During the 20-plus years John Lynch has spent in the healthcare IT industry, he’s learned many things, perhaps the most important being patience. Lynch, who recently took on a new role as VP/CIO at Greater Hudson Valley Health System, believes that the adoption of EHRs is going to result in tremendous benefits — but it isn’t going to happen overnight. CIOs, he says, need to view implementation as a journey and set realistic expectations for what transformation will require. In this interview, Lynch talks the importance of having integrated inpatient and ambulatory offerings, why it’s critical for vendors to understand their customers, and why it’s great to strive for flexibility — as long as you understand your organization’s limits.
- About Greater Hudson
- Running an Epic shop
- Integrated inpatient/physician practice offerings
- Comparing Meditech and Epic
- Vendor recipe versus flexibility
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We’ve had a very good experience with Epic, and I think that’s been impressive given the scale of growth that they’ve gone through over the past number of years, the demand on their product, and their ability to implement.
I think they’re forward-looking on tools that they put into the hands of customers to make the maintenance of their system easier. The implementation of changes to the system, upgrades, and the ability to do some disaster recovery functionality right out of the box with them is probably superior than any other vendor.
I think there is a lot of demand and pressure put upon hospitals and physicians and the technology providers for those groups these days as result of the requirements now placed on these organizations to implement electronic health records — and in a relatively short timeframe. Everyone’s scrambling to do this.
They’re very straightforward with the customers to say, ‘Do something out of the box with us in the implementation, and we can get it done in this shorter period of time. If you want to do more customization changes in terms of the content and workflow, then it’s going to take you longer to implement.’
Understand what your limitations are going to be trying to implement those types of changes and customizations, and deal more in reality in terms of what you can accomplish as an organization and what your vendors are capable of doing. Vendors such as Epic and Meditech — they’re established; they know what they can and can’t do, and you have to respect that.
Guerra: Good morning, John, I’m looking forward to talking with you about your work at Greater Hudson Valley Health System.
Lynch: Good morning to you, Anthony.
Guerra: All right, so you have two hospitals, I believe — Catskill and Orange. Why don’t you go ahead and give me the overview of the health system and the different owned entities — ambulatory, that type of stuff, and we’ll go from there.
Lynch: Greater Hudson Valley Health System is comprised of two hospitals. Orange Regional Medical Center in Middletown, N.Y., actually opened up just a year ago. It’s the first new hospital in the state of New York in about 20 years, and it was an offshoot of Arden Hill Hospital and Horton Medical Center in Orange County, N.Y.
The second hospital is about 45 miles away in Harris, N.Y., in Sullivan County, and that’s Catskill Regional Medical Center. It’s approximately 130 beds, and Orange Regional Medical center is approximately 400 beds. We do have ambulatory services — a number of imaging and outpatient clinics, and outpatient oncology. We do not have a large employed physician base at this point in time. We’re looking to expand that. But we have a number of small health clinics in our markets.
Guerra: Okay. And you’ve been there about four months, correct?
Lynch: That’s correct. I started in the middle of May this year.
Guerra: So it’s been a whirlwind?
Lynch: It’s been a lot of activity. I’m very pleased to be here. I think there are some exciting things on the horizon for Greater Hudson Valley, with first the addition of the new medical center and all the things that we plan to do for the communities we serve here. We just finished our final Epic hospital install in the beginning of July. The first hospital — Orange Regional Medical Center — went live about a year ago, and as I just mentioned, Catskill Regional went live just the other month. I’m happy to report we met all of the phase 1 Meaningful Use requirements the first week we went live with the Epic system. Everyone’s very pleased about that; the physicians and nurses are very pleased to have the Epic EHR as their primary information tool as they care for patients.
Guerra: Now we’ll talk a little bit more later on about your time at Provena Health, but were they on Epic over there?
