A few years ago, Massachusetts General was starting down the path of implementing a new revenue cycle when they hit a bit of a roadblock. The parent organization, Partners HealthCare, had decided to go “soup to nuts” with Epic, meaning that CIO Keith Jennings would have to construct a detour. But when your “world changes,” that’s exactly what a leader needs to do, and so he created in a new roadmap in collaboration with other Partners hospitals. Now, Mass General is in “a much better place,” according to Jennings. In this interview, he discusses the balancing act of keeping the goals of the hospital and Physicians Organization aligned, why his team is planning a staggered go-live, and the work they’re doing with population health. He also talks about how Mass General is working to make innovation and process improvement part of the culture, and what it was like stepping into Jim Noga’s shoes.
Chapter 1
- About Mass General & MGPO
- Governance structure at Partners
- “Natural tension” between CIOs & CMIOs
- Going “soup to nuts” with Epic across Partners
- Live with rev cycle, planning a “staggered wave” for clinicals
- “We’re hoping for some quick wins.”
- Facing a major strategic change — “The world changed.”
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Bold Statements
There needs to be that natural tension. They need to be able to independently push IS to move at the speed of business for them, and I need to be able to independently hold them accountable to standards and security and other pieces that they may want to run past for a moment while they’re trying to achieve the next breakthrough.
We’re very lucky to have this structure where we have the hospital and a single PO. It’s much easier for me to provide uniform service to everybody, and it’s rare that someone says, ‘You seem to be favoring one over the other.’
It dips our toe in the water and lets our largest institution in the system break some of the ice and get up on Epic, and we don’t lose any of that learning and momentum that we had.
We really think we’ll be able to learn from the work that Brigham has done. We shouldn’t suffer any of the mistakes or struggles that they had. We may have new ones, but we really should be able to stand on the shoulders of those giants and do a better job here.
If we went with the hospital and our full PO on the same day, we may have stretched everybody’s limits. And so breaking it up this way again gives us a learning opportunity, get some wins under our belt, and slightly reduces the complexity of that big go-live in April.
Gamble: Hi Keith, thank you so much for taking some time to speak with us today.
Jennings: Kate, my pleasure. Thanks so much for having me on your podcast.
Gamble: Sure. So to give our audience a little bit of an idea, can you just talk about Mass General Hospital and the Physicians Organization, in terms of hospital bed size, affiliates — things like that?
Jennings: Absolutely. I’m the CIO of Massachusetts General Hospital and the Massachusetts General Physicians Organization. The hospital is a 1,000-bed academic medical center affiliated with Harvard Med School, and the Physicians Organization is an 1,800-provider, large multispecialty group that’s primarily located within the hospital but has presence out in the community.
We’re also a founding member of the Partners HealthCare System. One of our peer institutions is Brigham and Women’s Hospital, along with Newton Wellesley Hospital. We have a handful of community hospitals and post-acute care facilities, and we have McLean Hospital, and a great mental health psychiatric facility. That’s really the scope of our system.
Gamble: In terms of the governance model, do you report to Jim Noga? How does that work?
Jennings: As part of the system, a fair number of administrative roles are part of Partners HealthCare, so I’m actually a Partners HealthCare employee. In this group, which is about 4,000 or so employees, we have a lot of the IS infrastructure and leadership, human resources, finance, purchasing — those kind of activities that offer benefit to all the hospitals in the system. And so I have a solid line relationship to Jim Noga, who’s the Partners HealthCare System CIO, and in fact used to have the position I have now. And then I have a dotted line report to Sally Mason Boemer, who’s the CFO at Mass General, and I have another dotted line to Greg Pauly, who is the chief operating officer for the Physicians Organization.
Gamble: Okay. As far as having the roles of both CIO at Massachusetts General Hospital and the Physicians Organization, I imagine they fuse together pretty well. Is it more like having one role?
