Now that it has been more than a decade since the initial push to establish EMRs through the federal Meaningful Use program, healthcare organizations are beginning to face something just as monumental, the need to tie technological advances across the enterprise: enterprise resource planning (ERP). It’s a big undertaking, but one that Onyeka Nchege, SVP/CIO with Novant Health in North Carolina, is queuing up to help his organization meet its overall goals. Not only will the ERP system alleviate pain points, but it will be part of the “secret sauce” all organizations need: a good back-office system, combined with a good EMR, he says. It will help the organization better manage day-to-day business activities, including accounting, procurement, project management, risk management, compliance, and supply chain operations.
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“I think gone are the days where you said, ‘Hey, it’s going to take me a year and a half to implement something,’ right? Those days are long gone, especially when you think about the pandemic and the things that we had to do to react and react very quickly.”
“We aren’t simply taking Novant Health’s current processes and transplanting them into a new technology. It’s not just a lift and shift for us, instead, you know, we’re making an investment that transforms the way our team members perform their work.”
“ … at the end of the day, I aim to ensure that these department leaders understand what our new systems have to offer, and secure their buy-in and input, and create change champions in those spaces.”
Guerra: Onyeka, thanks for joining me. Tell me about your organization and your role.
Nchege: I’m happy to do that. Novant Health is an integrated network of physician clinics, outpatient centers, and hospitals that delivers a seamless and convenient healthcare experience through more than 6 million patient visits annually. And our network consists of more than 1,800 physicians and over 35,000 team members that provide care at more than 800 locations that include 15 medical centers, and hundreds of outpatient facilities and physician clinics. Our core markets are in Winston Salem, N.C., where we are headquartered. We also have a significant presence in Charlotte and Wilmington as well.
Guerra: You have a big ERP (enterprise resource planning) project going. It’s a big deal. I saw the release about some help you were getting with that project. We’ll talk more about that. People have said that Meaningful Use spurred on the EMR implementations, and that went on for quite a long time, and now it’s time for some other big projects. Do you see that evolution over the last 15 years?
Nchege: So you see the big ERP, EMR implementations that are happening, but I think folks are starting to realize the value of what I’m going to call “time to market” and getting implementations done faster, so that your business can start to realize value sooner rather than later. I think you’re seeing more and more of that out in the marketplace, especially in the healthcare space, related to corporate systems, or back-office systems, from an ERP perspective. And then you’ve also got the patient-facing solutions, like the EMR. So, the combination of both of those together is really the secret sauce from a technology perspective within the healthcare space.
Guerra: I’m very interested in understanding how an ERP system request or implementation surfaces in a health system. Either you’re looking and you see what’s out there, and you say, to the business side, ‘Hey, guys, there are other options.’ Or, if these things bubble up from the business side, and they say, ‘Hey, by the way, we’re having some issues here. And we think maybe there are some tools out there that can help us, can you check it out for us and let us know?’ Tell me how that actually plays out.
Nchege: Yes, so I think whether it’s in the healthcare space, or any organization at all, the CIO plays probably two or three, maybe four different roles within the organization, probably in equal part. One is, “Hey, we need this.” And “We need this, as in the form of business capabilities that the organization might need to perform its functions.” And, you know, my role as a CIO, my team’s role is to figure out what’s out there to satisfy the need that we have. It’s understanding what’s out in the marketplace from an emerging technologies perspective, but even beyond that, asking are they things that we currently have in our footprint today, that we are only leveraging just a piece of? And then being able to say, did you know that we could do more with that? I think that’s where that comes into play. And as CIO, my team is always listening to stakeholders across the Novant Health enterprise. You know, our goal is to identify the pain points that exist so that we can alleviate any of that with technology. Ultimately, we want to improve the way that our team members work and the care that our patients receive. Novant Health’s leaders approach decisions and the future of our business as a team, with the CIO and the business leaders connected right at the hip and involved in critical decisions. I think the idea is the CIO and his team probably wear multiple hats. And depending on what’s being asked, that depends on how we how we show up.
Guerra: So, it goes both ways. It surfaces from the business, it comes to you, and they say, here’s the problem. And you try and figure out if maybe we have this in our footprint, or let me investigate, let me check the market out. And then I’ll give you a presentation on what your options might be. But as you said, it also can be you and your team suggesting it to the business. So that’s both ways.
