keep the old running.
DL: And how long is that?
JT: It depends on your project approach and timeline and structure. One system we’re working with is focused on one-year increments. So one year on revenue cycle, one year focused on clinical apps, and another year or maybe less on ancillaries and some of the specialties. That seems to be a typical timeframe. I think organizations are typically doing this in a three-year timeframe. It’s an incremental cutover. During that year you’re running dual systems. You run it out and you’re fully converted and you start with the next component, and by the end of that year you’re converted. It’s a very delicate balance because you’ve got feet in both worlds, and when you’re talking about clinical applications and process, there’s a lot at stake.