Taking the Long View and Embracing Complexity in EMRs and Healthcare IT

Electronic Medical Records (EMRs) are the lifeblood of a hospital. They map a patient’s journey from the moment he or she arrives at admissions to the moment of discharge. They live and breathe within an intricate healthcare ecosystem responsible for both clinical and financial outcomes – outcomes that not only affect the hospital, but the community it serves.

EMRs are complex, enterprise-level solutions that encompass so much more than just hardware and software. These mission-critical systems branch into dozens of sub-systems and serve a range of stakeholders including doctors, nurses, pharmacists, technicians, hospital administrators, private and government insurers.
 

Because of its integral position, choosing and implementing an EMR system is a vital undertaking.  The process requires a layered knowledge-base that is ready to deep dive into a world of untold contingencies.  And the choices made during the process affect the health system, the patients, the bottom line, and the organizational goals surrounding quality care. Making the wrong choice is NOT an option. Making the wrong choice closes your doors.

The typical lifecycle of an EMR system is an exercise in complexity.  The preparation process is a marathon, not a sprint. The selection phase alone can take a year or more.  Implementation and infrastructure build-out require another two. At steady state, the system will be maintained and updated for roughly a decade before the process repeats itself.

When a new EMR is launched, there is nothing gradual about it – we move from marathon to sprint. You simultaneously switch off the old system and go live with the new one. It's not a matter of replacing this or that module or sub-system until everyone in your organization is ready.  Instead, you build the new platform in the background as a shadow system until you are ready for launch. If you haven't mapped out your operational complexity in its entirety during the marathon, the whole thing can collapse in the sprint. And there are no second chances. 

So how do you avoid disaster? The first step is finding the right partner.

Taking the Long View

It's no secret that careers in healthcare are measured in decades. I'm not talking about just doctors and nurses here, but people involved in support services and ancillary industries, too. Think pharmaceutical and medical equipment reps. Think IT and financial professionals, such as myself.  It can take a decade or more to learn the complexities of healthcare.  The industry is enormous – representing a three trillion dollar market in the United States. That’s almost one-third of our GDP! Getting value from that investment is what drives the industry to move forward.

I've been working in healthcare since 1997. I was hired by Siemens Medical to start a healthcare financial division, helping healthcare providers finance the purchase of medical equipment and technology.  To do this, I needed to learn the industry inside out – the market, the technology, the regulatory environment, the revenue cycles and the equipment. But most importantly, I had to learn to listen to what the customer was trying to accomplish. I had to view the overall picture of the hospital.
 

To succeed in building long-term business relationships in healthcare, you need to see the big picture. You need to be more than a vendor—you have to think and act like a partner and a trusted advisor. And that is what drives the Healthcare Practice at Agilant.

Embracing Complexity

At Agilant, our healthcare experts accompany hospital clients through the entire IT lifecycle in supporting complex medical systems, like EMRs. We are on a different level than resellers who only focus on technology “point solutions”.  We are not just technology people—we are Healthcare people.
 

Agilant understands the complexities of healthcare ecosystems. Our expertise in clinical is seamlessly married to our understanding of IT.  By comparison, it's easier to learn what a printer does than to understand how a hospital works. And because Agilant has a wide array of specialists and engineers across IT platforms and verticals, when we meet with a hospital CEO to discuss a specific topic or solution set, we bring along engineer who understands the technology and how it fits into the health system’s IT environment.
 

When Agilant engages with a hospital, our goal is to understand the big picture. And to do so, we focus on People, Process, and Products, a model we refer to as P3. We ask the tough questions: Who are the users and stakeholders? What are the clinical and patient workflows? What hardware and applications are at work? What is your goal?

Once we've understood these three dimensions we can start building an integrated solution. This is what separates Agilant from 95% of the vendors out there. Most are good at the physical infrastructure side. But they are not good at data, and they certainly don't get process.

Implementing an EMR and Avoiding Costly Mistakes

So how does this all come together?  Let me offer the story of Rome Memorial Hospital in Central New York State. I can best describe Rome Memorial's current EMR as a best-of-breed, customized system.  Eight years ago, the hospital purchased an EMR package from McKesson, a pharmaceutical firm that has an IT division.  The package was purchased outright without project management or consulting support, and Rome installed it themselves.
 

Rome Memorial successfully built a highly customized system, but without the proper consulting expertise. And, consequently, have faced some difficulties over the years: application management/update challenges, cumbersome workflows, inefficient routing of clinical data, additional off-system work for billing, etc. A whole lot of extra challenges for a mainstream hospital.

