Timing is everything. When the Hospital for Special Surgery was beginning its EHR selection process, Epic released its orthopedic module and announced plans to offer remote hosting. For a hospital that specializes in musculoskeletal health and is located in New York – a city where real estate is at a premium, the decision was easy. Selecting a vendor, however, is just the beginning. In this interview, CIO Jamie Nelson talks about the strategy she used to build an Epic team, why she believes education is the key to data security, and how HSS has made innovation part of its DNA. Nelson also discusses the “boardroom skills” necessary for CIOs, why work/life balance doesn’t truly exist, and the next big frontier for her organization.
- About HSS
- Independent in a sea of giants — “Our long-term goal is to stay as we are.”
- Fortuitous timing with Epic
- The art of vendor selection — “There has to be a technical & cultural fit.”
- Staffing for a big project — “Always add more.”
- Adding resources for training
- CEO engagement — “That makes a big difference.”
- Pros of remote hosting
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There has to be a technical fit and there has to be a cultural fit, and we felt that both were very strong with Epic. We’ve been extremely happy with the system, with the organization, and with what we’ve been able to accomplish here.
I would tell anybody looking to do the same thing to always add a little bit more, because we’ve found that once we implement Epic, the appetite for information and features increased. So we have since added more staff than we originally thought we needed.
We brought in some new resources because we knew IT was going to be on the hook for training. We also made sure that training was going to be funded by the organization in terms of backfill. You can’t expect a thousand floor nurses to come through training and for patient care not to suffer unless you have appropriate resources.
We were just as busy on day 1 of Epic as we were the day before. Our quality indicators were excellent. Our patient satisfaction remained extremely high. So we really had a phenomenal implementation for lots of different reasons, but having that business and clinical focused leadership involved was key.
Gamble: Thanks so much, Jamie, for taking some time to speak with us today.
Nelson: My pleasure.
Gamble: Can you give an overview of Hospital for Special Surgery — where you’re located, bed size, things like that?
Nelson: Sure. We are a specialty orthopedics hospital located in New York City. We’ve been doing this for 153 years now. Our mission is around the treatment, education, research, and innovation around musculoskeletal health. And we’re very proud for what we do. We are, once again, rated number one in the nation by US News & World Report for orthopedic surgery, and again, number two for rheumatology. It’s an organization that is really focused on a single mission, and that’s really an exciting place to be.
Gamble: Right. And if you’re a big sports fan, like I am, you’re certainly familiar with the organization with all of the teams you’re affiliated with.
Nelson: A lot of sports figures and athletes come through here. We have performing artist, dancers — all sorts of people for whom musculoskeletal health is important to their livelihood. And also people who just want to get back to doing what they need to do and love to do. It’s amazing how much a bad back or a hip doesn’t work anymore will impact quality of life.
Gamble: Is the hospital is independent or do you have affiliations?
Nelson: We are independent.
Gamble: And that’s becoming more of a rare thing.
Nelson: Yes, but I think with the work that we do here and the quality measures that we have—we are a 4-time Magnet hospital, the only one in New York State — and because of what we do here, we can remain independent. Our biggest challenge is finding the capacity for patients that are waiting to have care here and figuring out how to do that fast. Our long-term view is to stay as we are.
Gamble: We spoke about three years ago — it’s hard to believe it’s been that long. But obviously your organization has undergone a lot of change since then, the biggest of which is probably the EHR landscape.
Nelson: I’m here five years now. Three years ago is when we started our Epic journey, because it takes about two years to implement Epic, and we’ve been live almost a year. I think we really struck it at a great time because Epic had just developed its orthopedic module, which we implemented, and they had just started their remote hosting offering, which we took part in. So it was a great time for HSS to implement Epic, and we’ve been very happy with that because that’s now the bedrock for a lot of other things that we’re looking to do.
Gamble: I would imagine the orthopedics module was a pretty significant driver in going with them?
Nelson: It really was, and we really feel that they were the best vendor for our particular organization. There has to be a technical fit and there has to be a cultural fit, and we felt that both were very strong with Epic. We’ve been extremely happy with the system, with the organization, and with what we’ve been able to accomplish here.
Gamble: As you alluded to, it’s a long process as far as implementation. One aspect of that is getting a team together. Can you talk about what went into creating the team that was going to be heading the Epic rollout?
