One-on-one With NYU Langone Medical Center CIO Paul Conocenti, Part II

June 24, 2011
With T&E trimmed, just as it is in all organizations, HCI editors rarely get a chance to interview sources in person. But when our source turns out

With T&E trimmed, just as it is in all organizations, HCI editors rarely get a chance to interview sources in person. But when our source turns out to be a fellow New Yorker, it’s time to take a cab across town for some real one-on-one time. I was lucky enough to do this recently, and have one of my best interviews of the year as a result, when I linked up with NYU Medical Center CIO Paul Conocenti. The result? An engaging look at a major medical center overhauling its IT environment to completely integrate the continuum of care. — Anthony Guerra

Part I

AG: At the magazine, we call what you are doing (going from one major vendor to another) a “big-to-big” conversion. That must be a tough to sell to the board because the organization has already put in a major system, no?

PC: It’s a great question. And I’ve told this story a few times, and I think it gets to the point.

Two years ago, we got a new CEO and Dean (July of ’07). Enter Dr. Grossman who is a huge believer in integration. While he was the Chair of Radiology, he transformed that department at NYU through the use of integrated technology. So, here I am, the new CIO (to him at least). Just that same year, March 2007, we had implemented this new clinical information system from Eclipsys. I’m a little crazy, but I’m not nuts. Now, I’m not going to go in to the new CEO and Dean and say, “Hey, listen, Bob, I’ve got a great idea, remember this big system that we just put in? Remember that new front-end registration system that we just put in with Cerner, just a year or so before that? You know that new OR system we just put in? Let’s scratch all that. Let’s forget that, let’s just start over again because what I want to do now is much more powerful, so let’s just do it all over again.”

No one in their right mind is going to go to the new CEO and just come out with that. The moral of the story is, he came up with it. This is driven by the Dean and CEO, he is so passionate and visionary about the fact that a medical center needs to have an integrated system, not an interfaced system, as there is a huge difference; a medical center needs to have integrated workflow, integrated decision support, integration is where the future is. He said, “Paul, we need to have an integrated system, and I know the Eclipsys system works great on the inpatient side, and it works great in this care setting, but we really need to have one system. Let’s see what’s out there.” And so with that, we put out an RFP to all the big players.

AG: Including Eclipsys?

PC: Eclipsys, Cerner, Siemens, absolutely. Went through that stuff and Epic came in first because what we were looking at now was not another inpatient system, we weren’t looking at an ambulatory EMR, we weren’t looking at a revenue cycle system. We included the lab systems and new radiology system; we threw the whole thing in there and said, ‘I want to see if there’s any vendors today — the landscape has changed over the last five years — that actually has all this stuff.’ We put in the request for proposal a whole section on what integration means, because we wanted to make sure that the platform was, in fact, integrated, not that we’re getting one vendor that had bought 15 different systems and tried to piece the stuff together, that doesn’t do me any good, I want an integrated system.

So we did all that, and we found that Epic not only came in first from a quality and a KLAS reports angle, but also in terms of price, surprisingly enough. They were less than their competitors. Even when compared against some of their competitors that already had a major piece in, like the inpatient system; they came out on top, because the implementation is not just licenses, not just hardware. The professional services component, and our people time component in implementing these things, is a tremendous cost, and if you’re dealing with multiple platforms, and if you’re dealing with product that is more difficult to use than another, that begins to add up.

When you look at a total cost of ownership, Epic’s not an expensive product. But you have to look at the total cost of ownership. If you’re only looking at a piece of it, you’re going to get confused. To answer your question, this was driven by the Dean/CEO — so we had over 500 physicians looking at this stuff, looking at gap analysis and other things, but the difference is we looked at this and we said, ‘Epic is the one, let’s validate that Epic is the right solution.’ And so we didn’t go through the dog and pony show with four vendors across 500 docs and clinicians and all that, because our analysis showed a pretty good size difference between first place and second place. So we just needed make sure that this system actually met our needs, rather than putting many vendors before hundreds of doctors. Before we did any contracting, we went through another six to nine month exercise, that’s where we engaged every nook and cranny of the place.

We walked away with the fact that we absolutely do have a vendor that has an enterprise solution. They have an excellent reputation in the area of service and we went to the board with that. And we got approved within this time period of economic, one would say, depression. And the board totally bought into our vision, which is to be an integrated world class patient-centered academic medical center.

AG: Were you involved with the selection of Eclipsys?

PC: Yes.

AG: Do you think you picked that system because there was a different vision of what you were trying to do at that time?

PC: Absolutely. At the time, I challenged that because I thought their vision was too narrow. So, the vision for selecting Eclipsys was purely inpatient. There was no integrated thinking other than inpatient involved. Basically, Eclipsys was put in to replace the old system. So, that strategy was prompted by cost, not vision, not business value. There was no business value associated with the selection of Eclipsys. It was cost-driven because the platform we had was dying. We were on a 30-year-old platform. The predominant reason that investment was made was because we knew we had an aging platform and we had to do something.

AG: So you just bought something similar?

PC: Similar to replace the old system. By the way, it has an ED system and pharmacy component, we’ll add that in and we’ll integrate that, and so the integration that we did with Eclipsys was integrating the inpatient setting, because that was the focus, that was the vision, it wasn’t to bring in the ambulatory, it wasn’t to connect the ambulatory with the revenue cycle, and to bring in the billing components. We’re patient centered, when we’re done with this transformation, a patient coming into the NYU network will get one bill. They’re not going to get 15 bills from different places that are all NYU because it’s a fragmented revenue cycle component, they’re going to get one bill that has all their services, and if they want to pay that bill, then they go to one portal and they’re going to be able to pay that.

If they want to schedule a visit with any of the providers within our network, they’d be able to go and schedule a visit, they’ll be able to see results, they’ll be able to transact. They’ll be able to, within the various consenting and permission levels, if they want to engage in our research community, say, “Okay, I want to sign up for a research feed, so that I can get the latest breaking research for the particular diseases and conditions of mine,” they’ll be able to do that.

If they want so sign up for being open to clinical trials that are happening within their specific situation, they’ll be able to do that, because we’ll be integrated with our research community. We’re doing a lot of work to integrate our clinical trial management system with our clinical system.

So it’s pretty far reaching, it’s great to be a CIO here. Of course, working here has its own issues, which basically means now you’ve got to do it. Most people are fighting to build a case for what they have to spend, and using up all their energy on that, but I don’t have to do that.

AG: Be careful what you wish for, right?

PC: True, be careful what you wish for, but it’s a good challenge.

Part III

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