The CIO role hasn’t merely evolved; it’s become “a lot more complicated than it used to be,” says Nader Mherabi, “because it’s multifaceted.” Whereas in the past, the focus was largely on applications and infrastructure — two extremely important concepts — now, CIOs are helping to set the strategy for the organization.
But with that added responsibility comes greater expectations, whether it’s being able to convey the critical role technology plays in patient care, stretch dollars, or command the respect of senior leadership. It is, in some ways, an entirely different set of skills that what was required even a decade ago. To Mherabi, however, it’s a welcome change, particularly when you’re part of an organization that’s moving the needle with digital health and pushing the limits with artificial intelligence.
Recently, healthsystemCIO spoke with Mherabi, who services as CIO and Vice Dean at NYU Langone Health, about the work his team is doing to create “one patient, one record” across the system, what it takes to establish a foundation for digital health, and how leaders can foster innovation. We also talked about the enormous potential (and biggest misconceptions) of AI, his soft spot for applications, and the skills CIOs will need going forward.
- About NYU Langone Health
- Rapid growth – “Our strategy isn’t to buy a lot of hospitals, but to integrate practices.”
- Epic Everywhere – “One patient, one chart”
- Creating a standard of care
- One formulary & one item master – “These are important things to have an efficient institution.”
- Replacing 142 systems in a day
- Being a “highly digitized” organization
- Virtual Urgent Care – “It needs to be convenient, and it needs to be easy.”
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There’s been a big shift toward ambulatory care, and so our strategy isn’t to buy a lot of hospitals, but rather, to integrate practices and create highly specialty facilities that offer great care, and bring technology together to provide the best possible experience.
It’s not just implementing an EHR, but all the quality standards built on top of it that makes us one institution. Whether you get care in Manhattan, Brooklyn, or Long Island, it’s the same type of care.
We have a highly trained, experienced team to do all of that. We use very few consultants. We do it with a lot of in-house expertise across all these areas. It’s something that makes us unique and we believe it gets us faster to where we want to be.
To have a digital strategy, you have to have a lot of things in place. You have to have a robust infrastructure. You have to have robust wireless. You have high power computing. You have to have data management so you can impact real-time analytics. There are so many foundations; if you weren’t thinking many years ahead, you’re not there.
In our market, patients have choices. It needs to be convenient, and it needs to be an easy experience.
Gamble: Hi Nader, thank you so much for taking some time to speak with us. Can you provide a brief overview of NYU Langone in terms of what you have, the care offerings, the mission of the organization, things like that?
Mherabi: Great. We are now called NYU Langone Health. We’re one of the major systems in the metropolitan New York area. Our mission is around teaching. We’re a teaching institution; we also have a big research portfolio, and we offer patient care. We are ranked by U.S. News and Vizient, which recognizes outcomes and care quality. We’re number one in ambulatory care and number two in patient care, which is very important.
NYU Langone Health System has six hospitals and over 300 ambulatory locations across the metropolitan area, as well as a few in Florida. We’re close to $9.5 billion in revenue. We just opened a new three-year medical school on Long Island focused on primary care, and the organization has announced it is offering free tuition — that’s very unique. We’re the first to do that. We also have highly specialized programs such as transplant, cardiac catheterization, and others.
Gamble: So it seems the organization is growing pretty rapidly.
Mherabi: It’s been growing for the past 13 years, especially in Brooklyn and Long Island. We just merged with Winthrop University Hospital, which is now NYU Winthrop Hospital, but we’ve also grown a lot in the ambulatory space. Our strategy is about providing care close to where people work and live, and so we have a lot of ambulatory locations that are multipurpose — they have specialists, imaging, etc.
There’s been a big shift toward ambulatory care, and so our strategy isn’t to buy a lot of hospitals, but rather, to integrate practices and create highly specialty facilities that offer great care, and bring technology together to provide the best possible experience. And not only that, but it’s convenient for patients, whether it’s close to their home or office.
Gamble: That makes sense. It’s certainly the direction in which the industry is headed in terms of providing care that’s closer to the patient, and keeping them out of the hospital except for when it’s totally necessary.
Mherabi: Right. So much care can now happen in the ambulatory setting, even procedures. We now can do same-day hip or knee replacement surgery, in some cases. So we’re seeing that shift to outpatient. And it’s the right thing, because patients want to be home as soon as possible.
Gamble: Absolutely. So it’s really been a key strategic goal for the organization to get this in place.
Mherabi: Yes. We have about 4,000 employed physicians throughout our system, and over 300 ambulatory locations. That’s what makes us very unique. We don’t have a lot of hospitals; but we do have a lot of ambulatory locations. And it makes sense, because hospitals are expensive to run.
Gamble: Let’s talk about the clinical application environment. Is Epic in place in most or all of the hospitals at this point?
Mherabi: We have Epic everywhere. We have this philosophy: ‘One patient, one chart,’ and we’ve integrated everything ever since. Any time we buy a practice or merge with a hospital, we immediately change the technology to our standards. Two years ago, we turned all of our ambulatory locations to Epic, then we moved all of NYU Winthrop inpatient on Epic to create an integrated institution.
