How NewYork-Presbyterian went from 9 EHRs to 1, according to tech chief Dr. Peter Fleischut

From robot and virtual pharmacists to the integration of a single Epic EHR instance across 10 hospitals, Peter Fleischut, MD, has overseen a number of tech implementations at New York City-based NewYork-Presbyterian.

In his new role as chief information and transformation officer, he plans to take things further, using artificial intelligence to ease the burden of clinicians and eventually reduce disease. He took on CIO duties following the departure of his former boss, Daniel Barchi, to Chicago-based CommonSpirit Health.

Dr. Fleischut, who is also a senior vice president, talked to Becker's about his new responsibilities, his hopes for AI, and his focus on creating "techquity" within the health system.

NOTE: The interview has been condensed and lightly edited for clarity.

Question: Can you tell us about your new role and what you've been focusing on lately?

Dr. Peter Fleischut: I've been with NewYork-Presbyterian now 17 years. In my former role, I was the chief transformation officer. I had worked for Daniel [Barchi] and ran our clinical information system — so our Epic transition — and ran our pharmacy and lab operations.

With the new role, I also cover all the areas of IT: infrastructure, network, cybersecurity, as well as our clinical information systems and the lab and pharmacy operations. With the transition, I spend my time probably a third with lab, a third with pharmacy, and a third with technology.

The past couple years have really been focused on standardization, regionalization, virtualization and engagement — those four major pillars. Not surprisingly, we were very focused on application standardization — working with our partners at Weill Cornell and Columbia, focused on consolidating our order sets, our formulary, our clinical processes — in preparation for the Epic go-live.

Now a big focus really is on the use of the data we have available. So how do we digitally transform in two major focus areas — reducing friction for our patients and our providers, and then second, how do we use data to really reduce the burden of disease?

Q: Can you give an example of how data could be used to curtail disease?

PF: We feel there's a really strong capability of bringing together multimodal data: So you have the clinical data and physiologic data and claims data, and genomics and pathology, so you can develop these AI models to really reduce disease.

For example, almost a majority of our patients get EKGs [electrocardiograms]. But not everybody gets an echocardiogram, which is an ultrasound of the heart. And only a certain subset of people end up getting the more complicated tests based on clinical symptoms and many other factors.

So what happens if we start using AI for all patients who get EKGs? Can we identify structural heart disease in a more accurate, more efficient way so we can find people who are undiagnosed with structural heart disease, like aortic stenosis, and by doing so expedite the time to diagnosis, expedite the time to treatment, and, overall, reduce mortality?

Q: How can technology be used to lessen friction among patients and providers?

PF: For our workforce, enabling things like dictation services, enabling enhanced processes using RPA [robotic process automation] and AI, so that it's easier for them to do their work.

We enabled a system where a patient can be in their bed, we have a camera on the wall and a TV screen, and we have a pharmacist who can remote into patients' rooms to do their med education. It gets the education from the people who are the best to deliver it, who are the pharmacists, and does it in a more consumer-friendly way.

We really strive to make sure that technology is not interfering with the bedside relationship and really that it's enhancing it. It also is a more efficient model because it allows a pharmacist to go from room to room across multiple hospitals to provide enhanced med education for our patients. Nurses love it. Patients love it. The pharmacists love it. It's a win across the board.

Q: How much of your pharmacy and lab work is tech-driven?

PF: It's actually kind of amazing. In pharmacy, for example, we've now implemented these robots that take up about a 12-by-12 or 15-by-15 foot room that run 24/7. And there are two types of robots — there's a box picker and a pill picker. And they basically, in real time, pick up every pill or every ointment and cream. The box picker is picking up ointments and creams, and the pill picker is picking up all the pills and the ordering. And it's done 24/7. And it puts them into these packets. And then those packets are either manually delivered to a floor or they're delivered via robots to the bedside of the patient.

This is another example of reducing friction for our employees. Because now we can have more people spending time at the bedside with the patients as opposed to picking pills or picking ointments and creams.

