During the first wave of the Covid-19 pandemic, the streets of New York City were deserted — even in the middle of the day. Organizations like the Hospital for Special Surgery were forced to pause all procedures. And yet, for the IT team, things were as hectic as ever. “There was so much break-fix work to do,” said Jamie Nelson, now in her 11th year as CIO at HSS. The book of business may have dried up, but “our teams were so busy with day-to-day projects that it didn’t feel like anything slowed down.”
As a result, once her team was given the green light to move forward with projects such as selecting a new ERP solution, they were ready, said Nelson. During a recent interview, she talked about how HSS survived the lockdown – and why she made it a point to show up every day, and her team’s big plans to continue to digitize as much as possible. She also discussed the “new paradigm” leaders face in the wake of Covid, and what worries her most as a female leader.
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- Although most work happened remotely during the early stages of Covid, Nelson remained onsite throughout to be able to support teams and make quick changes when needed.
- Despite HSS’ “book of business drying up” in 2020, IT stayed busy with day-to-day projects and break-fix work, Nelson said. “It didn’t feel like anything slowed down.”
- Six years ago, a “soup-to-nuts” Epic implementation took up most of IT’s time and resources; now the priority is digitizing back-office functions, which Nelson believes will be a game-changer.
- The ultimate goal with HHS’ new facility is to create “a tech-enabled building that delivers fabulous orthopedic healthcare.”
Q&A with Jamie Nelson, SVP & CIO, HSS, Part 1
Gamble: Hi Jamie, thank you as always for your time. A lot to talk about today, but I wanted to start with Covid and how it affected your teams. Obviously, everybody was hit hard by Covid in one way or another, but being in an epicenter like New York must’ve been very challenging.
Nelson: So, I actually came to the office every day. I have a place in New York City, and so I was able to walk to work. I have two offices: one is at the hospital. The desktop team is right outside my door. And I have my regular office at 49th Street and Third Avenue, where the larger IT team is based.
But I came in every day. We had to stop doing surgeries since orthopedics is considered elective, and we retooled several of our ORs to turn them into ICUs so that we could take Covid patients from New York-Presbyterian. We thought we were taking ‘Covid-light’ patients — but as it turned out, there’s no such thing as a COVID-light patient in the height of a pandemic. And so, we had patients on respirators; we even had sometimes die. That doesn’t happen here. We don’t have patients die. If somebody gets really sick, we take them over the bridge over to New York-Presbyterian. They handle that; it’s not what we do. But our clinicians just pivoted and did an amazing job.
It was a very unique time to be in New York City. You’d walk down 5th Avenue in the middle of the day and the street was empty. It was such a different time.
Gamble: For you, what was behind the decision to be there every day?
Nelson: There are two pieces. First, it was out of respect for the clinicians who had to be here. I’m a senior executive, and so I think it was important to support our clinical users and have visibility when they’re on the floors.
We were making a lot of very fast changes. I can remember talking to one of our senior surgeons who said, ‘Jamie, we need red, yellow, and green in our Epic to show whether someone is Covid-positive, pending, or Covid-negative.’ We were able to turn that around in a day. I met him the hallway to hear his request and we put it through. There was something very immediate about that.
However, I also had desktop staff. And in my opinion, if they’re in the line of fire, I need to be as well. I don’t have small kids at home. I could take the risk of being here, whereas some of my younger managers have families and different things going on that make it too difficult. So I felt it was supportive not only of our clinicians, but the staff who come in every day. I was with them every step of the way. We got suited up to go into the ICUs we were building, get the computers in there, and work with the teams. I was with them because it’s the right thing to do. I believe in leading from the front
Gamble: Right. And of course, some things had to be delayed or postponed. Can you talk about how those decisions were made? And was there a point where you decided it was time to move forward again, or did you try to keep momentum throughout?
Nelson: It’s interesting. There were financial pressures because our book of business dried up. We did have relief and I’m sure we billed for those Covid patients, but it’s not the same revenue as we had budgeted for with our full load of orthopedic surgeries. That slowed some things down.
