I'm here with Kristen Myers, Vice President of Information Technology, talking about health care leadership. Can you give me a little bit of background on how you got into IT in the first place, Kristen? >> Sure. So when I was in Australia, I actually worked at- >> Are you an Australian? >> Yes. [LAUGH] I worked at Scenic Corporation starting off as an Interface Analyst, that was my first job. And I was promoted to an Interface Architect. Then I was actually recruited by Keif Juvenal and Steen Young here in New York and brought over to New York. I thought I'd be here for one year, and it's been very interesting for me, because Mount Sinai actually was my first client when they were merged with NYU. And so 13 years ago, I actually came to this campus and started my carer here, and was on the Center Implementation. And for three years, I was with Mount Sinai in NYU, and ultimately joined Mount Sinai in a director position. I really wanted to own my own programs, I wanted to start my own department. And I was given that opportunity at Mount Sinai when we started the system selection for an electronic medical record. I actually started working with Dr. Kenry who is a clinical informaticist here at Mount Sinai. And we really recognized the need for an electronic medical record in the hospital based clinics. So we started a system selection in 2004 and went through a very rigorous process to ensure that all of the stakeholders needs were going to be met. All of the specialities were represented and we ultimately chose Epic as our electronic medical record. And so for the last ten years at Mount Sinai I've been implementing Epic here. And I have been promoted to Senior Director and ultimately Vice President. And we've implemented Epic across our ambulatory care network, about 500,000 visits per year and add out to hospitals, the 1,100-bed hospital here in Manhattan and the 200-bed community hospital at Queens. So my other department actually is the program management office. >> Your second hat? >> Yes, and that really evolved from the Epic implementation where >> We really needed a lot of rigorous planning, and execution, and change management to ensure that we had a successful implementation. And the program management office is now expanded, to to take on a whole host of programs across the health system such as meaningful use, and isodieten. So with the merger, we've had a lot of challenges but a lot of opportunities and we'll be moving forward with the Epic implementation at those campuses in the coming years. So, we have a lot of work to do. >> So just to clarify, you and your leadership role have responsibilities for system and application. >> Mm-hm. >> Epic and when it does a small electronic medical record. Plus also the business function in the program management and change management office. >> That's correct. And also on the Epic front, we're moving into revenue cycle for our faculty practice. So we'll be focusing on registration, scheduling, and professional billing. And we hope that the program is very successful in our faculty practice. So we can move on to hospital billing and have an integrated front-end without electronic medical record across the entire health system. That's the goal. >> You've been in Mount Sinai for a number of years and you've probably seen it tremendous amount of change in the status of health information technology here at Mt Sinai. Bring me back, and let's talk a little bit about the state of health information technology when you started here. >> Sure. So when I joined Mount Sinai, it had just been reinsourced from IBM by the CIO, Jack Nelson. So, when we were looking at the ambulatory care environment, what we found was most of the practices were on paper. Some had implemented pilot programmes such as solar power chart office in their practice, or logician, or even homegrown EMR. So it was really fragmented from a clinical care perspective. There are multiple registrations systems and unfortunately that's the current state. Ultimately we will move to an integrated platform with Epic but probably the most strides that we've seen in the last 10 years have really been focused on the clinical system integration which has been very important. >> One of the journeys that Health IT has taken over past 20 years is this evolution starting with best of breed systems, mostly because that's all there were, to integrated solutions. When you came to Mount Sinai, I would imagine it was an era in which the best of breed IT systems were flourishing. >> Absolutely, so we had TDS in the inpatient arena. So CPOE on the mainframe system. >> So it's computerize provider order entry? >> Yes. >> Using TDS switches Technicon Data Systems which got bought by Klipsch, I believe. >> Yes that's correct and we also had Ibex in the emergency department and we also had a home grown results repository called EDR that I believe was very much beloved by our physicians so >> And there was an anesthesia system in place? >> Yes Compurecord and we also have a surgical scheduling system, the still in process there. >> So tell me a little bit about the decision to go with an all-in-one IT solution. How did you get there? >> So in 2004 we started the ample tray system selection and I believe that most of the people who were involved in that system selection were really focused just on ample tray. A lot of people asked us, why are you going to have another system selection in 2009 for an inpatient system? Why don't you just choose Epic? And really what we wanted to do is make sure that the Epic inpatient system was the best system that we could possibly put in the inpatient arena. So we went through, again, a very rigorous process to ensure that we had the appropriate stakeholders and business sponsorship. And ultimately, it was 39 to 1 that the selection committee voted for Epic in the inpatient arena, which was a good result. >> Tell me a little bit about this best of breed environment that you inherited where were sort of the challenges and the problems. And how did you overcome them? >> I think one of the challenges we had was the emergency department specifically because they had invested huge amount of time and effort into customizing the product that they had. Which was Ibex, and the physicians and the nurses, everyone really liked the product. And the decision to move to Epic was a very difficult one for them. Our COO, and president and CEO Felt very strongly that we should have only one electronic medical record across the health system. And we worked with the emergency department to look at what functionality gaps were there in terms of their existing product to Epic. And we worked with their clinical informatics department, partnering them with Epic research and development to actually mitigate those gaps. And now all of the functionality that they really wanted in Epic became part of the product and is being