A year and a half ago UMass Memorial Health Care Associate CIO Karen Marhefka and her team embarked on what was dubbed the Cornerstone Project, a six-year, $100 million program to create interoperability among seven different IT systems: the organization’s ambulatory electronic medical record (EMR) from the Chicago-based Allscripts; its inpatient EMR, the Soarian system from Siemens Healthcare (Malvern, Pa.); its perioperative system, Picis (Wakefield, Mass.); its enterprise master person index (EMPI) and information exchange solution, from the Chicago-based Initiate Systems (now a part of IBM, Armonk, N.Y.); its clinical portal, from dbMotion (Pittsburgh, Pa.); its health information record management system, from Hyland (Westlake, Ohio); and a yet-to-be-determined emergency department system. Marhefka recently explained to Healthcare Informatics ’ Associate Editor Jennifer Prestigiacomo why Worcester, Mass.-based UMass, a system of five hospitals and more than 800 physicians, decided to build their own Frankenstein IT system.
Healthcare Informatics: Can you give me some background on the Cornerstone Project?
Karen Marhefka: UMass Memorial Health Care Center started three years ago by hiring our Senior Vice President and CIO George Brenckle to come in and bring in our patient information platform into the 20th century. We had been a Meditech shop for everything within the hospitals for 20 years and didn’t have a lot of capital money to upgrade those IT platforms. George started the process by researching the vendors out there and primarily focusing on our main HIS (Health Information System). Through a pretty exhaustive process, the team came to the conclusion that Siemens Soarian was going to be our main HIS for all the hospitals within our system. We came to the realization that this was going to be great for our acute care business and revenue cycle, but it really didn’t answer the specifics for what we need on an outpatient side. Our ambulatory HIS with Allscripts was already in implementation. As time went on, our IT and clinical leadership made a decision to pull in some other things that had been in the request bucket, but also bring in some talent that is going to help us pull all this stuff together, and that was how Cornerstone was born. He brought on-board myself and my colleagues Richard Cramer and Robin Sodano to glue all this stuff together. Essentially, Cornerstone is seven IT projects. The fact that it involves seven different vendors has everybody nervous, as that means a lot of interfacing and integration. We were very careful with choosing vendors that don’t have hard edges on their “picture frames,” but puzzle pieces. So they’re very good at interoperating with other vendors, hence the name Cornerstone. It’s really caught on and folks are loving the fact that they don’t have to remember seven different vendor names and don’t have to worry about how they’re all going to connect up so that it appears to be one system platform.
HCI: What was the strategy when choosing all these different vendors?
Marhefka: It was definitely about ease of implementation. They had to have a really good track record with implementation. The best product out there for what they represent, and certainly cost was a factor, too. Plenty vendors out there like the Epics and the Eclipsyses will tell you they can give you everything in one package, but you lose the best of an ambulatory system that way; you lose the best of an acute care system that way. And we’re definitely not feeling that using one legacy system is safer and easier and more cost effective. We feel like there are too many tools, too many smart people within our organization to work with the best of these separate systems.
HCI: When are you due to finish Cornerstone?
Marhefka: The whole thing is projected to be completed in four years. We’ve been in full implementation process for a year and a half. We’re at different stages with each of our vendors. So, we’ve actually been rolling out Allscripts for the last three and a half years. And what we’ll be doing with Allscripts in the next three to four years is adding all that cool functionality that makes it more robust. It’s a very difficult culture to bring over 900 physicians on to something. Everybody has the basics, but now we’re coming back around and putting in some of the headier functionality. Our entire revenue cycle will be transferred from Meditech to Soarian and will be going live next summer 2011. Most of our advanced clinical on the acute care side with Soarian won’t be completed till 2013.
HCI: How is the work you’re doing right now fitting into any plans for meeting meaningful use requirements under the ARRA/HITECH Act?
Marhefka: My job is dependent on making sure we get specific things done in specific timeframes in order to meet meaningful use. It’s very important. We have seven acute care sites and four of those sites are community sites we own. One is pretty far down on the implementation route. We actually as an entire system won’t be saying a year from now we’re meeting all our meaningful use requirements, but we’ll have parts of our system that can say that. So not only are we keeping our eye on the ball as a complete integrated system, we’re also doing it for each of our hospitals.
HCI: How are you synching up your system of hospitals that all have different IT systems?
Marhefka: Two of our member hospitals immediately came on-board to our Meditech platform and two of our hospitals maintained their autonomy for quite some time. One of our member hospitals HealthAlliance went ahead with their Siemens implementation and completed both financials and clinical successfully a year and a half ago. Once we’re finished at UMass Memorial Medical Center and two of our member hospitals, then HealthAlliance will come on our Soarian platform. The fourth member hospital, they are on Meditech as well, but they are on a completely different version of Meditech than UMass was, so we’re keeping them on that and will bring them on to Soarian platform at the very end.
HCI: Is UMass Memorial Health Care currently sharing information in an HIE or will your Initiate IS system be a springboard for that?
Marhefka: [Initiate is] definitely a springboard for it. We're working with Initiate to develop what we’re calling our community enterprise master person index as a start to an HIE. When we started to think about how UMass could be a player in the HIEs, we actually put ourselves in that community circle and thought that if we put all the pieces in place and made it easy that we’d have a lot of colleagues outside of our organization that would jump in. Well the feedback we got was, ‘I don’t want you having any more control over me than you already do’—which may be none. ‘I want to maintain my autonomy from you, and I essentially want to decide when I opt in and out.’ So instead we worked with our vendors to come up and put together the community enterprise master person index, which Initiate is the caretaker of. UMass is the first spoke to that inner circle, and we’re hoping that other organizations become additional spokes. There’s a fee for doing that, and a couple of options depending on what you want to exchange. It’s garnering a lot of interest and we feel it’s the right start.
HCI: What education are you planning for your doctors to adopt all these new technologies?
Marhefka: We have a very robust internal training department, and at the same time we have unbelievably talented physicians. There are six or seven of them that have been tremendous champions of the Allscripts implementation, and they are at our beck and call for the training department and the implementation team. We couldn’t have done it if we didn’t have these physicians. The challenge is to find the same ‘football team’ for the acute care side, and they will bubble up as they did on the outpatient side.
HCI: What capital outlay did Cornerstone necessitate?
Marhefka: The capital outlay for the five years is $60 million. If you add into that the increased operational expenditures with all this change, we’ve estimated it to be a little under $100 million over a six-year time frame that we feel it’s really going to take to be completely finished. But we’re never going to be completely finished.
HCI: How is UMass Memorial Health Care funding Cornerstone?
Marhefka: The system determined two years ago that they had to invest in these IT initiatives. We hadn’t made any changes to our IT platform in a long time. We had MacGyver’ed our IT platform about as much as we possibly could for 15 years. It actually served us pretty well since we didn’t invest in a lot of applications and software that were coming down the pike that were new like CPOE and all that. Now that technology has evolved to be much more, and everyone is having to spend that money again, where we didn’t. We've been using something that was quite antiquated. We were at a position where our organization said ‘Ok it’s time, and we’re not going to do this piecemeal. We’re going to focus on making it right, keeping the patient at the center.’ And that means it’s going to take a big chunk of money, so capital was apportioned and their sticking to it. Thank goodness!