John McDaniel, CIO of Trinity Health, a Minot, North Dakota-based health system
Photo: Trinity Health
John McDaniel has served as CIO and advisor to multiple health systems, health IT vendors and consulting firms. Currently he is CIO of Trinity Health, a Minot, North Dakota-based health system, and is leading an electronic health records system switch from Cerner to Epic – one that is not uncommon.
As such, he is filled with sage advice and hot tips for CIOs and other health IT leaders at hospitals and health systems who must change EHR systems.
The operational impact
For example, leaders must understand the operational impact of an EHR changeover, he said.
"From a CIO's perspective, transitioning EHR vendors – specifically from Cerner to Epic – requires a shift in strategy from procurement to operational alignment," he explained. "You really need to understand the impact the EHR has on every single operation within the organization. The first step we took at Trinity Health was 'thin slicing' each process in the organization.
"Thin slicing breaks down each process operationally to identify the root cause of problems," he continued. "These insights are then compared to each vendor's capabilities to see how the new system will impact operations, revenue recovery, patient care and revenue generation."
Each vendor was asked how their application, coupled with new AI technology such as ambient listening, would impact Trinity's results – for example, improve patient management, wellness management, community care and virtually every aspect of the health system, he added.
Prioritize discovery over RFPs
McDaniel recommends bypassing a traditional RFP in favor of a discovery-first process. Trinity Health invited three vendors to spend a week embedded within its departments. This allowed them to assess:
- Current operational challenges.
- Existing workflow structures.
- Specific requirements to remediate pain points.
"By the time the vendors demonstrated their systems, they were solving our specific problems rather than giving a generic pitch," he explained. "This led to a 98.5% consensus for Epic. While Epic carries a higher price point, the ROI is found in its superior integration across applications – in the aggregate, you simply get more."
Finally, the health system changed the name of its IT department to the digital transformation group. McDaniel said the department now is viewed as an organizational asset, and it has become part of every digital change at Trinity.
"The new EHR isn't just the CIO's recommendation, it is an integral part of our future vision and plan," he said.
The single source of truth
A critical initial step in the transition was evaluating data requirements and identifying the "single source of truth," McDaniel noted.
"We discovered we lacked both a consistent trusted data source for each requirement and a clearly defined legal medical record," he said. "Consequently, the health information management department became a foundational partner in the project's success.
"Data integrity is an iterative process that begins with rigorous cleanup," he continued.
Working with the HIM department and data experts from HIM and revenue IT vendor e4health, Trinity executed a strategy to:
- Validate data integrity. Determine which legacy data sets were reliable enough for migration.
- Define archival versus conversion. Strategically decide which data warranted active conversion into the new EHR versus what should be moved to a legacy archive.
- Standardize the legal medical record. Formalize the definition and requirements of the legal medical record to ensure long-term compliance and interoperability.
"While this phase is particularly challenging for organizations with disparate legacy applications, it is non-negotiable," McDaniel stated. "Failure to prioritize data hygiene on the front end of an EHR implementation risks automating inconsistencies or migrating erroneous data into the new environment – which ultimately compromises operations, revenue and patient care."
HIM essential to success
The data clean-up project enabled the health system to move the right data forward into the new Epic EHR. HIM's role was, and will continue to be, foundational to success, McDaniel said.
Regarding workflows, CIOs should ask specific questions, he said, such as:
- What will we automate?
- Why are we automating this workflow?
- Where is the supporting/necessary data found within the medical record?
The upfront focus on data quality and workflow efficiency ensures the new EHR implementation will achieve Trinity Health's strategic goals, he outlined:
- Improve patient throughput.
- Increase revenue recognition.
- Achieve cost savings.
- Realize operational efficiency.
"Finally, the strong integration of every Epic application makes the focus on data quality and workflows even more important," McDaniel concluded. "We are currently entering wave three of our process and Epic go-live is scheduled for October 1, 2026."
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