Chris Paravate, CIO, Northeast Georgia Health System, Chapter 1

If you’re going to be a successful CIO, you need to learn how to do one simple thing: let go, says Chris Paravate. Yes, CIOs need to be aware of what’s going on throughout the organization, but he believes their purpose is to educate, set clear expectations and provide guidance. In this interview, Paravate talks about the groundwork his team is laying to prepare to roll out Epic across the system, why he’s all about workflow training but cautions against overusing consultants, and how NGHS worked to achieve operational engagement. He also talks about the concept of humble leadership, what he learned from Allana Cummings, and what it takes to build a culture inside the IT division.

Chapter 1

• About NGHS
• Going Epic across the system — “It’s a very aggressive timeline and a very aggressive rollout.”
• Focus on staffing, project management & workflow training
• “You need bench strength to be fluid and dynamic.”
• Key to success: operational engagement
• CEO Carol Burrell — “She understands that this is going to be part of our DNA”

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Bold Statements

I have a lot of experience with the product, and I fundamentally believe you have no business implementing a system if you’re not going to staff it.

A big part of the principal trainer’s role will be to focus on workflow training and to be able to answer to the users why. I think if people understand the importance in how those decisions were arrived, they have a tendency to be a little bit more bought in and understand the importance of doing that work.

There are a lot of organizations that will go heavy on contractors with the idea that you’re going to scale back after go-live, and the reality is that what you need to implement it is generally what you need to support it. And when you bring in a bunch of contractors, you lose the opportunity to build a staff capable of supporting the tools and optimizing them and upgrading them.

A big part of my focus is not just building the capability for the implementation, but to build the capability to sustain the product and to keep pace with all the changes that we’re seeing in so many different areas.

We had over 150 physicians participate during those days, and I attribute that to the senior staff all understanding the importance in what their role was and what was going to be required, and making sure that those individuals understood the importance of that process.

Gamble:  Hi Chris, it’s great to speak with you today.

Paravate:  Great to speak with you as well. I appreciate the time.

Gamble:  If you could give an overview of Northeast Georgia Health System, in terms of what you have with hospitals, ambulatory care, things like that?

Paravate:  Sure. Northeast Georgia Health System has two acute care hospitals, one that’s licensed at 600 beds and another that recently opened in the last year with 100 beds. We also have both long-term care and hospice and we’re one of the largest emergency rooms in the state, in the top five. We’re also ranked number one in the state for cardiology as well as clinical care. Within our physician practice group, which is the Northeast Georgia Physicians Group, we also have 51 locations and just over 220 physicians in that group.

Gamble:  And the new hospital, was that something that was acquired or that ou as built?

Paravate:  It was built. It was actually the first net-new hospital built in Georgia in over 20 years. It was built and opened in April of 2015.

Gamble:  So definitely want to get into that in a bit, but to lay a little bit more groundwork, in terms of the clinical application environment, what type of EHR system do you have in the hospitals?

Paravate:  Currently at both acute care facilities, we run the McKesson Paragon product. In the ambulatory practices, we run Allscripts, and then for cardiology, we run GEMMS. And we just completed our system selection and have kicked off our Epic implementation to consolidate all of our health systems under one enterprise system.

Gamble:  That’s very exciting. What does the timeline look like as far as when things should get kicked off?

Paravate:  We kicked off in April 28. We’ve already started our design sessions. We’ve staffed up; we have 159 people on our core project team. Our target go-live is October of 2017. We will go live big bang, including acute, all of ambulatory services, long-term care and hospice all at the same time, so a very aggressive timeline as well as a very aggressive rollout.

Gamble:  Right. What kind of staffing and other things like that are you doing to get ready for that?

Paravate:  Historically, we didn’t have really a strong capability around training delivery and we were not as well prepared, I believe, as we needed to be in the project management category. I’ve implemented Epic and implemented Epic at Children’s Healthcare of Atlanta, and so I have a lot of experience with the product, and I fundamentally believe you have no business implementing a system if you’re not going to staff it. So we’ve increased our IT staff. We have a dedicated project team, but we also built a new project management office, and have hired 17 new project managers. We also built an Epic training delivery team and have hired 18 principle trainers to develop curriculum and to be focused on that, so as we go through design and through each phase of the project, they’ll be working on their respective training deliverables. Those were some big capabilities to add, but I think they were pretty essential.

Gamble:  Yeah, especially when you are talking about going big bang and doing so within a short timeline, it’s so necessary to have all of that training in place.

Paravate:  I think a lot of times people can justify that we need project team members, but don’t necessarily understand the aspects of project management, or really what’s involved in effective training delivery. Most people believe they can bring trainers on after they’ve designed the system, but what they lose out on is that they don’t get to understand why those workflows were developed that way and what decisions went into that. And so when they get into training classes, they can talk about, ‘here’s how you click on this’ or ‘here’s how you complete a flow sheet or a physician note,’ but they can’t explain why. A big part of the principal trainer’s role will be to focus on workflow training and to be able to answer to the users why. I think if people understand the importance in how those decisions were arrived, they have a tendency to be a little bit more bought in and understand the importance of doing that work.

