Maximizing Potential of the ERP and Long-Term Covid-19 Response with PeaceHealth
Episode 33120th November 2020 • This Week Health: Conference • This Week Health
00:00:00 00:33:59

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 Welcome to this Week in Health It. Today we have a great conversation. I get to talk to, uh, the application team, the leadership of the application team at PeaceHealth, a great conversation, uh, and we talk about implementing and managing a health systems application portfolio. Uh, wonderful conversation with, uh, these two leaders.

My name's Bill Russell. Sometimes I get bored reading the same thing over and over again. I'm a former healthcare CIO. I managed a 16 hospital system. . You know, five, $6 billion in, uh, in revenue. And when I left there, I wanted to do something to help the industry to stay current on what was going on in health it.

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Hello at this week in health Now onto the show. Alright, so today we're gonna have a fun conversation. We're gonna talk about selecting, implementing, and managing a health systems application suite and . I, I get to talk to a lot of CIOs and we talk strategy. It's nice to go get one level below that to the people who are actually in the weeds doing the work.

And so. To the leaders from PeaceHealth with me, Amanda Bass, the enterprise application manager, and Molly Catis, director of applications is with us as well. Good morning, welcome to the show. Good morning, bill. Thanks for having us. Yeah, so this is really good morning for you guys 'cause we, we are on opposite ends of the coast and you guys we're, we're kind enough to take a morning, uh, a morning show, but nothing's really going on in your world, so.

It's probably not that big a deal to, not a thing. Not a thing. Yeah. not a thing. So Molly, you were just some, some people might not know you as Molly Kas. 'cause you were just recently. Recently married. And actually I, I, I just wanna start with that story 'cause I think it's, it's fascinating 'cause you, you got married a month and a half ago and I think people are wondering like, what, what does that look like to get married within a pandemic?

We've heard some, uh, you know, interesting stories. My son actually got married in February. They took their honeymoon in. France and got back and, and when they got back, they closed down France. Like you couldn't go in or out of France. So they, they literally got married. They felt like the last people in and out of the country.

Uh, you know, give us a little, a little of your story if you're okay with it. Give us a little of your story. I'm, I'm, you know, I Sure. Interesting. Your son got in and the nick of time, that's for sure. So when, um, the pandemic hit, we were, we were planning to get married in September and, and that's a plan that we did go through with, but of course we had a larger wedding planned.

At a venue in Portland, Oregon, and we thought we were fine. No worries. This is all gonna be done by then. Turns out that that wasn't the case. We have family from California. They weren't gonna be comfortable traveling, and we really weren't comfortable bringing everyone together and putting folks at risk risk.

So we went through a couple iterations. We ultimately got married in our backyard. It then rained, so we had to then adjust again and, and transform our garage into a reception space. But everything that mattered was there. Our, our family, a couple of our closest friends, and it was, it was a very special day, but I guess it, everything that we're experiencing in the, in this year, we just had to go with the flow and adjust as, as we found it.

The, the other interesting part to that timing. And I didn't plan my date around this. It fell the weekend before, but we did a four version Epic upgrade the weekend before . I. I got married and so we were in the command center working. Amanda, who is here, was my lifeline keeping me sane through that whole time.

And then I had a great team that picked up the, the remaining work, which that upgrade went extremely well. So we were very thankful for that, and I was able to take a week and a half off to enjoy, uh, a honeymoon. So it was a crazy time, but it turned out to be so special. So you guys are the, I I mean, it's, it's, uh, the, the reason I love talking to, to you guys is you're the ones who make the CIOs look good, right?

So you're the ones who have to roll with the punches, make sure the applications get out there, respond to cyber attacks and all those things. So, so, so you guys are, are, are, are the ones who are, are, are really able to roll with the punches. Did you have a waterfall approach to your wedding or did you have an agile approach to your wedding?

I think it was more agile. It was just make a change and get it out there. Make a change and get it out there and, and see, and see what happens. And, and it, it was up to the last minute. It was great , but it was, it was wild. Alright, I I, it is a great story and congratulations on, on Your Wedding. Tell, tell us a little bit about Peace Health for, for those who aren't familiar with Peace Health.

