Maine Event: How A New Leadership Philosophy Helped Drive An Epic Turnaround

Jackie Cawley, Associate CMO & CMIO, MaineHealth

Jackie Cawley, Associate CMO & CMIO, MaineHealth

Andy Crowder, Corporate SVP & CIO, Scripps Health (Former CIO, MaineHealth)

Andy Crowder, Corporate SVP & CIO, Scripps Health (Former CIO, MaineHealth)

Before Andy Crowder signed on for what promised to be a significant task in helping to create a unified IT organization at MaineHealth, he had a prerequisite. The health system needed a CMIO and CNIO. And not just anyone, but two people with a strong track record in clinical leadership who were familiar with the organization.

Crowder got his wish, and nearly three years later, the IT departments for the 11 hospitals that comprise MaineHealth “are now one, operationally, procedurally, and culturally,” and the Epic project that had hit a major snag is now back on track. The difference? Having CMIO Jackie Cawley, who has been associated CMO for MaineHealth since 2012 and has a long history with the organization as a physician leader, and CNIO Teri Young-Hise, who previously held the CNO role at a member hospital.

“To lead an initiative of this magnitude would require an investment in senior clinical IS leadership that the health system had never made in the past,” said Crowder [who recently started a new role of CIO at Scripps Health].

Once in place, the new leadership team faced the tall task of consolidating nearly a dozen IT organizations and creating a “true shared services department” that centralizes tasks such as support, project management, and implementation planning. Once they were aligned, MaineHealth was able to focus on the Shared EHR Project to roll out Epic across the system — hardly a minor mission.

“It’s a very elaborate IT governance structure and stakeholder engagement model, and so shared decision making and governance are really critical aspects that have to be very mature,” noted Crowder. In other words, the organization needed a common roadmap that could provide one direction while taking into needs of each individual entity.

That’s where Cawley and Young-Hise came in. Rather than being holed up in an office trying to devise a plan, the two were out in the field, speaking with providers every day, asking questions and seeking input about content and design to make sure they had the pulse of the clinicians.

“We meet with those stakeholders all the time, and that’s been really key. We go where the work is, and we make sure we’re really visible,” said Cawley. “We’re very active with go-lives on the site, on the floors, in the practices. And we participate in our physician and nursing leadership meetings, so we’re right at the table with the rest of the team.”

Leadership used the feedback garnered from those interactions to develop a standard set of workflows and processes that could be applied throughout the system.

“It’s really helped us move toward having more of a MaineHealth identity,” said Cawley. “We now have a shared roadmap, which is foundational for Epic to implement all of the clinical and revenue cycle modules.” Currently, two hospitals — Maine Medical Center and Waldo County General Hospital — are live, along with some 1,400 ambulatory providers. Two more facilities are scheduled to go live in the spring, and two more at the end of the year. At the same time, Lawson ERP is being rolled out system-wide.

It’s a scenario many wouldn’t have thought possible a few years ago when the Epic implementation was delayed due to serious financial concerns. According to Crowder, who was brought in as interim CIO to help get the initiative back on track, the original budget projections didn’t account for the growing size and scope of the organization. As a result, a bond was raised to fund the remainder of the project.

But that wasn’t the only problem that needed to be fixed.

“We needed to transform this from what had been labeled as an IT initiative to a clinical transformation project,” said Crowder. Leadership across the organization spent months repackaging and recrafting IT governance structures and processes to lay the groundwork for a truly integrated organization. “It was a repositioning of what the real impetus was of the initiative. It was putting the patients and clinical outcomes at the center of that vision, and getting them reenergized about the outcomes that could potentially be achieved.”

From Cawley’s perspective, rebranding it as a shared project meant moving away from the local decision-making and ownership that had crippled it, and “getting people to act more clinically integrated.”

And with that solid foundation in place, MaineHealth is applying those same principles in other areas, including business intelligence (with Epic’s Cojito data warehouse solution) and population health (with Healthy Planet). There are also plans to launch MyChart at the bedside and replace a legacy clinical registry system, all while having a centralized support center to ensure everyone is on the right path.

“It’s a lot of focus on business analytics and outcomes and key clinical decision support at the point of care to drive some of our other quality initiatives,” said Cawley, who is drawing upon her extensive experience with population health as an executive sponsor.

And the work doesn’t stop there. An upgrade to the 2015 version of Epic is in the works to help meet behavioral health requirements, and additional hospitals and practices are being scheduled for migration.

The fact that MaineHealth is able to do all of this demonstrates how critical it is to have the right governance in place, noted Crowder, who strongly advises other organizations not to “go to the dance” without a CMIO and CNIO. “Any health system that’s doing clinical transformation projects has to have dedicated provider, physician, and nursing informatics leadership,” he said. “And these roles have to be strategic in nature, as they define the informatics objectives for the health system. Jackie, Teri, and the other VPs on the team are all true partners that are capable of stepping into the CIO role.”

And in fact, when Crowder announced he was making the move to Scripps Health, he was thrilled that Crawley was named interim CIO. “She’s going to do some fantastic work. We have a very repeatable model and some best practices from an implementation and strategic point of view. It’s nice to have such a great partner at the table through some of these successes — and the difficult times as well. I have no doubt they’re going to crush it on the next waves of Epic.”

As for Crowder, he plans to take the lessons he’s learned and apply them to the Epic rollout at Scripps, while Cawley looks to stay on course at MaineHealth using the tools she now has.

“Andy has built a great infrastructure and brought really great skillsets in with leadership, so even though we’re sad to lose him — because he’s been a great leader for our department and our health system — we’re feeling very confident,” she noted.

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