As a result, Agilant has been selected to work with Rome on a multi-year project to modernize their IT infrastructure, which includes the selection and implementation of a new EMR system. We’ll begin by running Rome's RFP process.  And in doing so, we are also responsible to conduct the internal valuations and assessments required to link their IT infrastructure, data, workflows, and extended applications into the new EMR. The decision framework takes the next 10 years into account. 

But more than just what exists today at Rome, Agilant also takes into account what their tomorrow will look like. Rome Memorial is moving toward a different model – they are building clinics. Clinics equate to a new type of healthcare outreach to the community.  And that type of future shift is important to understand as we search for Rome's next EMR. We have to build a solution that supports the P3 of today, with room to accommodate for the new business requirements of tomorrow. 

40,000 Hours

Implementing an EMR for a hospital the size of Rome Memorial will take over 40,000 hours.  There's a lot of collaboration and strategic thinking that must occur behind the scenes involving including all the key department and constituents to make sure the system is selected, implanted and supported to support the hospitals mission.  

This is the approach Agilant has proposed to the team at Rome to detail exactly how we’re going to do it.

First Step: Data Gathering. The Agilant team begins with a lot of upfront work.  We get to know the hospital organization, the staff, the service lines, and what makes them unique.  And we do it by asking the right questions: “How does your hospital function in this community setting?” “What are your short, medium, and long-term goals?” “What would make your job function easier in this environment?” These types of questions are deceptively simple, yet critical. 

Second Step: 360-Degree View. From our investigation and data gathering sessions, Agilant will build a 360-degree view of Rome Memorial. It is the only way we will be able to choose the right system and design the most effective and efficient IT infrastructure to support it. The new EMR will be integrated into all of the systems and procedures that Rome manages, and we absolutely must take that into account.  Every job function and every process is included. Every business and clinical unit in the hospital feeds into it; from supply chain to pharmacy to admissions to the patient. 

Agilant’s 360-degrees view takes into account the current and future states for the:

• application environment
• infrastructure
• department workflows
• security procedures
• print management
• patient portals
• ambulatory requirements
• disaster recovery & business continuity
• revenue cycle & billing requirements
• staffing & augmentation services 

Third Step: EMR Review. With the knowledge gained through the aforementioned due diligence, Agilant opens up communication with the leading EMR companies. Each is given opportunity to provide an overview of their platform, a technology roadmap, and their vision for the “hospital of the future.” 

Fourth Step: EMR Recommendation & Selection. After significant review, Agilant presents Rome with a final analysis, including our recommendation for an EMR software platform. 

Fifth Step: EMR Implementation. The reality is, Rome will buy about 80% of the functionality out-of-the-box and the remaining 20% will be tweaked to support their required workflows and workloads. This will save Rome both time and money. But it will ALSO prevent a repeat of the previous inefficiencies and headaches of the legacy system. 

At the end of the day, this is a 10-year decision for the hospital. Its implementation is going to turn the organization upside down for the next two or three years. Dozens of specialists are involved, both at the hospital and at Agilant. Getting it right is a requisite… for ALL of us.

Sixth Step: EMR Launch. In a couple of years, when we flip the switch on the new EMR, Rome Memorial staff and their patients will enjoy a seamless user experience. They will have a consistent interface. Data will flow to the sub-systems where it is needed. Patient privacy will be protected, and financial goals will be met.

After the launch, Agilant will be sticking around to ensure everything keeps running smoothly.

The Changing Face of Healthcare IT

As I mentioned earlier, business relationships in healthcare are measured decades. Agilant’s Healthcare relationship at Rome Memorial is fairly young, but our team has accomplished so much even in a short period. This is all a testament to the value of choosing the right partner and successful collaboration. The success of these early years is the seed for the next decades.

Agilant is looking forward to the future of healthcare, but we see many challenges ahead. For example, today EMRs from individual hospitals don't talk to each other, but tomorrow they will have to.  Data portability and mobility are going to be huge as healthcare delivery methods change. Cloud computing is another emerging technology that healthcare organizations are moving toward. Today, most EMR installations are premise-based. Tomorrow, as cloud security improves, more hospitals will leverage off-premise solutions

Healthcare today will always be seeking advanced ways to leverage technology and improve on clinical results and patient satisfaction tomorrow. Agilant is already positioned to have the expertise ready to support that future healthcare ecosystem. And for today, Agilant will continue to serve as a trusted partner and help hospitals embrace the changes to come. 

That is the true value we bring to the table, any day of the week.