Yeah, so Peace Health is a Catholic, not-for-profit healthcare system out in the Northwest area. So we have hospitals and clinics covering Oregon, Washington, and Alaska. We have 10 hospitals that range from level two trauma centers down to critical access hospitals, and a network of about 200 different clinic groups.

and we have roughly about:

And I think when people here Alaska, they're like, oh, that's, but, but if you, if you serve in Washington, a lot of times there's a.

Yeah, let's talk about roles. So, Amanda, welcome to the show. Give us, give us a little background and, and what your role is. All right. Good morning. Um, I'm manager of enterprise applications, so I manage all the inpatient applications on the Epic system, so inpatient, clenox, stor, um, also the ambulatory application on Epic, as well as all the patient experience modules.

So Haiku. EpicCare Link Care everywhere and the, and the most popular MyChart, so our patients can get into their, their EMR at any time. So very large group. Yeah. And that's, I mean, that's pretty, pretty significant set of applications. Molly, what, what's, what's your role? So my role as a director of applications is I support all of our clinical applications, but in my role, I also support all of our business applications.

And that's where I came up through, I came up through the business applications world within healthcare. So your your ERP, your workforce planning, your credentialing, and. Then actually at the very first week of the quarantine this year, I took the position as director over the clinical applications and business applications.

So I split my time on both sides. So. So how many applications do you currently have at P Health? Do you have like a, like an inventory that you're tracking? We do have an inventory and I actually looked this morning when I saw that question just to wanna get you an exact number. 799 is, you know it, it's interesting 'cause when I came in I thought, oh my gosh, we have 900 a at the health system I was at, I was like, we have 900 applications.

And I said that at a meeting and people were like 900 call. That's a, that's a pretty common phenomenon within healthcare. We, we have a significant portfolio of applications. Do you guys have an application rationalization focus for your organization? So we've, we've attempted to dig into application rationalization proper over the course of the last number of years, and we've done it in parts.

So we've, we've built up the inventory. So I was able to go in and see, yes, this is the inventory of our applications. But more importantly, we've established a governance model that is really helping us bring in operations to the table to say, Hey, we already have these applications. Can we have a conversation about what it would take to get you on that application versus you going out and buying your own?

We've done a lot of work to identify all of those rogue applications out in our facilities and inventory them and then make plans to overhaul. But I think mostly where we have focused and. For good reason is on that governance. So everything new coming in, we are saying, all right, we are an Epic first organization.

We're an infor first organization, and then we have a couple other primary applications that we tend to look to first to those vendors for a solution. If none of those work within that 80 20 rule, then we. Dig into other opportunities. Yeah, that makes sense. So Amanda, when, when did you, when did you make the move to, to Epic and how many applications, a lot of people talk about Epic really being the tip of the spear for application rationalization.

How many applications do you think got consolidated in that first pass of, of moving to Epic? Cool. So I've been on Epic and Shape One Shape or form or the other for. About nine years now. This is my second organization of a Epic shop, and when we started the enterprise. Install. I wanna say we took down at least a hundred if not more applications by just bringing everything into Epic and just to build upon the app application rationalization.

I think as managers and and directors we're constantly aware of our contracts. What's coming in? What are we allowed to expand upon, as well as making sure we're sticking with those vendors to continue to not expand those vendors any further. So yeah, really the enterprise go live really does start to slim that down, and I think it's become a culture that we have become epic first, as Molly was saying.

So, so talk a little, I, I do wanna talk about your ERP journey. That's one of the things I do really wanna get into. But since we're on the, on the epic topic at this point, talk about the, what happened during the pandemic? What were the kind of things that, that you were asked to do within the, within the EHR, with telehealth, with some of the other modules?

What were some of those things that you were, you were asked to do and, and, and what are some of the things that p. Yeah, so I think very first off, we were . Starting to change the questionnaires that were coming and the patients were being asked as soon as the CDC started releasing those questions and symptoms that they are aware of, um, the covid symptoms, that was our first kind of snowball, if you will, of, of the work.

