When one door closes another door (or window) hopefully opens. And that’s just what happened to John Kenagy when the door he’d been walking through at Providence closed. Just off interim status, Kenagy is now the CIO at Legacy Health, and loving every minute of it. That’s because the Ph.D. with an expertise in CPOE will be able to bring his research to bear right at the point of care. Being closer to the “rugby sport” that is healthcare IT has this veteran charged up again. To learn more about his plans for improving care by implementing clinical systems at Legacy, healthsystemCIO.com caught up with the long time West-coaster.
- Legacy’s application environment — “One word: Epic”
- The Pacific Northwest is absolute an “Epi-center”
- What makes Epic special?
- The power of honesty
- Order sets and CPOE
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… a good friend of mine, a CIO, basically said that as he looks for opportunities, once he’s been a CIO in an Epic shop he would not take a job at an organization that wasn’t running Epic.
I just think in terms of a company who is focused, I’ll be very candid, not on shareholder wealth aggregation, but on their customers doing the best that they can.
I think that if you have an enterprise system like an Epic or a Cerner, a McKesson Paragon, you don’t want multiple systems doing CPOE.
Guerra: Let’s talk a little bit about your health system, the application environment, what you’ve got going on.
Kenagy: It’s almost a one word answer, Epic.
Guerra: When did you make that decision?
Kenagy: The decision was made a couple of CIOs ago. A physician leader, great CIO who will have decades of his legacy at Legacy by moving us to Epic. About 2008, started the process and decision to what was the EHR platform of the future and decided on Epic and we did it, two-year design and then a one-year implementation across all six hospitals, completed in September of last year at our last hospital. The first one was in the middle of 2010 and then the final one was, as I sad, September of last year to get the full quarter of Meaningful Use for that hospital, actually at the end of 2011, and it’s Epic integrated so the employed physicians are, of course, all on Epic in their ambulatory practices, of course inpatient ED.
We are implementing the home health module for our hospice organization, and we are hosting Epic for the community, a program we call LEAP (Legacy Epic for Affiliated Providers). We have a number of physicians on it. I’m going to venture to say we’re in implementations right now, but I think we have about 45 physicians live in our hosted Epic module. Portland is a very wired community, and not just because of coffee and microbrewery. Of course this is the home to Logician, to Medical Logic, and so a number of practices, certainly the large ones, have been on an electronic health record for, in some cases, a couple of decades, and so as you pointed out that’s kind of everything out there, Sage, Greenway, Practice Fusion, eClinicalWorks, a lot of GE Centricity, some Epic in the larger groups, Vancouver clinic and Portland clinic going on their own Epic.
I think we’re all looking, because even Northwest is absolutely an “Epicenter” all the way from Providence, of course, moving to Epic and Swedish, which has been on Epic and the Everett Clinic and UW ambulatory down to Salem Hospital and OHSU and Legacy, so a lot of Epics in the environment which of course people who don’t know better, I don’t mean that in as obnoxious a way as it sounds, would think that it’s, ‘Really, well, you’re all on Epic, and so it’s just information flows freely,’ and while I think Epic has done a lot of work in that, particularly driven by the Kaiser deployment, and so inner changing data between different Epic databases is easier than I think of at a lot of other customers, it still is complex. You need to make sure – the rigorous requirement for sort of flawless integration of clinical data, particularly allergies and medications and problems is exceptionally difficult, and so we have technology which we use certified data to move information back and forth between us and referring providers, and it’s reasonably satisfactory but our industry just needs to grapple with that a lot more.
Guerra: The timing may have been off, but your experience at Providence and the Epic selection there, was that of any advantage to you when you were looking at, when you were interviewing with Legacy?
Kenagy: Oh yes, and prior to Providence I had it at Oregon Health and Science University where the organization went Epic, first ambulatory and then very soon after decided to do Epic Enterprise, so had rolled it out in an ambulatory setting and was in process at the hospital when I went to Providence and then came here. You know, I remember a good friend of mine, a CIO, basically said that as he looks for opportunities, once he’s been a CIO in an Epic shop he would not take a job at an organization that wasn’t running Epic and that wasn’t me who said that but you know, honestly, it really resonates with me. We are Cerner for laboratory. We do that on a hosted mode. Our lab is very happy with the relationship that they have and IT supporting that as well, and I’ve worked with a number of different vendors. I think Epic is a solid, strong vendor, but I think the marketplace needs to have competition and I think there are other good and improving vendors in the marketplace, but I’m pleased to be at a place that has Epic. You know, the interesting thing being here at Legacy is now the implementation is done so I helped bring Epic. Actually, the associate CMIO at OHSU brought Epic to OHSU and I soon became a true believer of – I helped be a catalyst at Providence to bring Epic there. Now, here, it’s done, and so it is actually nice to be at an organization where we’re out of implementation (although are you really ever) and being able to work on optimization and improving its use and adoption.