Jennings: Well, first of all, we benefit greatly by having the hospital and a single large Physicians Organization with it that saves an awful lot of squabbles. That doesn’t mean both the hospital and the PO are always moving in the same direction at the same time, so we always have to balance those activities. The Physicians Organization often wants to move faster or branch out into other areas than the hospital can or will, but just having two is great. And yet I’d like to think that both the hospital and the Physicians Organization get significant benefit from having the IT shop which cuts across both of them, having a single point in the pyramid that they can come to with questions or issues or requests.
Gamble: Right. On paper, it looks like it should be all smooth, right?
Jennings: Absolutely. It is.
Gamble: And then for the Physicians Organization, are there other leaders like who are clinical or physicians who then report to you, or how does that work?
Jennings: Do you mean in terms of CMIOs or the like?
Gamble: Yes.
Jennings: At least here at Mass General, the CMIOs report into the organizational structure and not IS. And in fact, others may disagree, but I actually believe that’s the way it should be, or at least for an organization of our stature. Because I certainly want the CMIOs to be IT-savvy and hopefully IT-friendly, but I think there needs to be that natural tension. They need to be able to independently push IS — me — to move at the speed of business for them, and I need to be able to independently hold them accountable to standards and security and other pieces that they may want to run past for a moment while they’re trying to achieve the next breakthrough or provide the next great care technique. It actually works very well for us here, and I think in many cases it’s actually the right model as opposed to having the CMIOs reporting to the IT structure.
Gamble: Right, interesting. So as far as how you divide your time, how do you do that between the hospital and Physicians Organization? Is it always changing as far as where most of your focus is?
Jennings: It is, and in fact, there are very few times other than budget time when I can really tell that what I’m working on is hospital versus PO — until someone has to pay, and then the line gets very clear very quickly. But our hospital internists and attendings are all part of the PO, so almost anything we do inside the hospital affects POs as much as the outside. And I don’t want to say we focus solely on the PO, but we’re very lucky to have this structure where we have the hospital and a single PO. It’s much easier for me to provide uniform service to everybody, and it’s rare that someone says, ‘You seem to be favoring one over the other.’ Again, it doesn’t mean that doesn’t happen from time to time.
Gamble: Yeah. Now, as far as the conversion to Epic, where does that stand right now — is the hospital live on Epic?
Jennings: No. So that’s an interesting question. Based on another project we had a while back, we ended up in a situation where we went live here at Mass General on revenue cycle, so we have the inpatient ADT, we have inpatient, hospital practice, and ambulatory billing up. And we have Cadence, their ambulatory scheduling product, up across the hospital and the PO.
In nine months or so, we are going to start a staggered wave of bringing some of our ambulatory clinicians up early. In December, we will bring 200 physicians and their practice and supporting staff up. In January, we’ll bring another 200 physicians up. In end of January or beginning of February, we’ll bring another 200 of our ambulatory physicians up, and then on April 2 actually, of next year, we will bring all the remaining ambulatory docs and the entire hospital up on Epic Clinicals.
Gamble: Okay. What was the rationale behind starting with rev cycle? What do you think were the benefits there?
Jennings: Well, the significant benefit is that we got a reasonable portion of it done early, but this goes back to being part of the system. We were going to go with another vendor a few years back and that was going to be a staggered install, and then the world changed on us with, accountable care and those kind of things, which forced us to reevaluate both our revenue cycle strategy as well as our clinical strategy. We were potentially going to stay on separate clinical systems — Mass General has a separate clinical system than the Brigham, although we have some warehouses and enterprise application, but by large, the two facilities were on standalone clinical systems.
But the world changed for us, we decided to go with Epic on rev cycle and Clinicals, and what had happened is the moment we made that decision, Mass General had been preparing to go live on the other revenue cycle system. We had done all the enterprise design and had really prepped the Mass General organization for revenue cycle go-live with a new system and rather than pausing all that work and looking at a big bang both for the Mass General and for the Partners system in general, we said ‘You know, we have an opportunity. We can bring up the revenue cycle since much of the planning and work has already been done. We’re changing horses to the Epic system, but we’re ready to go. We have a lot of learnings and other things in place. Let’s do this,’ and that did a couple of things for us.
