Odds are, while you spent the past decade focused on enhancing the critical functions of your EHR, you may have had little time (or money) to spend on your organization’s other important “E” system.
Your ERP.
Now you’re left trying to reconcile your state-of-the-art EHR with a lackluster, legacy ERP, which, in many ways, can be like trying to connect your iPhone with a walkie-talkie.
If you want these systems to operate cohesively, it’s time to turn your attention toward updating, upgrading, or replacing your legacy ERP system. And while you may be in the initial phases of planning your ERP update and integration with your EHR, we’re here to tell you it’s worth it.
We recently sat down with a few of our performance improvement experts who’ve witnessed these benefits firsthand. They just completed a project where they helped an organization enhance its EHR and ERP integration in the perioperative areas. By pinpointing and resolving the EHR/ERP integration issues surrounding the organization’s OR supply chain, the team helped the organization increase time savings and cost reduction – enhancements that have already added millions of dollars to its bottom line.
Listen in as our experts make a compelling case for driving functionality between your systems to realize these improvements in the OR and beyond. Also, if your organization is looking to upgrade your ERP system in the future, they outline a few steps you can take right now to make the transition easier in the long-run.
If you’d like to discuss this topic further, or if you’re looking for additional advice on your ERP migration strategy, please give us a call.
Show notes
[00:00] Intros
[03:31] EHR and ERP integration in the OR: Overview of client partner’s project
[04:33] Challenges and solutions: Conducting an assessment to pinpoint the organization’s main integration problems
[05:45] Results: Performance improvements the organization is experiencing between its ERP and EHR systems in the OR
[09:31] Other key areas of focus for EHR and ERP enhancements (outside of the OR supply chain)
[11:00] Successes: Breakdown of the ROI and cost/time savings the organization is experiencing
Transcript
Brian Beinborn: Hello everyone. I'm Brian Beinborn, vice president of strategic solutions at Nordic. For the last 15 years I've worked primarily in the clinical EMR space. I started at Epic and the perioperative applications, which introduced me to the integration supply chain and EMR. Today we hope to discuss the benefits of a well-integrated ERP to EMR foundation as well as the planning you can begin now for your eventual transition to your cloud. I'm joined by Michael and Munaf from our strategic solutions team. Guys, please introduce yourselves.
Michael Malecha: Hi, my name is Michael Malecha. I'm senior director of the ERP practice here at Nordic. I've been a consultant, a manager in the ERP space for healthcare for almost 30 years, and I was also the manager of ERP for Dartmouth Hitchcock Medical Center and director of ERP for South Coast Health for a cumulative total of about 10 years. So I've been in your shoes.
Munaf Noorani: And I'm Munaf Noorani. I'm a manager on our optimization team. I spent a few years at Epic where I led up the materials management work group, but have since then worked in OpTime/Anesthesia as well as the data & analytics side, which kind of melds together in the work that we're doing here with ERP to EHR integration.
Brian: Great. Thanks guys. The focus on this has increased a lot in the last few years. For most of the last decade or so, healthcare organizations have focused their time, energy, and resources on implementing EMRs. This means for many, the ERP system has remained stagnant in terms of functionality. With the impending upgrade to the cloud and the new attention ERP systems functional abilities, the timing is right to take a look at your current integration between ERP and EMR to maximize the benefits you set up for long-term successful transition.
Munaf, you recently completed an engagement with a partner focused on improving this integration in the perioperative areas. They came to us saying they were potentially losing over a million dollars a month in their perioperative supply chain. Could you give us a little bit of an overview of that project and the benefits that organization is seeing?
Munaf: Sure. So this organization came to us knowing they had a problem and that problem really nested within a database that they had sitting in between Lawson and Epic. They were requiring two users to manually update this interface on a daily basis to get information from the ERP system to the EHR. And this resulted in lags in authorization and pricing information getting to Epic, resulting in them not charging appropriately or knowing what they actually had on hand.
Brian: And Munaf, this is something we don't typically see in an Epic to Lawson environment, correct?
Munaf: Correct. It's a little unusual, but I think the downstream impact and the work that we did once we had gotten that interface fixed is something that we see in other organizations.
Brian: And we started to understand their problems by starting that project with a quick assessment. We did a very rapid assessment to be able to understand what those problems were and come up with the solution that included four parts, right?
Munaf: Correct. So we had four waves. The first included that interface piece to get the database out of there and set up a direct interface from Lawson to Epic. In that first wave, we also looked at their preference cards and tried to clean up those that may be outdated or should no longer be in the system. We had a second wave where we looked at supply chain communications with the OR and supplies being used outside the OR. A third, where we looked at case processing with the supply chain group and information that was being sent back from Epic to Lawson for pick tickets as well as barcoding.
Brian: And Michael, you probably understand, right? The benefit of having to have operations involved in a project like this.
Michael: Oh, absolutely. No longer are ERP components considered IT-centric. It's very much in the functional hands of the operations groups to both utilize the information and data as well as take advantage to gain further efficiency and improve operations based on the results. So these are not IT endeavors by any stretch.
Brian: So, Munaf, now that we've identified the problems, what were some of the outcomes that we found at this healthcare organization?
