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Epic, NYC Health + Hospitals and the largest, most complex public health system EMR implementation in history

mark stevens
Mark W. Stevens, Contributing Editor

NYC Health + Hospitals has been a pioneer in the use of electronic medical records (EMRs) going back to the 1980s, when it became one of the first large hospital systems in the country to implement an EMR. Their current clinical information system, QuadraMed, has been in place for more than 20 years and NYC Health + Hospitals leadership has determined that its functionality is not sufficient to meet the system’s future demands.

To meet the reporting and population health management demands required by payment and care delivery reform, NYC Health + Hospitals will now implement Epic in stages between 2016 and 2018. Once fully implemented, the health system will move from eight disparate electronic medical records system to a single and unified one. The implementation represents the largest of its kind in history.

The project: At a glance

  • NYC Health + Hospitals/Queens, NYC Health + Hospitals/Elmhurst, and the health system’s home care agency were the first to go-live with Epic in April 2016. Queens and Elmhurst hospitals simultaneously went live with Cerner Labs.
  • Total cost of Epic EMR implementation over 6 years (FY13- FY19): $764M. This includes the Epic product, integration with new e-prescribing system, interface with medical equipment, scheduling, registration and billing system; the cost of running the current EMR while in the transition; new hardware, and training for more than 20,000 daily users of the electronic medical records system – doctors, nurses, technicians, etc.
  • The total cost includes the Epic contract, which is valued at $303M, with $144M to be paid within the first six years for implementation.
  • Costs are partially off-set by federal “Meaningful Use” funding. NYC Health + Hospitals has already received more than $120M in MU funds.

The organization

NYC Health + Hospitals is the largest public health care system in the nation with a network of 11 hospitals including six regional trauma centers, community-based health centers, nursing homes, post-acute care centers, and a correctional health services unit. The system includes a home care agency and a health plan, MetroPlus. The health system provides essential services to 1.2 million New Yorkers every year in more than 70 locations across the five boroughs. Its diverse workforce of more than 42,000 employees are uniquely focused on empowering New Yorkers, without exception, to live the healthiest life possible.

The team

Sal Guido
Sal Guido, Senior Vice President and Chief Information Officer, NYC Health + Hospitals

Sal Guido is Senior Vice President and Chief Information Officer at NYC Health + Hospitals. He is responsible for the strategic and operational aspects of NYC Health + Hospitals’ environment in a multi-disciplined department, which includes all technology implementations, clinical and business application integration and support. Guido has more than 30 years of global achievements in leading-edge information management environments. Prior to joining NYC Health + Hospitals, Guido held similar positions at Viacom International, Tyco International, and the Federal Reserve Bank of New York with responsibilities for the IT strategic planning, project management services, and application development. The goal for Guido and the entire IT organization is to transform technological resources and talents into exceptional clinical and business platforms for NYC Health + Hospitals.


Pamela Saechow
Pamela Saechow, Senior Assistant Vice President for Epic Implementation, NYC Health + Hospitals

Pamela Saechow is Senior Assistant Vice President for Epic Implementation at NYC Health + Hospitals. Saechow brings more than 24 years of health informatics leadership and complex IT project support to the health system. Just prior to joining NYC Health + Hospitals in 2016, Saechow led the successful implementation of Epic at Sutter Health, a system with 50,000 end users across 26 acute care hospitals and 250 medical office locations.

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Stevens: In January of 2014, Mayor Bill de Blasio appointed Ram Raju President and CEO of NYC Health + Hospitals, the nation’s largest municipal health system with 42,000 employees who annually care for 1.2 million New Yorkers in more than 70 care locations across the five boroughs. Upon his appointment, Dr. Raju laid out an ambitious agenda to improve the patient experience and in turn increase the system’s market share and stabilize its financial health. How does the new EMR system, Epic, fit into Dr. Raju’s plan?

Guido: Dr. Raju’s vision for transforming NYC Health + Hospitals is rooted in making our patient experience the best it can be. This is why we don’t treat the Epic implementation as an IT project – we see it as a change agent to increase the care quality and satisfaction of our current and future patients.

Epic is really the foundation for our clinical and patient experience transformation. It allows for an enhanced focus on quality, patient safety, and performance measurement. It also equips our providers with sophisticated clinical decision support tools that are absent from our legacy system.

Once fully implemented, our new EMR will also create one universal patient record across the entire NYC Health + Hospitals system, making it easier for our clinicians to seamlessly access a patient’s medical record regardless of where the patient was previously seen. Our patients will also be able to engage in their own care by managing their health online through MyChart.

By leveraging Epic, we’ll get a fuller picture of each patient’s needs and provide more efficient services that will improve both their perception of care and their experience. Epic is how we’ll provide better care to all our patients, in every care setting across NYC Health + Hospitals. It’s a critical part of our transformation, which touches on every element of our growth strategy.

