New York City Health + Hospitals, the city’s public hospital network, is set to go live tonight with its new electronic medical records system.

The deployment of the new Epic Systems EMR comes at a time when the hospital network anticipates running a deficit of as much as $1.2 billion this coming year. Last month, New York City was forced to bail out the organization with an infusion of $337 million. In addition, the implementation has faced critics, including from the recently departed chief medical information officer for two of NYC H+H’s 11 hospital centers, who was quoted in a major New York paper saying the health system was launching the EHR system prematurely.

Bellevue Hospital
Bellevue Hospital

Health + Hospitals, however, has remained confident about the launch and says the project is coming in on time and on budget.

HDM contributing editor Elliot M. Kass reached out to Dr. Ram Raju, NYC H+H’s president and CEO, and the leads of the Epic project team to get an update on the switch to the new EMR. What follows is their collective response provided by email.

What is your target date for going live with the new Epic EMR?
The target date is this Friday night [April 1st] into Saturday morning.

What’s the status of the deployment? Will this be a phased-in cutover from the current QuadraMed system?
The new system is on time and on budget—$764 million over a 6-year implementation period set to conclude at the end of 2018. This weekend we’re implementing it only in our two Queens hospitals, but it will be rolled out to our entire system over the next two years.

How did you prepare for the go-live?
To help us manage the project, NYC H+H hired a best in class implementation team led by Edward Marx [CIO of The Advisory Board and its Clinovations subsidiary].

In May 2015, we held a two day Epic EMR strategy session to learn first-hand from other health systems about what challenges to expect and which best practices to follow. We also walked everyone present through our implementation plan. The session was attended by NYC H+H’s executive leadership, representatives from the Office of the Mayor and the CIOs of New York University Medical Center, Mount Sinai Health System, University of California at Los Angeles and Massachusetts General.

In addition, Dr. Raju went to Wisconsin and personally met with Epic leaders including [CEO and founder] Judy Faulkner. We are currently being assisted by a team from Epic that’s here, onsite in New York.

To set the go-live date and get the project scope on track, we aligned competing projects for lab, patient financials and clinicians.

It’s well known that NYC H+H is under considerable financial pressure due to the large number of uninsured patients that it treats. Can you give us some background about why you decided to migrate to a new EMR and the timing of that decision?
NYC Health + Hospitals was a pioneer with electronic medical records in the 1980's and became one of the first large hospital systems in the country to implement an EMR.

Our current clinical information system, QuadraMed, has been in place for more than 20 years, and its functionality is not sufficient for the current demands of the health care industry. For example, QuadraMed does not handle behavioral health or long-term care records, which are currently on paper.

While we have leveraged that system as much as we can and worked to improve it over the years, the new, smart EMR systems like Epic are much more advanced and offer robust decision support functionality—including far better data mining and interoperability, and greater capacity to advance quality initiatives and more efficient care coordination.

With the new Epic system, doctors and staff in any part of NYC H+H will be able to access patient records at any time, and improve their ability to communicate about shared patients or consult with other experts and specialists across the system. Also, it allows providers to share the patient record with other providers who touch the patient outside the public health care system.

What other benefits does Epic provide?
The new system offers more layers of redundancy and better support for business continuity in the event of a disaster. Patient records will be more secure from hazards such as fire, and [they will be] replicated at a back-up facility to guard against system failure. It strengthens our independent network. For example, if fiber networks were compromised across the city, we would still be able to remain fully operational.

Epic will allow us to engage patients with the industry’s number one patient portal. Patients will have better access to clinicians via secure messaging and direct scheduling, and they will be able to access to their medical records wherever they have an internet connection.

Very importantly, Epic will help NYC H+H improve its quality of treatment with clinical alerts and reminders. Examples include reminders that a patient is overdue for a pneumonia vaccine or a mammography, and alerts about potential allergic reactions to prescribed medications. This will improve our diagnostic and therapeutic choices, enhance our research and help us monitor our quality of care.

How is staff training proceeding on the Epic system? What types of training are taking place?
Over 7,000 hospital network employees have already been trained. There is a dedicated training center at the Metropolitan Hospital campus with 17 classrooms, 30 trainers plus training support staff—all running 24 x 7. The center will train another 9,400 users across Queens, Elmhurst and Home Health, the majority of whom are clinicians. To ensure quality and validate their training, they will receive a proficiency exam following their final class. We’ve also opened “Personalization Labs,” where providers get one-on-one training from expert Epic-experienced physicians.

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