David Lundal, VP/Regional CIO, Dean Health System & SSM Health Care
Whether it’s termed customer or colleague satisfaction, David Lundal is focused on not only ensuring those he serves have the technology they need to deliver superior patient care, but are happy to call IT when they need help with it. Specifically, the massive and complex organizations he calls home are well along the road of implementing just about everything Epic has to sell, in just about all their entities. To learn more about both his organization and how it’s working to have IT seen as sound service provider, healthsystemCIO.com recently caught up with the long-time IT professional.
Chapter 2
- Comparing Epic and Cerner
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BOLD STATEMENTS
I can tell you specifically in our implementation, we would have people (from Cerner) that would show up to help us that we were paying for by the hour that were really learning over our shoulders on the job.
Our people had been at SSM Healthcare about as long as our Epic folks had been alive.
When you have one patient having a Cerner system, for instance, at the hospital, and an Epic at the clinics, that’s not the best thing for the patient or patient care or for anyone providing care for them.
Guerra: Have you implemented any other vendor products in your career at other organizations?
Lundal: Yes, the job I had previous to coming to Wisconsin was at St. Joe Regional Medical Center in South Bend, Indiana. What I was doing there when I left was implementing Cerner PowerChart Office. The hospital there was in a partnership with the South Bend Medical Foundation in an organization called the Michiana Health Information Network, which was a Cerner database. The medical foundation would send lab results in there and then you could have a free web browser to see those results, and then the hospital was implementing different modules off of that system. The hospital has since gone live on Cerner. But that was my exposure to Cerner. And then various other systems that I’ve implemented in my career, but that’s the other big one.
Guerra: Do you see a distinct difference in the way Epic operates versus other vendors? Cerner is a great organization to compare Epic to. Is there a way you can compare your experiences with these two vendors?
Lundal: Yes, and you should know my experience with Cerner is now 10 years old. But what had struck me at first, when I first started hearing the Epic story, was just how similar their story was in terms of their strategy to Cerner’s. They would talk about it like there’s one integrated database and everything is playing off of that, which was much different than what you would hear with some of the vendors that were acquiring a lot of systems and then saying what they’d integrated. So it was one integrated database. That was very similar.
What struck me about Cerner 10 years ago — and I kind of now have this belief of all public companies — is the drive for more revenue and sales. It felt to me like it dictated a lot of the strategy, like, ‘Let’s sign more deals,’ which I think led to some implementations that didn’t go quite as well. I can tell you specifically in our implementation, we would have people that would show up to help us that we were paying for by the hour that were really learning over our shoulders on the job. But that, to me, was a symptom of how rapidly they were trying to get out there in the marketplace.
Epic, on the other hand, had the same story on the database side but they were, especially in the mid-2000s, very selective about their client base. I heard many stories of people that wanted to implement Epic and Epic said, ‘No, you’re not in the marketplace that we are looking to sell to.’ So they were kind of handpicking ones that would be successful in an implementation. Of course, a fail or a success is at least as dependent on the customer as it is on the vendor. This is a big thing to do, so that was a very smart strategy by Epic. But also too, it meant that their pace was pretty good. So the people that they were getting, I think, were more prepared to do an implementation. I can tell you, when I did the reference calls, they would say, ‘Epic is going to send you some very, very smart young people, but you need to own the implementation yourself, and you need to have experienced people on there; you can’t let them just do everything. You need to be part of that.’ That was very good advice.
But Epic has been a great partner working for us. I can’t comment as much on the Cerner. It’s very old information that I have. And I think Cerner was a great partner. It’s that dynamic on the Wall Street thing, I call it.
Guerra: You mentioned that – and I certainly heard before – Epic sends over some young folks who are bright but they don’t have 20+ years in the industry, working in the hospital, implementing systems. Of course I’m making an exaggerated point.
Lundal: Not too much, because when our first, say, year of our implementation on the SSM side, at Epic I think the average age of their employees was 26 to 27 years old. The implementation team that we hired from the ranks at SSM Healthcare, the average tenure at SSM was 26 years. Our people had been at SSM Healthcare about as long as our Epic folks had been alive.
Guerra: Right. But you make the point, when we’re talking about Cerner, that you felt like some folks were learning over your shoulder. When we talk about Epic sending in young folks, I guess you don’t think it felt that way, although it sounds like it could have been a similar dynamic to some degree.
