With any major decision, having the right representation is critical – even when the decision seems like an obvious one, said Rich Rogers, CIO at Prisma Health, in this interview. “You have to make sure you have a number of folks represented who voice that same opinion.”
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Gamble: Hi Rich, thanks so much for joining us. I look forward to talking about the work you guys are doing — obviously a lot going on there, and your leadership strategy.
Rogers: I’m happy to.
Gamble: Let’s start by getting a little bit of background information. Prisma is a large system with 18 acute care and specialty hospitals, correct?
Rogers: Yes. We do a little over $5.5 billion and we have around 30,000 employees.
Gamble: And you’re mostly in South Carolina?
Rogers: We’re completely in South Carolina. Prism Health was formed through the merger of Greenville Health System (in Greenville, S.C.) and Palmetto Health System (in Columbia, S.C.).
Gamble: You were with Greenville prior to the merger. Can you talk about what the organization did to come together as an integrated system? I’m sure that was an interesting experience.
Rogers: Yes. It’s been more than four years now. And while I’ve been through a lot of acquisitions in my career, this was the first with two equal-sized systems. I had never worked in that type of environment.
Bringing two organizations together was culturally challenging as well. We had to interview for our jobs and get selected because we all had counterparts, so we had to go through that process. Then it was about understanding the business strategy going forward and what we need to support.
Sometimes with these types of mergers, you act as a holding company and let the health systems function autonomously in their own markets, and maybe have a small corporate umbrella for doing things like population health.
We quickly realized based on market forces that we needed to integrate and take out as much expense as possible so we could act as one health system. Once that decision was made, we started looking at our systems and how we could start bringing things together.
Big decisions – “It comes down to governance”
The EMR is always one of the most visible decisions that needs to be made. We were on Epic in our Greenville market and Cerner and Meditech in Columbia; one of our facilities had some long-term contracts in place. So that was a little bit more challenging, but it really comes down to governance and making sure we have the right representation. Even when it looks like it’s pretty obvious what you should do, you have to make sure you have a number of folks represented who voice that same opinion before you make a decision.
That’s what we did. Epic made the most sense for us long-term as both the EMR and revenue cycle vendor. Once we made the decision to implement Epic in one service area, it pretty much meant we were going to be one health system. Then we looked at ERP, which was the next core system. We had multiple instances of Infor at the time; once you make the decision to go to a single EMR, you can only land tractions to one GL, and so that forced us to make a decision. We evaluated where Infor was going and what were the costs involved, and saw that it wasn’t expensive. There were also some areas like HR that weren’t thrilled with their offering, and so we evaluated the market, went through another RFP process, and selected Workday as our ERP vendor.
Core system work
We had made the decision from an architecture standpoint to start moving as much as we could into the cloud long-term. Once that happened, we looked at office automation and directory services and realize we needed to combine into one active directory. We selected Office 365 from Microsoft and SailPoint as our identity management solution that we would use with the implementation of Workday. We did that first, then rolled out Workday. From there, we were able to go live with Epic. That was the core system work we did.
Of course, we were hit with the pandemic in the middle of those implementations, but it really didn’t impact our schedule, rather than delaying Workday for 30 days. We powered our way through that time period; that’s how we go through it. And in the midst of that, we had to consolidate the staffs down to one and get to a single helpdesk. That was a lot of work.
Gamble: You mentioned governance. I’m sure it was key to address that right away, particularly with how much needed to get done.
Rogers: It was the first thing we had to do. We made sure our senior leaders participated in that, because those are big decisions with big dollar amounts associated with them. And so yes, that was key in getting the ball moving and getting decisions made.
Gamble: With the hospitals that needed to implement Epic, what was the strategy there? Was it a phased approach?
Rogers: Just one phase. We looked at all scenarios and the juice just wasn’t worth the squeeze doing it that way, and so, we decided to do it all at one time. The key was getting physician leaders and clinicians working together to agree on order sets and workflows. That was a challenge.
And I can’t say it was perfect. In some cases, it was ‘if you don’t show up to meetings and provide us with input, we’re going to go with what we currently have built in Epic. And we did because we weren’t going to change the date. There was, of course, some aftermath as a result of that, but we worked through it.
It’s usually the same thing. Primary care just rolls with it, while some of the specialty areas are more likely to get upset and escalate issues with the CEO, which we’ve dealt with. Again, we got through it.
Shift to remote training
Gamble: I can understand that strategy. If you were doing it phases, Covid would have certainly put a wrench in those plans. It did regardless, I suppose.
Rogers: Yes, it did. Probably the biggest challenge was getting to a consistent care model, which was difficult. All support was remote at that point for both Workday and Epic. It wasn’t the first time we went through an Epic implementation, but it was the first time everything was remote, including training, and so we had to shift. Looking back, we probably could have done a better job, but we were winging it. Still, we got everybody through, then we were hit with a surge right before we went live in our Midlands market. It was a challenge, but we did it.
Gamble: Remote training definitely comes with challenges, but it was a necessity, so maybe it forced people to adjust.
Rogers: Yes. Even simple things must be factored in. When you’re going live on Epic and you have a lot of people who don’t typically work from home — and aren’t set up for that — you have to make arrangements in your facilities, while also doing social distancing and accommodate folks who aren’t in a position to do training from home. So yes, it presented a few challenges logistically.
Beyond “staying in the game”
Gamble: Right. So, I’d like to talk a bit about the partnership with Siemens, and what the goals are there.
Rogers: What we found is that our technology had become a bit dated. And so, we had to make an investment just to bring that up to speed. That, first and foremost, was the driver behind that. We looked at Siemens, Phillips, and GE as potential partners, and Siemens came out on top. We wanted to upgrade our technology; to do that, we needed the modalities to stay in the game. But our question was, what else could they bring to the table and what could we do together?
Developing an “innovation arm”
Siemens brought forth advanced technologies that we didn’t have, and some AI capabilities, particularly in diagnostic areas. Not only to replace equipment, but also to help us with utilization and where we should place certain devices based on our population. They brought that expertise to us, along with some advanced technologies that we could embed into our workflows in the clinical environment. That’s taking place now.
Beyond that, we also wanted to do things jointly and bring in our medical staff and research team, and identify places where we can innovate together; for example, if Siemens might not have a product today, but they want to work with us to develop the technology. That’s taking place now as we identify initiatives that we want to work on with them. That’s something we didn’t have before — that innovation arm.
Gamble: That sounds like a really exciting thing to be part of.
Rogers: It is. It’s been a good relationship so far. Part of it comes from our CEO, Mark O’Halla, who has said, ‘we have so much to do in our industry. We can’t do it ourselves.’ And so, we need to partner with like-minded organizations that hold the same values and work together to benefit our industry. That’s the approach we take with our vendor relationships.