As is the case with many EHR implementations, the road to roll out has not been an easy one for New York City Health + Hospitals, the largest public health system in the country.
Which is not entirely surprising given the project’s scope: NYC H+H is undergoing one of the largest Epic implementations in the country that will ultimately unify 40,000 users in more than 70 patient care sites.
The initiative was among the first to launch with both a customized electronic health record system and revenue cycle modules. It also put NYC H+H in the league of EHR go-lives with a budget that surpassed $1 billion. Earlier this year, in fact, the Mayo Clinic CIO Christopher Ross discussed it's $1.5 billion EHR and IT modernization replacing Cerner and GE with Epic.
NYC H+H, in fact, announced the launch of its Epic EHR and rev cycle tools, dubbed H20 by staff abbreviating Health+Hospitals Online, into a production environment at its Woodhull facility and 10 community health centers and clinics in Brooklyn.
While the system said the implementation and subsequent testing went smoothly, the road wasn’t always pothole-free for the Epic project. Here’s a look back at the ups and downs of the project’s past as it steams ahead towards full implementation, slated for the last quarter of 2020.
March 2016: CMIO steps down citing patient safety issues
Charles Perry, the CMIO for the system’s Queens and Elmurst hospitals, resigned his post reportedly over safety concerns surrounding the Epic EHR rollout and potential implications for patient safety and harm. While Perry told Healthcare IT News that he had no comment, two posts on a whistleblower blog site that included purported email exchanges between system executives including Perry indicated that there were serious concerns about the rollout, saying it was introducing “grave patient safety risks” as it strained to meet the rollout deadline and that a crash was inevitable.
NYC H+H fired back, saying it would not jeopardize patient safety simply to meet a deadline and that the project would stop if a patient safety issue was identified. Officials went on to say that a team of roughly 900 technicians would be working around the clock through the week of the first implementation to ensure a smooth transmission.
April 2016: First Epic rollouts
NYC H+H rolled out the first Epic electronic medical record system on April 2, 2016, at two hospitals: NYC Health + Hospitals/Elmhurst and NYC Health + Hospitals/Queens as well as the 20 off-site neighborhood health centers affiliated with the two hospitals and the system’s home care service.
February 2017: Delay and next go-live
However, this month also saw the delay of the next big phase of the rollout by several months to take into account insights gleaned from the first phase of the implementation, saying they were moving ahead at the “appropriate pace to ensure the best possible result for patients and providers.”
The system declined to specify what those insights were, but said the project was still on budget.
The next go-live, meanwhile, went forward on February 25, 2017, at NYC Health + Hospitals/Coney Island.
May 2017: Integrate EHR with rev cycle
NYC H+H announced a plan to integrate an Epic revenue cycle module into its EHR. The price of the project, which started out at $764 million for the EHR, would grow by $289 million with the additional cost of the revenue cycle module. That price tag would be an investment over five years as it is fully implemented. The city of New York was expected to allocate $150 million in capital funds and the system would invest $139 million from its operating costs.
At the time, H+H said they expected the rev cycle software to capture $142 million in added annual revenue, based on patient volume for 2016. They also said the revenue cycle system would improve clinical documentation to support billed services, cut claims denials and speed up reimbursements.
December 2017: New CIO and President come onboard
Kevin Lynch, a healthcare IT leader for 25 years and the soon-to-be-former CIO for LA County’s Department of Health and Human Services, is tapped to be H+H’s new CIO. Lynch had served as CIO in LA County since 2010, and notably, oversaw the implementation of its enterprise wide EHR from a fragmented clinical IT system. In a former role as a corporate director at Jackson Health System in Miami-Dade County, he did the same. LA County is the second largest public health system in the country after H+H and Jackson is often ranked third.
H+H president and CEO Mitchell Katz formerly headed of LA County’s Department of Health, asked Lynch to come aboard. Both of their tenures began in January 2018.
October 2018: Big EHR go-live
NYC Health + Hospitals announced the launch its Woodhull and 10 community health centers and neighborhood clinics in Brooklyn. This was the first implementation of the integrated EHR system that included both the clinical and revenue cycle modules.
At the same time, the system retrofitted the already installed electronic medical record systems at its Coney Island, Elmhurst, and Queens hospitals along with another 15 health centers and neighborhood clinics in Queens and Brooklyn with the new revenue cycle module.
The four hospitals and 25 community-based ambulatory care sites mean that 14,000 active users will now be working with the new EHR system.
“Successful implementations are possible only following an incredible amount of planning and hard work,” said Lynch. “We have diligently created a good design-build-test-train-and-implementation process that has resulted in this effort. We see our energetic, enthusiastic staff using H2O effectively to provide patient care.”
The new integrated EHR system features Epic’s patient portal MyChart, giving patients digital access to their medical records and the ability to view medical test results, request prescription refills, send messages to the care team, and access appointment information.
It also includes decision-support tools that equip providers with alerts to prevent medication errors, avoid duplicative and unnecessary tests, and keep patients preventive health screenings on schedule.
The revenue cycle module enables more simplified billing as items are recognized as billable at the time they are ordered. It paves the way for population health efforts with more refined data on clinical groupings of patients.
NYC H+H's next scheduled launch is in spring 2019 at its Bellevue and Harlem hospitals as well as 19 community health centers and neighborhood clinics in Manhattan.
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