What a rural North Dakota health system learned from 13 rounds of data cleanup for Epic and Workday

Key takeaways

Trinity Health, a three-hospital system in rural North Dakota, is implementing Workday and Epic as one program, and it took 13 rounds of test files to clean the data its siloed applications held. The system is now live on Workday and plans to go live on Epic by the end of 2027 while it works with Epic on Orchard, an implementation process for smaller organizations. CIO John McDaniel says assigning data owners and winning staff adoption mattered more than the technology.

Trinity Health is a three-hospital health system in deeply rural North Dakota, serving a catchment area roughly the size of Ohio. So when CIO John McDaniel decided to modernize its operational and clinical infrastructure by simultaneously implementing Workday and Epic, he knew it was an ambitious undertaking.

But it wasn’t until the organization began testing its Workday integrations that the full extent of the data challenges would be revealed.

It took 13 iterations of test files to get the data right.

“We had a large number of disparate applications that were siloed, with redundant data in every one of those systems,” McDaniel explained to Digital Health Insights. “We would build the test file and then realize we had so much duplicate data, so much bad data, that we’d have to go back and do another iteration.”

“Eventually, we got to a point where we were satisfied that the data was clean enough to support our needs going forward, which was an important milestone for our implementation project.”

For McDaniel, the experience reinforced an important lesson about large-scale technology implementations.  Success depends on more than choosing the right platforms.  It also requires a strong commitment to data integrity, an understanding of how to construct new workflows, and effective collaboration with the people that will support both of them during and after an implementation.

Two birds, one stone: Going all-in on infrastructure transformation

Trinity Health needed a comprehensive modernization strategy that would tackle all the major clinical and administrative functions of the health system.  

“We decided that there were more advantages to doing both at the same time than doing them one after the other,” he explained.  “We could avoid duplicated integration work if we addressed everything at once.  That would allow us to use our internal teams and other resources more effectively.  And since we had some hard deadlines and internal mandates to meet, it just made sense for us in this case.”

“People have asked me if I would make the same choice again, and I absolutely would.  I’ve talked to some of our allies around the state, and several said they wished they had done it as well. They implemented Epic first and then Workday, or vice versa, and had to go back and change some of what they’d just done. It has been very challenging, but our staff understands the mission, as well as the reasoning behind it, and they’re ready to do whatever needs to get done.”

Getting the house in order before go-live

More than a dozen rounds of data cleanup offered Trinity Health some valuable insights into how to keep its existing data in good shape – and make sure that new data starts out as high-quality as possible.

“During the cleanup process, we learned to assign data owners so that data cannot change without the owner’s knowledge and consent,” said McDaniel. 

“The first thing we asked was, what application is the trusted source of data? Where do we know it’s accurate? Once we decided on a source of truth and assigned the data owner, they could say, ‘Yes, this is the right data; this is the right system.  And this is what we use going forward for loading into Epic or Workday.’”

“It helped prepare us better for Epic, because we were able to start working on workflows that exist today and preparing them for the workflows we’ll have with Epic.”

The health system even found some opportunities to improve its billing, enabling them to tune up their revenue cycle management in advance of the major push to implement Epic, as well.

A temporary pause to support a big leap forward

Trinity Health is now live on Workday, but the Epic implementation is taking longer than initially planned – for a very specific reason, McDaniel said.

“We wanted to be very intentional about how we brought in Epic.  It’s a phenomenal product, but we quickly found that the implementation methodology is designed for organizations much larger than ours,” he said.  “We went to Epic and brought up some of the issues we were facing, and they agreed that there’s a need to right-size the process for smaller-scale organizations.”

Trinity and Epic are now partnering on building out a new implementation process better suited to smaller organizations, called Orchard, with a focus on how to simplify and redistribute some of the administrative tasks involved.  

The collaboration has resulted in an extended timeline, McDaniel acknowledged, which caused a few temporary bumps in the road.  

“Obviously there are challenges, because I had staff who were already Epic-certified that I couldn’t utilize yet,” he said. “But ultimately, that allowed me to redeploy those individuals to work on projects that had been on hold to prioritize the Epic and Workday tasks. That has actually allowed us to get some other things in order that will help us prepare even better for the next steps of bringing in Epic.  There are always ways to produce benefits, even when we’re making changes to the original plan.”

Trinity Health is currently planning to be live on Epic by the end of 2027.

The importance of getting the fundamentals right

For Trinity Health, and health systems like it, thorough preparation is key to succeeding with complex, large-scale implementations.  

That preparation has to be beyond data integrity and workflow optimization.  It also has to include creating a culture that celebrates the tenacity it takes to chase clean data through 13 rounds of test files, and the flexibility required to elevate what’s best for the organization long-term above the need to meet initial deadlines.

“We all know the technology works. I’ve been doing this for more than 50 years, and the technology working is almost never the issue,” said McDaniel. “The issue, especially in rural organizations, is culture. Will the people work with the technology? A lot of times, that’s where you get resistance. Even some of the best systems fail because users won’t adopt them, or they try to use their old processes with the new tools.”

“We worked with our folks to say, ‘Here’s current state today. Here’s what current state’s going to be in the future.’ They started to understand the impact it’s going to have on them, and got them thinking about how they could work with the changes. That’s critical to enacting the changes that we want to see.”

A two-in-one implementation plan might not be for everyone, but it can be a highly effective strategy if the right foundations are in place.  Establishing clear data ownership, addressing existing workflow inefficiencies, and engaging staff throughout the process can help organizations avoid costly complications while laying the groundwork for long-term success.

Jennifer Bresnick is a journalist and freelance content creator with a decade of experience in the health IT industry.  Her work has focused on leveraging innovative technology tools to create value, improve health equity, and achieve the promises of the learning health system.  She can be reached at [email protected].