Lynch: We had just finished implementing the Epic ambulatory system. We had the Meditech inpatient system for the hospitals. We were also just going through a merger with Resurrection Health Care. The new merged organization is called Presence Health, and Resurrection was just in the midst of an Epic inpatient and ambulatory install for their six hospitals. Provena had another six hospitals that came to the merger and I think the assumption probably is that long term, the six Provena hospitals that have joined the new organization will probably implement the Epic inpatient system at some point in time.
Guerra: That’s certainly the pattern that we see in the industry. If an organization starts putting Epic in their ambulatory facilities, then it’s not too long that the current inpatient system is going to be around.
Lynch: I think the biggest concern will be cost. As you know, the Epic System as good as it is, is expensive. And while I was at Provena Health, we actually did a review of systems there and we had a preference to move forward with Epic, both inpatient and ambulatory, but we couldn’t afford the cost of the inpatient system. But we were pleased to be able at least go forward with the ambulatory EHR, because we had approximately about 60 employed physicians, growing that to over 100, and we had no ambulatory EHR for our physicians, so we needed to implement something. We were looking at several different vendors, and we were happy to work out something with Epic on the ambulatory side there.
Guerra: Yeah, because it’s not like Meditech had a fully integrated ambulatory product that made total sense to put in, right?
Lynch: They do have one, but it wasn’t on the short list of vendors that we thought had a real viable ambulatory EHR to provide to physicians.
Guerra: Right, so why not go outside of the Meditech product because there’s nothing really inside that could work?
Lynch: Correct, and there aren’t many vendors that provide an inpatient EHR that also have a relatively good ambulatory EHR, so obviously there’s been a lot of integration between the inpatient EHRs and the ambulatory across the system. So we assumed that would probably end up being the case for us, and again having the ability to move forward with Epic on the ambulatory side, we were pleased with that.
Guerra: Who would you say has that — Epic and Cerner? Or is there anybody else you think that has the complete package?
Lynch: Cerner has a package, and the Eclipsys-Allscripts combination now has a package.
Guerra: Fully integrated though, off the same database?
Lynch: Well, they’re different products. McKesson has products that are integrated. I do believe that in terms of actual content integration, Epic and Meditech probably have more integrated solutions in that space, but I think by far, Epic has a far superior ambulatory product in terms of functionality.
Guerra: Yeah, I’ve never heard anybody comparing Epic and Meditech in terms of ambulatory products.
Lynch: No, not in terms of functionality. But in terms of integration with the inpatient, Meditech certainly has good integration there. I think the main concern is the functionality of the ambulatory product.
Guerra: You mentioned cost stopping you at Provena. Is that going to come into play with any of your work over at Greater Hudson Valley in terms of the Epic stuff, or is that already taken care of from a budgeting and cost point of view?
Lynch: Well, the good news is that it’s pretty much all taken care of at this point in time. For us, like many other community health systems, the financial side of the equation is always a struggle, especially with current and upcoming regulatory changes on payments. But the good news for us is we’re now live with a system, and so I think we’ve passed that hurdle at this point in time.
Guerra: Having worked with Meditech and Epic and maybe some others, is there a way you can describe the difference in terms of the service that they provide?
Lynch: We’ve had a very good experience with Epic, and I think that’s been impressive given the scale of growth that they’ve gone through over the past number of years, the demand on their product, and their ability to implement. We’ve been pleased with the service that we’ve gotten from Epic. I do think they take a very forward-looking attitude. They seem to be very customer-focused, not only in terms of development of their product, but how they implement. They want to be successful there. They want their customers to be successful. And in terms of the maintenance support that they provide, I think they’re forward-looking on tools that they put into the hands of customers to make the maintenance of their system easier. The implementation of changes to the system, upgrades, and the ability to do some disaster recovery functionality right out of the box with them is probably superior than any other vendor.
I will say this. I’ve worked in the Meditech space for a long period of time and I do think that they provide good customer service too compared to other vendors that I’ve dealt with. I think they do a pretty good job with their customer service. In fact, I would probably put Epic and Meditech both at the top in terms of service that they provide their customers.