Nchege: That’s correct. Yes. And in this case, the original need came from our enterprise. So, our People & Culture team specifically were the first area of Novant Health that that raised this issue. Novant Health’s discipline is to approach technology needs on an enterprise basis. I’m responsible for ensuring the use of modern IT software and technologies to streamline business operations. This includes managing and implementing technology to support Novant Health’s goals. So, when Novant Health leadership established our long-term strategic goals, we looked across the entire technology portfolio to assess if we had the right systems, processes, technology in place to support those goals. And as a result, we identified a need to better streamline, standardize, and improve our team members’ experiences using enhanced technologies.
Guerra: So, when you say an enterprise basis, that means even though the request bubbles up from a particular department, we’re going to take a look at things and we’re going to come up with a solution that could apply elsewhere, not just to your niche, but one that’s good for the enterprise. So, you’re going to have to give us a minute, because we got to check things out. Right? This is not like we get it tomorrow. This is not ordering it on Amazon, it comes next day. This is: we have to do what’s right for a very large organization.
Nchege: Yes, that’s a great way to say that, because the intent is, “Let’s try not to put one-off solutions in place, right?” Or you put a solution in that only satisfies one part of our business. And not to say that that doesn’t happen, because it does, because all of our business partners don’t use all the same technologies. But where possible, we want to put a set of systems in place, a suite of products in place, that can be leveraged across our entire business. And so, we involve technology experts and business leaders to collectively recommend solutions. And, moreover, we collaborate to determine what’s the best way to put this technology in place.
Guerra: You know, I mentioned next day delivery with Amazon. Earlier in the conversation, you mentioned the concept of speed, and moving quickly to respond to the needs of the business. There is a balance between next day delivery, and I’ll talk to you in eight months when we have a report based on your request. How do you manage that as the leader of the IT organization? Obviously, you want to move as quickly as possible always to respond to the business. That’s how the business decides if you’re doing a good job, right? Are you helping us do the business we need to do? So, talk to me about handling these things as quickly as possible to satisfy the business, but still doing the due diligence you need.
Nchege: I think there’s a balance that you have to strike when it comes to speed to market. I think gone are the days where you said, “Hey, it’s going to take me a year and a half to implement something,” right? Those days are long gone, especially when you think about the pandemic and the things that we had to do to react and react very quickly. So, there’s an expectation from our organization collectively, that things are going to move at a speed that matches the need that I have. And so, we have to take into account what’s the organizational need? How critical is that need? Is it something that truly has to be resolved tomorrow morning? Or is it something that we can say, “Hey, listen, let’s take a holistic approach to the work that needs to be done and figure out how? What’s the best way to get that done?” I think it’s a balancing act.
But beyond that, it’s also about education and communication. Making sure that we are in lockstep with other functions within our organization so that everyone understands, “Hey, let me let me walk you through the processes that we have within our digital products and services organization. Let me walk you through the thought process when it comes to a technology solution.” Making sure that everyone truly understands how this process is going to work. Who’s going to be involved in it? How quickly can we deliver value? And what value can we deliver? So, I think the things that go into making that work, because if you don’t – to your point – what ends up happening is, “Hey, you guys aren’t moving fast enough. I’m going to go on the outside and find someone who can help me get this done faster.”
Guerra: Yes, and there’s a whole bunch of issues that come with that.
Guerra: Because that’s gray IT. It doesn’t go through governance; doesn’t get security vetting, and then it’s, “Oh, help us connect this to the network.” Or you tell me?
Nchege: That’s absolutely correct.
Guerra: That’s a big problem. And I’ve talked to a number of CIOs and CISOs. And that still is a problem in many organizations. It’s not something that’s easy to fix. Right?
Nchege: Yes, it I think it’s a constant conversation piece, right? Within all organizations, that no matter what industry you’re in, that it’s a partnership between the technology organization and the other functions within the organization. And making sure everybody understands what can and can’t be done, and how quickly it can be done. But I will tell you, the technology organizations just don’t have the luxury of sitting back and saying, “Hey, give me time to go figure all this out. I’ll be back when I get back,” right? I just don’t have the luxury to do that. And I don’t, I don’t believe that we should either. Again, we should be moving at the same speed – where it makes sense – without sacrificing quality. We should be moving at the same speed as other functions in the organization.
