Piedmont Healthcare’s award-winning Supply Chain team may operate under an established operational “ideal” that reads well on paper, but as a top-flight enterprise should, they’ve really managed to put a lot of their information technology aims into practice.
Granted, among their closed-loop connections resides a few crossed wires and frayed hairs, but that’s expected with such a culturally charged and operationally intricate enterprise designed to link disparate departments and functions together via IT.
In their quest to achieve interoperability system-wide, Supply Chain tackled the item master, implementing a single item master to coincide with the implementation of Piedmont’s ERP system from Oracle’s PeopleSoft. At the time, Piedmont consolidated eight different item masters and incorporated all of its physician practices that didn’t access any item master for ordering supplies, according to Amy Chieppa, Executive Director of Integration, Performance and Systems.
The single, standardized item master provides a set of standards for all facilities in the system to follow, one source of information for reporting, and it controls the purchasing process to the point that only approved suppliers are available in the item file.
“We leveraged GHX’s Nuvia tool to assist with merging them all and the data cleanse and normalization descriptions and assignment of UNSPSC codes,” Chieppa told Healthcare Purchasing News.
Chieppa acknowledges that data cleansing and dirty data can be a convenient excuse for delaying implementation or even the decision to implement a single item master but that should not encourage procrastination from pursuing an obvious efficiency tactic.
“No data cleanse is ever perfect because data is constantly changing,” she emphasized. “Dirty data will always be there whether you have one item master or many, and data cleansing is an on-going way of managing data – not an event to do monthly or quarterly or when it gets really dirty.”
Chieppa highlighted a number of challenges they faced.
“[You] cannot clean your item master without cleaning and normalizing your manufacturer master and vendor master,” she said. “In addition, there is a sequence – and art – to this.”
Conversions take time, too.
“It took us about four months to ‘stand up a single item file’ but we had a lot of ongoing corrections, removal of duplicates, etc., for about a year – and really ongoing,” she said. “We worked on it for a lot longer, but had a major setback with the normalizing/cleansing of the vendor file, which was being done independently by another group with a focus on primarily the remit vendor and not accounting for the supply side related to divisions, ordering/EDI, etc., so by the time that was corrected and we had to do a mini-restart we had about four months.”
Chieppa admits that estimating an average conversion time can be difficult to quantify because any calculation will depend on the number of item files being cleaned and merged and what are the important elements that make up an item file.
She further identifies three ongoing caveats:
- It will depend on how well the manufacturer information – company and catalogue number – is up to date
- How well the vendor MAD (merger/acquisition/divestiture) has been managed, how many technologies are applied
- How effective are the controls/philosophy in place to update the item file. The key ingredient is those who do the work. Those people and the work do not only include the analysts’ data dump and comparisons, but the people who can/should vet and provide updates – purchasing, sourcing, contracting, business partners, operations, including inventory and receiving.
Another challenge is you “have to have a methodology for how the item master will feed other systems and stick with it,” she continued. “Plan for and incorporate within the methodology – everything from how to build reprocessed items, managing reusable items, whether to source items from multiple vendors, feed to Epic (EMR) or [point-of-use] systems, GL, inventory, cost accounting, etc. This can take time and can be difficult to find out who can answer questions or make some calls, especially if you have started work to change some of those systems, such as overhauling the [chargemaster] or implementing a new EMR.
“[You] also must have governance/rules and discipline from day one on how to maintain the data,” she said. “Have hard stops for things that have not been specifically decided. This can be difficult to capture all the things that need to be accounted for – especially if you’ll be changing other systems.”
Chieppa admits that they are more than 10 years into this project and “still cleaning … not done yet.”
Piedmont also continues to discuss how to improve the chargemaster system-wide.
“Our single item master is linked to multiple chargemasters – not one-for-one but through shells – but the chargemasters are standard/normalized,” Chieppa said. “There have been discussions about going to one chargemaster. There is a daily interface from ERP to EMR. The item file houses all the information, including charge shells, revenue codes, ‘static’ or fixed charges, etc., needed to determine/calculate charges and facility charging. There is a setup on both the ERP and EMR to ensure items that need to be charged for interface correctly into the various charging modules. The chargemaster team reviews all item-adds and relative changes and communicates what needs to be updated in the item master.”
Supply Chain was able to hook into Epic’s clinical system for the operating room (OpTime) and cath lab (Cupid) to stop non-approved, off-contract purchasing, according to Alex Bonno, Executive Director of Operations.
“Cupid is Epic’s clinical documentation module for the Cath Lab,” Bonno explained. “Implementing Cupid required us to make some changes and add some additional Supply Chain Services resources to support the new process flows and product needs. OpTime is Epic’s clinical documentation module for the Operating Room. We try to leverage our existing resources where and when we can, but it is also a part of our Supply Chain Services culture to look for opportunities to take over other ‘shadow’ supply chains and to work with our hospitals to prudently provide additional services as needed or requested.”
