Of the many components needed to ensure a successful EHR implementation, one of the most important — and least recognized — is grace, according to Stacey Johnston, MD. As Chief Applications Officer and Epic Program Executive at Baptist Health, which recently marked a major milestone, she often reminds her teams to be patient with each other and themselves. This particularly holds true for those who have been pulled away from their everyday roles to serve as analysts. “You’re not going to be perfect,” she said during a podcast interview with Kate Gamble, Managing Editor at healthsystemCIO. “It’s a new skill you’re learning that will continue to improve over time.”
During the interview, she talked Baptist Health’s Epic journey—what they’ve done so far and what they need to do going forward, and what she considers to be the most important components of any major initiative.
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- Johnston’s previous experience as CMIO at a community hospital, where she “worked closely with analysts to build out templates,” provided the perfect preparation for her current stint as Epic Program Executive at Baptist.
- As a practicing hospitalist Johnston has insights into which alerts and clicks can be eliminated to ensure a system works as efficiently as possible for end users.
- Optimization is critical with any rollout, but before any changes can be made, the stabilization piece must be addressed.
- Successful implementations involve strong working relationships among clinical and operational leaders, clinical informatics teams, and applications teams.
- Don’t underestimate the value of patience — especially in the midst of a major initiative. “You’re not going to be perfect. It’s a new skill you’re learning that will continue to improve over time.”
Q&A with Stacey Johnston, MD, Chief Applications Officer, Baptist Health
Gamble: Hi Stacey, thanks so much for your time. The first thing I’d like to do is get an overview of Baptist Health. You’re located in Jacksonville, Fla. — what’s the size of the system?
Johnston: Sure. We are currently a 5-hospital system. One of those is Wolfson Children’s Hospital, which is nationally ranked. We’re building out a sixth hospital that will open sometime this fall, following our Epic go-live.
We have almost 200 ambulatory clinic spaces. We scale into Georgia and all the way toward Tallahassee with our clinics, and we’re continuing to grow.
Gamble: It sounds like it. And it’s a populated area you’re serving, which I’m sure is part of the growth strategy to be able to provide more coverage.
Johnston: It is. I believe Jacksonville is among the top 10 cities in the country in terms of growth. We’re seeing a lot of that, which gives us a great opportunity to grow our practice.
Gamble: In your role as chief application officer, what do you consider to be your core objectives? Who do you report to?
Johnston: I report directly to the CIO. I was previously the chief medical information officer. They originally brought me in as the associate chief medical information officer, which is the heir apparent to the CMIO.
I’ve been here for not quite four years. I was the associate CMIO for a little more than a year, and I was CMIO for about four months when the decision was made to move to Epic, and they asked me to be the Epic Program Executive leading the implementation. Interestingly, I cut my teeth as the CMIO at a smaller community hospital, where I worked closely with the analysts to build out templates and work on best practice advisories, alerting, and running reports on who’s doing pajama time.
“Unusual” reporting structure
The analysts didn’t report to me from an HR standpoint, but they did report to me for the build aspects. When I came here, the analysts didn’t report to the CMIO at all. We had done a little bit of restructuring as people transitioned out of the organization and there were several retirements. As part of that, I ended up having several analysts and their managers report to me, mostly focusing on oncology, laboratory and pharmacy. I grew up doing that, and so I always thought analysts report to the CMIO; now I know that’s unusual.
Anyway, as we looked at the restructuring and our Epic plans, we wanted to realign with the typical CMIO responsibilities of workflow, informatics, and working closely with physicians. And so, because I had been leading the Epic implementation, it made more sense for me to continue focusing on applications. Obviously Epic is my biggest application, but it’s just one of 300. I have responsibility for everything that feeds into and out of Epic — all the clinical and revenue cycle applications.
Value of provider input
I chose this role because I wanted to make sure we had ongoing optimization efforts and focused on continued efficiencies and taking code upgrades. I think sometimes having a provider in this space makes it easier to focus on what’s best for the clinicians and caregivers. I’m a hospitalist by background; I still see patients on the weekends. The fact that I use the system enables me to understand where we get hung up, what alerts we can eliminate, and where we have one too many clicks — whatever we can do to make it more efficient for end users.