And there's similar technology in lab. Lab has had that technology and technologies like it, like automated lab lines, for a while now.

Q: What do you bring to this role having come from a clinical background?

PF: My prior boss used to commonly talk about people, process and technology. And it's 80 percent people, 15 percent process and about 5 percent technology. In my prior roles, I was vice chair of operations within the anesthesia department. I used to work across nursing, anesthesia, surgeons. And working across a lot of different people, coming up with new processes is something I was really good at, and it's something that definitely is relevant in this role.

So it's great to apply technology, but it's really heavy work across these very different groups of people: How do you align on one set of processes, and then how do you digitally transform or automate in that role?

It's a very exciting time. Healthcare is very complex, and we have an unbelievable commitment to our patients and employees. It's truly exciting, with some of the advancements that are out there from a technology perspective — but it's not the only thing. You need to really have good governance, good communications to achieve the goals that we're trying to achieve.

Q: In retrospect, was it the right decision to go fully to Epic for your EHR?

PF: It was a great decision. Our partners at Weill Cornell and Columbia, and New York Presbyterian — the three institutions really came together. And it was a great project. It was amazing work done by all the doctors, the nurses, the frontline staff to really align on processes.

It was challenging. We did it during COVID. We had our first go-live on Jan. 31 of 2020. Unfortunately, we would have a go-live then a surge, a go-live and a surge. And we did that for about two years. It was extremely challenging to stay on target, but we did it and our teams did an unbelievable job doing so.

Across the board, we're really glad we did it. We had about nine EMRs that we changed. It overall is a better experience for our patients. The challenge here was doing it and only having one instance across all of our hospitals and all of our medical groups.

We basically had one set of drugs we used, one set of order sets we used, we used one chargemaster. Some other places may have built custom EMRs for each hospital. We built the same one for every one of our hospitals.

Q: Did you choose Epic because it was the most-common EHR you already had, or was it the best choice for what you were trying to accomplish from an EHR and digital health standpoint?

PF: It was less about which vendor — it was more about the way we did it. We had to go from 10,000 order sets down to 1,000. That is extremely hard to do with the number of doctors that we have.

We had nine different instances or different vendors of EMRs in place. We knew we needed to choose one. We looked at them all and did a thorough process. And, ultimately, we felt that Epic was the one that met most of our needs because we really had to do a lot of standardization. And we're really happy with that decision.

Q: Your role also focuses on innovation, data and analytics, artificial intelligence, telehealth and cybersecurity. Anything else in those areas you're excited about?

PF: AI provides a lot of opportunity, but it needs a lot of dedicated focus. We have probably over 100 AI initiatives and projects underway in every area of clinical medicine: radiology, critical care, cardiology, OB. They're very critical, but they need to be implemented with the same rigor and structure we do with other implementations.

Telemedicine has been essential during COVID. I don't think it's that new or novel. I think it's just one of the ways in which we deliver care.

And we're very fortunate to have a really great chief technology risk officer. The focus on cyber and overall technology risk is something we should always be talking about, especially with our patients' data, with medical devices.

Q: Is there anything else you hope to accomplish in your new role?

PF: In the short term, if we can really reduce friction it could be very impactful for our frontlines, to make it easier for them to do work. And in the long term, we want to reduce the burden of disease. The next 10 to 20 years need to have advancements in reducing the burden of disease that have not been achieved.

I'm honored to be able to work with two medical schools at Columbia and Cornell. They're really great institutions. So we're in an ideal opportunity. Our job as leaders is to really lead this next phase in technology. It's not something that's value-neutral. And with our focus on health equity and health justice, it's going to be exciting the next couple of years.

One term that I did not coin but I like is "techquity." We're about a third Medicaid, a third commercial [insurance], and a third Medicare. We have to make sure that healthcare is accessible by all, and as technology advances we have to make sure that all of our patients have access to the right devices, the right internet plans.

We need to be intentional about how we provide services and make sure that when we introduce technology, we're not worsening disparities, we're actually leveling them.

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