In a blog note posted yesterday, I quoted an interview of Daniel Barchi, SVP/CIO of Carilion Clinic, by Mr. HIStalk regarding the health system's conversion to Epic (see: What's Up With Soarian; CIO Barchi of Carilion Clinic Responds). There was another portion of the interview that caught my attention in which Barchi discusses the goal of system integration as the major driver for the deployment of the new software. Below is an excerpt from the interview:
Q: You just finished your massive Epic project, with eight hospitals and 100 practices brought live over a couple of years. Tell me about that project.
A: When we decided that we wanted to integrate from 11 different medical records — 10 electronic and one paper — down to one integrated system, it was 2006. At the time, we were also merging from being a confederated health system into a single Carilion Clinic, so the two projects converged nicely.... We knew we had the focus of the entire organization, so we took advantage of it and used it as a tool to integrate all of our hospitals and our practices onto one platform as rapidly as we could, while still protecting the use of clinical data and the health and safety of our patients....
Q: You mentioned Carilion’s move to the practice-type model, the Mayo model, in 2006. What kind of IT changes did you have to implement to support that?
A: It was all about integration. We had 11 different systems, more than 512 different interfaces, and we had the challenges of trying to get down to a common way of operating....We thought we were only going to be able to do that, not by brushing up on our 500-plus interfaces, but by having it all operate on the same system. One thing that we had done was that we had a whole lot of experience with the GE Centricity product. In the previous eight years, we had rolled out GE Centricity to every one of our 140 physician practices. When we implemented Epic, we knew that we had a responsibility — not only to our patients, but to the doctors that had put all the work of entering and maintaining that information — of having it available at their fingertips the first time they logged in to Epic. One of the biggest early challenges we had in this project was converting literally eight years’ and about 800,000 patients’ worth of data from GE into Epic. We had a small team led by two of our physicians and about five of our IT people who did nothing for about four months than plan the migration of the data and test it over and over again.
When hospital CIOs speak about integration, they are usually referring to the reduction of the number of diverse systems co-existing in the hospitals and physician practices under their control. As he describes the situation at Carilion prior to the Epic roll-out, the central IT group was supporting ten different EMRs and 512 interfaces. As noted in yesterday's note, Epic was chosen to replace the Soarian hospital EMR and the GE Centricity office product previously installed in 140 physician practices. This notion of choosing a single-vendor product obviously has great appeal for CIOs as I remarked previously (see: Optimal Training and Background for a Hospital CIO):
....[T]he natural instincts and training of the majority of hospital CIOs today is to select new systems, particularly EMRs, from a short list of the products available in the market. The majority...are unready or unprepared to manage open source software, develop some software internally, or more fully integrate their myriad legacy systems. For the most part, this "buy over make" strategy will be solidly endorsed by their hospital executive colleagues, including CEOs.
Also of great interest Barchi interview was the description of the database conversion and migration process involving seven people over four months. Obviously, the testing of the quality and integrity of the newly-formed and integrated clinical database is of paramount importance. The attention of physicians to this process is of great importance since they would be most sensitive to even subtle errors occurring during the conversion. Frankly, I am surprised that it only took four months.
Did you have Soarian? Did you convert the data out of Soarian into Epic or some other database?
Posted by: Brenda Johnson | March 23, 2011 at 03:16 PM