Information Technology Integration Activities when Hospital Systems Merge
Throughout the past two years, the leadership team within the Information Technology Department at the Mount Sinai Health System learned that integration is not an exercise or an event, it is a journey. The journey started for the former Mount Sinai Medical Center and Continuum Health Partners in the fall of 2012. Leaders from both organizations’ IT Departments began to assess information technology capabilities and staffing resources across the proposed 750-person department. By the time the merger was finalized a year later, a series of plans were in place for what would be the newly unified health system IT blueprint: a “Day Zero” plan followed by a 100-day plan, two-year plan and five-year plan.
The integration journey will likely continue as the Mount Sinai Health System’s Information Technology Department grows and offers more services. With an expanded scope, the organization also has more opportunities to innovate by shifting the focus from daily IT system maintenance to positioning the department as an enabler and facilitator of technology-supported change.
“It is certainly an exciting time to be a Chief Information Officer in healthcare,” said Kumar Chatani, Chief Information Officer and Executive Vice President at the Mount Sinai Health System.
“My responsibilities have expanded from two hospitals and the Icahn School of Medicine at Mount Sinai to seven hospitals, a School of Nursing and an Accountable Care Organization,” said Mr. Chatani. “I was able to work with the IT leadership team to deliver on all the key programs needed by our newly formed health system.”
Information Technology Department Integration
The creation of an integrated Information Technology leadership team was accomplished within the one-hundred day plan, which all sites and systems contributed to. The team first evaluated current high-priority and in-flight projects to ensure they were aligned with an integrated health system. Some projects were put on hold or completely stopped, while others were accelerated. During this time, the Program Management Offices from all entities began sharing methodologies, tracking, and reporting tools and consolidated operating and capital budgets for the following year.
An automated tracking tool was quickly developed that facilitated status reporting and communication within the team to catalog and monitor all IT integration activities. Reports from the tracking tool continue to be reviewed at regularly scheduled meetings.
The IT leadership team knew that a successful integration depended on seamlessly blending the work of 750 employees spread across the New York metropolitan area. Planning for the human side of the large-scale change started with frequent updates using multiple channels familiar to each entity. Leaders placed a high priority on transparency and communication in an effort to proactively inform teams of concerns that would impact their day-to-day lives. Outreach included town hall meetings, guided tours of hospital campuses, individual team integration activities, and title equalization across the enterprise. Kumar Chatani, the Chief Information Officer, also rounded to various locations as a way to increase visibility. Teams were quickly aligned, and were introduced at social events and mixers.
Clinical Information Technology Integration
Leaders identified clinical integration as a critical success factor that would operationalize the strategic objectives of the newly-formed health system. A long-term plan was established to deploy Epic, an electronic medical record (EMR), across all hospitals and owned physician practices. The EMR was already in place at Mount Sinai Hospital and Mount Sinai Queens but given the scope of the implementations, interim solutions were necessary. The key mandate was that within 90 days of the merger closing, the newly formed health system needed to be able to support any physician to practice at any site. The implementation would not be a “big bang” approach, but would follow the sequencing of specific clinical service lines and specialties that were identified by executive leadership. With a total of seven disparate EMRs across the enterprise, the goal was to allow providers to quickly work across the enterprise by following the steps below.
- Create interim solutions to quickly credential physicians at different sites.
- Begin the implementation of a patient identity management solution to provide a common identifier to all patients across the health system.
- Connect our private and regional health information exchange solutions.
- Embed icons within legacy systems for one-click access to other EMRs.
- Cross-train physicians and clinical staff to use other EMRs.
Longer-term plans include the following steps below.
- Deploy the Epic EMR to physician practices within the merged entity that were still documenting patient encounters on paper.
- Implement enterprise-wide population health management tools to foster quality and manage risk.
- Consolidate departmental systems.
- Implement a unified patient portal to provide a common experience for patients regardless of where they enter the health system.
Business Systems Integration
Integration and consolidation of most business systems, including revenue cycle and enterprise resource planning systems were identified as longer term projects. A number of interim solutions were required, however, to support integrated operations such as the creation of a joint employee roster. As the Epic EMR is rolled out to physician practices, the health system is taking the opportunity to simultaneously consolidate those practices into a single system for registration, scheduling, and billing.
Technology Infrastructure Integration
Part of the “Day Zero” plan was to establish secure high-speed data connections between all sites, synchronize global e-mail address books, and link internal phone directories. These tasks were crucial to foster more effective communication. Multi-media collaboration technologies, such as video conferencing, were quickly deployed or connected to facilitate face-to-face meetings across an expanded geography, reducing the amount of time necessary to travel between sites. Looking further ahead, there is a need to consolidate help desks, form a single active directory domain that will replace the four directories currently in place, integrate data and voice communications, and consolidate the data centers.
The leadership team within the Information Technology Department learned many valuable lessons throughout the two-year integration journey. Key points focused on how and when to communicate, sharing the vision of the future state, and being flexible and willing to adjust the IT blueprint.The list below outlines important lessons learned.
- Leadership needs to communicate frequently and be visible to the staff and key stakeholders.
- It’s important to paint the vision of the future state and show staff the big picture early on.
- Difficult staffing decisions must be made quickly.
- The business requirements will evolve over time. It’s important to remain flexible.
- Integration will be harder than expected. Don’t strive for perfection.
- Listen to the team.
- Have a sense of humility and anticipate that there will be a lot of lessons learned along the way.
- Ask colleagues and outside consultants (if needed) for advice.
- Do not lose focus of day-to-day operations throughout the integration.
- Review the integration plan annually with all partners.