And we started to see that building up further as well with the labs. The labs were a big body of work to make sure we had the right swabs, the right tests, the orders, et cetera. Probably a couple weeks after the work started to build, we recognized this was a larger issue than than we expected, and that's when the Washington started looking at this as a pandemic.

So we called it incident command center. As an organization, we had a large or in system incident command and as a TSP slash IT shop, we decided to pull together our own incident command center. So I was heavily involved in, in developing that. So it was developing a process. I. Of making sure we had the flow of how these work, these questions, these these requests come in to make sure that our teams were protected so that they could be heads down, get that work done, and we, managers and supervisors, directors could work to make sure we're getting all of the pieces, the parts that they need to do that build.

So anything from. Update those questionnaires. As we talked about the labs, a lot of orders were updated, of course, because of the needs for Covid. Telehealth was a very, very large effort that happened in about, I wanna say two weeks, which was expected to be a six to eight week project. We put telehealth in for all of our clinics so that our patients could still receive care via telehealth, um, and not come into the clinic and be exposed.

So did you just expand what you were doing with Telehealth or did you head in a different direction at all? We were fresh out of the gate, started telehealth brand new, so it was something that was kind of on our roadmap down the road and at the pandemic allowed us to get that going very, very quickly.

So, so that's the response. Molly, coming back to you, I mean, how has, how.

How, how we're moving forward, what's, what's the new steady state? Are we, are we even in the new steady state yet? The answer to that is probably no. But are we approaching it? Are we, are we getting back to like normal health IT operations? You know, that, that's something I, I think about a lot because a lot of our operations partners and, and rightly so are, are starting to push projects forward that were potentially put on hold.

A lot of these projects are moving forward. But we're also still very much within our covid response. And now we've just, this week ramped back up with the latest surge. So our, our current state, I wouldn't call it a steady state, is one of, we are still responding to Covid. The labs never backed down. A couple of our other teams really never backed down from that response.

But we're still responding to Covid. We're now shifting back into an incident command mode. Covid, but we're back up to our project levels that we were at pre Covid. So we typically run about 99 to a hundred. IT projects at any given time outside of a pandemic. When, when we went live, when the pandemic hit and we put everything on hold, that wasn't essential.

We went down to, I would say, maybe about 10 active IT projects. We're back up. We are over that a hundred mark again on the IT projects that we're pushing forward. So our, our new state is that of how can we take our teams and keep the focus on covid, but also respond to our organizational needs to keep some of these projects going.

So staffing is a huge consideration right now of, fortunately, we're financially in a place where we can bring in a little bit of help. And we're working through that strategy now. . But how do we keep the focus on Covid so we can respond to our organization needs right away? How can we keep some of these projects going that now are very critical?

Some of them are very critical to our repositioning and our financial stabilization based on what we went through with Covid. I. So we're still defining our steady state at this point, and it's an extreme challenge and something I'm, I, I am so grateful to have the leaders that I, that I work with every day, Amanda and our, our whole leadership team, because we're just in constant troubleshooting mode and, but we're keeping that energy high.

So from an operation standpoint, are you guys. Taking the upgrades like you, you normally do, and, and you're, you, you're back to the, the steady state operation never really ceased. So you're, you're doing all of those things, plus you're, you're taking on the projects. Yeah. Is, am I hearing that right? Yeah, that's right.

So our, our, the upgrade that we took in September was originally planned for May. When Covid hit it got pushed out to September thinking everything was gonna be great and. When the summer wore on, the determination was made by our organization and our leaders to let's move ahead with the update. We were very much behind.

Now going into:

We, we do have to have a significant amount of flexibility. So we are, we're working through that as, as we speak. Yeah. Well, let, let me, let me transition to ERPA little bit here. So, 'cause I've wanted to have a conversation on ERP and that's, that is your, your, your background, Molly and a lot of health systems have, are now making this transition.

They did so much ER work. Three to five years, and now they're starting to pay attention to the ERP. Tell us where you guys are at, where, where P Health is at on your ERP journey. Yeah, so we're, we're a little bit ahead of most organizations is, as I hear it, listening, listening to the community. We actually just finished, actually, it's been a year ago now, we finished an upgrade to the Infor version 11 cloud.


