Sentara Healthcare

Norfolk, Virginia

  • Annual revenues of $2.8 billion
  • Staff of more than 19,000
  • More than 2,500 affiliated physicians including more than
  • 380 physician medical group
  • The largest health care provider in southeastern Virginia and northwestern North Carolina
  • Operates 7 hospitals, 10 long-term care facilities, and offers a 380,00 member health plan
  • As a large integrated care delivery system, Sentara offers a wide variety of clinical programs, including heart, cancer, orthopedics, and OB
  • Reimbursement for care includes commercial health plans, individual health plans, Medicare, Medicaid, Tricare, and charity care

Stage 7 Award
Recognized hospitals in 2010: 6

Challenge: In 2003, Sentara had many disparate legacy IT systems for managing business and clinical operations. In 2005, after successfully implementing a system-wide integrated PACS system, CEO, Dave Bernd, challenged the organization to find a comprehensive health IT solution to alleviate the fragmentation of information conveyance across the enterprise. After a rigorous search for a suitable IT solution and an extensive Total Cost of Ownership analysis, the executive board decided that although the estimated ROI was less than the required threshold, the EMR was warranted to transform care delivery.

Implementation Solutions: The first hospital implementation began in February 2008. By the end of 2009, with six hospitals fully implemented, nearly $17 million in annualized benefits were achieved. These benefits are attributed to the hospitals, the health plan services and home health operating at the full benefit level, as well as reductions in IT maintenance costs formerly associated with the multiple vendor contracts for various legacy applications.

The eCare project team included operational and physician stakeholders to assure ownership across the system. Six Sigma process improvement was used to redesign 16 major workflows to achieve maximum benefits. A phased implementation approach was used with the philosophy of build once roll many. The system design and build began in June 2006 after team training and certifications were completed. Subject matter experts were recruited from across the system to assist in design and validation of each application area, these SME’s transitioned into a super user role upon implementation.

EMR Solution: Epic

Recognizing the ROI of EMR Implementation

  • Annualized return on investment (ROI) benefits for the first five hospitals is $24 Million (2009 Jan – Nov annualized data compared to 2006 baseline year) which far exceeded our 2009 expected/budgeted benefits of $16.6M. Those benefits are expected/budgeted to grow to $29.3 M in 2010 and $38 M in 2011.
  • At four hospitals in the first six months of 2009, about 41,000 potential medication errors were avoided when nurses cancelled medication administrations due to barcoding alerts.
  • Inpatient lab tests have been reduced by 5 % due to elimination of duplicate orders.
  • Readmission ratio at our first four go-live hospitals have been reduced by more than 18%.
  • The time to assign a bed has decreased 90 minutes with an 80% reduction in time to admit an ED patient.
  • 190 FTEs have been reduced/redirected to more value added activities.
  • Documentation, transcription, medical records, and malpractice premium costs for Sentara Medical Group cost $1.4 million less.
  • Sentara Health Plan realized $2.7 M in benefits in 2009 due to reduction in severity-adjusted length of stay for patients at our first four go-live hospitals.
  • Reduction in nursing unit overtime and purchased labor due to more efficient shift handoff processes and better retention of nurses.
  • Length of stay has been significantly reduced at four golive hospitals with more than $6 M in savings realized due to streamlined pace of care, CPOM, reduced adverse drug events and more efficient discharge processes.
  • Increased Outpatient Procedures due to being easier to do business with and better quality and timeliness of care and/or communications with physicians.
  • Streamlined Record Completion with significant reductions in medical records and coding personnel with more than $1.1 M savings.
  • Reduction in paper costs with more than $1 M in savings for reduced use of paper, storage and printing supplies.
  • Reduced transcription costs in excess of $1 M.
  • Decreased Time for Test Results and reduced time for medication orders due to CPOM and streamlined communications.
  • Throughput improvements include 7 of 10 emergency departments improving their triage performance, 4 of 10 improving their admit time performance and all hospitals improving their patient throughput times.
  • Core measures have also improved in most of the hospitals.

Lessons Learned

Understand and redesign workflow for efficiency.

  • Knowing the intricacies of the workflow processes and how technology is incorporated are the keys to achieving desired goals.
  • Mapping AS-IS workflows helped the team to identify and commit to opportunities for improvement.
  • Validated workflows served as a mechanism to rigorously evaluate vendor demonstrations.

Create a deliberate implementation strategy.

  • Strategies need to enable problem identification early in the process.
  • The first go-live hospital leadership must demonstrate adaptability and provide strong support for change.
  • All employees and clinicians must attend training and pass a proficiency test to get their log-in ID.
  • The sooner the physicians use CPOE, the sooner the benefits will be realized.

Ensure compliance through operational leadership and salient outcomes.

  • EMR is an operations project, not an IT project.
  • As opposed to a mandate, EMR adoption is best achieved if operations embraces it.

Optimize to expand benefits.

  • EMR is much more than a plug and play; it is a continuous improvement process.
  • Optimization demands rigorous metrics and leadership accountability

“The unique IT system features and configurations, cost of ownership, recruitment of a talented team, as well as unforeseen requirements common to all EMR implementations point to the need for poignant change management.”

Dave Bernd | CEO | Sentara Healthcare


If you are a healthcare provider and would like more information on how to obtain your hospital’s EMR score, e-mail us or call us at 866-546-2900.