Two hospitals at the NYC Health & Hospitals system are expected to make the switch this weekend from their decades-old electronic health record systems to new ones. It's part of a $1.4 billion health information technology upgrade that's faced unprecedented controversy and public scrutiny.
All systems are go, said Dr. Ramanathan Raju, CEO of the nation's largest public health system, an 11-hospital integrated delivery network with more than 80 community clinics.
Raju said they are prepared to fix any problems that might arise. “We're continuing to evaluate and monitor it."
The so-called EHR “go live” is scheduled for late Friday night and early Saturday morning. That's when the hospitals will turn off the existing QuadraMed EHRs and turn on new ones from Epic Systems Corp., which has a 15-year contract with the system.
On Monday Raju toured Elmhurst Hospital Center while Ed Marx, a veteran of multiple Epic installs elsewhere and the chief information officer of this project, spent a few hours at Queens Hospital Center, talking with employees about their attitudes, training and sense of readiness.
Both said they were buoyed by the gung-ho attitudes of the troops.
“I feel confident, technologically, because my folks said we've got it there, and I feel confident having met with the frontline people,” Raju said.
The EHR installation throughout the New York system's facilities is expected to cost $764 million and take six years. Epic's share is pegged at $302 million.
Eric Helsher, vice president of clinical success at Epic, said this project is no small task, considering the turnover involves systems for outpatient, inpatient and ancillary clinical services.
“On the other hand, it's a scale we've experience doing,” Helsher said, ticking off as examples several large, high-profile healthcare organizations that are Epic customers. Its largest are the sprawling Kaiser Permanente system with 38 hospitals and Partners HealthCare with 12 hospitals.
Marx said New York City Health & Hospitals will have expertly trained nurses or physicians—so-called super or power users— to advise their colleagues. In all, 440, at a ratio of 1 for each 6 of their professional counterparts, are trained.
Epic also will have about 275 of its personnel on hand for the launch, Helsher said.
Go-lives are always tense for provider organizations, regardless of size and even though experts say few go awry. Those that encounter problems often blame the vendor.
But this New York project has become a true Big Apple in-the-klieg-lights kind of event.
For one thing, the sheer size and public ownership of the New York system has attracted a lot of attention, according to Helsher.
But the project has also attracted an unusual amount of controversy.
In 2012, immediately after New York announced it was awarding the contract to Epic, losing bidder Allscripts Healthcare Solutions, issued a highly publicized protest, with then-CEO Glen Tullman claiming his company's bid would have cost $700 million less.
Allscripts sued, but dropped its suit a few months later.
Then, last year, two top IT officials, two other administrators and seven consultants at the hospital were shown the door, with the New York Post reporting that the healthcare system's inspector general had launched an investigation into the EHR project.
Then, in February, the first of five anonymous blog posts appeared at a site called WhistleBlower@NYC Health + Hospitals, containing what appeared to be an insider's account of difficulties with the installation.
The Post this month published three more stories critical of the project. They alleged that the launch is being rushed, possibly putting patient safety and privacy at risk. The Post, relying on unnamed sources, said Raju was “under the gun from City Hall” to meet an April 1 deadline and feared he'll be fired if he doesn't.
Then, the Post reported that a physician, Dr. Charles Perry, resigned from the healthcare system and in a resignation email “urged colleagues ... to sound the alarm" to stop the system from going live. He likened the impending launch of Epic to the Challenger space shuttle disaster of 1986 in which its seven-member crew died.
Raju dismissed Perry's criticism and the allegation that he was rushing the job under pressure from City Hall.
"This has been a very methodical, painstaking process," he said.
And the change is necessary, according to Raju.
The New York hospital system met its meaningful use targets with the QuadraMed EHR, but it needs more features to move forward, Raju said.
Both the system's behavioral health and long-term-care facilities still run on paper records.
In a statement, the hospital system also said it needed an upgrade to a “smart EMR” that offers “robust decision support ... far better data-mining and interoperability, and greater capacity to advance quality initiatives, care coordination, and efficiency.”
Last year, Raju announced a plan to boost the number of patients the system sees by 40% to 2 million a year. He also wants to double health plan enrollment to 1 million. These are all efforts to become “financially viable and stable" by 2020. In its fiscal year ended June 30, 2015, the system posted an operating loss of $58 million on operating revenue of $6.46 billion.