Gamble:  Right. Is this something that comes from your past experience just in having that focus on workflow training?

Paravate:  It does, and it takes a little bit extra work to get there. Historically, you’ve seen a lot of other Epic sites that have brought a lot of contractors in or maybe just said, we’re not going to train workflow — we’re going to train functionality, and workflow will be learned in the department. Adding those things in can be costly, but having a smooth go-live where you’re really focused on enhancing the system and optimizing — there really is a big difference between that and a go-live where people maybe know how to click on the screens, but they don’t understand what they’re trying to accomplish and they don’t understand how they’re going to leverage the tool to do that.

I think there are a lot of organizations that will go heavy on contractors with the idea that you’re going to scale back after go-live, and the reality is that what you need to implement it is generally what you need to support it. And when you bring in a bunch of contractors, you lose the opportunity to build a staff capable of supporting the tools and optimizing them and upgrading them, and I feel strongly that you have to build a team that’s capable of managing that. There’s a role for contracted staff for consultants, but it’s not to take the place of staff that you really should be hiring in the first place.

Gamble:  Right, that makes sense.

Paravate:  As the organization makes changes and continues to go through what I think we see as an industry of accelerated changes, you’ve got to have the bench strength to be able to respond to that and be fluid and be dynamic. You might be able to make the changes by leveraging consultant resources, but there was a bunch of decision-making that went into designing the system, and when you start to make changes to those designs without understanding the implications, you really put the organization at risk, because a lot of times, particularly in an enterprise system, there can be unintended consequences of making changes to the design without really understanding the original design intentions.

When you look at some of the Epic sites that implemented before there was a model system or a foundation system, with a lot of those decisions that went into designing those systems, those individuals carried a lot of subject matter expertise with them when they left. And then subsequently what happens is those organizations struggle a little bit more with upgrades and with changes in adoption that are occurring as the organization grows. So really a big part of my focus is not just building the capability for the implementation, but to build the capability to sustain the product and to keep pace with all the changes that we’re seeing in so many different areas.

I think the other huge advantage we uniquely have is because we are a late adopter to an Epic implementation, we’re able to leverage a lot of the data analytics tools that Epic is now developing. We’ll be able to consolidate tools like an enterprise data repository, and some of the care coordination analytics can be more embedded within the product. We’ve got probably a descending view on how we’re going to leverage Epic from the data analytics perspective that I think a lot of the customers who were earlier adopters of Epic maybe didn’t have an opportunity to leverage and now they’re considering it. So it’s an exciting time. We really are fortunate to be implementing such a powerful product, and I think a big key to that for us is really the operational engagement.

And I think we talked a little bit about this at HIMSS, this is truly an operationally lead project. For example, Carol Burrell, who’s our president, chairs the Epic steering committee. In my career, and in a lot of my peers’ careers, we’ve never had a CEO chairing the EMR adoption. And the reason why that’s so important to her is she understands that this is going to be part of our DNA, and that these tools are so enabling or can be so debilitating if they’re not implemented well. And so a focus of mine has really been on operational ownership. I make sure that everybody in the C-suite really has a clear understanding of what they’re accountable for and has clear ownership in the implementation. That’s probably one of the things that’s probably even more unique than at least my past experiences has been how much operations is truly driving us.

Gamble:  How has your organization been able to do that as far as working with C-suite leaders to really get more ownership and involvement?

Paravate:  It really started with even the decision to go to market. As we evaluated our current tools and our increasing complexity, we determined that we really needed to find a single platform for our health system. And it started with really educating the senior staff on the market and what were the tools out there. And so as we went through that early analysis and then even in the system selection, two months before any activities were to take place with the organization, that senior staff was informed of it. For example, when we said we’re going to work through the RFP requirements and here’s what our approach is going to be and here’s how we’re going to engage your staff, we were telling them two months before we were going to engage them so that they understood what process was and they clearly understood how they were going to need to make sure their staff were involved.

So when we did three days of demos for both Epic and Cerner, we had over a thousand people participate in demos. We had over 150 physicians participate during those days, and I attribute that to the senior staff all understanding the importance in what their role was and what was going to be required, and making sure that those individuals understood the importance of that process.

As we collected that information and the evaluations from the selection, we were able to tabulate that and quantify the results. Those results were presented to senior staff, but also to a steering committee that represented medical, clinical and overall operations. And so they could see how things were scored, how they were evaluated, how their staff were informed, and what they were hearing from staff, and how it aligned to the scoring and the outcomes. It was a very transparent process; the senior staff was well informed and it was clear as to what their role was going to be. I think it also is a tribute to Carol, our president and CEO. She was very clear that she expected that everybody was engaged and that the selection was a health system selection, not an IT.

Chapter 2