We also had a design that was based on a non-shared services model. So it was originally designed when we were very disconnected as an organization, very separate within our states, within our facilities. Over time, we moved to a shared services model and. Our ERP needed to reflect that as well, and that was a big piece of the project.

So the, the ERP selection process is, it always fascinates me. You have the, the aspect of being the incumbent, so you went with the incumbent, which was infor. There's also the aspect that some might do maybe the financial and. I love when we put those teams into a room, and invariably what happens is one side feels strongly about one solution and one side.

There are trade-offs in these solutions today. How did you, how did you sort of, uh, bridge that gap between, between the stakeholders? It, it was, it was a challenge certainly, but it was a necessity. And I think all parties knew that it was necessary to come to an agreement where they knew there were going to be trade offs, but we needed to get to a place where it all flowed together and worked together.

said, we started on Infor in:

And things broke a lot. We could not easily upgrade. So when we went to go do the vendor selection, we did look slightly, I wouldn't say we did a full analysis of other vendors, but it was determined that we were already on in four. In four at the time, was showing best in class for that full suite. As you weight out all the pros and cons, our biggest.

e go to the cloud? Because in:

It, it's really interesting the implementation of these things. These things are so important. I was talking to ACIO yesterday and he, he said he went into a meeting and. They were, they were talking about how bad a system was. So he came back with a, with a couple, you know, slides and said, Hey, what if we implemented this system?

Would you be excited about that? And they said, that looks like exactly what we need. He goes, great, because that's what we have. We just need to implement it. Right? And that, that's an old, that's an old CIO trick, but essentially it, it. The implementation of these things is where the rubber meets the road.

And we heard this with the EEHR. The implementations had to continually be optimized. We had to keep, keep doing that. Is the same true with ERP? Are we, uh, once you implement, is it just a constant iteration cycle of, of I don't know, of optimizing the, the platform? Oh, absolutely. And in fact, we are right in the beginning stages of a

defined optimization project. So we had a consulting partner come in, interview a number of our users from our back office, power users to our managers, to all sorts of just that, that standard caregiver who is just logging into view their performance evaluation. So they came in and did a, a full survey, found a set of pain points, and now we have

I believe it's about 17 projects that were just delivered us, delivered to us to say, Hey, if you do this, you will take care of these pain points. And so just this week we're reviewing that statement of work to move forward on the first grouping of projects. And I'll tell you right off the bat, it's a lot around.

Some of the basics, just how do we take this new structure that we have, our HR org structure that now matches our gl, how can we take that structure and automate even more? So, hr, uh, is based on the caregiver's manager. Finance likes to deal more in the manager's department. And so how can we fit all of this together?

And there are ways we just need to optimize. Um, the other big one is reporting. Always, always reporting , always. So that that's another . Big piece we're gonna tackle, and then a few things in supply chain, mobile supply chain is always a challenge, getting those processes going. So yes, optimization. We are a year out from our go live, and now we're starting into.

Some strategic optimization. Yeah. Re reporting's interesting. To me. They're like, because when they, whenever they talk to me about their canned reports, I, I just look at 'em. I'm like, our health system's different. I mean, , and it's invariably you, you have to create so many custom reports. Amanda, I want to come back to you.

We, we have this, we put so many of our workers out of the, out of the home, and you have a significant part of the organization. How, talk to me a little bit about how the, the work from home experiment, a pilot or whatever, how that's gone for you and what are some of the challenges that you and your managers have faced?

Yeah, so I actually think it's been really good for our group. Especially, we have folks in all different locations, and so all of us being virtual has allowed us all to come into one platform for communication. So we actually saw, with our Epic upgrade, we had a, our very first virtual command center, and we received a lot of feedback that it was actually better because the communication was seamless.

We had one platform, one way of communicating. I will say the biggest challenge is probably getting my people to take breaks. , they, they wanna work constantly. They wanna get stuff done. They wanna do the right thing for our communities, which is why we love them and why they are great at what they do. But getting them to take breaks and getting them to sign off at a an appropriate time is probably our biggest challenge to prevent burnout.

