Steve Hess, VP/CIO, University of Colorado Hospital
Like most CIOs in healthcare, Steve Hess has no shortage of things to do. First off, he’s knee-deep in a multi-year Epic implementation that will see him bid farewell to many incumbent vendors now, and more in the future. Secondly, he’s morphing the business side of the house from a best-of-breed environment to one concentrated on Lawson. And, as if that’s not enough, he’s working toward Meaningful Use while keeping a close eye on UCH’s ICD-10 conversion prep. To learn more about how Hess is juggling everything, healthsystemCIO.com editor Anthony Guerra recently caught up with the Denver-based CIO.
Chapter 2
From McKesson, Picis, Allscripts, GE (OR, anesthesia, patient accounting), 3M for CDR (“islands of information”) to Epic
“Why not Epic?”
Lawson for ERP, etc.
The art of vendor disengagement
Analyzing the “most integrated” vendors
Epic has room for improvement too — “some of the silos are still maturing”
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Bold Statements
We had a lot of great automation already in place, but just islands of information rather than integrated records.
So this organization did a system selection really without a CIO, which on the surface sounds like a really bad thing. But I think it was a great thing because it brought a lot of the organization—the physician leaders, organization leaders, and a lot of staff—into that system selection process, and it really made it a University of Colorado Hospital decision, not just an IT decision.
It wasn’t that the CIO had created this vision and no one was on board with it; it was quite the opposite. Everybody created this vision, and now it’s mine to help execute.
And almost across the board, the vendors have been very engaged and responsive, and although they’re obviously not happy, they understanding why we made this decision, and they see the value of moving away from somebody’s transparent systems.
Guerra: Let’s get some baseline information. You knew that you were going to be an Epic customer; tell me a little bit about that. And I know you are fairly new to the organization, and we’ll get into more that later, but were you there when Epic was selected? What do you know about that process?
Hess: Sure. I came to University of Colorado Hospital in July of 2009, so I’ve been here a little over a year and a half. What’s neat is that it was a very automated enterprise, but very best-of-breed. We had a completely automated ED with one vendor, and we had a completely automated inpatient system with another vendor. We had a completely automated ambulatory system—not in all of our clinics, but in most—with another vendor, automated OR with one vendor, and anesthesia with another. So we had all of these great automation tools, and we were doing bedside barcodes and meds administration, and doing CPOE in the ED and in ambulatory.
We had a lot of great automation already in place, but just islands of information rather than integrated records. So probably a year before I arrived, they started a process (we have some new leadership here) to look at whether we should be moving to an integrated EMR across the enterprise. And there aren’t that many vendors out there that can really do everything, including all the financials.
Before I joined, University of Colorado Hospital took the approach of looking at Epic from a perspective of, “Why not Epic? Why won’t Epic work for us?” Epic was getting a lot of good press, it was being adopted widely, and the market share was growing every day. That process—the evaluation, the financial analysis, and so on—probably took a good year. And when I was interviewing for the position, I knew that they were in the latter stages of that system selection, and it was looking like it was going to be Epic.
So the board approved it in June of 2009, and at that point, I already had accepted the opportunity. When I got here, I hit the ground running with the contract; I got it finalized, and we kicked off the project in February of 2010, about six or seven months after I joined the organization. We just went live in February of 2011. So essentially one year from our kickoff, we went live in our first ambulatory clinics, and that includes the registration, scheduling, HIM functions, billing, and so on.
We’re rolling it out in multiple phases across our ambulatory areas in the next couple of months, and we’re going live with the hospital, the ED, and the ORs in September of 2011. So in total, from the time I joined, it’ll probably be a two-and-a-half to three-year project, but the reality is that this organization spend a good deal of time doing the due diligence around the analysis for a year prior to that.
Guerra: Was there something unusual that brought about the exit or the transition from one CIO to another toward the middle or end of the system selection? That sounds unusual.
Hess: I think they were disconnected, to be honest with you. We have a new leadership team that joined the organization, including the CEO, CFO, COO, and VP of Ambulatory Services, so the executive team has really turned over quite a bit in the last five years. I think some of that was just a natural transition of the executive leadership team. I believe the CIO position had been vacant for almost a year before I joined.
So this organization did a system selection really without a CIO, which on the surface sounds like a really bad thing. But I think it was a great thing because it brought a lot of the organization—the physician leaders, organization leaders, and a lot of staff—into that system selection process, and it really made it a University of Colorado Hospital decision, not just an IT decision.
So again, on the surface, doing a system selection without the CIO may seem like a dangerous thing, but I think it actually worked out wonderfully for us, because it created a lot of engagement and alignment of where we’re going, and I see that playing out everyday.
Guerra: Was it harder for you to come in without the CIO, as opposed to a transition where maybe there be a little overlap, or at least someone left things in a certain order? Was it harder for you to come on board in this kind of vacuum, or was it fine?
Hess: No, I thought it was fine because the strategy and the vision were very clear, and again, there was a very aligned vision. It wasn’t that the CIO had created this vision and no one was on board with it; it was quite the opposite. Everybody created this vision, and now it’s mine to help execute. The other interesting part is that we also made a decision in parallel with Epic to collapse our ERP Solution as well.
