Electronic Health Records (EHR, EMR)
Wake Forest's Epic EHR rollout was a money pit. Here's how they turned it around
CIO Chad Eckes transitioned the severely outdated system to a converged infrastructure resulting in faster workflow, higher uptimes, increased speed and value.
In 2014, Wake Forest Baptist Medical Center in Winston-Salem was losing tens of millions of dollars and a major cause was the costly roll-out of both an Epic EHR and Oracle’s PeopleSoft human resource management system.
The situation was so dire that Wake Forest posted losses of $78.4 million that year. And that was after Wake Forest saw operating losses total $53.6 million in 2013 and Standard & Poor’s later downgraded its credit rating as a result.
“When I came to Wake Forest in 2014, I was tasked with leading the institution’s turnaround,” said the system’s CFO Chad Eckes, who originally signed on as CIO. “Much of the problems back then were rooted in IT struggles.”
Broken here, compromised there
The Epic and PeopleSoft implementations, taken together, were a veritable money pit for Wake Forest.
“Those software projects literally broke the organization financially,” Eckes said. “We were losing money at the time as a result of some of the broken pieces and systems in place.”
One major problem was the core infrastructure, in which Wake Forest had underinvested as a way to afford the pricey PeopleSoft and Epic software projects.
[Also: Coast Guard seeks new EHR vendor after failed Epic implementation]
Sixty-four percent of its data center equipment was more than seven years old and frequently broke down. Wake Forest lacked modern standardized equipment because it had previously treated IT procurements episodically, that is to say on a single project-by-project basis. As such, the IT shop would purchase hardware, implement it for a particular initiative, and then not have enough budget to upgrade when the time came.
“As a result, our system was highly compromised,” Eckes said. Enough so, in fact, that even the board was concerned that if IT were to shut the system down, they couldn’t be certain it would even come back online.
The solution: Convergence
Issuing what Eckes described as an immediate call to action, the board authorized a significant investment to allow Wake Forest to find a more robust platform that ultimately would lead to a strong return on investment from a tangible basis.
Eckes and his team determined the antiquated platform needed to be replaced, as it was underperforming in terms of speed. With 4,000 to 8,000 users on the Epic system, it could take multiple seconds just to load between each click because the infrastructure wasn’t correctly sized.
Wake Forest chose a converged infrastructure with a hybrid cloud, Dell EMC Vblock, because it was exponentially faster than other options and wouldn’t require more staff, Eckes said.
[Also: Epic, Allscripts only big-name EHRs certified for 2015 edition; See the list]
The majority of the project time was spent waiting for the Vblock to be installed in the factory, which took about three months Eckes said. Once that finished, the equipment was installed in less than two days and ready to begin transferring to the system.
Wake Forest chose for self-service to be built into the application, which allows the IT team to create its own storage provision.
The platform is not only fully standardized, but it moved from 2 percent virtualization to 95 to 100 percent. The organization also moved 16 physical servers to the new platform.
The plan worked
Wake Forest dramatically improved data center and software uptime from the low-80 percent range to nearly 100 percent, Eckes said.
“Every transaction has improved by 30 to 40 percent,” Eckes explained. “If you think about nurses and clinicians, they’re doing these transactions hundreds of thousands of times a day. We gave them back 30 minutes to an hour of work time that can be used to see patients.”
Eckes also highlighted an increase in speed and value Wake Forest achieved by moving from its prior episodic procurement model to constantly maintaining systems, which nearly eliminated the setup time for projects
IT staff maintenance was down 70 percent. In the past, IT could spend 30 percent of project time on setup, now it’s down to hours or, at most, a few days.
[Also: Allscripts, Cerner, Epic signal more open EHRs ahead]
Wake Forest also eliminated the need to build out a new data center space: Rather, it replaced 45 racks of IT per data center down to 15 racks of converged infrastructure per center.
“For the most part, transitioning to the converged infrastructure wasn’t an event staff knew about,” Eckes added. “We made sure it wouldn’t impact staff. It made the clinician more excited as they knew it would increase up-time and performance.”
The bonus: Wake Forest’s most recent financial statement shows revenues of $1.3 billion, which is 12.7 percent higher than the prior year.
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