Stevens: A public health system, particularly one the size of NYC Health + Hospitals, is very complex. Please detail some the complexities, (including the community partnerships which form an integral part of the overall organization), and offer both challenges and give strength and guidance to the organization, its mission and work.

Guido: We’ve been fortunate to have the support and guidance of our many partners and industry colleagues in this effort. Once we selected Epic, we reached out to IT experts from local and national leading academic medical centers and invited them to review and critique our EMR implementation plan, so we began the process with a wealth of best practices. We also recruited the support of some of the nation’s leading EMR experts, including The Advisory Board Company/Clinovations’ Ed Marx and Dr. Matt Lambert.

As the City’s health system, we have the privilege of working closely with the Mayor’s Office of Technology and Innovation, other city agencies, and numerous community-based organizations. The Epic implementation will help us streamline many clinical and business applications, which means we’ll have much more data to inform our decisions. Since we all share the goal of providing exceptional services to all New Yorkers, our relationships with the community and local officials help to bolster our efforts.

Saechow: Our key technology partners also played an important role in ensuring the success of our first go-live at our Queens care locations. Epic and Cerner executives joined Dr. Raju and other NYC Health + Hospitals leaders at monthly governance meetings and provided invaluable guidance leading up to and throughout our first go-live. We’ll continue to work closely with our community and IT partners as we roll out Epic at all of our facilities.

Stevens: Epic was chosen with both NYC Health + Hospitals physician and C-suite active participation, input and leadership, which remains on-going. How was NYC Health + Hospitals’ EMR evaluation, acquisition and implementation process developed, how is it working and how and why is it unique?

Guido: As the largest public health system to adopt Epic, we relied on our most valuable asset to help us select the new EMR – our employees. Our clinical leaders, doctors, nurses, and other staff from across NYC Health + Hospitals played a critical role in the EMR selection process. We wanted to invest in a sophisticated IT product that also met the needs of our clinicians so we can deliver the best possible patient care. There was a clear consensus among our providers that Epic satisfied these requirements.

Our employees continue to be instrumental in customizing Epic for the unique needs of our system. In preparation for the first go-live, staff from across all of our care locations participated in clinical workgroups that guided the work of the EMR build teams. As a result, the system reflects the significant and fruitful collaboration between our clinical and IT teams. I think these relationships will continue to help us refine and improve the system at each phase of our EMR rollout.

Saechow: The engagement and commitment at all levels of the organization was particularly valuable during the first go-live, as we simultaneously launched Epic and Cerner Labs. For us, Epic is a transformational, system-wide effort that stems beyond IT, which makes a big difference in how our staff views and overcomes the challenges inherent in such a complicated project.

Stevens: NYC Health + Hospitals plans to roll out Epic to its facilities in the Bronx at the end of 2016. Studies have shown that most healthcare organizations do not plan adequate time or resources to support staff training regarding the implementation of new clinical and revenue cycle software/IT systems. What has NYC Health + Hospitals done to ensure staff will be fully prepared? What are some of the other milestones you are planning for in 2016 and beyond?

Guido: A transition to a new technology, especially one as significant as a new EMR, can understandably make many employees nervous. A robust training program and a solid support system at go-live helped staff at our Queens hospitals feel more comfortable and prepared to launch Epic.

All of our EMR training takes place at Basecamp, a state-of-the-art IT training lab. About a 70-person training team runs classes 24/7 in 16 classrooms that accommodate up to 250 learners. We make sure to regularly survey our learners about their training experience, which helps us continuously improve the curriculum and instruction. Our employees also have the opportunity to practice what they learn in training in a simulated EMR environment at any time.

Saechow: With the help of our training partner, the HCI Group, we put a solid implementation plan in place that kept patients first and extended the on-the-ground support staff needed to begin working in Epic. Some 900 specially-trained Epic users provided at-the-elbow assistance to our clinicians during our go-live period in Queens. A 24/7 team of IT experts, clinicians and operational staff was also on-site at each hospital to respond to any problems and ensure streamlined communications. These teams were ready to dispatch support staff to quickly address any critical issues.

Since medication safety is always a top priority for our staff, all high risk medications were reviewed by two pharmacists, an extra level of protection that exceeded best practices for medication safety at EMR go-live. No EMR launch is without any issues, but I think the training and extensive support we offered to our employees made the first rollout as smooth as expected.

Guido: We’re currently preparing our Bronx facilities for their Epic go-live at the end of 2016. By implementing the EMR in phases, we can ensure that we have the needed resources, IT infrastructure, and support to make each implementation a success. In the coming months, we’ll be busy training our Bronx clinicians and monitoring our technical readiness. Of course, we’ll be using the lessons we learned from our first go-live to help guide the second Epic rollout every step of the way.