Lundal: I think they knew their stuff about Epic very well. They weren’t learning anything from us about Epic. But what they didn’t know as well was healthcare, and so we needed to bring healthcare there because they don’t know that. They have very smart people and, as you know, very smart people can sometimes be very confident. So they sometimes will come and think they know it, but you need to be very strong in terms of your own beliefs and making sure your voice is heard. But I’ll give you an example of the partnership there.
A few years ago, I had asked the people I worked with, ‘Okay I’m going to talk to Epic. I have a call coming up with Carl at Epic, what can you tell me? What are the challenges?’ They would say, ‘One challenge is, they just don’t know our business.’
So I thought about that, and I talked with Carl, and we had this idea. They didn’t know what kind of an impact it would have, but we’re here in the same town, and we have a very robust volunteer program at our hospital here in Madison, St. Mary’s Madison. So what if, as part of the initiation process at Epic, some of their people can come through on a volunteer basis at our hospital and work out on the floors and do different things. Maybe that would give them just a little bit of a sense of what’s going on. It might be very helpful to them.
So we made the connection. Carl thought that was a good idea. We made the connection with one of his folks and our director of volunteers at St. Mary’s. That program is now at least 5 years old, and they continue to send people through it.
Now I think they’re hiring 1,000 people this year, so I don’t think it has a huge impact. But it does have some. One of the people, by the way, decided to go to medical school after volunteering at our hospital. To me, that’s just an example of how the partnership works, and I think it’s very good.
Guerra: Was there an upside to that for your facility, even if you’re not getting those folks? Or do you assume you’re getting all those folks that you help train on your project?
Lundal: Who knows? How do you measure something like that? I think if there’s an upside, it’s kind of minimal. But I think that it does maybe, overall, provide a connection at Epic, that what they’re about is healthcare as well and that’s what we’re about. So if it does anything a little bit there, then I think that’s a good thing. I don’t know if any of those people will ever end up working with us or not. Some of them are probably moving on to other places, but if it keeps that mindset even a little bit, maybe that’s a good thing.
Guerra: I guess even having young, smart folks volunteering, they’re providing value to your facility as they’re volunteering too.
Lundal: Absolutely.
Guerra: I was going to ask you about being in the same town. Did you even have a choice of going with another vendor? I’m just kidding.
Lundal: We did. Going back to the founding of WIITTS. WIITTS was founded in 1999 based on the fact that 90% of the patients admitted to St. Mary’s Hospital are Dean patients. In 2007, we started working toward one patient, one record, anywhere, anytime and that’s what kind of drives us on the technology side in terms of our planning. That wasn’t something we said back in ’99, but that was the intent. This is the same patient, let’s do something together.
In ’99, I don’t believe Epic even had an inpatient product. When you back to the strategic plans, Epic wasn’t really anything, even for the clinic, and they had the clinic implementations. So in 2002, the contract was signed with WIITTS to do Epic for a clinical data repository and all of the ambulatory products. We started down the path and the hospital started contributing interfacing data into the clinical data repository, so it was at least a place where you can get an integrated look at the patient, even though you still had paper charts at the hospitals. So all the transcription was in there, all the lab results were in there, etc. So it was the foundation for it.
Then back in the late 90s or 2000s, SSM Healthcare looked at the market for electronic health records and deemed that it wasn’t ready yet for inpatient. So we took a pass, SSM Healthcare. We looked at it again in the mid-2000s and we did a very robust vendor selection with our incumbent vendor McKesson, HD, HBOC, STAR product is what we have had in all of our hospitals and Cerner.
So it was a very robust process. There was definitely a possibility that it could have been any of those three that SSM Healthcare would have chosen. If they chose one of the others, I’m fairly certain that Wisconsin would have said, ‘Can we do Epic, because we have this partnership with the physicians? We already have this clinical data repository in place.’ When you have one patient having a Cerner system, for instance, at the hospital, and an Epic at the clinics, that’s not the best thing for the patient or patient care or for anyone providing care for them. An integrated database is the ultimate expression of that. That’s what would have happened. The way it turned out, Epic was going to be the choice for everyone, so we didn’t have to do that, which I’m very grateful for.
Now we’re positioned very, very well with this common electronic health record platform for where healthcare is going. The other stat that’s very important for us is 40% of the patients that we care for are Dean Health Plan patients. So we have this three-legged stool where if we can do the right thing for the patient, and if we can reduce the cost in some way in terms of claims, we’re preserving some revenue on the premium side. That sets us up well.
On July 1st, we started Medicare Shared Savings Program Track 2, and so we’re in the Medicare version of that now. Medicare is another 30%, so about 70% of our business now, we think, is in this accountable business, where we’re accountable for the care. The integrated platform is a great foundation for us to do very well in that.
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