Guerra: Right. Let’s get back to the ERP a little bit. You said it came out of the People & Culture department, can you give me some idea of what they were trying to do that surfaced the need?
Nchege: Yes. So I think from our People & Culture perspective, I think it’s just an understanding of how do we administer to and manage 35,000 team members with antiquated technologies, which is what we had in place already? So, at the end of the day, that’s really what it came down to is, “Help us figure out how we manage this many team members, and in an environment where we are constantly looking at opportunities for growth, whether it’s organic growth, inorganic growth.” And we continue to add the one ingredient that makes all the difference in the world for our organization, which is our people. How do we put together a technology and a solution, or solutions, that allow us to manage, call it “the asset” that we have within our organization.
Guerra: Was it siloed data? Was it, for example, I have this piece of information here, and I have this here; these don’t talk to each other. And I’m not able to get a complete picture. So I have to create spreadsheets that bring in the data I need. And it’s just cumbersome. And it doesn’t update by itself, that type of thing?
Nchege: Yes. So you hit it right on the head without me giving away all of the dirty laundry. That’s exactly what it is. You’ve got disparate systems that don’t talk to each other. You’ve got folks that sit in other parts of our organization that are unable to access systems, so we will be wanting to get down to a system that allows us to be able to integrate all of our functions. But not just within the People & Culture space. But when you think about supply chain, you think about finance, you think about the technology space, how do we connect all of those back-end systems together so that they talk well together? But also, how do you integrate with an EMR? When you think about patient information, how do you make sure that, from a revenue cycle perspective, there’s connectivity between the EMR and finance systems, so that became the call to action, if you will, for us as an organization.
Guerra: So, you went with Infor for ERP, and you’re using Grant Thornton for help in implementation. We did a whole webinar on using outside help and professional resources and that type of thing, because there’s a lot of nuances there in selecting and arranging all the issues associated with that outside help coming in. Did you know right off the bat, “We’re going to need outside help”?
Nchege: Yes, I’m happy to talk through the Grant Thornton partnership. So, we selected Grant Thornton as that partner given its experience in healthcare operations, large scale implementations, program management, and change management. So, when we thought about the things that we believed would make our ERP implementations successful, those were the kinds of things that we thought about, and we were looking for a partner that could help us achieve that. When I think about long term partnerships and bringing in organizations to help you get through large scale implementations like this, I always say it doesn’t start at the time that you make the decision to bring a partner in, it actually starts well before that. So, think about the courting process, right? You want to go with a partner that you truly understand who they are, and you understand what they do, and what they bring to the table. And oftentimes, I see a lot of organizations start that process when it’s time to bring somebody in, you know, they start doing all this research and all these interviews, and I’m not saying you shouldn’t do that, but there’s something to be said for tried-and-true, been-in-the-trenches-with-you, and been-a-part-of-the-organization. So even though we made the decision in December of 2021 to go full speed ahead, Grant Thornton had been a part of that journey for the better part of two years with us in terms of walking through the need, developing the business case for it, helping us understand what it is that we would need and why we would need it. So, it was a fairly easy decision to go with Grant Thornton.
Guerra: So that’s interesting. They helped you from the beginning of this whole process; vendor selection, right through to they’re going to do the implementation and help you with the change management. Does it come up in your role where sometimes you don’t have the option to go with a firm that does A to Z. And you say, I would love to have a firm help me with the implementation who I may also want to use down the road but sometimes you can’t find someone who does it all, so you have to split up the work.
Nchege: Yes, so to provide a little bit of clarity, in this case, while we’re talking about the ERP implementation, and the work that we’re doing on the ERP rollout, we are also in the middle of EMR integration work. So, we call that the total project, the business transformation initiative, which includes an ERP rollout, corporate system modernization, and then a EMR integration. So, we originally started talking about – to your point here – about potentially having one partner that will do all of that with us. We ended up saying, “Hey, you know what, Grant Thornton, you’re going to focus on the ERP implementation work. And we’ll go out and find someone else to do some of these other pieces, as well.”
So, we did go through a process of getting to know other partners in this process to make that work. Because sometimes you don’t necessarily have the opportunity to go with one partner soup to nuts. So, in that case, we made that decision. But I will tell you that, our Infor implementation, which is our ERP, it’s more than just an ERP rollout. We aren’t simply taking Novant Health’s current processes and transplanting them into a new technology. It’s not just a lift and shift for us, instead, you know, we’re making an investment that transforms the way our team members perform their work. So ultimately, this will allow us to deliver more remarkable patient care.
