Perhaps the most common thread for health IT leaders during the past few months has been the spike in telehealth adoption. Organizations had to quickly expand — or in some cases, build out — their offerings to ensure care continuity. But there were a select few who already had the infrastructure in place; one of those was NewYork-Presbyterian, an academic health system located right in the heart of the Big Apple.
The fact that NYP’s OnDemand platform was already being utilized on a large scale came in handy, particularly during the early days of Covid. Some might even say the organization was lucky. Luck, however, had nothing to do with it. Instead, it was leadership’s dedication in pushing the initiative forward — without pushing it on physicians — and ensuring the right pieces were in place, that led to what has been a tremendous success story, according to Daniel Barchi.
Recently, healthsystemCIO spoke with Barchi about how Covid affected his team’s strategy (particularly in terms of its Epic implementation), why transitioning to remote work turned out to be a positive, and how disaster planning is forever changed.
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- Being located in New York, one of the areas hit hardest in the early stages of Covid, it was critical to focus first “on the most important aspects of clinical care,” and putting other priorities on the shelf.
- The fact that NewYork-Presbyterian was able to safely open a new facility during a pandemic, despite dealing with a surge of patients, is a credit to the leadership team and its ability to “plan and execute.”
- Having an integrated EHR platform wasn’t just helpful in terms of being able to provide quality patient care; it also helped keep NYP’s implementation schedule on track.
- In some ways, utilizing a remote workforce can increase efficiency, particularly when it comes to go-live testing.
Q&A with Daniel Barchi
Gamble: In terms of the status now in New York City, there has been a dramatic decrease in Covid cases, correct?
Barchi: There has. We’re averaging less than 1 percent positivity rate in testing, and have been at or below that level for quite a while now. And so we went through the worst of it in March and April, but I think that New York as a whole is managing COVID well.
Gamble: It’s interesting; I remember speaking with CIOs in areas like California, which experienced a resurgence after they appeared to have flattened the curve early on. I’m sure that’s at the forefront of everyone’s mind — not thinking you’re too far ahead of this thing.
Barchi: While I think we’re very happy with where we are. We certainly don’t want to take our eyes off of the need to be careful. That means guarding everything that both health systems and the government are doing in the state of New York.
Gamble: In what ways has the pandemic most significantly affected your strategy?
Barchi: From an institution point of view, New York-Presbyterian has been operating in incident-command-center mode to make sure that we manage all 10 campuses and work well with Columbia Doctors and Weill Cornell Medicine so that we have a coordinated response. We’ve focused on the most important aspects of clinical care and have been thoughtful about our shorter and longer-term projects and what gets prioritized.
I’m proud to say that even in the midst of all of this, we had a successful Epic Go-Live at Columbia right before Covid hit in February. At the beginning of August, we opened the Alexandra Cohen Center for Women and Children, which is the first new birthing center — the first new hospital — to open in New York in quite some time. That was enormously successful and has been a great asset for mothers and newborns. I’m proud that our operations team was able to carry out that plan and execute on time, even in the midst of all of this.
Gamble: And that was a new construction project?
Barchi: Yes. For some background, we broke ground on the David H. Koch Center in 2014. We opened the David H. Koch Ambulatory Surgery Center, which was the first 10 or so floors of the building in 2019. The Alexandra Cohen Women and Children’s Hospital, which we just opened, occupies the top five floors in the same building. So, we had already built shelf space on top of this new building for it to go in. It’s a beautiful building, and now it’s entirely open.
Gamble: What did it take to be able to get a project like that finished on time? What were some off the challenges in being able to do that?
Barchi: I credit the leadership team with being able to balance all the clinical response to handle the Covid surge and care for our patients safely, and at the same time, prepare for this major opening and make sure it happened safely. And then on August 2nd, to be able to transport more than 75 mothers and newborns across from Weill Cornell Medical Center to the new Alexandra Cohen Children’s Hospital in one coordinated effort. I think it’s a testament to the ability to plan and execute that health systems in United States are demonstrating every day in the midst of this crisis.
Gamble: You mentioned that Columbia went live on Epic in February — was that affected by Covid? Either the implementation itself or post go-live assessments?
Barchi: When the pandemic hit, we turned our attention quickly from implementation to using the system. We would have focused more on optimization, but we were quickly forced to use Epic as a fully integrated EMR, both for operations and to get data out of the system.
It also pointed out the value of having an integrated EMR such that with our next go-live, which is planned for late October of this year, and we had a choice to forego the implementation altogether — this was the second of our four implementations — or to push it off. Instead, we decided to move it up. We’re actually going to go live about four weeks early to get the benefits of the integrated EMR at our Weill Cornell Medical Center and then we’ll move on to our final to-go-live. And so, even as things have been very busy and we’ve been focusing on patient care, we accelerated that implementation because of the value of the integrated EMR.
Gamble: How was the organization able to pivot like that?
Barchi: To be frank, what made it possible is the outstanding people of New York-Presbyterian, Weill Cornell and Columbia Doctors. We have an outstanding Epic Together team made up of about 300 individuals across those three organizations. That Epic Together team made our first go-live run so smoothly, and enabled us to support the Covid surge, while also accelerating the second major go-live of more than 15,000 people so that we could move it up by four weeks. And so I credit the talented people who are doing this work day in and day out.
Gamble: And after the second go-live, there are two more planned. What’s the timeline for those?
Barchi: In 2021, we’ll go live with New York-Presbyterian Queens and New York-Presbyterian Lawrence Hospital sometime around mid-year. Toward the end of 2021, we’ll go live with New York-Presbyterian Brooklyn Methodist Hospital and New York-Presbyterian Hudson Valley Hospital.
Gamble: I imagine there’s a blueprint in place, but it is challenging to go forward with an implementation when you’re dealing with so many other concerns (for instance, a pandemic)?
Barchi: Yes. Our first priority, of course, is patient care and the safety of our patients and our staff, and thereafter, it’s becoming an efficient, high-quality major medical center. The technology, the analytics, and the tools that our doctors and nurses have are important to making that happen.
Gamble: Was it challenging having people transition to remove work? How did you approach that?
Barchi: As the pandemic hit, we sent home as many of our back office teams as possible so that they wouldn’t be in our clinical and operational spaces, and those teams have done remarkably well maintaining the efficiency of their roles in finance, HR and IT. In fact, with our second go-live, the Epic Together team has found that being remote actually makes it easier to do integrated testing. Because instead of moving everybody from their desks into a conference room to do testing together, they’re remaining at their remote desks and working on an integrated shared virtual workspace. And so the integrated testing, which lasted several weeks before our first go live, took about the same time for our second go-live, but was very smooth and straightforward.
Gamble: Was there already have a remote work policy in place, or was it something you had to do when Covid hit?
Barchi: We had some experience with it. Some of our teams have been working remotely remote working for several years, but it was not across the board, and so this shift to having most of the back office staff go remote was quite a jump. But the IT team handled it quite well. I credit Leo Bowden, our chief technology officer, with making it happen almost overnight.
Part 2 Coming Soon…