“I tend to have a pessimism and skepticism around technology.”
It’s not every day a healthcare IT executive utters those words (at least, not publicly). But for Erik Pupo, who recently took on the role as CIO at Columbia University Irving Medical Center, it doesn’t mean being averse to technology, but rather, taking a more realistic approach to what it can and can’t do. At least, not until the right pieces are in place.
Recently, Pupo spoke with healthsystemCIO.com about the priorities on his plate, most of which revolve around plans to move to a single EHR platform, and creating the infrastructure and governance to make that a reality. He also talks about how his diverse background has helped prepare him for his first CIO role, the two-way street that needs to happen with change management, and the potential mobile health offers in improving care delivery.
- About CUIMC
- Epic Together initiative w/ Weill Cornell & NewYork-Presbyterian
- CIO’s role in “helping clinicians understand the impact an EHR will have.”
- “Hodgepodge” of EHRs in physician practices
- Building IT governance from the base level
- Customer experience – “We want to have channels available to answer questions.”
- Positioning IT “as a major component of what we do.”
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We’re doing a lot of the technical preparation, which involves doing inventory of, and understanding, our overall infrastructure — where we need to improve, and where we need to do perhaps a little more.
Much of our focus with workflow is on helping clinicians understand what they do now and how that will change. And so my role as CIO is not just to prepare, but to message and to assist and to be very closely aligned with what each of our clinical departments want.
A project like Epic is going to making some people happy and others not happy. And so we want to have channels available in IT to answer questions, make improvements, and do whatever we need to do to keep our customers happy.
Everything that goes into running a hospital day to day, I’ve tried to position technology as being a chief component of that.
Gamble: Hi Erik, thank you for joining us. I look forward to speaking with you about the work your team is doing at Columbia University Irving Medical Center.
Pupo: My pleasure, I’m happy to join.
Gamble: Let’s start with an overview of the organization, and where you’re located.
Pupo: We are located Upper Manhattan. Columbia University Medical Center serves the entire Manhattan community and we are part of the NewYork-Presbyterian health system. We also work very closely as part of that system with our sister institution, which is Weill Cornell Medicine.
Gamble: And you have the School of Nursing and College of Dental Medicine, and also teaching hospital affiliates?
Pupo: Yes. We have the School of Nursing, the College of Dental Medicine, Mailman School of Public Health, and the Vagelos College of Physicians and Surgeons. As part of that, we have departments that focus on various specialty areas — for example, cardiology and ophthalmology. We’re very well-known in several specialty areas. My role as CIO is to serve the entire institution, as well as work with my colleagues across the NewYork-Presbyterian system.
We also have about 1,800 doctors as part of ColumbiaDoctors. They work as part of a larger network with NewYork-Presbyterian, so many of them spend time in the hospitals and at the various faculty practice sites.
Gamble: Columbia is involved with Epic Together, and initiative with Weill and NewYork-Presbyterian to create a single EHR platform. Can you talk about this project?
Pupo: Sure. Right now, we’re going through much of the preparation work associated with the clinical adoption of Epic — the various modules, workflows, and building out and approving the flowsheets we needed to develop to walk them through how Epic will work. We’re at the stage now where we’re doing a lot of the technical preparation, which involves doing inventory of, and understanding, our overall infrastructure — where we need to improve, and where we need to do perhaps a little more to prep the department or clinical groups for the Epic go-live date, which is scheduled for January of 2020.
Much of our work in the IT department is focused on that — it’s a lot of preparatory work to get all of our various teams that are spread across the medical center and campus ready. We’re doing that in coordination with Weill Cornell and with NewYork-Presbyterian.
Gamble: And is there a lot of focus on training?
Pupo: Yes, a lot of focus. In fact, one of the key areas we’re focused on is the ability to build out our training program. We do a lot of town hall meetings and a lot of individual training sessions across our specialties.
Gamble: With the town halls, are there clinical informatics leaders who are taking the reins?
Pupo: Yes. Many of our clinicians who are involved in adoption workgroups are working very closely with a lot of the staff on the ground to implement Epic. We have a lot of dedicated resources both on the clinical and technology sides. We have informaticists who work on various aspects of data with many of the analytics programs we need to get ready for Epic, such as a joint analytics working group to develop a warehouse or data lake structure we can use across the system. That’s an example of some of the programs they’re doing. Much of that work is still left to be done.
Gamble: Right. I can imagine it’s challenging to try to predict what workflows will need to look like. What is your approach to making sure this works the way the majority of users want it to work?
Pupo: Sure. Much of our focus with workflow is on helping clinicians understand what they do now and how that will change — the impact an EHR will have on those workflows. And so my role as CIO is not just to prepare, but to message and to assist and to be very closely aligned with what each of our clinical departments want to do with Epic, and if necessary, to make configuration changes and adjustments as needed.
Gamble: Does part of that include managing expectations?
