Don Paulson, CFO at University Hospitals Health System, knew he could not sustain the financial longevity of the six-hospital delivery system indefinitely. The Cleveland-based organization had multiple revenue cycle systems in place, and to make matters worse, it had different chargemasters in place--a dozen in total--across its hospitals. Standardized processes were lacking, and the organization's ability to generate valid, enterprise-wide business metrics was minimal.

In 2006, the health system began a four-year journey to consolidate its revenue cycle systems, looking to standardize on the Soarian platform from Siemens Healthcare. It deployed Soarian on a staged basis, completing the installation at its 1,000-bed flagship academic medical center in 2010. "We did not want to put all of our cash flow at risk at one time," Paulson told attendees at HIMSS11.

Prior to deploying Soarian, the health system cleaned up both its master patient index and its charge master, he said. It also put in place processes to improve collections from patients at the point of service.

Although the Soarian deployment ran into a few glitches--including one troublesome period in which a faulty interface wreaked havoc on data--the health system managed increasingly smooth transitions as it moved from hospital to hospital. To measure the impact of the new revenue cycle system, Paulson created a metric called "AR recovery days." It shows how much an individual hospital veered from its AR baseline during the deployment and how long it took to return to normal. Early on, AR recovery days stood at nearly a month, but by the time the health system rolled out Soarian at its 1,000-bed facility, impact was nominal with only five AR days at stake.

Paulson credited the success of the transition to the organization's approach to change management, an effort led by Liz Novak, vice president, I.T. The health system tasked a group of change management experts to oversee planning, training, and cope with any user resistance. "It is not enough to teach the application, you must show people how to do their job," using new software, Novak said.

University Hospitals Health System created detailed crosswalks, which outlined how various revenue cycle tasks, such as charge entry, were completed in the prior system, and the steps they required in Soarian. The change management team was hired based on their skills in such areas as listening, presenting and working with adults. Without good listening skills, she explained, project leaders would be unable to decipher any underlying issues staff had with the new software.

At the get-go, the health system ranked key department members on their acceptance scale of the forthcoming technology, color-coding their acceptance as red, yellow, or green, ranking them on a scale from outright opposition to full acceptance, Novak said. Many people fell into the middle group, but Novak said their reluctance was primarily based on a need to understand how the new system would work. Only a small minority were outright resisters, less than 10 percent, she said. They just needed individualized attention to learn the system and understand its benefits.

Communications were the cornerstone of the transition, Novak pointed out. To manage enterprise communications, she created "strategy documents" which laid out the system needs and communications required to address them for multiple departments. "It was the who, what, where, when, how and why," of the plan, said Novak, who created the document on an Excel spreadsheet.

--Gary Baldwin


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