A Look Back: Decisions that Led to a Unified EHR with MEDITECH Expanse

Sobol: Welcome to the CereCore podcast where we focus on the intersection of healthcare and IT. From practical conversations to strategic thought leadership. Let's unpack the decisions, challenges, and journey of those whose purpose is to deliver technology that improves healthcare in their communities.  

Today on the podcast we are delighted to have Tom Kurtz as our guest. Tom is the Chief Administrative Officer at Memorial Healthcare located in Owosso, Michigan. 

Tom, thank you so much for joining us. We’re going to go ahead and jump right in. So if you would, tell our audience just a little bit about your professional journey and your leadership role today Memorial Healthcare there in central, Michigan. 

Kurtz: Sure, I've been at Memorial Healthcare, 7 years next week. I'm coming up on an anniversary here at Memorial. Started out my career at Memorial as Chief Information officer. And since that time, we've grown a significant amount in that 7-year period that I've been here. We've grown by over 50% in that time because of some of the skills and backgrounds that I've had in my past career. I've added some roles and responsibilities as you have seen in that CIO role in many Industries to grow much beyond into many operational areas.  

My title now is Chief Administrative Officer a handle most things that don't relate to direct patient care. So, IT, business development, public relations, all of our land and property management, public safety, and pharmacy, which is kind of an interesting connection, but that's largely because we have a strong footprint in the retail and specialty pharmacy market. 

 I've grown into those business operations as well. My professional journey here again started as Chief Information officer and has built upon that with the set of skills that I've had. 

Prior to Memorial, I had a long career in higher education. So, that's where I spent most of my time before jumping into healthcare. I spent 15 years both on the IT side but also on the academic side of things, leading programs and doing curriculum development and that sort of thing. It's been a great seven years. I've enjoyed healthcare significantly, and in that time, we've accomplished some very great things here at Memorial. 

Sobol: Oh, that is very true and certainly your background and now current responsibilities and perspective brings a unique lens to this conversation. Appreciate that engagement and involvement. One of the things that can sometimes be a challenge for healthcare leaders is the development of culture and collaboration and the balance that plays not only with the community but with the organization and then how technology kind of ties that all together. If you had to sum it up -- is there a secret sauce in your leadership strategy or approach there at Memorial that it helps you really enable that? 

Kurtz: Well, I think personally my leadership style is to always listen first. I try to do my best when working with any of our community -- whether it be our physician community our employee community or our general community of patients in our area being a community hospital. We are very, very closely tied to our community market. I think that my leadership style is really built around that -- listen first, act second.  

I think I do a pretty good job of understanding needs and requirements before going out and suggesting anything that would meet that need. So that technology piece and that tying in the technology piece to it really is solving problems that exist in the market or allowing new initiatives to be created that could improve the care of our patients, the work of our employees, and our physicians as well. Really using that technology as an enabler, but only doing so after listening to those needs of most of our stakeholders and we treat those stakeholders and like I mentioned three pockets – our physicians, our employees, and our community and each one is so vitally important for the success of a community hospital. 

Sobol: You are spot on there and it is always that challenge too. I think folks that come from a pure technology background sometimes miss that component -- and they think oh my goodness, you've got to be on the latest and greatest. Or hey, this is a really “cool” technology and you just have to use it. 

Well, is there a business case? Is there a need? What is it solving? Really appreciate that approach and perspective. One of the things you all embarked on was a consolidated EMR journey a few years back. Quite frankly, you were one of the organizations leading the pack in and around that consolidated MEDITECH Expanse platform -- across both the acute side as well as the ambulatory. Looking back on that, can you walk our listeners through some of the discussions and thought processes that prompted Memorial to head down that path? 

Kurtz: Absolutely. I think the best place to start is where we were as an organization when I started. And this isn't about me and my role and what I've done here, but really kind of setting the stage of where we were pre-EMR selection. We had been a long time MEDITECH customer. We were on MEDITECH Magic for 20 plus years. In our ambulatory practices, MEDITECH didn't really have that ambulatory solution that met our needs. CIOs past selected Allscripts as our EMR for our ambulatory practices. When I arrived, we were on MEDITECH Magic for 20 years and on Allscripts Pro for 10 years and had those systems significantly very tightly integrated between the ambulatory practices and inpatient side. But what we had found is, even though they were very tightly integrated, it wasn't really truly a single patient record.  

There were things that were missing. There was documentation that couldn't be accessed from one side or the other. There wasn't that seamless communication between referring provider or consultant on the inpatient side to the primary care on the outpatient side. 