And it’s not just Epic. We’ve built so much on top of Epic to create a standard of care. The way we take care of sepsis, heart failure, every condition uses those standards. It goes everywhere — even our value-based management and analytics strategies. So it’s not just implementing an EHR, but all the quality standards built on top of it that makes us one institution. Whether you get care in Manhattan, Brooklyn, or Long Island, it’s the same type of care. It’s the same standard.
Gamble: Right. So, as you said, it’s not just about getting the EHR in place. But it does provide a foundation for all these other important components.
Mherabi: Correct. For us, it’s really all about quality of care and standardization. The EHR enables you to have standardization, but it’s about what you build on top of that. We have care pathways so that our physicians can practice in a consistent way. We also leverage that for supply management and cost efficiency. For example, in our entire health system we have one formulary and one item master. These are important things to have an efficient institution.
Gamble: You mentioned that when a hospital or practice is acquired, the strategy is to move it to Epic right away. I imagine it’s important to have a blueprint in place so you’re able to do that in an efficient way.
Mherabi: Yes. Part of our strategy is to immediately develop a technology plan. I go to the board and lay it out. It’s a multiyear plan, but we do it very quickly. And it’s not just Epic; we replace everything else. They get our supply chain system, our ERP system, and our lab, pathology, radiation, and oncology systems. We have a core set of clinical systems that everybody uses.
A few weeks ago, we replaced 142 systems in one day. It’s something most organizations wouldn’t dare to do, but we thought it was the right thing, and it worked. We gained experience with this when we acquired our Brooklyn Hospital, and were able to do it successfully.
Gamble: What do you think was the key to being able to convert that many systems in a short amount of time?
Mherabi: It’s like the saying: how do you get to Carnegie Hall? You practice, practice, practice, and plan. We have a very seasoned team. We have a good strategy. We have oversight. We really plan well. We execute, and we do change management really well. We have a highly trained, experienced team to do all of that. We use very few consultants. We do it with a lot of in-house expertise across all these areas. It’s something that makes us unique and we believe it gets us faster to where we want to be.
Gamble: I imagine there are tweaks or changes you make along the way to ensure it’s an effective blueprint.
Mherabi: Absolutely. And of course, you learn as you go, but we always stick with our strategy. We have a flawless and highly focused execution, and that matters.
Gamble: Definitely. I’d like to talk about Digital Health Everywhere. As you know, digital health has become a buzzword, but it’s such an important strategy, and I’d like to get into the work your team is doing in this place. First, is this something that really has become part of the organization’s philosophy?
Mherabi: Absolutely. We’re probably one of the most highly digitized organizations in the nation, along with a few others I can think of. Part of the foundation of what we’ve done, and the blueprint of our technology strategy, is around thinking through how we can move the organization forward. Our leadership and our board support the idea that in order for NYU Langone to excel, it has to be highly digitalized.
And when you say digital, there are so many interpretations. But to us, it’s about doing things differently in a way that’s efficient, that leverages technology, that provides better care, and reduces costs. So there are a lot of aspects of being digital, but to have a digital strategy, you have to have a lot of things in place. You have to have a robust infrastructure. You have to have robust wireless everywhere. You have high power computing for scientists and for your data model. You have to have data management so you can impact real-time analytics. There are so many foundations; if you weren’t thinking many years ahead, you’re not there.
And then you start looking at extending it to patients and family, which is what we’ve been focused on all these years: to create an institution that’s paperless. You can’t be digital if patients come in and you start handing them papers. You can’t be digital if doctors are using a different EHR to document a telemedicine session. That’s not being digital; that’s just having a telemedicine presence.
We do the hard work, and I think that’s important. When you do that, it gets you to a different place. For us, it’s all one patient, one chart. We do telemedicine through our Virtual Urgent Care program. The doctors are on the same Epic instance. The patients use MyChart to schedule their visits. You want it to be a great experience, right?
Gamble: Right. The patient experience component is really big. Something like Virtual Urgent Care can be a difference-maker, especially in New York, where people have choices. For some, it can be really challenging even to get out of the house, and so that really speaks to improving the experience.
Mherabi: Think about it. It’s Saturday morning, you feel sick or your child feels sick, it’s snowing, and you don’t know what to do. Our Virtual Urgent Care is for patients age 5 and up. That’s the convenience factor. It’s also easy to use. With a few clicks, they can schedule a virtual visit with one of our board-certified ED physicians. We don’t farm it out to other places, so you know who you’re going to get. Quality is very important for us. Some organizations offer virtual visits, but they farm it out to telemedicine providers.
In our market, patients have choices. It needs to be convenient, and it needs to be an easy experience. With Virtual Urgent Care, it takes just a few clicks to schedule a virtual visit.
We also offer virtual visits for pre-op and post-op care. We’re pushing our surgeons to offer telemedicine services for follow-up appointments because it’s convenient for patients. This way, if someone has a knee replacement, they don’t need to come in. They don’t need to find someone to drive them to the office, just so a physician can say, ‘Okay, it looks good. Go home, and call me if you’re in a lot of pain.’ That’s the whole point.