Dave Garrett, SVP & CIO, Novant Health, Chapter 1

When people hear that a health system completed a major EHR rollout three years ahead of schedule, it’s going to raise a few eyebrows. But it’s precisely what Dave Garrett and his team were able to accomplish at Novant Health, which went from having 90 billing systems and a dozen EHRs to one consolidated system. The strategy? Start with small waves, gain confidence, then go bigger. The keys to success? Governance, executive buy-in, and super-users. It may sound simple, but it required a great deal of trust and collaboration. In this interview, Garrett talks about what it takes to complete an enterprise-wide transformation, and how they’re working to achieve the goal of “one patient, one record, one remarkable experience.”

Chapter 1

• About Novant
• From 90 billing systems & 12 EMRs to 1 integrated system (Epic)
• Completing a 5-year rollout in 2 years
• “Bigger and bigger” waves
• Novant Health Community Connect
• Getting past cost — “You can always find something cheaper.”
• One patient, one record, one remarkable experience

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We actually got pretty confident along the way in terms of our ability to roll out, and we started taking on larger and larger waves of implementation.

I’ve been in the healthcare business in IT for 30 years, and it’s pretty remarkable how the organization came together like that.

The fact that we were able to get everybody up that much quicker was big. It’s the old analogy of ripping the Band-Aid off versus pulling it off a little bit at a time. But it really wasn’t as painful as some people might think.

It isn’t what I would call cheap. And honestly, when you think about the total cost of ownership, which a lot of independent practices don’t always do, it’s not as expensive as you think either.

We wanted to make sure we could do that ourselves manually and with the current systems before we tried to use a computer system to force some of that transformation and consolidation and standardization across the board.

Gamble:  Hi Dave, thanks so much for taking the time to speak with us today.

Garrett:  Absolutely.

Gamble:  Just to start off, can you give a little bit of background information about Novant, just in terms of the number of hospitals and what you have in the way of ambulatory, things like that.

Garrett:  Novant Health consists of 15 acute care facilities in three states. We’re just getting ready to open up our 15th facility in the Haymarket area of Northern Virginia later this month, as a matter of fact, so our 15th facility will be opening up. We’ll have 15 acute care facilities across that 3-state footprint. We also have roughly 380 ambulatory clinics spread across the 3-state footprint and that consists of about 1500 employed providers. We are not an academic medical university, so I would say that as things go, we’re relatively large in terms of our employed physician group as opposed to other organizations our size when you look at number of facilities. We’ve got about 25,000 employees across our 3-state footprint as well. So that gives you a little bit of a feel for our size.

Most of those facilities are located in the North Carolina area, specifically in the Charlotte and the Winston-Salem markets. We also have a shared services organization that has been in existence for almost two years. It’s expanding out to many different facilities across not only in that 3-state footprint but going beyond that. Those services really consist of anything from working with acute care facilities across our footprint to taking advantage of our supply chain opportunity, all the way through to where we would actually manage the facility. And it could even lead into merger-acquisition activities all the way in the other respect. So that brings us into Georgia, and we’ve started moving into some other potential states as well.

Gamble:  You’re a pretty quickly growing organization.

Garrett:  Absolutely.

Gamble:  Let’s talk a little bit about the clinical application environment. I know you have Epic, and I wanted to talk a little bit about that roll out. Going back a little bit, when did it begin as far as the selection process and starting to roll that out?

Garrett:  Actually, the selection process itself started a little over three years ago. We started on the ambulatory side. You’re going to hear me use the word Dimensions. It’s interchangeable. Think of Dimensions as the overarching umbrella that contains Epic as well as several of our other go-forward strategic platforms like McKesson PACS and a handful of other scenarios. Epic makes up about 90 percent of that Dimensions umbrella, but you’ll hear me say dimensions just because it’s so ingrained in my vocabulary.

We started on the path of evaluating ambulatory systems a little over three years ago — almost four years now. We went through a pretty rigorous selection process including our incumbent, which was Allscripts — that was the main incumbent, just to give you a feel for our scenario. Across our physician practices, we had nearly 90 billing systems that we supported in various stages, and we also had about 12 or so different electronic health records that we also supported from different vendors. So we took a very deliberate approach to consolidate into one vendor business partner across the entire ambulatory footprint for the professional billing, scheduling, and electronic health record. So we went through a pretty rigorous process almost four years ago and narrowed it down to three, which included Allscripts, Cerner and Epic, and then went further and eventually settled in on Epic.

We started that process and had a five-year rollout to go across all 380 clinics in those three states. We actually got pretty confident along the way in terms of our ability to roll out, and we started taking on larger and larger waves of implementation. We completed the implementation of waves in two years, so we finished three years ahead of schedule. We came in under budget and we were able to capitalize on Meaningful Use dollars even faster than we had anticipated. We got, at this point, 99 percent of our clinics — if it isn’t already 100 percent — who are up and running and have actually achieved Meaningful U se. So that’s been pretty phenomenal for us.

Along the way we were also able to achieve HIMSS Analytics Stage 7 with our EMR adoption. We were the sixth in the country and the first in Carolina to achieve such status. That’s a pretty big milestone and pretty much validates the amount of work and effort that went into the planning and execution of rolling the ambulatory project out three years early.

