How El Camino Health is Boosting Productivity Through an ERP-EHR Marriage

Enterprise resource planning modernization enables integration of systems from medical records to payroll.

As health systems finish modernizing their electronic health record (EHR) systems, attention is turning to renovating enterprise resource planning (ERP) software, and the benefits of tightly integrating the two.

Deb Muro, chief information officer of the nonprofit health system, El Camino Health, with hospitals in Mountain View and Los Gatos, California, says the process has improved productivity and enhanced access to data that proved vital during the current COVID-19-challenged times.

Speaking at the College of Healthcare Information Management Executives CHIME20 Digital Recharge event in November, Muro said the integrated system provides El Camino Health's top executives with a constantly updated view of such data as how many COVID-19 patients the health system has in its census, current supplies of personal protective equipment, and profitability of various service lines.

"This was one of the largest, most important projects that we were working on last year," Muro said. "Being able to determine what resources are needed is critical."

The business rationale for upgrading El Camino Health's ERP involved consolidating six existing ERP systems, and enabling better data flow between ERP and EHR systems. "We had several manual processes that had been in place for years," Muro said.

Additional benefits of the upgrade included improving data security and improving employee convenience, Morin said.

The integration continues as 2020 comes to a close. El Camino is beginning to implement Clinically Integrated Supply Outcomes Model (CISOM), an eight-stage model from the Healthcare Information and Management Systems Society (HIMSS) that provides a strategic pathway to track processes and products used in care, by mobilizing data to create real-world evidence of impact and outcomes for patient populations.

"It's so exciting to follow a model that will help bring success," Muro said. "El Camino Hospital has a rich heritage of technology. We were the first hospital in the nation to implement CPOE [Computerized Provider Order Entry] in 1972 with Lockheed Martin, and we've just continued this desire for innovation through the years."

Formulating the Right Partnerships and Stakeholder Participation Was Essential

A key element of getting to this point was partnering with a consultant and vendors who are aware of best practices when performing such an integration, Muro said.

In this case, the EHR vendor was Epic, the ERP vendor was Workday, and the consulting firm is Avaap.

Ben Morin, practice director at Avaap, led El Camino Health's deployment of Workday HCM [human capital management], payroll, and finance modules. Morin had led rollouts of Epic at other health systems, and Muro had led the rollout of Epic and Workday at El Camino Health during her four years there.

The transition to Workday was driven by the fragmented, incomplete nature of what preceded it.

"HR was challenged with multiple applications cobbled together [and] very little reporting capability," Muro said. "Supply chain was asking [for] a system that could meet [their] new business needs, [and] finance wanted to modernize the application platform. Bringing those three operational areas together [for] consensus on one system that can meet the needs of those three very disparate areas is quite the effort."

Morin said pitfalls await the health system that lacks involvement from operational owners of ERP and EHR systems. Involving those stakeholders, and taking a holistic view of how integrated data from each system can benefit the enterprise, is key, he said.

Cloud-Based ERP Meets Regulatory, Cybersecurity Requirements

Business operations need to be open to allowing and completing software upgrades, Muro said. "Thinking about a cloud-based solution was really optimal," she said. Going with cloud implementations such as Workday also allowed El Camino Health to meet modern regulatory and cybersecurity requirements of all its IT systems, she said.

The three touchpoints between the two systems were finance, supply chain, and business intelligence, Morin said. Everyone involved needed to agree how the systems would work together, he said.

The project involved a lot of work. El Camino Health needed 107 points of integration between the ERP and EHR, Morin said. "It was significant, but it was worth it," Muro said. "The more that you can automate those processes, then you're freeing up your staff and your operations employees to be able to focus on other things."

 As an example of the integration taking place, general ledger integration has to pull transactions from where they originate in the EHR, and place them in the Workday ERP. But the integration ended up requiring mapping El Camino Health's legacy chart of accounts in Epic's GL modules to the best practices in Workday ERP, Morin said. These best practices allow important functions such as replacing inventory and charging supplies to the proper accounts to flow smoothly between systems.

The last of the Workday functions to be implemented will be supply chain, and it will benefit from El Camino's implementation of CISOM.

"CISOM looks at outcomes, the usage of your supply chain, and how it supports the patient and your providers," Morin said. "Moving up the CISOM ladder focuses on governance and interoperability. When you get to the highest levels, population health becomes important as well, [and] predictive analytics, so you can proactively support the needs that you're going to have."

Morin advises others performing ERP‒EHR integration to "push your teams to always be in collaboration.

Muro also suggests utilizing each technology to its full capabilities. "Many CIOs are in the same situation where we've implemented lots of technology, and we've probably used about 50% to 60% of the capability," she said. "All of us are trying to understand how we reduce technical debt," reflecting the additional rework caused by choosing a limited solution now, instead of using a better software approach that initially takes longer to implement.

"A key component is consolidating your applications to some really critical applications that are doing a lot of R&D," Muro said.

Push your software vendors to solve your pain points, she said. "Address that gap so you don't have to go buy more software. "I love to hear that Workday has been onsite at Epic discussing how they can work more efficiently together."