Ballad Health responds to merger by effectively implementing common EMR and ERP systems within three years, and is in the process of implementing a new enterprise imaging solution.

All health systems will eventually be faced with the challenge of re-evaluating their current enterprise imaging solutions to find a more streamlined, cost-effective option that will meet current and future patient-care needs. This may be in response to the development of new imaging technologies such as artificial intelligence (AI) and cloud-based storage; health system mergers; or complex imaging silos, storage and workflows that have evolved over the years.

Ballad Health — a 20-hospital health system with 13,000 team members that covers 29 counties and 950,000 residents across an 8,600-mile rural catchment area in northeast Tennessee, southwest Virginia, northwest North Carolina, and southeast Kentucky — faced this challenge head-on after a merger in 2018.

“When Ballad Health was created through the merger of regional health systems Mountain State Health Alliance [MSHA] and Wellmont Health System, we had to figure out how to join and blend each system’s technology to create the infrastructure we needed,” said Pam Austin, senior vice president and chief information officer for Ballad Health. “Our first challenge was merging the EMR — Wellmont used Epic and MSHA used Cerner.”

Additionally, Austin noted that the health system was operating under a strict deadline. Its Certificate of Public Advantage (COPA), a cooperative regulatory agreement governing the merger established by Virginia and Tennessee, required Ballad Health to implement a common EMR platform within three years.

“We looked at the two incumbent vendors only, and after performing due diligence, we determined that Epic was a better choice for Ballad Health,” said Austin.

In June 2020, well before the three-year deadline, Ballad Health’s ambulatory clinics moved to the Epic system, followed by 12 former MSHA hospitals that October. During this time, Ballad Health also performed a simultaneous analysis and consolidation of their enterprise resource planning (ERP) system to reduce duplication of functionality while ensuring the continuity of core business applications — especially their payroll system.

An Application Rationalization Analysis

With the EMR and ERP projects complete, Austin and her team focused on performing an application rationalization analysis — looking at who had what, and where there was duplication.

“We were using three legacy imaging solutions with pending end-of-life dates, so addressing our imaging was a critical need,” said Austin. “We were faced with picking one of the three existing platforms or choosing a different solution.”

Austin pulled together a group of executive vice presidents who approved the governance group of radiology, IT, and operational leaders across all the departments that would be using the system. The governance group worked together to prepare a budget and timeline and provided critical input throughout the process.

“Support from our organization and the voice of our radiologists was a critical success factor,” said Austin. “From the beginning, we prioritized including people who would use the imaging application. We even asked them to write down their priorities for the new solution.”

Ballad Health ended up going to market with an RFP, setting the three existing solutions aside in favor of pursuing another option.

A Patient-Care Perspective

When selecting their new imaging system, the team’s first priority was finding one that would be the best long-term solution for Ballad Health patients — one, three, and five years into the future.

But to analyze the potential long-term impact of each solution, they needed to investigate their potential enterprise imaging partner — asking questions about their potential partner’s plans for future releases and implementing new technology, while simultaneously assessing workflow impact across all the different “-ologies” that would be using the system.

“The big question was ‘How do we want to care for patients?’” said Austin. “We wanted to find a solution that simplified our imaging environment, reduced variation in workflows and had long-term scalability.”

Throughout the selection process, Austin said her IT colleagues promoted the idea that finding a new enterprise imaging solution wasn’t an IT project — instead, the IT team leveraged their governance process to give radiology “ownership” over the project.

“Ninety percent of any IT project is managing the people and the process, so we focused on change management from start to finish,” said Austin. “Our role in IT was to help people understand how and why the process would be changing and keep the project within scope — and we found that the way we communicated, early and often, was critical to our success.”

The team also considered cloud-based storage options, use cases for AI solutions, and privacy and legal issues around these emerging technologies. Ultimately, the team decided not to pursue AI or cloud- based solutions at this time.

“Our storage is on-premises right now, but we are looking at cloud-based options long-term as part of our DR [disaster recovery] strategy,” said Austin. “With AI, you have to look under the covers and understand how the algorithm works to ensure the technology produces good, accurate information, as well as what kind of human interaction is required to validate it.”

Austin said any future changes in AI imaging would be funneled up through the Radiology Governance Group and the Technology Steering Committee, which includes representatives from the business, clinical, executive, compliance, legal and marketing teams.

Governance and Communication Deliver Outstanding Results

Like most IT departments, Austin’s team was also faced with managing the demand on resources caused by supporting the old imaging systems while implementing the new.

By focusing on change management, governance, and communication, the team minimized misconceptions and miscommunications — especially if concerns arose around what was actually purchased compared to what the team thought they purchased.

“The process was good for IT, as well as our radiologists — and we couldn’t have done it without them,” said Austin. “We got an in-depth understanding of the radiology team’s concerns and issues, and how we can engage them in the future.”

Austin said Healthlink Advisors contributed to Ballad Health’s continued success by assisting with project management, escalation, communication, and other issues that arose during the process.

As an IT leader who has overseen extensive EMR and ERP projects — and is in the process of consolidating imaging — within three years, Austin shared advice for health systems which are about to embark on similar undertakings:

“Governance is key. Communicate as much as you can, and be sure to involve the business side,” said Austin. “Remind your governance teams and the business side that this is not an IT project. Keep the scope narrow, and everyone’s expectations on the same page.”