Simple Google searches will reveal the good, the bad and the ugly challenges healthcare organizations experienced when converting to Epic’s medical software, and Piedmont is no exception. They did acquire some “scars” in the process, according to Chieppa. But some of the challenges can be traced to internal processes and systems and their compatibility to Epic. She offered some encouraging words of wisdom for those undergoing or considering an Epic conversion.
“Do not be afraid to ask questions and be vocal if something does not track,” Chieppa advised. “Even if you are not sure if something is important, or no one can answer questions to satisfy your understanding, keep asking questions. Keep being vocal. Items will play a much bigger role with Epic than anyone can imagine – on the [supply chain management] side or clinical side – and the less integrated you are on your legacy systems, the bigger the change with going to Epic or any fully integrated EMR. Understand what Epic will need and start making the changes in the legacy systems – or at least the processes and data – prior to going live as much as possible. Take the time to understand how your information flows and where it goes – and why or why not – as well as the impacts it has on everyone else.
“Do not label things as ‘an IT thing’ or ‘an Epic thing’ and do not assume someone will have all the understanding and answers when something goes wrong,” she added.
Piedmont continues to work on developing a unified contract repository, according to Greg Milton, Director of Project Management.
“We have a single item master but, unfortunately, we do not have a single repository for contracts,” Milton said. “Legal requirements for a database and the database needs of Supply Chain do not always mesh. We have contracts loaded into PeopleSoft, MediTract – a contract repository heavily utilized by our Legal department, a GPO contract repository, and CCX – a contract module of GHX. Items built in PeopleSoft have their corresponding contract loaded into PeopleSoft as well. Many of the GPO contracts are housed within CCX but not in MediTract due to the limitations of that particular database and the fact that the terms are regularly updated for these contracts. The constant uploading of amended [terms and conditions] and price changes was a non-starter. MediTract also houses many sensitive HR contract, physician contracts, affiliations with schools and programs, and other items.”
Supply Chain’s link across all contract databases is the department’s internal supply chain contract number, which is Supply Chain-assigned and housed in MediTract, PeopleSoft and CCX, according to Milton. The bridge for GPO contracts is another Supply Chain-assigned contract number for that GPO. “For all things that we pay for, PeopleSoft would be the source of truth,” Milton said. “[This includes] the item file, POs for purchase and/or contract POs, which cover scheduled payments/services. The actual documents would be in the GPO system or MediTract.”
Piedmont’s expansion and growth over the years represents an ongoing challenge to Supply Chain’s IT efforts, Milton indicated.
“This is a real problem particularly for an organization with a single item file,” he said. “The need to bring acquired facilities onto PeopleSoft in order to facilitate HR and Finance transactions shortens the window of time for Supply Chain to move the facility to all of the standards that currently exist. As a result, new items are added to the item file in the course of the acquisition, and this opens the health system to creep – a potential reversion back to products from which we converted away or the erosion of contracts with market share commitments.”
But Milton acknowledges that these growing pains are neither surprising nor unique.
“The reality is that our marketplace is in the midst of an accelerated rate of merger and acquisition that promises to reshape the metro area to resemble many other markets across the country,” he said. “North Georgia is late to the game in some ways. And the reality is that hospitals are going to move forward with the acquisitions that make sense as they emerge. We will not get a second bite at the apple so to speak. It is left to us to cope with this reality as best we can despite the obvious extra work that it creates. I think it is a nod to the team at Piedmont that we have kept our heads above water in the midst of such tremendous change and we recognize the ongoing and recurring work we have to re-rid ourselves of the ‘cancer’ that appears with each new acquisition. With a prolonged break in acquisition activity, we will find ourselves with another two-to-three years of work to eradicate the creep entirely.”
Thankfully, Piedmont’s C-suite recognizes the work in front of Supply Chain even when the mergers are completed, and endorses the additional resources Supply Chain needs to continue, according to Milton.
Supply Chain played a critical role in Piedmont’s integration efforts, insists Joe Colonna, Vice President.
“I think the groundwork was laid when we went to and have maintained a single version of our ERP system and related tools with a single item master for the system,” he said. “In some ways, that was the easy part. The challenge is giving the ERP and other systems what they need to function at a high level. That work has been done incrementally over months and years by building out systems and processes to improve data, transactions and efficiencies. This, coupled with the equal commitment to a single version of our EMR systems, has allowed us to deliver on our promises to the organization and put tools in place to measure and validate outcomes. The trust is built on using these tools to help the organization, not just in areas like savings, but [also] in quality and safety initiatives and in process improvement. However, I think this is an always will be a journey. With every new addition to the organization, we have to implement, systems, process and earn that trust again.”
Pressed for further explanation, Colonna clarified his classification of ERP and item master consolidations as easy exercises.
“You can create a single item master with bad data,” he explained. “The cleansing, maintaining the integrity of your data and your processes are the hard parts. Especially as you grow. It is easy to be tempted to just say, let’s get it in the system, and we can clean it up later. In our case, we had to make a change in ERP systems ahead of our EMR conversion. We made the decision, at that point, to go from multiple item masters in multiple ERP and [materials management information] systems to one single item master and one version of our ERP system. At the time, it meant five hospitals and 100+ physician offices. It helped to have the burning platform of the pending EMR change.”