And we as an organization have a significant presence when it comes to our employed provider group. We have 110 providers over 28 practices that spawn seven counties. 

When we have that integration between the entirety of the care continuum from that ER visit to the inpatient stay back to the primary care, home health, and hospice integration and those types of things. It's very important for us to have that level of integration -- that singular patient record-- to really help the care of the patient by having that entire, holistic understanding of the patient's experience throughout the care continuum.  

We realized at that time that having two separate EMRs, as tightly as integrated as they were, wasn't going to get us to that point where we could appropriately track health maintenance, track compliance in the healthcare, track avoidable ER visits, tracking mortality rates and all the different quality measures that we track in a day-to-day basis. 

It became more of a chore than it could be in a singular patient record because we had those two separate systems, two disparate systems that were completely different in the way we pulled data. Completely different the way they interacted with the patient. Having a substandard, in my opinion, patient portal because we had to integrate that patient information from multiple sources.  

That holistic patient record not only impacted the clinicians’ ability to make good decisions because of that holistic care, or data, but also impacted the patients as well by having that singular patient record and they can see all aspects of every visit that they've had and Memorial under that one patient portal. 

Sobol: That’s excellent. As you embarked upon this, obviously there were --you touched on it earlier when you talked about decision-making --a number of stakeholders. As you got into the project and as you started looking at it, you added another stakeholder in there and it was our privilege to kind of help you through that journey from a CereCore perspective. Can you tell us a little bit about what that looks like, what that decision-making process was, and then just how that engagement across that continuum -- your physicians, your clinicians, taking into consideration the community needs, the software provider and then CereCore. How that all worked together. And were there any challenges that may have come up because of that, and recommendations that you would have for others as they begin to look at a similar project on a go for basis. 

Kurtz: You know, Phil, I think you could really build an entire podcast series around that question.  

Sobol: You’re right. 

Kurtz: It's very complex and trying to do so with a little bit of brevity. It's gonna be a bit of a challenge.  

Sobol: Maybe a highlight or two... 

Kurtz: It was clearly evident to us that we did not have the volume of resources necessary to be successful in an EMR implementation, while keeping the wheels on the bus. Right?  

In our implementation year saw a 26% growth in our net patient revenue, and the year after go live, we saw a 12 or 13% growth. So, we did not as an organization put our institutional objectives aside to focus on an EMR implementation. Nor where we interested in doing so. We knew that we had to have additional resources in order to complete that.  

Resources is only one piece of the puzzle though. Because I will tell you that not any individual, myself included, in the IT architecture at Memorial had ever done an EMR implementation. That in and of itself also led us to have a need for outside expertise. 

So, resources and expertise. The last piece of the puzzle is we needed an outside view. We again have been in business for 101 years. We had been on the same system for 20 of those 101 years. We needed that group that was going to come in and ask the challenging questions. And not accept the answer of we've always done it that way. And not allow us to... not take the best approach in workflows and decisions and the ways we implemented the system just because we've always done it that way. So again, we needed to have that that expertise that resources and that group that would put us in check, if you will, in making sure that we're doing everything appropriate and doing it the right way.  

Sobol: Sure. No, it's that's excellent. There's a number of organizations that implement a new system that covers both ambulatory as well as the acute side of things some choose to break it up. 

You chose to go all at once from your standpoint. If you had to give maybe a word of advice for the next organization that's looking at this coming off of a similar situation. Legacy, Allscripts, an ECW or you name it and coming together -- are there a couple nuggets of wisdom of post implementation clarity that you would you would offer up for folks?  

Kurtz: Two. There are two things I would say. One --rip off the Band-Aid. It is your goal to have a unified system. Doing it in pieces doesn't get you there any more quickly. In many cases creates more challenges than it solves in terms of having to reintegrate existing systems together and sometimes you would go backwards to go forwards. So, you would be losing functionality, losing integration, and going backwards.  

The second piece is: make sure everyone's on the bus. Right. This is one of the things that CereCore helped us with. They facilitated the discussion between three major constituencies: between the physician group, the IT organization, and administration in making that decision on going big-bang. Because we at the time were the third largest big-bang that MEDITECH had done or it might have been even the largest. I think we're third now, I think a couple of larger institutions have gone live after us. Saint Luke's I think is another one that was a little bit larger than us that went live after. Really, looking back at it three years later, I would not have changed that decision. I think it allowed us to focus on our end goals and objectives.  

