When an organization achieves Epic Gold Stars Level 10, it means they’re doing something exceptionally well. In fact, just 17 health systems across the world — 0.3 percent of all Epic users — have earned the title. And so, when RWJBarnabas Health joined the elite club last fall, it was extremely validating for Jordan Ruch, who has served as IT Project Director for the enterprise Epic implementation. “We have an unbelievable team,” he said.
During a recent interview with Kate Gamble, Managing Director at healthsystemCIO, Ruch discussed the “comprehensive approach” his team has adopted to drive results, “from system selection to implementation to go-live support and optimization,” and how they leverage metrics to ensure goals are being met. Ruch, who has been with the organization for 21 years, also talked the building blocks of transformation, why adaptability is such a critical component of success, and how his background in project management helped prepare him for the CTO role.
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- In addition to the Epic rollout, which has been “an amazing transformation on the clinical side,” RWJBarnabas recently implemented ServiceNow and is migrating all employees to Microsoft Teams.
- “When any health system grows the amount that we have over the past 5 or 6 years, there needs to be a focused effort on standardization, or else you end up with a flea market infrastructure.”
- One of the keys to achieving Epic Gold Stars Level 10 is the organization’s metrics-driven approach. “Our build and our implementation of Epic is a very measured and a very heavily planned project.”
- Another is providing consistent support for users. “Go-live support is an area in which we’re heavily invested. We’re there, shoulder to shoulder, during the activation.”
- With any major change, “there are going to be issues. There are going to be things you missed, or things that need to get tweaked, or items that you don’t know about until you activate.”
Q&A with Jordan Ruch, CTO, RWJBarnabas Health
Gamble: Hi Jordan, thanks so much for taking time to speak. I’d like to talk about some of the initiatives you’re working on, including the Epic rollout, and get the perspective of the CTO.
Ruch: Glad to be here. We have a lot going on. You brought up one of the big transformations — Epic. I’m the IT project lead for that. It started with the vendor selection process, which involved thousands of people from my organization. We ended up having pretty unprecedented involvement across the board. I think there were 3,000 individuals who were part of the process. Ultimately the decision was Epic — it was unanimous. That was about three and a half years ago.
“It’s been an amazing transformation”
We’ve been doing rollouts throughout all of 2021 and 2022 after having our build finalized. But it has been an amazing transformation on the clinical side. And so, standardizing from many platforms down to Epic is probably the largest transformation that any healthcare system can go through. It’s definitely the largest project we’ve ever taken on, but it’s been fantastic.
That’s just the clinical side. From an organizational transformation perspective, there are two other major tracks I’ve been working on. I could talk a lot about Epic, but we’re also going through a business and collaboration tool transformation at the same time. We’ve decided to standardize our implementation of Microsoft tools. Last year, we negotiated a deal to provide that to all of our employees. At many organizations, nursing has no access to the office suite — Word, PowerPoint, Excel, things like that. But we’re a research-minded organization; standardizing on Epic from a clinical perspective showed our entire health system the power of being on one platform.
We’re taking that same concept on the business side. We’re moving everyone to 365. Everyone gets Teams, everyone gets all of those business and collaboration tools. That’s another example of transformation.
On the service side, we’ve been live with ServiceNow as a service management platform for IT for the last year or so. We’re in the process of rolling out HR and will likely go to supply chain, legal, employee self-service, all of that. Organizational transformation is also happening at the same time. There’s a lot changing in our environments across the board, which is really exciting.
“Flea market infrastructure”
Gamble: There’s a clear theme emerging of standardization. With an organization the size of RWJBarnabas, I’m guessing that’s a big part of the strategy to standardize and make processes smoother.
Ruch: When any health system grows the amount that we’ve grown over the last five or six years, there needs to be a focused effort on standardization, or else you end up with a flea market infrastructure. And it’s one that’s not easy to support, not easy to maintain, and does not operate efficiently.
I think pandemic response highlighted a lot of things in our industry. But standardization — particularly the types we just talked about — is critically important for us to deliver excellent customer service.
From a clinical perspective, we were starting to roll out Epic when you-know-what hit the fan. And so, our entire team went remote. Unfortunately, we had just built a mega office complex with space for about 400 people. It was a huge conference and training center. We questioned whether we were going to be able to continue the project. We met with Epic leadership and with our implementation leadership team, and decided we were going to keep moving forward — and we actually saw productivity go up. It was fascinating to be part of an active implementation during that time.
“We turned on a dime.”
We’re very metrics driven. Our build and our implementation of Epic is a very measured and a very heavily planned project. And so, we knew what our productivity benchmarks were when everyone packed up their desks. We have evidence to show how efficient that environment can be. We really turned on a dime. We implemented Teams early for that group; it really helped our team stay connected and keep collaborating. Productivity went up 42 percent according to our project management tracking tool. It was amazing.
Gamble: Certainly some difficult timing.