We were fairly best-of-breed across HR, payroll, benefits, and financial, so we collapsed all of them to a single solution as well. That project by itself would probably be a very major project for most organizations, but we’ve actually been implementing it in parallel with Epic. And the team has done great with it, but it’s been dwarfed by the Epic project.
Guerra: It’s very interesting transition period that you’re describing. I’m thinking of it almost in a sports analogy where you’re the coach and they pick who’s going to be the franchise quarterback right as you’re looking to come in. So we’re you rooting for Epic? Were you monitoring the process because that’s pretty much going to be your shop?
Hess: Yes.
Guerra: This is a big part of your life, of your career with this organization, and yet you were on the outside of these critical decisions being made.
Hess: Well actually, what’s interesting is, that’s part of the reason I was attracted to this opportunity. I’ve been in healthcare IT over 19 years. I was CIO at another organization for five years previous to this, and we had implemented Cerner as center of our core EMR. And we had a core EMR strategy there, but we also had a little bit of a best-of-breed. We had this disparate financial system, and I had always been kind of watching Epic and frankly admiring Epic—the way that they structure their organization, the approach they take, and the success they’ve had with their implementations. I had heard a lot of good things about it, so that’s one of the things that attracted to me to this opportunity.
So I actually knew a lot of what I was walking into, and my expectations have been met, to be honest. I think this is a great organization with a new executive team that’s just striving to be great—not settling for anything less than greatness, which I love, and that’s working with a core EMR vendor who is really trying to do the right thing for patient care, for patient safety, and for their clients. I’ve lived it this past year, and as we go live, we’ve had our bumps and our idiosyncrasies along the way, but for the most part, it’s been successful and we’re positioned for greatness moving forward.
Guerra: What was the incumbent inpatient clinical vendor that was replaced?
Hess: For most of the nursing documentation, it was McKesson.
Guerra: What about in the ED?
Hess: In the ED, we had Picis.
Guerra: What about ambulatory EMR?
Hess: That was Allscripts. And we also had GE in the OR and anesthesia, and also patient accounting, and we had 3M for CDR. You name, it we had it.
Guerra: So a number of those are no longer necessary with Epic coming in?
Hess: Yes, we’re actually running many of them in parallel because until we’re up on all of them in production, we still need them. But yes, absolutely, we have a legacy system archive and rundown plan, essentially, that is being executed in parallel with the Epic implementation.
Guerra: Any best practices or lessons learned in terms of disengaging or handling the transition period with these vendors that are no longer going to be a part of your future strategy?
Hess: That’s a great question. I’m not sure I have any strategy. We’ve been very transparent with the vendors, which I think at the end of the day has it’s ups and downs. But I live by that, so we engage them fairly early, and in all of our discussions, we engaged them honestly and transparently, telling them what dates we’re looking at. For the most part, what I’ve seen is an understanding and an appreciation of that transparency and the open dialogue in trying to get to as much of a win-win as possible as you run down maintenance contracts.
And almost across the board, the vendors have been very engaged and responsive, and although they’re obviously not happy, they understanding why we made this decision, and they see the value of moving away from somebody’s transparent systems. They don’t obviously like losing clients, but we’re probably not the only ones who are having these conversations with them.
Guerra: You mentioned Epic as being one of the few integrated systems. Do any others come to mind?
Hess: Well, I think that every vendor will say they’re integrated, but I think some vendors have gone down the approach of acquisition-to-integrate, versus some who have built it from scratch. The two big ones that come to mind are Epic and Cerner. Cerner has obviously developed from a clinical side, and it’s still fairly new to the patient accounting side, but I think their strength is still in clinical. And they’re still growing a little bit in the ambulatory areas as well. I think Meditech is the other one that some hospitals around here have also used from an integrated prospective.
I think they also are mature and maybe on the ambulatory side a little bit so I think those are kind of the three that stand out to me—they’ve set themselves apart in that they’ve built an integrated system from scratch rather than building through an acquisition.
Guerra: Would you say Epic is strong in the clinical space, and also strong with the ambulatory, clinical, and the patient accounting?
Hess: I think so. I mean they’re not perfect by any stretch, but throughout the years they’ve been strong across many different spectrums. And they’re still developing new modules, so we’re having conversation with them about the cardiovascular space. And although they’re not mature enough there yet, we’re going to be looking at implementing them in the oncology space, and we’re looking at them in the future potentially for our lab system.
With Cerner, their foundation was really the lab system, whereas Epic doesn’t have one that’s ready for us yet. So it’s interesting; I think the vendors over the years kind of leapfrog each other in different modules or spaces. Epic has really good systems across the board, but still obviously needs to mature in some of the different silos.
Guerra: So with some of those silos, you stick with your best-of-breed system until Epic’s products are mature.
Hess: We have to, unfortunately. Epic will most likely never get into patient monitoring devices and will probably never get into the imaging space, and imaging is a big part of what hospitals do. So there’s never going to be a hospital that can only do Epic and live with it and that’s okay.
You have to know where Epic is going to be playing and where it’s going to be strong. When we do have a new system, whether it’s a nurse staffing solution or an acuity solution or whatever, we take the approach of, “Why not Epic?”
So we really do look at Epic first and what they have in that space, and we’ll take a good-enough solution with Epic rather than a great solution from a best-of-breed, but obviously there are some cases where Epic just does not have a solution yet.
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