First, it dips our toe in the water and lets our largest institution in the system break some of the ice and get up on Epic, and we don’t lose any of that learning and momentum that we had. And then we leaped frog a little bit; Mass General came up on revenue cycle and Brigham a year later — in fact, just two or three months ago — came up on revenue cycle and Clinicals, and nine months from now will come up on Clinicals. And it really worked out well for us. We had done a lot of work and were prepared for the rev cycle, both Mass General and the Partner system, we got to kick the tires a little bit and do a lot of lessons learned. Our lessons learned for our revenue cycle really fed into the Brigham’s planning for their full system go-live, and we’ve also had the opportunity now to watch the Brigham go-live on the clinical components, which has really changed how we are planning and making preparations for the Mass General go-live in a few months. So I’m not sure that you could find a strategy book that says this is the right way to do it, but as it turns out, it’s going to work out wonderfully for us.
Gamble: So now having that whole strategy in place with revenue cycle and then switched out the vendor, I’m sure that had to come with its set of challenges, but it sounds like it’s something where it did end up working out well.
Jennings: It absolutely worked out well. We are in a much better place having gone through all those trials and tribulations. It just paid tremendous benefits for Mass General and the system in general that it worked out this way.
Gamble: As far as Brigham going up on Clinicals, you said that it’s already changed some of the strategy for you guys—is that just from seeing obviously what worked and what didn’t and being able to apply that?
Jennings: Yes, absolutely, in a whole bunch of ways. They learned from our rev cycle go-live and in fact, we had the rev cycle system running for a year, so I think a lot of that is easier for them because it’s tested round and we may have made some changes. But the Clinical go-live is much bigger than the rev cycle go-live by order of 10 large, in terms of the number of people who need to be trained, richness of the applications in there, so there are a lot of new things to learn and experience. So we’re actually changing a whole bunch of things, including the way we do training and the training curriculum. There are a handful of system settings that we might want to change, but most of it is really how do we prepare the clinicians and staff to adopt a new system.
And the Brigham folks did a wonderful job, but there’s always opportunities to learn and improve, and on a daily basis, we’re getting there. Even now two or three months later, we’re still getting their after-action and their optimization reports, and it’s all feeding into our preparation. We will, I’m sure, still have issues. Bringing the Clinicals up when revenue cycle’s already live, we’ll probably have some unique “oops” that we’re going to trip over, but we really think we’ll be able to learn from the work that Brigham has done. We shouldn’t suffer any of the mistakes or struggles that they had. We may have new ones, but we really should be able to stand on the shoulders of those giants and do a better job here.
Gamble: Yeah. And then as far as the decision to stagger it through the physicians, I’m sure it’s the same basic idea where you go through those first 200 practices and kind of see what can be applied to the next wave?
Jennings: Correct. We really did it for two reasons. One, as you suggested, we get to try first and learn with a smaller, more manageable group, which is very important. Also, in theory, we’re hoping for some quick wins. Good news and bad news travels pretty quickly, and we’d like to get 200 folks and their associated practice members up and running to help calm or provide some feedback to everybody else who’s waiting and saying, ‘Are going to be able to do this?’ So it’s all good news, but again, it also gives us some practice.
And then the other thing it does is by bringing up those ambulatory groups in the three waves prior to go-live, it actually reduces the scope of our go-live. One of the things that we have found is that Epic has some big customers, but very few of their customers have gone live on such a big bang at once, and if we went with the hospital and our full PO on the same day, we may have stretched everybody’s limits. And so breaking it up this way again gives us a learning opportunity, get some wins under our belt, and slightly reduces the complexity of that big go-live in April.
Gamble: And Epic is being implemented across all of Partners eventually, right?
Jennings: That is correct. We’re going across the whole system, soup to nuts.
Gamble: Okay. I’m sure that will probably be some kind of case study in the future for other really large organizations.
Jennings: I hope so, and I’m not trying to give an advertisement for them, but we’re really excited about the way our system is going to be able to function once we get it rolled out. I think there are going to be some real benefits for our clinicians, for our staff and most importantly for our patients once we get everybody up on a single record. It will change a lot of the way we do business, in almost all cases, for the better.
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