Mergers and Acquisitions: 3 steps to integrate health IT systems

The following is an excerpt from an article published in the FierceHealthIT's eBook "Health IT System Integration and Interoperability: Challenges and Solutions." Download the eBook here to read more.

By Annette M. Boyle

As the healthcare industry continues to consolidate, leading chief information officers (CIOs) find that developing a template or common approach to marrying disparate systems saves time and minimizes headaches.

"Mergers, consolidations, affiliations--in Boston, the combinations take on all flavors," says John Halamka, M.D., chief information officer for Beth Israel Deaconess Medical Center in Boston, a 649-bed patient care, teaching and research affiliate of Harvard Medical School. "You have to be agile, but the last thing you want is a one-off approach where you look at each deal and say, 'now what do we do?'"

While the specifics of each combination vary, CIOs that have undertaken multiple mergers or acquisitions recommend the following six steps for bringing two or more information technology systems together. Here are three:

Understand the Culture and Style of the Players: "What IT does is driven by the style of the business," says Tracy Parham, R.N., vice president and CIO for University of North Carolina Health Care System in Chapel Hill, an eight-hospital integrated system affiliated with the UNC School of Medicine. "In some cases, the parent organization comes in and dictates that everyone integrate into their system. You'll have a different plan with that style than you will with an organization that believes that the sum is greater than the parts, where you'll evaluate who has the better system for each aspect of the operation and work toward a best practices future state."

Build the IT Strategic Plan Based on Value Drivers and Key Players: The first steps for the IT department depend on the reason for the merger and the stakeholders' most urgent needs. If economies of scale or cost reductions are driving the deal, the IT plan "might start with the revenue cycle," Parham says. "If the stakeholders have focused on branding and connection, it could be that the human resources and communication systems come first. Overall, the goal of the CIO is to develop systems that enable the business to pursue a strategic method of achieving profitability."

A merger that brings together two or more organizations in the same geographic area will want to "ensure interoperability and may want to put all the clinical information into one electronic medical record (EMR)," says Bertram Reese, senior vice president of information systems administration at Sentara Healthcare, a 10-hospital integrated health system with ambulatory, long-term care, hospice and emergency medical service components based in Norfolk, Virginia.

If the organizations serve different communities and both have EMRs that meet Meaningful Use, the CIO may "take two looks at unifying the systems because all the entities are on the glide path to getting money from the federal government or avoiding meaningful use penalties."

Beyond the organizational level, CIOs and others involved in the merger process recommend explaining the value of the deal to various leaders in the combining entities and ensuring they understand value the partnership brings to them individually, says Donna Schmidt, R.N., director in the health industries practice at global consultancy PwC. While competition slowed merger activity 10 years ago, "with healthcare reform and shifts in the industry, that's really changed dramatically," she says. "People are much more willing to come together."

Still, figuring out who makes which decisions can be challenging. "The structure and governance of the IT services is dictated by the business model," Parham says. "For example, who will make the final decision about what's happening with the technology? Will there be a merged steering committee? There needs to be a clear IT governance structure in order to accomplish business goals."

Develop a Detailed Work Plan: Parham starts her planning by identifying the top five business initiatives. "If you aren't aligned with what the business is trying to accomplish, you will be wasting resources and money," Parham says. "Moving IT services to value-add instead of being perceived as a cost for the organization is a goal."

In addition to the top goals, Schmidt focuses on what needs to happen to close the deal and in the first 100 days of the combination. "Look for the quick wins, what your customers--whether patients, employees or executives--see as value, particularly those you can do with the technology you have and without huge expenditures," she says. After that, organizations should look at projects that drive value to the bottom line but are costly and time-consuming and save the most complex and expensive undertakings for last.

Clarifying priorities with other senior executives makes juggling competing projects possible, Halamka says. "It's a stressful time for CIOs, who are doing ICD-10,HIPAA, ACA and then have all of these mergers and acquisitions to manage. You have to sit down with the staff and senior executives and determine--given time, scope and resources--what can be deferred." Halamka points out that regardless of will and resources, no organization can expedite everything.

"Nine women can't have a baby in one month," he says. "Some projects simply take more time."

Once all stakeholders agree on the needs, priorities and budget, Halamka publishes a timeline and communicates what will be done and why, based on the current state of each partner's systems and data and the desired future state of the combined organization.

"Change management is the hardest aspect of the whole process," which makes setting clear expectations and timelines for execution critical, he says. 

To read the rest of this and other articles, download FierceHealthIT's free eBook, "Health IT System Integration and Interoperability: Challenges and Solutions."