And in Grant Thornton, we found a partner that could guide and collaborate with us on this journey and walk with us as we embarked on a multi-year endeavor. At Novant Health, we’ve got a long-standing relationship with Grant Thornton. The firm basically worked with us to the point I made earlier, to do the phase zero analysis of the project, which helped us understand our current state and where we could transform. And we felt extra confident with selecting Grant Thornton, because GT had handled many large-scale projects similar to ours. And, you know, finally, we both share a longstanding focus on leading-edge technologies, and we also share very similar kinds of people-first culture values, which are critical to the success of an ambitious, shared technology endeavor like this.
Guerra: Very good. You’ve bitten off a lot. EMR, ERP. You’re not sitting around over there.
Nchege: It ain’t for the faint at heart.
Guerra: Let’s talk a little bit about that. Let’s talk a little bit about when we max out or when we don’t want to take on anymore. Every CIO is going to deal with that. Every CIO has got a maximum the throughput they can manage with the staffing they have. Also, it’s been said that organizations can only handle so much change at any one time. Thoughts around that? Around making sure we go as fast as we can, but perhaps not faster than we can?
Nchege: Yes, so I believe it’s a matter of understanding what the organizational needs are. And coupling that with understanding the rockstar team you have. Whether it’s the internal team you have, or the external partners that help your IT teams go the distance, if you will. So, I think it’s a matter of understanding that because there are some things that our organization is going to need that we’re going to say, look, we have to get this done, right. And to get this done, we’re going to need to go out and get external resources to help us make that happen. Or we may have to reallocate some of the resources that we currently have to get after it. But as an organization, we made the determination that the business transformation initiative was a priority project, priority initiative, for us as an organization, and we allocated what we needed to get it done. But for me, it’s a matter of understanding, with our executive team, with our business leaders, what is it that we need, what capabilities do we need to continue to push the needle forward. Whether it’s things that help us optimize the work that we’re doing today – or we are in a place of, “Hey, did you know that this is coming?” And let’s get ahead of that. So, you start to think about being innovative in your business and some of the things that you believe are going to make a difference for the organization.
Guerra: Do you think the key here is transparency on your part, to the businesses and to your people? Transparency in the sense of, “Here’s what we’re doing for the organization, here’s the project, here’s what’s happening, here’s our budget, here’s what we’re doing with what we have, if you want more, here’s what I need in order for that to happen,” because if you always say yes, you’re not doing a service to your team, you’re going to have team members burning out. So, part of your role is that transparency.
Nchege: Yes, it’s transparency both ways. It is transparency all the way around. And that’s why I use the word education and communication. It’s transparency around, “Here’s what we have today. Here’s what we can do, here’s what we can’t do. And here’s what we believe you as a business leader ought to be thinking about.” So, I think it’s more than just transparency on my end. It’s also transparency on the part of my team members and other parts of our organization to be able to say, “Hey, okay, here’s what I’m thinking about today. Here’s what I need to do to run my business. But here are some of the things that I’m thinking about for tomorrow.” This allows me then to go back and start to brainstorm with our team around how we’re going to fix what’s needed today, to deliver what’s needed today. But we also need to be thinking about the idea of having a scout team go out ahead and find some of the things that we might need as we go along.
I believe it’s transparency on both sides, and then education. So, we can’t create an environment that’s a black box for other parts of our organization. They’ve got to understand what some of the limitations are, for us, as an organization, and what are some of the things that, no kidding, we can knock them out of the park and knock it out far, and so we ought to focus on some of those things.
Guerra: So, let’s talk a little bit about that communication with the business leaders. Tell me a little bit more about how and when that happens. Is it one off? Is it regular with certain individuals? Obviously, everyone’s in a remote environment. There’s a lot that happens on Zoom. All these conversations you’re describing that sound so important, how do they actually happen?