Ruch: We were in the process of standardizing the build and getting decisions for the build to happen right as the pandemic started. So yes, kind of a bad time, because all of our clinical experts obviously knew what the priorities were. And what we ended up doing was strategically pausing the ED, the lab and some other areas. We knew what the focus needed to be for those groups, and we were able to keep the majority of the project moving forward and making decisions so that we could stay on track with our build. That period of time was really about mapping out all of our decision trees and starting the build during that same time. That’s why it was so metrics driven and so measurable — because the build tasks were all laid out for us. We knew exactly what we needed to accomplish once all those decisions were made. And we could watch how quickly we were able to get that build accomplished.
“Heavily invested” in go-live support
Gamble: What was the strategy in terms of supporting users during the go-live?
Ruch: We had a pretty comprehensive strategy for activation. Go-live support is an area in which we’ve heavily invested. We have at-the-elbow support and a super user program. We’ve actually had four major activations, with two more coming. Our at-the-elbow partner had more than a thousand people at one of our recent activations, and we supplement that with our own staff for a period of 3 to 6 weeks. We’re there, shoulder to shoulder, during the activation. That’s a key part of our success.
We’re one of just 17 organizations in the world to achieve Epic Gold Stars Level 10 recognition for our implementation, which is a credit to the excellent job the build team did. It’s another measurable outcome we’ve been able to achieve. We have an unbelievable team — that’s the secret to our success. It’s not any one person; it’s our team.
“Many little wins”
Gamble: Sure. That’s a really impressive accomplishment. Having a great team is certainly a critical component, but what are some of the other factors that have contributed to it?
Ruch: We have a comprehensive approach toward how we manage the project from system selection to implementation to go-live support to optimization. It’s taking the best available models that Epic has fine-tuned over the years, but also learning from our own team, many of whom have a lot of experience implementing Epic at other organizations.
I think our success is built upon many little wins that have happened over the past couple years. I’m so proud of the team, not just for achieving Gold Stars 10, but for the feedback we get while we’re rounding. Our command centers were still onsite through the whole thing. We’ve always done in-person command centers, oftentimes at the facilities that are going live.
In our last acute wave, we have three freestanding acute hospitals going live at the same time, along with a medical school, a cancer hospital, and a children’s hospital. Walking around and seeing the transformation on the ground as it’s happening and hearing the feedback has been incredible.
I had the fortune to also be part of implanting the EMR that we were displacing. I’ve been with the organization for about 20 years. I implemented and decommissioned that system. To go through that process with all of the clinicians and caregivers is something I’ll never forget. It was amazing to see all of the hard work. It was a two-year project before we ever went live, and to see all of that hard work pay off and to see the efficiencies that really started right away was amazing. We were back to baselines in quality, in finance, and in every area we were measuring before we closed the command center down. Within weeks we were back to baseline — and above it in many areas.
One of the really important points is our go-live support strategy. We made it a point to show that we were there. Everyone wore color-coded vests. The busses pulled up every morning; we all came out and were there during each activation. That means a lot.
“It’s a single click to open a ticket”
We also had a pretty innovative support desk structure and call structure. This ties back to ServiceNow, one of the other organizational transformations that my teams have been leading. Our ServiceNow system is integrated into Epic. In the past, opening a ticket was a phone call — what’s your workstation name? What’s your username? What patient are you looking at? What workflow are you trying to manage? Through our integration with ServiceNow and Epic, it’s a single click to open a ticket. It knows who the customer is, it knows the patient, it knows the workflow, it knows the machine that you’re on, and just creates that ticket for you and routes it to the correct team to be worked on.
The other key is to have a well-developed incident handling and service platform. With any change of this magnitude, there are going to be issues. There are going to be things you missed, or things that need to get tweaked, or items that you don’t know about until you activate. In those cases, having a really well developed and thought-out service platform, particularly one that is tightly integrated and has paid huge dividends for us. We were able to act really quickly.
That was also recognized by the clinical community; the idea that, ‘I opened this ticket, now it’s already resolved.’ The whole process of even opening the ticket used to involve a phone call where you had to answer all these questions and find the machine’s name. That’s another important component on the service side.
Gamble: That’s a huge win. There has always been a lot of focus on how to make certain steps easier for the people who are providing care. I can see that that really being a big win. Did that tie into the decision to have these big three transformations going on at the same time? That’s a lot.
Ruch: It is a lot. But it’s all about customer service. At the end of the day, that’s the business we’re in. We want to provide the best customer service to our clinical and business partners in the organization. Epic is a big example of that. I think the business and collaboration tools and the service platform are three examples of how we’re trying to improve our overall service delivery at RWJ Barnabas Health.
“Shrink the uncertainty”
Gamble: There was one thing you said really made me think, and it’s that you can’t anticipate everything that’s going to go wrong. You have to have a plan in place.
Ruch: If you think about the implementation life cycle, there’s a hype period, and then you plateau. From our perspective, having that support structure in place really helps narrow that gap. There’s a jumping off point when you make any change of this magnitude. Our goal is really to shrink that period of time and shrink that period of uncertainty by doing an excellent job with training. That’s another big area of focus for us. The better we’re able to train our customers and make sure they’re familiar with this new environment and all the new workflows, the fewer incidents we’re going to have, and the less confusion there is going to be when we go live.
