If you’re going to lead an organization through a merger, the one thing you can’t be afraid to do is step on few landmines, says Bobbie Byrne, who encountered several during the union that created Edward-Elmhurst Health three years ago. What leaders can do is to be sensitive of the differences that exist between cultures, and keep the lines of communication open. In this interview, she talks about how to navigate partnerships with competing organizations, how her own experience as a pediatrician factors into her rollout strategy, how getting people to think “Epic first can be both a blessing and a curse.” Byrne also discusses her new role, which is a reflection on the organization’s strong focus on consumer driven health, her thoughts on managing expectations, and what she considers to be the “most fun part” of her job.
Chapter 1
- Edward-Elmhurst Health’s formation in 2013
- Chicago’s “extremely competitive environment”
- Collaborative competition with DuPage Medical Group
- Partnering with physicians — “It’s part of our DNA.”
- Moving Elmhurst Hospital to Epic
- At-the-elbow support & specialized training
- “It’s time consuming, but it’s really worth it.”
- Pros and cons of “Epic first”
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Bold Statements
It’s really nice to be able to use everything we learned when we rolled out the first time — the things we did right and the things we did wrong, and then try and just do everything right with the follow-up hospital.
We knew going into this implementation that we really had to take Epic’s tools and push them as absolutely far as we could in order to meet the patient movement processes that had previously existed at Elmhurst.
The biggest piece is we now have a really experienced team. The first time we did this, we didn’t know what we didn’t know, so we sort of were fumbling a little bit in the dark with two hands out in front of us. Now after being live on Epic for over three years, you’ve made a lot of mistakes, and we’ve already corrected some of them. It just feels more confident.
I’m a pediatrician. I need very different things than my friend the cardiologist does from the system. So don’t teach me his things and don’t teach him my things. You have to prioritize it and say, ‘yes, this is going to be more expensive training, but we’re going to do it.’
The number one priority is always going to get done, regardless of the team that’s requesting it. That’s not a problem. It’s the number four, five and six priorities — how do these happen and which one gets prioritized higher? I actually haven’t talked to another CIO who has this system nailed.
Gamble: Hi Bobbie, thank you so much for taking some time to speak with us today.
Byrne: Good morning, Kate, happy to talk to you.
Gamble: If you could just start off by giving an overview of Edward-Elmhurst Health, what you have in terms of hospitals, ambulatory care, things like that, and where you’re located.
Byrne: Edward-Elmhurst Health is a system that was put together from a merger of Edward Health and Elmhurst Health. We did a merger about three years ago where the two Edward hospitals combined with the one Elmhurst Memorial Hospital, so now we have three hospitals. We have probably about 60 or more ambulatory locations and a pretty large medical staff as well as a large employed and affiliated physician base.
We’re located in DuPage County, which is outside of Chicago. We have a little bit of a unique situation in our area that there is an independent multi-specialty group called DuPage Medical Group, which actually is now at about 600 physicians, so really a very good sized medical group. We work very collaboratively with them, including sharing an instance of Epic with them. So our environment is in some ways that of a very typical community hospital, but we have some kind of unique situations as well.
Gamble: And being located outside of Chicago, I’m sure you’re in a pretty competitive environment as far as some of the health systems and hospitals.
Byrne: We’re in an extremely competitive environment, one which is wonderful if you’re a patient, because I think we have just wonderful competitors around us who give excellent care and who keep us on our toes as well. You really can’t go wrong with many of the health systems in Chicago if you’re trying to receive care.
We are also challenged in that we have many health systems, but really only one dominant commercial payer in Blue Cross, which also creates interesting dynamics in the Chicago market. The other thing that’s happened is mergers, of course. I think all over the country — but certainly here in Chicago — it has really been ramping up and it’s been an active conversation. It seems like every health system is talking to every other health system at some point.
Gamble: When you talk about there being one dominant payer what does that really mean from your perspective? What are the biggest concerns with that?