But some things accelerated. We built up our infrastructure to support remote work, and telehealth accelerated. A lot of things kept going — and in fact, went even faster. Digital kept moving because our CEO felt like we can’t let digital fall behind. And so, a lot of digital initiatives moved forward. Things like ERP slowed down.
Coming back in full force
But I would say about a year ago, we really came back full force. Patients started coming back. Revenue was coming back. And so, we started to move forward with these important projects, including development of a new inpatient tower that we’re building adjacent to the hospital.
Last summer, we were able to get funding and move forward with projects. Our teams were very busy during Covid, because there was so much break-fix work to do. Our clinical systems were still being actively used to support telehealth. We were rebuilding ambulatory functions in Epic because we had co-located surgeons and were making moves so that offices had social distancing protocols in place. That’s all built in Epic. Our teams were so busy just with the normal day-to-day projects that it didn’t feel like anything slowed down. But the bigger things started to come back about a year ago.
Gamble: And ERP was one of those?
Nelson: Yes. Like many institutions, we put a lot of time and resources into our clinicals. I believe we’re live with Epic six years now. That was a really big deal. We did soup-to-nuts: revenue cycle, ancillary systems — if Epic had it, we implemented it. That was a big implementation. We were really coming from the stone ages.
But we hadn’t touched ERP. Lawson, which is our current ERP provider, announced that by 2026, they would not be supporting the version we’re using. We knew we had to do an ERP, because there are things we can’t do. For example, our new CNO was trying to send an announcement to every nurse in the house. However, we don’t really have a way through an HR system to identify every nurse so he can send out a mass email. Those capabilities just aren’t there with some patchwork Legacy systems, which have not been prioritized.
And so, about a year ago, we began the search in earnest, and hope to get a contract signed soon. Our vendor of choice is Workday, which we’re very excited about. But it will take another two and a half years by the time we’re done. It’s almost like going back Epic decision days. We have to make some fundamental choices about how we’re going to construct the system and what functions we need.
“Do we still want to do business a certain way?”
Here’s a great example: everybody badges in. I badge in every day, even though I’m exempt from overtime. Do we still want to do that? Why did we do that 10 or 15 years ago? Is it worth the headache for the admins or timekeepers who have to track us down if we forget to badge in? Those are the sorts of questions we need to ask: Do we still want to do business in a certain way?
It’s also cleaning up the item master and supply chain stuff. But it’s going to be very exciting. Phase 0 is probably going to take six or nine months, and then we’ll start the implementation. We’re digitizing the back-office function for many users, which is so important.
“Like having banking on your phone”
For the staff, it’s going to be like having your banking on your phone, so you’ll see your paycheck. You’ll see how many days off you have. You’re going to be able to make changes if you move or get married. You’ll be able to do a lot of this in a mobile-first digital framework, which is going to be wonderful for all of our end users. And then all the things you can do in the background with a much more modern cloud-based architecture is going to be really a game changer for the organization.
Gamble: Right. We’ve all gotten used to things like online banking — that’s how it should be. But these systems have been in place for a long time, so it’s going to be interesting.
Nelson: It’s a matter of prioritization. Certain things take precedence. I’ve been here 10 years – I’m actually in my 11th year, and we had to rebuild the whole physical infrastructure when I got here. We had to put in clinicals, revenue cycle, and so many other systems. Now, digitizing supply chain, finance, and HR functions is the next big thing. It’s very exciting.
Gamble: It is. And I imagine that philosophy will come into play with the new construction that’s happening.
Nelson: Yes. We’re very excited because we’re thinking about it as the hospital of the future. We’re actually playing with the technologies in our current building so that when we get into the new building and try out technologies, they’ll work. Our goal is that when the new building opens, we can provide a technology-first patient experience.
It’s interesting. I’m sure you read about Amazon acquiring One Medical. I was at a Salesforce function the day that was announced, and one of the speakers was a clinician from One Medical in New York City. She couldn’t comment on the acquisition, not surprisingly, but she said that what attracted her as a clinician to One Medical is that it’s really a technology company that delivers healthcare. I’m thinking that our new building is going to be a tech-enabled building that delivers fabulous orthopedic healthcare.
Part 2 Coming Soon…