Our training program was thrown a huge curve ball with the pandemic. We had designed all of these state-of-the-art training rooms with crazy displays everywhere and smart screens and we couldn’t use any of it, because we weren’t allowed to do in-person training. And so, we pivoted and redeveloped our training model to be what we call VILT (virtual instructor led training), where we actually bring everyone on site, but they’re in cubicles instead of a classroom. That way, we can maintain social distance and stay safe, but also have an environment that’s quiet and set up correctly with multiple monitors and equipment and peripherals they need to be trained on, in a more controlled environment.
We didn’t elect to have most of our customers train completely remotely and watch a video, because I think the learning is different when it’s in a controlled environment. That was another key to our success — we were able to quickly redevelop a training model that really works in this type of environment. It was a virtual instructor-led training model where our instructors and our learners were in the same space. They were in the same building; they just weren’t next to each other.
Thriving through transformation
Gamble: That’s something I think you’ll be able to draw upon in the future — even if it isn’t a situation like Covid. But you’ll have a blueprint.
Ruch: Yes. And to your question earlier about the secret sauce, I think our ability to deal with change is one of our organizational strengths that we keep going back to. Whether it’s dealing with the pandemic or adjusting to a new clinical system or a new business system, our ability to adapt to, and highly function through, periods of transformation is another key strength.
The ultimate goal of change is stability. You’re either trying to fix something or stabilize something. And yet change itself requires these periods of uncertainty and instability in its very nature. And so, I think part of our secret is our ability to thrive during change and to get through it as a team and get through it together. In fact, our project is called Epic Together. That’s what we’ve branded it.
“The people are the secret”
Gamble: That’s so important, because you can’t necessarily teach how to deal with change, right? I would think it’s a combination that mostly comes down to having the right people.
Ruch: I think that’s right. The one thing that’s most important, if I had to choose, is definitely the people aspect. We spent a very significant amount of time interviewing for the hundred positions that needed to be filled as part of this initiative, and the people are the secret. There is no close number two.
Gamble: I’m guessing part of it is getting a feel for how they respond to certain things, which isn’t easy. You have to figure out the right combination when talking to someone and really try to pick up on certain attributes.
Ruch: We were fortunate enough that most of our interviewing happened prior to our work environment changing due to the pandemic. We had a large corporate HR center where we did thousands and thousands of in-person interview with my leadership team, and that entire leadership team is still intact. The same group we launched the project with is heads-down working on our next implementation, with the team we all built together.
Gamble: That’s so important, especially now with all the movement we’re seeing.
Ruch: There is a lot of movement, but we have very low turnover rates. Part of it is the excitement of being first to have an active implementation at a 10; we all knew that we were doing something special, even when we saw productivity spike as we went remote. The team was energized by that. There are a lot of examples of our collective strength keeping the energy up throughout the project. It’s been fun.
Gamble: Switching gears a bit, I noticed that you have a lot of experience with project management. How has that helped you in your career?
Ruch: I started as a programmer doing HL7 interfaces, and then for a long period of time, I ran a project management office. Having that experience as a project manager and as a leader of the project management office has really helped. Our work is very project oriented. Epic is a major project. The same can be said for Microsoft 365 and Teams. It’s just a major project. And so, yes, I go back to that experience quite often.
Another component that has helped me in particular is I have a lot of experience in different areas of IT. I’ve been a director, a CIO, a chief innovation officer, and now a chief technology officer. Having that broad experience also helps when there are questions that need to be answered and direction that needs to be set; that’s helpful to go back to, because I’ve seen many of the problems that have come up in one way, shape, or form.
Gamble: And in those areas where you don’t have the experience, like clinical, do you have people you can turn to?
Ruch: Yes. We have a really strong informatics program. We have a number of physician leaders and nursing leaders that are part of the project and have been from the beginning. I’ve known those people for 20 years. It’s like a family that we’ve been blessed with to work through this transformation. But yes, the physician advisory group on our team is great. You don’t have the success you have without great clinical leadership.
Gamble: So you feel that you’re in a good place at this point.
Ruch: Yes. We just had an ambulatory focused activation a little while ago. Our activation timeline is very busy. We have some major acute facilities that are going live in 2023, but we’re prepared. Our team is well prepared and able to deliver the same quality activations that we’ve done in the past. Now, we’re more than halfway through it. We really have something to point to, and to assure us that we can do it.
So yes, going into the first activations, you always feel like you’re well prepared and like you’ve checked all the boxes, but you don’t really know until you go through an activation if something is going to shake loose. Our team just knocked it out of the park, and so we’re all feeling good about where we are.
Gamble: That’s great. Congratulations on what your team has been able to do. That’s amazing. We appreciate you sharing some of what you guys have done.
Ruch: For sure. I’m happy to share and to learn from others, because there’s plenty that I need to learn as well. I’m a big proponent of lifelong learning.