Byrne: I think the issue is we are trying to be very creative in different mechanisms of delivering care and negotiating contracts and trying to really embrace being paid for value instead of volume. We certainly are able to do that, but if we do those types of demonstration projects with a more minor payer, it’s just a much smaller impact. So really what happens is that we are very often looking to Blue Cross to see what source of innovative programs they are interested in doing with us. And we have done several with them, but it really ends up being that it’s our one go-to on the payer for payment innovation.
Gamble: Right. And you mentioned a lot of merger activity, which is really typical of what we’re seeing across the country. It seems like more so in certain areas, like Chicago, where as you said there is such a high concentration of health organizations.
Byrne: There’s one merger here in our market that I think nationally is being watched because the FTC has been challenging it, and that is the North Shore Health System merger with Advocate Health Care. It’s getting kicked back and forth in the courts right now, and it is very similar to another case in Pennsylvania. There’s just a lot of eyes on the Pennsylvania case and on the Chicago case to see how much the FTC is going to allow in consolidation and in mergers. It’s interesting to read the papers.
Gamble: Definitely. Are you involved in any kind of partnerships at this point?
Byrne: I think probably the most important partnership that we have is with DuPage Medical Group. We share an instance of Epic, and anybody who understands Epic knows that sharing Epic is a major partnership commitment. But we also work on other vendors. We have a couple of other vendors that we work on with them, mostly ones that are tied to Epic.
We also help each other out with staff. If they have a big go-live, we try and help, and they try and help us with our big go-lives. It’s been a very fruitful partnership. It would take a long time to list all the different ways that we work together. They actually provide our professional billing services through their administrative arm, so there’s just a ton of different things that we do with them.
Then the interesting thing is we also compete with them. They also have some certain ancillary services that we have at the hospital, so we compete on that. Right now, of course, everybody is trying to hire as many physicians as they can, so we tend to compete with them on that. So it’s an interesting dynamic. We call it like ‘collabo-tition’ or other made-up names to talk about how we cooperate and we compete.
Gamble: Right. I can see why it is the most important partnership in thinking about where things are headed right now with this climate and really needing to be in that position with a big medical group.
Byrne: Absolutely. Edward has been traditionally a very physician friendly organization. When our CEO started over 20 years ago she really started with this concept of physician partnerships. We have this partnership with DuPage Medical, and we have a close relationship with another large cardiology group called Midwest Heart. There’s a long history of working with physicians. I think we now have five joint ventures in surgery centers. It’s just something that’s really part of the DNA of the organization to work with physicians in this way.
Gamble: You mentioned that the hospitals are on Epic. All three of them are at this point?
Byrne: No. Edward Hospital, which is an acute care hospital, and Linden Oaks, which is a behavioral health hospital, have been on Epic now for over three years. And all of our physicians are on Epic as well. Elmhurst Hospital is moving to Epic Oct. 1, so that really is going to be the last. And that completes the puzzle of getting the whole system onto Epic.
So it’s pretty exciting; it’s really nice to be able to use everything we learned when we rolled out the first time — the things we did right and the things we did wrong, and then try and just do everything right with the follow-up hospital.
Gamble: I was going to ask you about that. You were part of the system when the first hospitals went live on Epic, so is there anything that stands out in particular that you do plan to do differently with this roll-out?
Byrne: There are quite a few things that we will be doing differently that relate to just the different cultures of the organization. So the whole way that patient movement works on our Elmhurst campus is very different than the way that patient movement worked on the Edward campus. We knew going into this implementation that we really had to take Epic’s tools and push them as absolutely far as we could in order to meet the patient movement processes that had previously existed at Elmhurst.
Elmhurst built a brand new hospital five years ago and really was very innovative in the way that they wanted to track and move patients and be very efficient in the way that the patients tracked through the day. Some things like every activity is scheduled for patients all day long. If it’s therapy, it’s scheduled. If it’s an MRI, it’s scheduled. Certainly lunch is very scheduled. There’s a scheduled rest time for the floor where the whole floor is quiet. So there are some of those things that were really, really patient friendly that we wanted to make sure that we kept. Previously Elmhurst had used a niche vendor for that; we were really trying to keep everything in Epic if we possibly could. I’m really excited to see how this is going to work. I think the Epic tools, with a lot of configuration and a lot of real thoughtful processes, are going to make a difference.
