12 Feb CIO Leadership: Lundal focused on Epic implementation
Madison, Wis. – For Dave Lundal, vice president and regional CIO of SSM Health Care of Wisconsin, Epic Systems’ electronic medical records implementation at St. Mary’s Hospital is not a simple matter of “what’s in it for me?”
Given the structure of SSM, Lundal cannot afford to take a “my-way-or-the-highway” approach. The Epic project is a combination of strategy and relationship management because the implementation is not taking place under one ownership umbrella, so even if Lundal wanted to proceed as an exalted ruler, which is not his style, he would still have to focus on making good business cases and coordinating details with various SSM players.
SSM Health Care of Wisconsin is comprised of St. Mary’s Hospital in Madison and St. Clare Hospital and Health Services in Baraboo. Both hospitals are part of SSM Health Care, which has 20 hospitals and is one of the largest Catholic healthcare systems in the nation.
As part of SSM’s Project Beacon, St. Mary’s already has implemented the GE Centricity Picture Archiving and Communication System, and in May it will be the first SSM facility in Wisconsin to go live with the Epic EMR. Epic has been designed for a significant level of collaboration across all SSM hospitals, so Lundal doesn’t have the luxury, or the burden, of being a bull in a China shop.
“Our system has had a decision-making process where stakeholders have come together to decide on how it needs to be designed to work across all the hospitals,” he said. “Sometimes that has implications on how you would do something in a particular hospital that has to be agreed upon, whereas in a paper world those hospitals can exist pretty independently.”
Further complicating Lundal’s EMR decision-making is the fact that this interdependence is not a sole function of SSM. St. Mary’s and St. Clare also are part of an integrated delivery network in Wisconsin that includes their major partner, Dean Health System. The facilities are in the process of implementing Epic on a database on which Dean is almost completely live for its physicians, so “we have our integrated delivery network collaboration too,” Lundal said.
Integration collaboration
Along with Jerry Roberts, vice president of information services for Dean, Lundal co-leads the Wisconsin Integrated Technology and Telemedicine Systems (WITTS), a joint venture between Dean Health System and SSM Health Care of Wisconsin. Its purpose is to implement advanced clinical systems like Epic in the Dean-SSMW integrated deliver network.
The Epic call took some time to make because there were integration issues to work through. In 1999, St. Mary’s and Dean made a strategic decision that in order to be the type of integrated deliver network they wanted to be, they needed to integrate technology. The organizations formed WITTS, and in 2002 the network began to implement the Epic suite of programs in the Dean-SSMW delivery network.
For several years, St. Mary’s and St. Clare actually have been live on Epic for clinical data repository and on Identity, an Epic module for enterprise-wide master patient indexes, and they have been adding clinical data to the repository. They also have been live on scheduling and registration since 2005, giving them the same scheduling and registration system as Dean Clinic and St. Mary’s-Dean Ventures. When patients access care anywhere in the integrated delivery network, the network already knows their demographic information and knows they have been part of the system.
Compared to implementation, making the actual business case for the Epic EMR was a piece of cake. In late 1990s, SSM looked at the question of whether to implement an EMR, but after a market survey, it decided not to proceed because it did not believe industry vendors were mature enough “for what we were looking for,” Lundal said.
The organization began the process again in 2004, the year President Bush announced a national goal for every American to have an EMR within 10 years, and made the decision to move forward as a system because this time the standard requirements were available in the market. To confirm its hunch, SSM worked with BearingPoint to come in and do conduct an opportunity validation, and an affirmative consensus developed.
“Trying to get to a net present value was not the most important factor anymore,” Lundal explained. “It was about patient care, safety, and quality, but a lot of it was that the hospital needed to do this in order to be current.”
Lines of communication
Other than its multi-level nature, the Epic decision-making process hasn’t varied from decision-making that is typical on other IT projects. As a health system, SSM has a clinical transformation executive steering committee comprised of very senior leaders and chairs of its medical informatics and nursing informatics committees. This committee makes major directional decisions, but project teams in different functional areas, including nursing and pharmacy, ensure that projects are organized around user groups.
“We call these our listening posts where we look for direction on what we should be doing with technologies as a health system,” Lundal explained. “That has helped facilitate decision-making.”
At another level, a steering body of SSM and Dean Systems meets regularly to review projects, and hospital-specific decisions are forwarded by the respective information management committees of each facility.
“It’s very similar to other implementations, but it’s multi-layered as opposed to what you might see in a stand-alone entity like a single hospital,” Lundal said.
Frank Byrne, president of St. Mary’s Hospital, talks about the importance of marrying technology with process transformation, but Lundal said the biggest challenge with the Epic implementation is the massiveness of the project, especially since it’s going live all at once. St. Mary’s is not going to go live floor-by-floor or unit-by-unit, and Lundal does not expect perfection right out of the gate.
There will be stage after go-live that Epic likes to call optimization. At that point, St. Mary’s will enter a continuous improvement phase that is consistent with the SSM philosophy. Sometimes, it will involve customization and sometimes it will entail a rethinking of workflow, but it always will involve clinicians.
“I’m a CIO and I’ve never seen a patient, and I try to stick to what I know,” Lundal said. “The first thing I know is we need clinicians involved in projects so they can make the vision their own.
“Our philosophy is the Epic software is not an IT tool. This is something our clinicians own and we are here to support it.”
Cost controls
Lundal, a native of South Bend, Ind., earned his undergraduate degree from Indiana University and an MBA from Bethel College. Prior to joining SSM, he was director of home care and physician systems for St. Joseph’s Regional Health System in South Bend.
From his IT vantage point, he firmly believes that information technology like EMRs and PACS have the potential to help control healthcare costs, and employers will sooner or later demand them because current annual cost increases are not sustainable.
“If we create infrastructure where medical images are available anywhere,” he said in reference to PACS, “and we put clinicians in places where they never have to reorder something because they can’t find something, I hope there is benefit to society in terms of cost.”