The foundation of Tenet's ambitious health I.T. systems strategy announced in January is a highly integrated, single vendor approach that will replace, in some cases, best-of-breed systems. Cerner's Millennium suite, which already has been partially implemented across 14 of its hospitals will be installed across the enterprise.
Two Tenet hospitals not slated to be part of Millennium implementation are already up on health information systems from Meditech Inc., Westwood, Mass. The decision whether to scrap Meditech in favor of Cerner has not been made yet. "We didn't include them in the first round, but we have ability to go with Cerner if that's our long-term decision," said Liz Johnson, Tenet vice president of applied clinical informatics.
The two primary drivers of the change in strategy-and philosophy-are elevating the need for clinician input and the importance of tailoring systems around workflow processes."We've been struggling with this because we want the best of breed, but we want it all from one vendor and you can't have both," Johnson said.
But a commitment to single source can be risky, and Tenet's move is being met with skepticism in some quarters (see sidebar, page 85). Johnson and other project leaders know success hinges on meeting the needs of their clinical staff and managing the disruption and dissension that is part and parcel of large-scale I.T. initiatives.
A Typical Hodgepodge
Tenet like other large hospital groups has a hodgepodge of computer systems and paper-based processes that have crept in over the years and don't work together: hence, the decision to rationalize and go with a single vendor.
"I have a vendor that's really good at a cardiology lab system, but that same piece of software won't work nearly as well in outpatient surgery," said Johnson. "Our hospitals had been collecting these types of applications that were really good, but they did not talk to each other and they certainly weren't the same from hospital to hospital."
The Millennium system will replace paper-based and some computer systems and includes clinical documentation, pharmacy, closed-loop barcode medication administration, and computerized physician order entry with decision support. Millennium is in its 15th release and comprises a suite of clinical and financial applications.
Johnson, who's a master's degree-trained nurse and chairs or sits on numerous health information organizations, is charged with the rollout which is slated for completion by 2014. She has a long way to go: only two hospitals in the initial 14 have clinical documentation and only one has closed-loop barcode medication administration. The focus to date with Millennium in the initial 14 facilities has been departmental systems such as radiology, laboratory and pharmacy, according to Johnson.
Since launching a clinical informatics program in 2005, momentum for the idea of a highly integrated system from a single vendor has been building.
Too Much Knowledge
"Let's say we had a different strategy and we're going with Epic, Cerner, McKesson and Eclipsys. By making that kind of commitment, we have four bodies of knowledge and workflow. We have to understand all those technologies which are all unique," she explained. "One vendor and really building on that knowledge is better than building it four times."
How many best-of-breed systems will be sacrificed for the greater good of integration? To answer that, Johnson says her challenge is to balance departmental and hospital needs with those of the enterprise.
"I don't think the sacrifice is overwhelming. There will be small things that a department had in the past that we have to determine how to provide in the future. An individual department is going to sacrifice a little because [the system] won't have every bell and whistle. Over the years, major vendors have recognized the need to be able to customize to specific departments," she said.
Will Tenet tear out existing systems or say "no" to other systems clinicians might prefer? Again, her response is to marry clinician and system before reaching a showdown.
"We are not talking about going in and pushing out a pathologist system for managing his or her personal work or a system attached to cardiac catheter machine. We are going to integrate that data into the overall repository (Cerner Clinical Data Repository) so it's in a single place," she said.
She compares the transition to new systems with making the move from Lotus spreadsheet software to Excel.
"When I went from Lotus to Excel, I thought I was going to fall apart. But the reality is it's the decision of the company and in order for me to communicate in a spreadsheet, they wanted Excel. You learn how to do it," she said.
Asked again if Tenet would say "no" to a clinician who might prefer something outside Millennium, she reframes the question. "It's too early to know how big a problem that is, but it's more 'I want this outcome.' How do we get to that outcome? That usually satisfies the need," she said. "There may be a specific thing a physician does not want to do. He or she wants to do something the medical committee doesn't think is necessarily the right thing to do. There has to be collaboration with that doctor," she said.
On the Paper Trail
At the same time, she must make sure manual processes do not endure in some hospitals while the new Millennium systems are embraced in others.
"We have to be careful about not allowing the paper process to go on for a long period," she said.
Johnson and company spokesman Dave Matthews declined to reveal how much the project will cost or projected return on investment. "We don't release that information," said Matthews. The financial impact of I.T. now or in the future was nowhere to be found in Tenet's detailed statement about third-quarter results.
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