But I think overall it's been a very good experience. I've heard a lot of great feedback from my, my direct caregivers and others. A few of course missing the interactions with people in the office, but for the most part, they're really enjoying being home and being able to be heads down, um, and get their work done and, uh, and not have that commute time back and forth.

So are you still doing at the elbow kind of support just with people who are practicing? Distancing and those kind of things. No, we're, so for the IT side, we are not doing at the elbow support. We are all virtual. We do have our training staff who they will provide their . The new employee training on a monthly basis, and they do have classroom training, but it's very limited to eight people per training room, so they are trying to do as much virtually also by the learning home dashboards available in Epic.

Really pushing out the materials to the system so they can grab that at the moment when they need that as well. So you took an upgrade while virtual and you're probably planning some significant work. While virtual is is, I mean, what are, what are the things you're finding that are more effective in this virtual environment?

I would say hands down communication. Again, we have one platform, or not just an email, and I think email is . I think every organization just, it's, it just gets overwhelming and you just try to get through. You can get through right. Email. Email is the second worst form of communication, actually, third worst form of communication.

Second is texting. First is, uh, tweet. So yeah, that's, that's the line of poor communication right there. Yes. So we also transitioned to teams. Very heavily, I wanna say, right as we went virtual or right before, and we all had to adapt that as well as being home as well as being in a pandemic, et cetera. But the team has taken it with strides and just has really adapted it very quickly.

I. And I think that's been the number one thing for my group anyways, so that I have seen as an organization is that we are able to communicate even better than we were face-to-face because everybody's hearing the same thing at the same time. We're not having these hallway conversations and then having to waterfall it down to our groups and maybe missing part of that conversation because we're playing telephone.

ng to see. So as we looked at:

Sorry. Yeah, yeah. No. Looking into the magic ball here, I'm trying to see, well, certainly we're like many organizations, we're having to look at our current position in our markets. Uh, our patients are not going to expect to receive care in the same way that they did prior to Covid, and we have to adjust to meet that need.

Uh, obviously telehealth is a big question. If we expand that, just depending on what our payers move forward with. But that, that's, I guess I would just say that there's a lot of question marks. We're quickly working, uh, through strategy with our operations on what our repositioning, what our go forward model is going to be.

But in terms of the day-to-day work that is happening, I. Focus, I think is going to be the most prominent word coming out of all things Covid. We had so much focus in the beginning, we're moving away from that, unfortunately. But now it's our job as managers and directors to keep our team, to move our teams back to that focus and try to.

Manage and protect them from this noise that is coming in from 15 different directions. And that is the challenge, is to say, Hey, look, when Covid hit and we had all of this focus to get work done, we were turning work out to operations quicker than they, they could operationalize it. Now we're in a place where that expectation is still there, but we have the layer of

quickly. That's gonna be what:

Yeah. No, but I love, I love that idea of focus and the expectations have changed and I think it's interesting. I, I, I appreciate Will connecting us.

I, I mean, I think this has been a great conversation. I really appreciate it and I feel for you, by the way, because your, your CFO was in charge of our financials at the health system where I was the CIO and it's, it's a catch 22 because, uh, he believes in technology and he is brilliant. So he'll find the money.

So. I have a feeling your project list is only gonna grow. So on the off chance that he's listening to this, I'm gonna remind him what I always used to remind him, which is you have to prioritize. So if, if Darren happens to be listening to this podcast, that just a, a, a shout out that you have to prioritize.

You can't do it all. So, hey, I want to thank you guys. This, this has been a great conversation. Thanks for coming on the show. Thank you, bill. Thanks for having us. This is great. Yeah. Thank you so much for the opportunity. This is awesome. Appreciate it. That's all for this week. Special thanks to our channel sponsors, VMware Starbridge Advisors, Galen Healthcare Health lyrics, serious Healthcare Pro Talent Advisors Health Next, and McAfee for choosing to invest in developing the next generation of health leaders.

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