Gamble:  How were you able to achieve that? It’s a big thing being able to deliver projects on time and under budget — but that’s really on time.

Garrett:  It is, and quite honestly, it really stems from governance and executive buy-in from the whole organization. The fact is, we had a very strong governance process we never deviated from, which also includes decision rights and all that. So it was pretty much a governance process consisting of our physicians across the ambulatory setting, as well as administrative aspect. It was a phenomenal. I’ve been in the healthcare business in IT for 30 years, and it’s pretty remarkable how the organization came together like that.

That’s really how we did it. Quite honestly, we started out with smaller go‑live waves. When we did our Allscripts go-live it was a large group of physicians that we wanted to bring all up at the same time. There were over 200 physicians in that group, and we wanted to do it all at one time. We did it and it went extremely well, and it gave us the confidence to say, why can’t we keep doing this? So our small waves became fewer big waves, and that’s how we did that in two years versus five.

Gamble:  In doing it that way, did you find that there were best practices or lessons learned that could be applied to subsequent rollouts?

Garrett:  Absolutely. As a matter of fact, we just had to know that it was a matter of scale, so we had to bring in more people. We utilized more consultants. We still used the same number of consultants that we would have over five years; we just accelerated the spend and then overall spent less, because we became very, very efficient using those best practices. The fact that we were able to get everybody up that much quicker was big. It’s the old analogy of ripping the Band-Aid off versus pulling it off a little bit at a time. But it really wasn’t as painful as some people might think.

Gamble:  Right.

Garrett:  That experience and those best practices also allowed us the confidence and the ability to roll out Novant Health Community Connect, which is an offering that Epic provides where we actually sell the Epic software on behalf of Epic to small independent practices that normally would never be able to buy the product, because Epic is not in their market. They don’t sell to small practices. It allows us to sell a product and install the product on our system, using our people. We train, we implement, and then we support it. And so it gave us the confidence and ability to do that, and actually we’re doing that quite well.

We just went live with our fourth clinic and it represents about maybe 15 to 18 physicians across North Carolina. That’s been a wonderful experience as well where we’ve learned lessons along the way, because as you can imagine things are a little different when you’ve got an employed group of physicians versus independent, non-employed physicians. It’s been very, very successful for us.

We continue to do that as part of our strategy to provide the best patient care to our patients, because quite honestly, when our patients are on the same system, there’s no need to worry about an HIE. There’s no need to worry about faxing. There’s no need to worry about making phone calls. Your record is sitting in our system — collectively, our systems, so that independent practices can see the electronic health record for Dave Garrett just as well as a Novant Health Medical Group physician can see Dave Garrett’s clinical record. The financial information is completely walled off in separate so no one can see each other’s financial information. So an independent physician can feel comfortable that no one’s peering into their financial capabilities. It’s pretty ingenious on the part of Epic to do that, and quite honestly, it’s worked out very, very well for our patients.

Gamble:  I’m sure that it helps with the other barrier for independent practices being cost, especially with a system like Epic. We know it’s not cheap, so having some help with that is a nice motivator for them.

Garrett:  Exactly. Quite honestly, it isn’t what I would call cheap. And honestly, when you think about the total cost of ownership, which a lot of independent practices don’t always do, it’s not as expensive as you think either. They can always find something cheaper. I can always go to Wal-Mart and find something a little cheaper than I might have found at Belk’s, but nonetheless, they are getting the best system available for an affordable price. Certainly not cheaper than they could with some other internet-based type of service providers, but I think they’re getting a lot more for their value. And we’ve actually got a pipeline that’s getting pretty deep for us to roll this out to independent practices.

Gamble:  So you’re finding there’s a growing demand for it.

Garrett:  There is, as a matter of fact. And what we anticipated, and what we’re finding is true, is that when we go live with our acute care facilities with Dimensions, it creates an additional demand in that particular market, because the physicians like to be able to be linked with a nice, large acute care facility — or even if it’s not large, a very high quality acute care facility — in their particular market. When they hook up with Community Connect, they’re directly connected with that same patient record that’s coming from out of the acute care facilities that most likely their patients most likely will be sent to in the event that there’s a need for acute care facilities, which kind of leads me into the acute care process.

The acute care process was segmented differently than ambulatory. The ambulatory was ready to go first. With acute care, we were deliberately holding off on consolidating and going to one electronic health record because we were actually we were doing a lot of transformation amongst clinical teams or amongst order sets — amongst everything across all of our acute care footprint. We wanted to make sure we could do that ourselves manually and with the current systems before we tried to use a computer system to force some of that transformation and consolidation and standardization across the board.

It’s been my experience that sometimes people confuse the computer system they’re implementing with being the culprit or the reason why people are consolidating and bringing standardization across the organization. And so we did a lot of that ourselves manually, and then when the organization was ready, we said now we’re ready to go ahead and evaluate, purchase, and implement an EHR in a clinical system across the board.

So what we did, just like we did with the ambulatory, is we went through a selection process. It included the incumbent, which was Siemens, and we narrowed it down to Cerner, Epic and Siemens. Siemens was eliminated first, and then it came down to Cerner and Epic. We went with Epic for a lot of reasons — not just because ambulatory had already selected Epic, but for a lot of other reasons. And so it did bring us to one consolidated EHR across the board. And that’s one of taglines: one patient, one record, one remarkable experience.

Chapter 2