Nchege: So, it’s about having management routines in place. Where so it starts at the very top. So, you think about our organization at Novant Health, Carl Armato, (the CEO) has a weekly set session, which anyone in our organization is able to tune in and listen to: Carl’s Corner. And on a weekly basis, you can hear Carl talk about things that are important that are going on in the organization. And you can hear Carl talk about ideas. So where does he see this organization going? And then you take that a step down, our executive team has, you know, periodic meetings, the senior leadership teams have executive sessions as well, where we’re able to hear about some of the things that are going on in the organization.
And then again, you continue to push that down into the organization. You take the office of the CIO, for example. I have a monthly meeting with everyone within my organization to share some of the projects that are happening. All the things that we’ve got going on, here’s what I’m hearing from other parts of our organization. And we do that across the board. So that’s one way that we continue to get that information out across the organization. And then we have steering committees that help us also start to prioritize the work that needs to be done.
So, I think we’ve built management routines that allow us to be able to do that. And the same is true for the business transformation initiative and the ERP work that we’re doing right now. So, we’ve said there’s a multi-year rollout for this body of work. We have periodic sessions to describe this multi-year work. When is it going to be available, including putting together SharePoint sites where we continue to update that site and have dynamic content out there, that allows the organization to understand what’s going on. So that’s very important, especially given that these are big projects in the organization.
Guerra: You mentioned it came out of People & Culture, but we know these are big projects. Can you think of any other key executives you deal with in an ERP project where the CIO needs to have some direct conversations, to make sure those people are informed and on board?
Nchege: Yes, so at Novant Health, there are two key layers of leadership that we have leveraged for our transformational work. The first layer is executives from across the organization who have been instrumental in developing our business case, the strategy, the goals for transformation, with very close collaboration and involvement from our chief financial officer, our chief transformation and digital officer, our chief administrative officer and their leadership teams. It’s the CIO, it’s the SVP of finance. It’s our chief procurement officer, our SVP of supply chain. Those are all roles that the leadership level has been engaged with and, quite frankly, there isn’t any role that has not been engaged already.
And as we previously talked about, an ERP implementation is more than just a technology initiative. It’s people; it’s process. It’s supported by technology. And so, as the CIO, I’ve got to develop partnerships across the organization and respond to, or facilitate, the needs of the entire organization. We also have a steering committee, as I mentioned, and that includes senior vice presidents and above, from our regional markets, and from teams in areas such as digital products and services, people, culture, strategy, execution and clinical programs.
The steering committees also includes representatives from our physician network and nursing teams, then that second layer is operational leadership in a wide range of areas, including all the same groups that I mentioned before, along with infrastructure, cybersecurity, and communications. Some of our departments have historically used their own systems and processes, and it will be a substantial effort for them to transition off of their legacy technologies. But at the end of the day, I aim to ensure that these department leaders understand what our new systems have to offer, and secure their buy-in and input, and create change champions in those spaces.
Guerra: Very good. Well, we’re almost at a time. I’d just like to get your final piece of advice, and I want to frame it up this way. Think of a CIO at a comparably sized health system. And the requests from the business around ERP are just starting to surface. So, they’re starting to have those conversations, the business is starting to express what could be a possible need for a new ERP system. What’s your best piece of advice at that point for how they can get off on the right foot?
Nchege: So, for me, it’s all about understanding what your organization needs. I think a lot of times we may want to move forward, but we just don’t understand what the organization needs. But being in the seat that we sit in, from a digital products and services perspective, as the CIO and all the other leaders that make up the digital products and services organization – I think it’s incumbent upon us to be able to bring that expertise to the table. We have to say, “Okay, here’s what you’re looking for. And here’s what you want. Now, let me also throw in what’s possible,” right? And what’s available and what’s out there. And I think coming at it from that perspective allows everyone to be successful going forward, because it starts to open up the dialogue, and the communication footprint for everyone in the organization to be able to weigh in and say, “Here are some of the things that we’ve got going on at Novant Health. We’re committed to delivering a remarkable healthcare experience to the communities that we serve, supported by world class technology, personal communications and care that’s easier to access and understand.”
So, you know, we’re focused very heavily on the future of Novant Health and success to us means staying at the forefront of technology and scalability, employee experience, patient care, those are all things that are meaningful to us. And so, we’re willing and determined to continue to invest in our future. And I would encourage others to think critically about the multifaceted benefits of transformation.
Guerra: Wonderful, thanks so much. That’s about all we have time for today. I really appreciate it. Great chat.
Nchege: You are more than welcome.