Nelson: Sure. First, we had to make sure that we had the right sized team. So we had Epic and some consulting partners help us to think through where our current team stood and what we needed to add. I would tell anybody looking to do the same thing to always add a little bit more, because we’ve found that once we implement Epic, the appetite for information and features increased because of what the staff was not able to do with the system. So we have since added more staff than we originally thought we needed, which I consider a good thing.
What we did next is we outsourced our legacy system so that everyone in our current staff who wanted to become Epic-certified and move forward with Epic could do that. We had a third party take care of the Legacy system, so everybody had an opportunity on Epic. We really didn’t want to split the department among the people who had supported the old system and the people who were on the new one. I don’t think you get the most engaged group of employees when you have two sides. So I think that was a very important thing to do.
We also had a mix of taking our own staff, who became certified, and bringing staff in from the clinical and business areas at the hospital who wanted to move to IT into the team, and then bringing people from the outside with Epic experience. It was a nice combination of three different types of employees who became a very effective team.
Gamble: What about leadership — was there a particular group that was charged with that?
Nelson: IT was the leader. I had someone who was running my financial system, who was very smart, a real change agent, and had lots of credibility within the institution — she had only been there for about a year and a half, but was very, very good — and I made her the Epic project lead. She wasn’t a clinical person; she hadn’t had any Epic experience. But I knew that she’d be an excellent leader, and she wound up building a great team around her.
Going forward we used management consultants to fill in roles, but we led this implementation. She has a very strong team and we’ve had a lot of involvement from our clinical and our business users in terms of leading their own teams moving forward. I think we had a lot of success because of those factors.
Gamble: Would you have done it again that same way where you had so much different representation? It didn’t prove to be too many opinions?
Nelson: No, because it wound up really being a very user-led implementation. Our user community — which included clinical and business users — didn’t have a feeling that IT was pushing the system on them. They really were leading with us. You have one person in charge, but it’s a very senior team member who works alongside the staff. We have the clinical leadership. We have revenue cycle leadership. We have research leadership. We have physician leadership. So we kind of orchestrated things so that we have a first violin, a first cello, a first trumpet. It was really excellent.
Gamble: One thing we hear that’s often a strong focus with an Epic rollout is training. How did you approach that?
Nelson: We built a big training team. We did not have a very robust training team, so that’s one of the areas where we brought in some new resources because we knew IT was going to be on the hook for training. We also made sure that training was going to be funded by the organization in terms of backfill. You can’t expect a thousand floor nurses to come through training and for patient care not to suffer unless you have appropriate resources to backfill their work while they’re in training. So that was an important part of our financial model to make sure we had appropriate resources to backfill our clinical staff when they came to training.
Also, with some of our business and revenue cycles staff, if we had people that were really focused on the implementation, we made sure to backfill their roles so they could help define, design, and test this system. So I think that was really key.
Gamble: For the most part, have things stayed on track?
Nelson: We finished that implementation on time and on budget, which we’re very proud of. It was a very successful implementation. Epic said we were in the top 7 percent of implementations. Our revenue cycle improved — we had absolutely no variants in our operating room schedule. We were just as busy on day 1 of Epic as we were the day before. Our quality indicators were excellent. Our patient satisfaction remained extremely high. So we really had a phenomenal implementation for lots of different reasons, but having that business and clinical focused leadership involved was key. And our CEO who is extremely involved, very engaged in the process, and felt that its success was his success as well — that makes a big difference.
Gamble: Another thing you’ve mentioned before was the ability to have Epic hosted remotely. Why was that something you wanted to do? What have been the advantages of that?
Nelson: A couple of things. Before I even got here, we had a history of remote sourcing its applications. Our current billing system was remote-hosted, and was is the clinical systems, which was AllScripts. We already had a history of doing that. And because we didn’t have the expertise; we would’ve had to bring in staff to run a 24 x 7 clinical and revenue cycle system.
The other issue is space. We’re in New York City, and real estate is extremely expensive and hard to come by on the Upper East Side. It would have been expensive to find a suitable space for our data center for this system, so it was really much better having Epic run this. The ability for them to staff it with their own people, and have their own best practices and their staff who knew the architecture and the technical environment, while also having it hook right back to the application staff there, was huge. It’s a good environment, and it’s proven to be very, very reliable. We’ve been very pleased in the first year.