Guerra: You just said that the CIO said he wouldn’t work at a non Epic shop. Why do you think that is?
Kenagy: You know, Lawson asked me that question. Lawson, similar, not that question directly, but Lawson has such a footprint in healthcare, and they said, ‘You know, we talk to people, we talk to CIOs,’ this is an executive at Lawson, ‘We talk to CIOs a lot and they just wax eloquent about the relationship with Epic, what is there about that?’ and I’m not a wholly owned subsidiary of Epic and clearly as a nonprofit I need to include all the small legal print about – this is not an endorsement of Epic, this is a personal view — but I think it is the business tactics. It’s a quirky company that has its own culture, but I think, in terms of forthrightness, honesty, delivering on expectations, saying no, saying they can’t do something when they can’t and being rightfully proud, and they are a proud group in terms of what they have done, but haven’t drunk their own Kool-Aid, and so I just think in terms of a company who is focused, I’ll be very candid, not on shareholder wealth aggregation, but on their customers doing the best that they can. I think it was such a refreshing change from pretty much all of the other relationships I have that it’s pretty amazing. I mean, really, a standup company that delivers a great product that is built from the ground up that doesn’t have architectural problems of acquisitions and a series of that and has solid business practices that stand behind that product and put a lot of money into support and a lot of money into development and very little money into marketing and sales, and it shows.
Guerra: Isn’t it amazing how much a company saying no to something can make you happy?
Kenagy: They do. Yes, I have a great example of it. At Providence, we were pursuing it for the laboratory and saying we want an integrated system, but they said, “No, our product is not mature enough for what you do. Wait a couple of versions and it will be world class but not now.”
I remember Judith Faulkner — of course, just a lot of the reason that company is great, her vision — but she was once telling, meeting with my team managers and told the story, told that basically she meets all new employees and part of her onboarding is not only relating the mission and the values of Epic but she also teaches a class in honesty.
Kenagy: Yes, and everyone asked, ‘Well, what does it mean to be honest with everyone? Don’t lie?’ And she said, ‘Yes, that’s a part of it but, going beyond that, it’s not only don’t lie, but also don’t mislead and don’t let people hear just what they want to hear. It is your duty to correct them.” I expect that’s not in a lot of other sales company’s presentations.
Guerra: That’s fascinating. Maybe you could do some PhD work on Epic. I think that would sell. That would sell.
Kenagy: Well, you know what? I have been impressed. We had, as I said, Lawson, we’re really renewing our relationship with Lawson, and I am seeing very positive signs of the same things I’ve saw with Epic. Again, I’m not endorsing the product. We’re not profiting on it either.
Guerra: I don’t think we need to run the disclaimer again. (laughing)
Kenagy: Oh, we need to have that. Bring it up. I mean and, of course, I won’t say the vendors that are on my Dante’s circle of hell list but, you know, I just think that a lot of vendors talk about partnership but don’t really live it.
Guerra: Well, let’s touch on one other vendor that came up when I was just doing some research, Wolters Kluwer and their Provation product. You got contracted with them recently. It looks like July 2012?
Guerra: You’re doing some work with them? Tell me about that.
Kenagy: I’m pretty excited about this environment with that. We are working with them for a newly hired gastro neurologist in a community, in our Gresham community so that was underserved in this area and the physicians are really interested in joining Legacy. I’m excited about it and, frankly, one of their conditions for coming on board is this software package that they believe really sharpens their game as a clinician. You know, since that was fairly well-known to the vendor, those were always not the greatest negotiation positions to be in between us and the vendor, but I was very impressed with the folks that they had and how that will integrate into our record, and where it doesn’t.
Epic doesn’t do everything, and it will be the transaction core of everything we do but there are a lot of others, as I’ve mentioned, Cerner Lab where we have a great relationship as well, so Provation will be one of those specialty systems that will plug in to the overall EHR.
Guerra: Do you think that off the shelf order set package is necessary in order to do CPOE well?
Kenagy: Well, we want to make sure our electronic health record and certainly CPOE is not patchwork quilt of multiple systems, so we are doing Provation not for the electronic health record or CPOE, so the physician will be using Epic for his scheduling, Epic for his documentation and order entry. It is the actual in-procedure documentation and capturing the images of the GI procedures and helping do the sort of clinical diagnosis that Provation will be doing. We have limited it into really being like a specialty lab system where data will come out of that into the Epic record, but the physician’s overall documentation and certainly CPOE will be done on Epic. I think that if you have an enterprise system like an Epic or a Cerner, a McKesson Paragon, you don’t want multiple systems doing CPOE. Actually, I think it’s just too risky for medications and allergies and things that don’t go well across vendor proprietary systems. So we’re kind of limiting our bolt-ons to what really is a bolt-on and not a like functionality replacement.