Love Thy Vendor?

With so many vendor staff members in play, CHW has taken steps to ensure that CareConnect participants maintain their priorities. Symbolic of that effort, the CareConnect staff sport name badges that simply identify them as members of the implementation team, omitting any references to their software company affiliation. "Members of the CareConnect team introduce themselves that way," Ferguson says. "It is an important behavioral issue that has helped us bond together as a team." In addition, CHW has established unwritten rules that regulate what Ferguson dubs "the sales gene." Software company members of the CareConnect group do not talk about new products or software enhancements. "They are not coming here to represent the vendor and introduce new products or services," Williams adds. "We need their expertise, not their salesmanship."

3. Establish a governance structure

After years of following a "best of breed" IT strategy, Baton Rouge (LA) General Health System is shifting gears. The two-hospital system has embarked on a $16 million clinical IT overhaul. It will rely on software from McKesson to automate every nook and cranny of the operation while knocking out dozens of interfaces that supported niche applications. The old approach made vendor relations a challenge, recalls Dionne Viator, senior vice president and chief financial officer. "If one product went down, we had to ask if it was a technology failure, an interface failure, or if data had been corrupted elsewhere," she says. "Diagnosing these issues became an all-out scramble to find ownership of the problem."

By deploying an integrated package of applications from McKesson, Baton Rouge General is looking to leave those finger-pointing days behind. The change is pronounced for the community health system, which staffs some 450 beds. To smooth the transition, BRG has devised a highly structured governance arrangement to manage the project and resolve any issues promptly. McKesson is deeply embedded, providing representatives at every level of the four-tiered project management hierarchy. Viator describes it as "a culture of accountability."

At the grassroots level, more than two dozen project teams work on niche applications, addressing local workflow questions and figuring out how to make the technology work in a given department. Those teams report to a two-person project management office that is co-chaired by Viator's IT director and a McKesson representative. Monitoring the entire effort is the leadership committee, which Viator co-chairs with another McKesson executive. Meeting monthly, this group includes senior executives from the hospital in addition to McKesson senior corporate staff, or "decision makers," as Viator calls them. At the top sits the governance board, which meets quarterly and is staffed by Baton Rouge's CEO, Bill Holman, and McKesson's erstwhile CEO, Graham King, now a special project consultant for the software giant.

The elaborate structure is devised to keep the project moving swiftly, Viator says. "We may be paying them, but we have accountabilities both ways," she adds. "We both need to be involved in building, deployment, and making changes in the operation. It is just not 'plug in the computer and walk away.'"

Thus far, most issues are resolved at the project team level, Viator attests. On occasion, however, issues work their way up the hierarchy. One thorny problem about access to physician EMR data went all the way to the governance board, Viator says. Some physicians wanted to control access to their patient data in the ambulatory EMR, but the integrated nature of the software enables data sharing, and the hospital wanted to ensure that ER physicians had access to patient histories when appropriate. Ultimately, Holman had to lay down the law. But McKesson provided insight into how its other customers had tackled the issue, Viator says. "Healthcare is in rough waters, and [McKesson is] our rafting partner."

4. Keep talking

Holston Medical Group is an oddity among independent physician practices. Not only is the 152-member multispecialty group highly automated, it has used its 12-year-old EMR technology to support new revenue streams, participating in clinical trials and pay-for-performance initiatives with health plans. "I knew the future in medicine would be to use IT," says Jerry Miller, MD, Holston's president and founder. "We now have electronic records on 245,000 patients and conduct 46,000 outpatient visits each month. We run a disease management program, two diagnostic centers, three surgery centers, three urgent care centers, and a hospitalist program. I attribute the modernization of our practice to using the EMR."