Munaf: Sure. Let's start at the top with the piece that's more Epic-centric than ERP-centric. Preference card maintenance. When we started, they had 17,000 preference cards in their system, which was way more than seemed appropriate for the number of surgeons that they had. We did a few searches and looked at those surgeons that may be retired or no longer with the system and found almost 11,000 extra cards that weren't really needed. And we just went ahead with their operational group and deleted those out of the system. We found another 1,600 or so that they made inactive but thought, "Hey, these providers may come back, but at least let's get them out of our day-to-day maintenance."
Brian: And preference cards are really the backbone of everything in the OR right? I mean, they impact scheduling, billing, documentation, supply chain, patient throughput and efficiency. So having a clean preference card file really kicks off the entire surgery process more efficiently. Correct?
Munaf: Correct. And going along with that with editing their preference cards and getting that interface set up, we saw their charging per case increase dramatically. It went up roughly $662 per case, which multiplied out by the number of cases that they're doing per day and per room over the year is a huge number.
Brian: And then you mentioned the second phase was the more integrated with the supply chain group and the operational having both groups there. I mean ultimately the success of this project was based on those groups coming together and having a good relationship.
Munaf: Definitely. And I think to go with that, with enhancing those communications, fixing that interface and getting them set up to send information back from the OR to supply chain, we also saw a huge reduction in the amount of items being returned from the OR to supply chain at the end of the day every day, which helps out with ordering but also just saves time so that people in supply chain aren’t having to credit items back into the system. Just to put some numbers around it. When we started the project, they returned over 600 items a day from the OR back to supply chain. And towards the end of the project that number dropped down to 384, and the cash value of those items was over $4,000.
Brian: And you guys also implemented barcoding and the OR, correct?
Munaf: Yeah, and that's one that was definitely a big time-saver and one that made the nurses really happy. We had to work with our supply chain counterparts to make sure we were interfacing the GTIN number so that each of those supplies would be recognized by a barcode scanner. But once we had that set up, barcoding worked flawlessly and actually it helped out their other regional sites since they share an item master.
Brian: And with cleaner preference cards, supply chain leadership involved, we also saw a few unintended benefits like reduced turnover times.
Munaf: Yeah, that was one of the more interesting ones, ‘cause I don't think we expected it and I don't think the OR expected it either. But we did see turnover time reduce between three and five minutes over the course of the project, and when you account for the number of cases and rooms, again, that really adds up if you're able to add another case. That's adding so much more productivity to your OR.
Brian: And Michael, this is like one example of where ERP and EHR integrate together one area of improvement, but there are others that there's value to be gained from as you prepare for the cloud, the integration with other verticals, etc.
Michael: Well, you're absolutely right Brian, in looking at this type of an optimization project, there's really no wrong time to take it on. For instance, if you know you're going to be going to the cloud, but it's a long ways off, you'd best take advantage of the time you have before that project begins to do this type of optimization and begin to take advantage of its cost savings that can be derived immediately.
Further, some of the data cleansing, item master cleansing and cleanup data normalization, consolidation of M&A data – if you've been through acquisitions and affiliations and consolidating that information into single files that are uniform – that type of work should be completed prior to embarking on any type of an upgrade and especially a move to the cloud. Too often organizations will include those type of cleansing operations and optimization processes within the sphere of a project and the challenge there, is that these are really sub-projects unto themselves and they can actually impede the progress of your move to a cloud system. So doing them early on makes a lot of sense. Again, if the cloud move is a long ways off, you'll have plenty of time to take advantage of these improvements in the immediate term.
Brian: Munaf, you were mentioning some of the wins. So the turnover times the increase, the reduction in returns to the sterile core to reduce the reduction of waste items ... What kind of comprehensive kind of outcomes and ROI are we looking at here?
Munaf: I think to add another one quickly, when we are looking at the out of OR supplies that may not be charged for, we did find that there were some high-dollar perfusion items that they weren't charging for. So we did add those as well. And those in it by themselves were over $800,000 a month. When we looked at the total impact of this project over that first year, we estimated roughly $29 million of return for this hospital. That's something that they were really happy with and it's something we were really pleased with as well because it's immediate return on investment in a project.
Brian: And we realize not all of that is direct, right?
Munaf: Correct. And I think with all of these, you know, they are somewhat dependent on the operational staff's commitment to keeping their preference cards clean. To keeping these communication lines open with supply chain. But I believe it's a start in the right direction and they're seeing the return, so there is no reason for them to not keep those going.
Brian: And we talked briefly about the depletion interface, the ability to send messages from Epic OpTime for supply usage back to Lawson. In this case, Michael, that's a great way to improve perpetual inventory in the ERP system.
Michael: I think to your point, Brian, the complexities of supply chain in the healthcare setting are enormous, especially when you're working with a tremendous number of immediate orders that have to be supplied through your own supply house as well as the unusualalities that come along with a high-volume consignments as well. So the trackability and the maintenance of a tight inventory leads to the cost savings we're discussing and the efficiencies and the awareness that the items that are going to be required for any specific case are going to be on hand.
Brian: Definitely. I mean, this was a fun project. I think Munaf and I can speak to that. We had a great partner, great group of consultants, and it was very fun to dive in and see this sort of improvement, and it's something that we'd love to continue to be able to do in the future because we think the outcomes are really substantial.
So I just want to thank Michael and Munaf for their time today and helping us explain not only this project, but some better of the integration benefits between ERP and EHR and want to let anyone know if they have any questions about ERP, supply chain, or any other services, feel free to contact us here at Nordic.
Munaf: Thanks, Brian.
Michael: Thanks, guys.