Playing it safe doesn't seem to be the most important concern for Hackensack University Medical Center's CIO Lex Ferrauiola and CTO Ben Bordonaro. If that was the case, they'd almost certainly leave their current IT infrastructure alone, and leave Siemens and GE in place. But the duo has other plans — turning HUMC from a medical center held together with interfaces to a truly integrated organization, promoting data transfer across the continuum of care, from inpatient services to ambulatory physician practices. To make that dream a reality, the organization has settled on Epic. And while its vendor of choice comes with a high price tag, Ferrauiola and Bordonaro say you get what you pay for.
AG: Give me an idea of your IT environment. What are your core clinicals?
LF: Well, actually we're mixed. We've been on GE's LastWord. It's now being sunset. GE's trying to get everybody to move to the Centricity product. But that's really our clinical information system. We've been on it since 2000 for nursing documentation and CPOE and pharmacy and so forth. We've been on SMS or Siemens Invision since 1990 to do all out patient accounting.
We had the vision about seven or eight years ago that we really wanted to move to integration, which included not just the hospital facility, but also the community physicians. We really wanted to do a model that would be able to host practice management, and EMRs for the community physicians as much as we could within the constraints of the law.
We were going to go in one direction but we had to change paths. We are very close to finalizing a contract with Epic. The plan is to go full-force with Epic for everything — the inpatient, the outpatient, and hosting community physicians to give them the service to ambulatory and EMR practice management. That's pretty much what our plan is.
We have a certain degree of integration now between SMS and GE, and some of the environmental systems, but we really want to have full integration.
AG: So just to be clear, the Epic implementation would be a replacement of Siemens' products?
LF: It would be a replacement of GE, which is our clinical system now, and it would also be a replacement of Siemens for the patient accounting system. Basically, it would be a replacement for different vendor systems for different applications. For radiology, we have GE. For the ER, we have LogiCare. All that would be part of the Epic system.
AG: The two main systems that you would be replacing would be Siemens and GE, plus a lot of ancillary systems, so you're going to be an Epic shop.
LF: Yes, that's the vision. It will happen in phases; it won't happen in one big bang. We have to do the inpatient clinicals first because that product is being sunset by GE.
AG: Can you tell me a little bit about what that takes to move from one large vendor to another?
LF: You have to have a clear vision of what it is you want, what the end is going to look like. In our case, it's full integration so that the community physician will have access to the same information that the patient has access to from their home. It would really be a foundation of one patient, with one record that's accessible all the way around. First of all, it takes a lot of money to move in that direction. When you make a decision that the platform you're currently on is either going away or needs to go away, you have to do the assessment.
One of the vehicles that was valuable to us was the KLAS report. We looked at the KLAS report heavily. You're very familiar with it, the marks that Epic received are much higher than anybody else. That was helpful. But we really needed to have a collaborative, interdisciplinary team from the medical center, with heavy physician chairs on it, nursing people, operational people to look at different products and different systems and conduct site visits. Then there's the support, and for the money, Epic is very, very expensive.
AG: So you had to make a case to the board?
LF: Sure, of course. It wasn't necessary to make a case that we need to move in a direction that will be fully integrated, because people are aware of that. They know the product base in healthcare has evolved over the last 10 years. But most of the clinical systems that are out there are second-generation systems, like the GE system, the Siemens' system, and the vendors are moving towards products that have integration. For instance, Siemens is moving towards Soarian, Epic has that integration already. Eclipsys is buying a lot of companies and creating a sort of pseudo–integration. They're trying to put those systems that they're acquiring around a central database, but they're still separate systems, but it is a form of pseudo-integration.
Even our board members understand that the future is integration and the present situation is that most systems are not integrated. Healthcare has a very heavy dependence on interface engines and interface technology. Interfaces are resource consuming. They're error prone and that's not the real world anymore. The technology has moved on.
AG: There's a fundamental decision many make between best of breed, accepting interfaces, versus an enterprise solution. Oftentimes it's thought that if you go enterprise, you suffer in terms of functionality on some of the ancillaries. Obviously you've gone the enterprise approach. Have you had to fight battles with some clinicians that are focused on getting exactly what they want for their specialty?
LF: Let me give you an example. We have the chairman of our ER who is very progressive, very technology oriented. He's very, very strong on getting an ER system that would do everything for you. He looked at a couple of vendors. He looked at MedHost, he was very, very impressed with them. But he sees that there are issues. If you have a system that is interfaced, there are problems in the ER. How do the ER physicians enter orders? How is their integration with pharmacy? If you don't have that, you have to rely on interfaces, and it's difficult.
He was willing to really look at the enterprise solution. And he went on site visits, and he saw that the Epic ER system would really meet the needs that he had. It might not have all the bells and whistles that he saw with MedHost, but it was adequate and the value he would get from that integration outweighed any of the extraneous bells and whistles that might have attracted him in the other direction.
BB: I think that's the ultimate battle. When you're looking at strategy, do you go best of breed or do you go integration. And there are definitely pros and cons to either one of them. If there was a perfect solution, then you would look across 1,000 hospitals across the country and they would all be doing it. But nobody's doing it only one way or the other. It's really a tossup. I think sometimes that comes down to what you're applying it to.
You were talking (before the interview) about the differences in need between a 150-200 bed community versus an eight hospital system. We're kind of somewhere in the middle, but we're a full acute-care hospital. We've almost come full circle, in that we were a somewhat integrated, best-of-breed system. Then you realize the shortcomings of that, because we have all these ancillary services. So, if you're a massive facility, but you're into cancer care, it might be a little bit easier to get best of breed because you're getting best of breed for cancer care. You're not going to be adding a Level II trauma center. You're not going to be adding all the other diagnostic, the lab outreach program or a commercial lab. So when you start adding all those other ones, I think we saw over time that we were going with the biggest, the baddest, and the best of everything in a single system, but the integration was really hurting us. And people would have to go into multiple systems for multiple things.
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