We also took the time to make sure that everyone was on the bus when we made that decision. We couldn't say halfway through, “Oh man. We shouldn't have done it that way.” Well, you were part of that decision process. 

These are the reasons we made that decision and I stand by that decision three years later. I would not change that. It really worked out for us. There were significant challenges that we had to overcome in order to do that. Largely on the complexity of go live. It is the biggest piece. When we had a hospital, an ER, and at the time, 100 providers, over 26 practices in six counties. It was a monumental task to do that go live and have that supported appropriately because of that big bang approach.  

Sobol: Understanding that approach and that pre-planning to make sure that you're properly staffed and executed and even more so the critical nature of ensuring that all those stakeholders are engaged throughout the process and that they're in essence putting their name to the decisions --right or wrong. Hey, we were all engaged, we were all involved and we're all on the same team, which is a good thing on a go forward basis.  

As you're looking back now, post go live -- and granted it's been a go live amidst an anomalous situation over the past several years with covid to say the least. Has Memorial been able to see some of the benefits of moving to that singular patient record across both the ambulatory and acute side? 

Kurtz: You know we have and some of those were immediate -- for example just in lab. This is a very specific example. Orders in lab being tied to results coming back and making sure that the providers can see that their patients are within compliance. I mean that was an easy, big win. The order instantaneously was resulted and there was no second-guessing.  

Our orders process was actually done through a SharePoint middleware system to get between the two EMRs. Those are some immediate wins. Other things are seeing the entirety of the physician note, progress notes as patients are in the hospital. Our primary care physicians would get an instantaneous notification if they have any of their patients in the ER or in an inpatient setting and they can see as the care is happening. They can see that information about how their patients are being cared for in the inpatient setting. So, some of those were very instantaneous and very quick wins.  

Long-term, I will tell you it's a journey. And we're not complete with that journey. We are not to that point where we were with our previous systems of where we squeezed everything there was out of that orange and making sure that we have optimized every piece, and every application, every piece of documentation, every integration, every tool and functionality. 

We're not there. We're three years in but two years of that was Covid and we were in an institution where we were changing floors from one use to another it seemed on a day-to-day basis. We are moving covid patients. We grew to having too many covid patients where we had cohort them in different locations. We stood up clinics for everyone that was symptomatic. I mean, we were really reacting to that pandemic and that was less than six months from our go live.  

We did not have that opportunity to really spend the time in doing that post live optimization work. Honestly, we're just getting to it and getting to it now and getting some of those things done. And so really it is a journey. It does take time. We have not accomplished every one of our goals. We had been set back by the pandemic, a couple of years' worth of work, but I'm confident that we're gonna get there. It is just gonna take that time and effort and dedication and getting back to that normalcy within our day-to-day operations, hopefully.  

Sobol: That normal rhythm. No, you're right. Certainly, it's a testament to you and your team and across the spectrum of healthcare workers how they were, you all were, able to pivot and adjust and meet the needs of the community. In particular, even coming off of an implementation so quickly. Those sorts of undertakings are not to be taken lightly. They are very all consuming. They take a lot of time and effort and a lot of mental effort too. And so then to hop right from that to having to deal with Covid -- just a tremendous testament to you and your team. As we've worked with you all and gotten to know you, we just can't say enough about the dedication that you all have. Really appreciate you sharing with us on that.  

One of the things that as you went through this process, then Covid, and as you're now looking forward to an optimization standpoint. How are you handling those sorts of requests? How are you gathering what optimization should we be looking at you? Do you still have steering committees in place? That will take a look at those and say okay we've had this request. Oh, it may cross over it. May it may impact both the ambulatory side or it’s the acute side. How are you going to address that as you move forward into that optimization phase? 

Kurtz: It's gone through iterations for sure. We were standing up what I would consider a very robust multi-disciplinary change control process. That was the last big step we took right before covid hit. Things have changed since then. In terms of things that we had in the past -- like the provider advisory committees -- what that has spawned into really is a holistic provider advisory committee that talks about everything from practice management to patient flow to interaction between primary care and specialty.  

We actually combined that IT or EHR provider advisory committee with a holistic employed provider group committee. So, we have that group that handles EMR requests and prioritization. We also have our med exec because not every provider that we have is employed. So, we have our medical executive team. We have a clinical EHR team that looks at things that are not physician related like our outpatient therapies, our lab environment, radiology, nursing those types of things.  