“Leap of faith”
This was a leap of faith for me. I’ve been in the CMIO role for 10 years. I’ve never led applications before — at least not in a formal sense. But my heart is in applications and everything it takes to make the system feel like home. I want it to work really well. It’s not just about putting systems in; it’s about making these systems work to the best of their ability for a particular organization. Each organization has nuances, but if you can make your system work to the best of its ability to meet organization needs, then I feel like I’ve done a good job.
Gamble: Right. As you said, it was a leap of faith to take this role, but it’s important to find work that you’re passionate about.
Johnston: Exactly. I’ve found that I really enjoy applications. I enjoy working with analysts. Most of my analysts have come from the bedside. Most of them are caregivers or are caregivers. Having pharmacists build out the system for pharmacy, and having nurses build out the clinical workflows and flow sheets, as well as the assessments for their nursing colleagues, is so special. You’re taking something and building it from the ground up.
Go-live as the start, not the end
And the go-live is really just the first step. I try to remind everyone that the system is not going to be perfect when we go live. By having a strong working relationship with your clinical and operational leaders, your clinical informaticists, and your application team — having that strong triangular relationship — we’ll continue to focus on improving the system, gaining workflow efficiencies, and enhancing the patient experience.
Post-live optimization roadmap
Gamble: It sounds like optimization has to be part of the strategy before you even go live so that it can start right away. Does that make sense?
Johnston: Yes. I’ve been told from our consultant counterparts that you can’t begin optimization on day one. We do have to stabilize. But as soon as stabilization is over, we plan to optimize. Actually, we already have a list of 50 project requests and optimizations that we put in as change control requests throughout the duration of the project. We tried to put in whatever we could, but there came a time where we couldn’t make any new changes. And so, we put them in a post-live optimization roadmap. Sometimes it’s implementing new modules, and sometimes it’s a new third-party interface we want to build out because it allows for data sharing to occur more seamlessly.
“We’re all in this together”
Gamble: When organizations like Baptist are implementing Epic, what are some of the most important points? What can be done to help move the process along and ensure success?
Johnston: It’s really about teamwork and collaboration. Each of our meetings begins with a welcome from me and closes with an inspirational story. Sometimes it’s my own personal story, or sometimes it’s something I’ve read. Usually, the theme is how we cross this journey together.
We talk about how this is a marathon, not a sprint. I recently shared a story about a marathoner who collapsed just a hundred yards from the finish line at a race in London. Then another marathon stopped running, picked up this person, and physically carried him across the finish line. I always bring it back to the idea that we’re all in this together. We have to help each other across the finish line. And so, if you’re application is ahead of schedule, maybe reach out to those who are behind and see if you can assist them.
We also talk a lot about grace. As a mentioned before, there are many people I’ve pulled from the bedside to help who have never been analysts. They were nominated by their peers and direct managers to fill a role. These people are used to being at the top of their game — they’re some of the best pharmacists and nurses out there. And so, when they come in as analysts and they struggle with the build or struggle with some of the concepts, it’s very difficult for them.
I always try to remind them to provide others with grace, as well as yourself. You’re not going to be perfect. It’s a new skill you’re learning that will continue to improve over time. Don’t beat yourself up. And so, I would say the common themes are working together and helping each other out. The only way we can get there together is through teamwork.
Gamble: I really like what you said about grace and how important it is to have that, especially with a big initiative — or any big change, for that matter.
Johnston: Exactly. I brought it up at our last build readiness assessment that the system isn’t going to be perfect. This is phase one. We’re going to work closely with Epic to continue to optimize workflows.
Also, it isn’t just our team building this; we’re all in it together. We had more than 350 physicians build out the system and more than 1,200 non-physicians participate in the build. That’s a tenth of our organization, which is huge. Because this is so important. Each of our workgroups was co-led by two physicians: one representing adult medicine and one representing pediatrics. It’s really special to have that much physician engagement. We said from the beginning that this was going to be a clinically and operationally led initiative, and I believe we’ve held that as our mantra throughout the implementation.