Guerra: A lot of customers benefit from the wisdom that their vendors have derived over multiple installs — dozens of installs of their product. They know how to do it so that it’s going to work. That’s what I think some of what you’re saying is echoing; that you appreciate that recipe — that they’ve got the recipe. Sometimes though customers chide at not being heard to a certain degree or feeling a lack of flexibility — ‘We want to do it this way,’ or ‘we need more time.’ There’s a balance there, and when it comes down to the nut-cutting, it may not always be a very friendly conversation. What are your thoughts around that about a vendor showing you its recipe versus, to some degree, having some flexibility to your specific needs?
Lynch: I think it’s extremely important. I think there is a lot of demand and pressure put upon hospitals and physicians and the technology providers for those groups these days as result of the requirements now placed on these organizations to implement electronic health records — and in a relatively short timeframe. Everyone’s scrambling to do this. Many hospitals and physician practices are behind timeframes to get this completed, so they’re in a rush to do that. And obviously the vendors have high demand on this right now, and the ability for them to keep up with this and hire enough people to get these implementations completed in a timely fashion for their entire customer base, along with anyone else that might be making decisions these days on either first-time implementation of an EHR or knowing now we have to do something a little bit more permanent and reach meaningful use — perhaps selecting a different vendor. It’s a lot of work, a lot of activity, and a lot of planning in a short timeframe.
My experience with Epic has been that they will show you the options. If you want to do something out of the box with them, they can. I think they’re very open and upfront with customers in terms of what that approach looks like, and the limitations that might exist doing something out of the box and not having an opportunity to make some adjustments on the software and implementation that would better fit workflow needs for a particular health system. And I think the same is true of Meditech. I do think that they provide those options to their customers and they’re very straightforward with the customers to say, ‘Do something out of the box with us in the implementation, and we can get it done in this shorter period of time. If you want to do more customization changes in terms of the content and workflow, then it’s going to take you longer to implement.’
I think those two vendors do a good job of providing either option to their customers and being realistic with them on what the outcome of both of those potentially might mean to their organizations, and then it really comes down to making the decision that’s best for the health system. How much time do we have to complete this and try to achieve all the benefits of Meaningful Use that have been laid out by the government and hope for the best.
Guerra: As a customer, have you ever experienced this, or how would you feel if you told the vendor such as Epic or Meditech, ‘We want to do it this way,’ and they said, ‘Well, we don’t think that’s a good idea.’ And you say, ‘No, we want to do it this way,’ and they said, ‘Well, it’s really not going to work. We’ve seen it, and it’s not going to work.’ ‘Well, we want to do it this way.’ Would you expect them to go ahead and do what you wanted or to say, ‘No, we’re not going to be able to go forward.’ Have you ever experienced anything like that?
Lynch: I haven’t. Those questions need to be asked and discerned upfront before you decide on your vendor. You need to understand what you’re going to be able to get from the vendor, and if it doesn’t match up, you need to ask those questions early on to see whether or not they can match up. If they can’t; if the vendor is reluctant or uncomfortable with doing that, then that’s not the vendor you want to go forward with. I think if you’re hearing that same answer from all the vendors that you’re looking at, I think you then have to relook at what you’re trying to accomplish there.
With a vendor such as Meditech and Epic — and I’m sure it’s true with many of the other vendors that have been implementing health EHRs or inpatient systems for a long period of time — they have lots of experience. You have to understand and listen to and appreciate that experience. No one wants to step out over the ledge and try to attempt something that either they’ve had experience with or they feel pretty confident is not going to go well for either party. There’s no sense in not being successful at what you’re trying to attempt here.
My advice would be you need to do that discernment upfront; understand what your limitations are going to be trying to implement those types of changes and customizations, and probably deal more in reality in terms of what you can accomplish as an organization and what your vendors are capable of doing. Vendors such as Epic and Meditech — they’re established; they know what they can and can’t do, and you have to respect that.