Pupo: It’s a lot of work on expectations, and work on communication in general. There always has to be input and output coming in, where I’m listening to their concerns, and they’re listening to a lot of the messaging we’re doing as an organization to make sure they’re able to support the Epic project.
Gamble: So it’s letting them know there are going to be challenges, but not taking too much of a ‘doomsday’ approach so it doesn’t become a dreaded event.
Pupo: Yes. And there’s always dread, but we expect that. A lot of people were taken aback by the recent New Yorker article by written by Dr. Atul Gawande (Why Doctors Hate Their Computers), and there was a lot of concern. Our messaging was, ‘look, there’s always going to be potential challenges in an Epic project of this scale. We need to be prepared as an organization for best-case scenarios and worst-case scenarios. We need to do risk management, and do what we need to do for business continuity, for our revenue cycle, for clinical care to our patients to make sure all of that is moving forward as we expect.’
Gamble: What are physicians that are part of ColumbiaDoctors using? Is it a hodgepodge of EHRs?
Pupo: It is a hodgepodge. We use Eclipsys. We use Allscripts. We have some departments with EHRs that have either been developed or were purchased. Cornell is a unique case because they have Epic already. So we’re leveraging the work they’re doing. NewYork-Presbyterian has a situation similar to ours; as they’ve acquired different hospitals, they’ve acquired their EHR infrastructures. So all of us are pretty happy we’re moving to an integrated EHR, but of course that involves moving across multiple systems. We have about 170 interfaces in total, which is going to take a lot of work and a lot of time to integrate.
Gamble: And you said Weill Cornell has had Epic in place for a while?
Pupo: They have. They’ve built out a lot of what they wanted to do, and spent a lot of time and money doing that. So we’re working with them very closely to make sure that we’re aligning as closely as possible with them. They’ve implemented a lot of the workflows we’re looking at, and so we want to not just model that, but improve on what they’ve done and make our instantiation of this joint EHR even better.
Gamble: Do you anticipate doing site visits and things along those lines?
Pupo: We’ve already done a lot of that. We’ve done a lot of site visits with Cornell, with Presbyterian, with colleagues at other academic medical centers, and with using institutions using Epic.
Gamble: And you said the aim to go live in January 2020. Meanwhile, I’m sure there are other priorities on your plate. What else are you focused on?
Pupo: A lot of our initiatives focus specifically on the infrastructure components — making sure our network is up to date, and all the machines we have, including desktops, laptops, and mobile devices, can meet Epic standards. We’re also looking at cloud services and cloud-native applications so that we can build a broader analytics strategy, both at the institutional level and at Columbia, with what we can do with data that’s stored and generated as part of Epic. I’m also trying to build out the overall governance structure to keep the organization moving forward.
Gamble: From a governance standpoint, what are some of the priorities? What are you looking to do?
Pupo: What we’re really looking to do is first build a base-level of IT governance. We haven’t necessarily had that to the degree that I’d like, and so we’re spending a lot of time building up governance in various areas we’re focused on as part of our strategic plan, including cloud, and some rationalization of our IT infrastructure and assets.
I’ve really tried to focus on customer experience, because a project like Epic is going to making some people happy and others not happy. And so we want to have channels available in IT to answer questions, make improvements, and do whatever we need to do to keep our customers happy.
We’re also focused, as I mentioned, on analytics and business intelligence. That’s a key component we’re looking at, both from a strategic and operating level model, but also in making decisions on how we’re going to implement analytics as a platform and as a service for the entire campus.
Gamble: Now, you came into this role in the summer. Was it pretty clear where the organization was headed? How much did it impact your decision, especially knowing that a lot of governance work needed to be done?
Pupo: I recognized right away it was going to be a challenge — that wasn’t a major concern for me. My concerns related to how well the organization would adapt and want to take on change, and I’ve really seen that as a positive. I’ve gotten a lot of positive feedback on changes we’re making in IT, as well as changes for the organization as we move forward. A lot of that has been good, and now we need to follow through on that.
Gamble: Do you think it has been an advantage being new to the organization?
Pupo: I think that has definitely helped. Being new to the organization, everybody has been receptive to me being a driver of change. That’s been good. What I’ve tried to do is bring the infrastructure discussion to the forefront of what we’re doing as an organization. I equate IT to a lot of the infrastructure that we manage physically. We manage a hospital. There are a lot of machines. There’s a lot of facility infrastructure and power. Everything that goes into running a hospital day to day, I’ve tried to position technology as being a chief component of that.
Every day, we have to turn everything on — whether it’s computers, data storage, or the network — and make sure it runs not at 99.9 percent, but at 100 percent. The expectation is that everything works and everything runs, all the time. That, very importantly, is something the organization has been very receptive to, which is to say, ‘We get it. We understand that we want to position IT as a major component of what we do.’ And that’s where the reception has been very good.