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
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.