In terms of some of the other things we tried out the first time that worked really well, I think because I’m a physician, I’m very, very passionate about physician training. We initially had on the Edward campus 17 different specialty specific curriculums. We do all specialty specific training. The way we do our personalization lab, our optimization — that one-on-one training is very time consuming, but I think is really worth it.
The way that we support clinicians, we have a 24/7/365 team that will immediately come to the elbow of a clinician who needs assistance. There are some things around that where I thought we did well on the Edward campus and I wanted to just enhance and maybe even double down a little bit on the Elmhurst implementation.
Gamble: Right.
Byrne: Honestly, I will say probably the biggest piece is we now have a really experienced team. The first time we did this, we didn’t know what we didn’t know, so we sort of were fumbling a little bit in the dark with two hands out in front of us. Now after being live on Epic for over three years, you’ve made a lot of mistakes, and we’ve already corrected some of them. It just feels more confident. You just feel much more secure that when you’re making a decision, that you’re making it with full and good information, and it’s the best one you can make.
Gamble: Right. And the emphasis on training is something that really makes a lot of sense. What we hear a lot is that people wish they would have done differently is either provider more training or more specialized training, like you said. And even at-the-elbow support is something that I think a lot of people would do if they had to do it again.
Byrne: I think the problem is it’s expensive. That’s where you have to really believe in it and prioritize it, and say ‘I’ll cut something else from this in order to make this work.’ I mean, it’s much more efficient to put 12 physicians in a classroom and train 12 physicians than it is to put four cardiovascular surgeons in a classroom together and train them just on the things that they need to know.
I’m a pediatrician. I need very different things than my friend the cardiologist does from the system. So don’t teach me his things and don’t teach him my things. You have to prioritize it and say, ‘yes, this is going to be more expensive training, but we’re going to do it.’
Gamble: Yeah. Maybe more money up front, but you save on not having to go back and train again.
Byrne: Exactly.
Gamble: Okay. So obviously that’s a huge focus with that coming in October. Then for the hospitals where Epic is already in, is the focus on just really trying to always get more out of the system and optimize, things like that?
Byrne: When we first implemented Epic people would ask how we measured success, and we had all sorts of KPIs and all sorts of metrics that we followed. I said my personal definition of success is, after we’ve implemented it, if operations or anybody in the organization has a problem, I want their first question to be, ‘Is there a way that Epic can help us solve this problem?’ Whether it’s a workflow issue or efficiency or revenue or patient safety, it doesn’t matter. Sometimes Epic is not the solution, of course. But I want people to always be thinking Epic first.
I think that I almost pushed that too hard because now the demand for enhancements and workflow changes and ability to use Epic to solve problems has absolutely outstripped our capacity to implement those enhancements. Once we get Elmhurst Hospital live, we really have to not only start knocking away at some of that backload of enhancement requests, but really start to get a little bit better in our prioritization of how we do them. We just have too many.
Gamble: Right. That brings up an interesting point in talking about expectations and how those can be managed. On one hand, I’m sure you’re glad to see people really wanting to use this technology, but then on the other hand you do have to deal with the expectations that are kind of beyond what can be done at this time. Any thoughts on how you can weave through that?
Byrne: I think we’ve done what other organizations have done and pulled together cross-functional teams of individuals who represent different parts of the organization, have different perspectives and values, and try to get that key group together to prioritize. I think it works okay. I don’t think it works great. I think one of the biggest challenges we have is saying things like, ‘this might be the clinical team’s number one priority, and this might be the revenue cycle team’s number one priority — which is the number one of those two priorities?’ And we end up making judgments that don’t always feel great on either side.
In reality, the number one priority is always going to get done, regardless of the team that’s requesting it. That’s not a problem. It’s the number four, five and six priorities — how do these happen and which one gets prioritized higher? We’re looking at doing things like setting percentages where each team gets a set percentage of enhancements, and then trying to juggle it at that stage. I actually haven’t talked to another CIO who has this system nailed, and I think for us it’s about to get more complex because we now are going to have another acute care hospital on the system, so now we have to balance the demands of the different acute care hospitals.
Chapter 2 Coming Soon…
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