Universal Health Oncology Case: Merger, Chrystal Conversion, Gap Analysis, and Workflow Problems

Case Context

Universal Health is a large not-for-profit health system with 12 hospitals across three states and two large oncology programs in Arizona. The case centers on major operational differences between Oncology South, which came into Universal Health through a recent merger/acquisition tied to Academic Hospital, and Oncology North, which had already been part of Universal Health for about eight years.

Chrystal EHR Conversion

Because Oncology North was already using Chrystal, the Universal Health enterprise EHR, that platform became the model for converting Oncology South from its prior EHR. This created concern at Oncology South because oncology care is operationally complex and the conversion would affect both daily workflows and the broader operating model. Previously, each oncology program had worked relatively independently with IT to create custom solutions, but the merger required movement toward a standardized oncology solution across the organization.

Gap Analysis Findings

Chrystal alignment specialists were engaged as part of the conversion effort, and one of their first major tasks was a gap analysis and prioritization of oncology-related EHR functionality. The analysis found that Universal Health’s oncology build did not align well with Chrystal’s recommended oncology specialty design in several areas. Oncology North also reported that, despite years on Chrystal, its current build still had important functional gaps for oncology clinicians.

Workflow and Documentation Problems

In response, Universal Health assembled a focused team that included a project manager, nursing informatics, Universal Health IT staff, Chrystal oncology alignment specialists, Chrystal oncology IT experts, and oncology navigators from both sites. Initial concerns centered on prior authorization and financial gaps, the workflow/functionality needs of oncology providers and clinicians, and the fact that oncology navigators had little to no oncology-specific functionality in Chrystal.

The case emphasizes that oncology patients have distinctive needs because treatment is frequent, prolonged, and often stressful emotionally, physically, and financially. This increases the importance of reliable workflows for navigation, assessment, and insurance-related coordination.

Navigator Workflow Differences and Shared Needs

Observation of current-state workflows showed that the oncology navigators at North and South performed the same broad role but with significant operational differences. For example, Oncology South made initial patient contact by phone within three days and oversaw all oncology patients, while Oncology North first engaged patients at the initial physician clinic visit and primarily followed patients with identified needs. Both programs were using paper-based navigator assessment forms, but they also shared some EHR-related approaches.

Across both sites, navigators/coordinator RNs wanted discrete data for reporting, used shared electronic forms and free-text notes, and wanted oncology documentation to be easier for clinicians to find inside Chrystal. These common needs supported development of a single future-state design.

Project Goal

The dedicated team’s responsibility was to document workflow, assess end-user needs, and submit a final design recommendation with training materials to the Universal Health IT build team within eight weeks. The overall aim was to use current-state findings, gap-analysis results, and shared oncology requirements to create a more effective enterprise oncology navigator solution.