We have multiple groups get together and they make those decisions when it comes to prioritization, and it first starts by again, identifying the problem, looking at appropriate solutions, what tools do we have in place to achieve those, and then prioritizing them as much as we can. 

And it's not an easy task, right? Because there's multiple people that have multiple needs and getting them to all agree upon a prioritization is a bit challenging. And so again, I'd love to see that get to a greater level maturity here as well. And that's something that we continue to work on. But again, it's some of those post-live challenges that you're not done after your go live command center shuts down. Everyone knows that. Everyone knows this is a long journey, but for us it has come in multiple iterations, and probably will have several more in the coming months. 

Sobol: You are spot on with that. I'll even take it a step further. I think so many times when you embark on a journey like this or even on an optimization project, you're doing it for a specific reason. You're looking for outcomes. You're looking for results and so many times the tendency is to go live and go, "We made it.” 

Versus then saying okay, but now let's start measuring and tracking those results or they what we thought they were going to need going to be. And it's a number of things. One -- it’s looking at that to make sure that the process that you went through. First, identifying and approving those is solid or maybe it needs some tweaks, but then secondarily and I think almost more importantly internally you need those celebrations of success. You need to be able to as an organization point and say look what we did. Yes, this was hard work, but look at the results. Look at how those results are not only impacting our clinicians, our organization, but our community as well in a positive manner. We always love seeing the stories that come out about those successes and look forward to seeing many more of those to come out of Memorial there.  

Kurtz: Well, you want to take advantage of those wins, right? You know, we just had our triennial survey that was a year late because of covid with The Joint Commission. It's more like a four-year survey rather than a three year. So just a small win in looking at The Joint Commission survey and what they did or did not find as opportunities for improvement in our EHR. We were very satisfied. There was not a lot of room for identification for opportunity purely on the EMR implementation side. 

There's some documentation things that they always find and those types of things, but even those are small wins and in particularly going through the first survey and a new EMR that can be a bit nerve-wracking and can be a bit stressful. We passed that test and so that was a testament to our teams and in the work that we've done to ensure that we are under that continual readiness for many of those things. Those are small wins. 

We also had those wins when the CereCore team -- our go-live team departed us. We had a great dinner when we celebrated that team -that team that was with us for 18 months and --and seeing them leave and understanding. Oh boy. Oh man, now it's us. Right. Now we're on our own. But really our CereCore relationship has gone well beyond that and we've had multiple instances where we've taken advantage of many of the services that CereCore is able to provide and to make sure that we're appropriately getting things done in a timely manner. So yeah, you do want to celebrate those wins as you have them, and some of them can seem incredibly small, but are yet quite satisfying.  

Sobol: Absolutely. Well Tom, as we wrap this up, are there any last nuggets of hindsight? Insight that you would want to share with our listeners as they are doing a couple things. One is they're looking at potentially moving to a consolidated single record, from an EMR perspective, or in general, when they're looking at embarking on something that is transformational inside of their organization. 

Kurtz: The biggest thing I could say is do your due diligence, and if you if you need help with that find a great partner to help you with that due diligence. We spent two years looking at different solutions. We did not only look at MEDITECH. We looked at other solutions as well. Just because we see this as a minimum of a ten-year project and this is one of institutional priority. And it has to be treated as such. Get engaged with the entirety of the executive team, the administration, the leaders, the physicians. Get everyone involved in that decision-making process so you're not second guessing yourself later on. And we're not.  

Really dedicate the resources necessary to make the project successful. There are no shortcuts in this process. There are no ways around the expense. It is a big expense and it needs to continue to be treated as such. Like you mentioned, celebrate the wins and continue working in that environment.  

And the last thing I will say. We actually put this on a banner and put it in our war room, if you will, of our EMR decision making process. We are not allowed to say, "We've always done it that way.” And when particularly going through a transition of this magnitude, you have to look at things holistically and you can't say we've always done it that way. That's what I would leave people with. 

Sobol: I think that is fantastic advice. Wonderful. Well, Tom, as always, thank you so much. I appreciate your time today and look forward to our future endeavors together. 

Kurtz: Phil, always a pleasure. Thank you. 

Sobol: Thank you.  

Thanks for listening to the CereCore Podcast. If you like this conversation, check out our other episodes visit us at CereCore.net to learn more about our IT services and connect with us on LinkedIn. At CereCore, we are healthcare operators at heart and know the difference that the right IT partner can make in delivering quality patient care 24/7. 

Let's help make IT better. Here's to the journey.