Hours before NYC Health + Hospitals rolls out new EHR, CEO Dr. Ram Raju sets the record straight

Days before New York City Health + Hospitals' scheduled go-live on its Epic EHR, Ramanathan Raju, MD, president and CEO of the public health system, spoke with Becker's Hospital Review about the implementation process and addressed rumors circulating about the project.

Some background: NYC Health + Hospitals signed a contract in 2013 to implement Epic's EHR. The $764 million contract represents the implementation and maintenance cost of the EHR over six years. Dr. Raju's predecessor, President Alan D. Aviles, signed the contract. When Dr. Raju joined NYC Health + Hospitals in March 2014 from Cook County Health and Hospital System in Chicago, he took over the project.

The health system is replacing its QuadraMed EHR. The home-grown system has been in place for more than 20 years and some of its functions aren't keeping pace with the health system's needs. For example, Dr. Raju says NYC Health + Hospitals serves the mental health needs of close to 40 percent of New York City's 8 million residents, and QuadraMed doesn't offer electronic records for behavioral or mental health.

After more than two and a half years of planning, NYC Health + Hospitals is now in the go-live process of the new EHR. As of Wednesday, Dr. Raju reported everything is on schedule for an April 1/April 2 go-live at the system's Queens and Elmhurst campuses. Dr. Raju says he will be at Elmhurst Hospital during the go-live and his second-in-command will be at Queens Hospital.

"I don't have a crystal ball, but I think we are taking all the precautions. We have put everything in place in the right way, and we are moving in a very deliberate, cautious fashion to implement [the EHR]," Dr. Raju says. "As of now, everything looks good, but we are not going to lower our vigil. We will continue to monitor it."

Editor's note: Interview has been edited for length and clarity.

Question: You held a meeting last May with leaders of other organizations that have also implemented Epic's EHR. What were some of the similarities coming from other hospitals and health systems regarding Epic implementations, whether challenges or expectations?

Dr. Ramanathan Raju: We held the meeting for two purposes. One was to ask them to check the tires and look under the hood of my implementation plan and see if there's any tweaking I need to do or if there's something [where] I'm totally off base. They suggested some valuable tweaks and mostly agreed with the plan. The second part of the discussion was what they have learned during the implementation. So it was two-fold. It was to check our plan and to learn from others' implementations — what went well, what didn't go well and how to prevent that from happening to us.

Some of the things are very general, like we need a lot of support, visible leadership and people should know leadership is behind you. They also said train people many times, don't train them once. Send them back to the lab as many times as they want so they get comfortable with it. They also said sometimes people do well in training, but the first time the new system comes in, it becomes a different experience for them because they've been used to a different system for many years. They said productivity will take a hit. That is fine, we understand that.

Q: I read that you have worked with Judy Faulkner, the founder and CEO of Epic, on this implementation and said she was the one who suggested bringing Ed Marx into the project.

[Note: Ed Marx is a consultant with The Advisory Board Company who is helping lead NYC Health + Hospitals' Epic implementation. He previously was CIO of Arlington-based Texas Health Resources.]

RR: Judy Faulkner is always present in our governance committee meetings every month. That is apart from the local representative, the person who's in charge of NYC Health + Hospitals' implementation, who is also always there. When I first came here, I made a trip to meet with Judy. I had some major concerns regarding the implementation, policy as well as people working on it. Judy shared the same concerns with me. We said, "Okay we are going to make a few changes, we are going to do things differently." And when I started calling her and asking who are the best people who can help me implement Epic, she gave me two names. Ed Marx's name came up. We sought out Mr. Marx, had a couple of discussions with him and he agreed to come on board to help implement.

Q: A number of anonymous sources have spoken out about the Epic go-live, including one blogger calling him or herself a whistleblower. How would you respond to the allegations that going live on the new EHR at this time is not conducive to patient safety?

RR: I would respond and say they're not true. Nobody's more interested in being careful with patient safety than me. We are doing everything possible to make sure of that. Second of all, there is nobody putting pressure on me to complete this by a particular date because the dates are all goals. They were set by me. I could always change it if I wanted to.

I can't prevent people from writing whatever they feel when there's no backup or any factual information. I can't do anything about it.

As of now, with all sincerity I can tell you I will never, ever, ever put a patient at risk because of some arbitrary deadline I need to meet. As of now, I have not identified any major patient safety issue. And if I find one in the next 48 hours, of course I will fix it.

There is a large group of people sitting down at the table trying to make sure we're all ready to go, that we've dotted every 'i', crossed every 't.' We did, but we still have to be vigilant.

Anybody can have a blog. That isn't our issue. The issue at the end of the day is we are trying to do everything possible with the system. As a physician, as a surgeon, I find it insulting that I, as a doctor who believes in 'do no harm,' would put patients at risk because I want to [meet] some arbitrary deadline. That's what I can tell you.

Q: Thanks, Dr. Raju. Any final thoughts?

RR: This is going to make our patients' experience better. It's going to make sure our doctors and providers get the best product to deliver the best possible care to our patients. We serve 1.4 million very vulnerable New Yorkers. We are the safety net of safety nets. We provide the most uninsured care for undocumented immigrants in the country. We are really a mission-based organization trying to achieve social justice and healthcare justice for all. We believe that our patients, our doctors, our nurses, our providers should have a state-of-the-art IT system, and that's what we're getting.

We're doing everything possible to make this go smoothly, make sure everything works well, make sure there are no patient safety concerns, make sure the quality is maintained, make sure the patient experience is good. I'm committed to doing that. I will watch it and I will not rest easy until I get that done.

More articles on NYC Health + Hospitals:

NYC Health + Hospitals CEO shares turnaround plan to narrow $1.2B budget gap 
The corner office: NYC Health + Hospitals' Dr. Ram Raju on the 'essentiality' of public hospital systems 
Mayor de Blasio enlists consultants to aid financially ailing NYC Health + Hospitals 

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