rolled out across the country. So, I think that from a change management perspective it was very successful because the emergency department felt that their views were being heard by this enormous software company in Madison, Wisconsin. >> So, take me back a little bit. It sounds like when you started this process of going to a single medical record system, you were coming into an environment where a lot of different areas of the hospital and the healthcare system were really in best of breed environments. >> Yes, I think one great example is really the emergency department that had invested a lot of time and energy into the IBEX product. The physicians and nurses really liked the product, it worked well for them, and they were really unsure as to whether they should migrate to Epic. However, our CEO and president of the hospital felt very strongly that we wanted one medical record across the entire system. And that was a very important that we stuck to that principle. So we worked with the emergency department, we identified where the perceived caps were in the Epic product and we partnered the clinical informatics team with Epic research and development. And we're able to really bridge that gap before Go-Live in the functionality that was developed in Epic, and ultimately, that functionality is being rolled out across the country. And we ended up with a very successful transition in the emergency department with very limited to no revenue being lost in the transition, which was of extreme concern to them. >> This process of rolling out the in-patient electronic medical record. It's the kind of project that makes a lot of healthcare organizations take a deep breath and maybe a gut check. For you this was, what, an 18 month project? >> Yes, 18 months. >> And you didn't look at it just as, we're going to install this product. You looked at it as something where the change management had to be built into the process. Was that standard at the time, or was that something that was forward looking? >> Epic was forward looking. When Epic provide their project plans, there is very little reference to the change management aspects. And we had a great hire, Ellen Assesi, who had a change management background. And she really worked with the project managers to incorporate a strategy where we blended our project management methodology with change management. And really focused on the human factors of the implementation. So I think it was unique. >> If I remember correctly, about six months into the project we were behind schedule on a couple of things because we ran into a certain amount of resistance that caused the Mount Sinai team to need to change the project plan in a way that didn't affect the timing of the Go-Live, but restructured the organization. Tell me a little bit about what happened and how that decision was made? >> So, I think that what we recognized when we were following the Epic methodology, and their flight plan as they call it, was that, Mount Sinai is a very complex academic medical center. And there were a lot of specialized work flows that needed a lot of stakeholders involved in the design sessions and the validation sessions. And so, we had to work with Epic to really change their methodology, which they were receptive to. So we could make sure that we got all of the stakeholders at Mount Sinai involved in the decision making. And ultimately, I think that was key to the success of the overall program. >> So, maybe a lesson to our future healthcare leaders is that while vendors frequently know what they're doing and their advice is good. This has to be taken into the context that only you know about as the person at your own healthcare organization. >> I agree totally. I think that you have to own your own program, and you also understand the risk tolerance of your organization, and no vendor truly understands that. I mean Mount Sinai is a very risk adverse culture and we wanted to make sure that this transition was completely successful. And we did receive recommendations from, not only the vendor, but other clients to move forward with a big bang implementation. And after consulting our clinical and partners and also our executive team, it felt more comfortable with a approach. And I think that was the right decision even looking back a few years, it's still the right decision that we made. >> When the electronic medical record launched at Mount Sinai, things went fairly successfully overall and Mount Sinai did receive some recognition for this. >> Yes, they did. We were recognized by the HIMSS Enterprise Davies Award for excellence in an electronic medical record implementation. The team was also recognized by the New York PMI, Project Management Institute, for Project of the Year. And the institution received HIMSS level six. And ultimately, we'll be going to HIMSS level seven, which is the highest level of EMR adoption that you can get. So, I think that the recognition is really a reflection on the meticulous planning that was done initially in the program. I think the executive sponsorship from Dr. Davis Down, I think the clinical partnerships that we had with the clinical informatics team. And ultimately, we had a really great team. >> I really like the fact that we got the PMI award, because as I understand it, the Mount Sinai impatient EMR project was being judged against nuclear power plant projects. >> Yes. >> And all sorts of other, not just within healthcare, but major projects out there. >> Yes, and that was very exciting, so I think that project management is becoming more of a recognized discipline within healthcare, which is good. >> So, talk about the importance of having your project management team as a partner in any kind of IT project or implementation of this size. >> So, I think that what project management gives an initiative is really structure, governance, organization. And it's really important that we have business sponsorship, and that the business sponsors take ownership of the overall program, and also the results of the delivery of the program. >> When I came into this business I thought that project management was that you make a list of things that you need to do and then you check them off one by one but it's certainly more than that. There's a whole methodology behind it. >> Yes. Is there a right methodology? Are there more than one methodologies? Do you mix and match? >> There are multiple methodologies out there. I think that it really depends on the program. If you're looking at software development, there's a methodology called Agile, which is very different from the Waterfall methodologies that we use in large implementations such as Epic or SAP. So I think you really need to fit the project management methodology to the exact program that you're working on. >> And how much of this do you think is invisible or behind the scenes from the perspective of our healthcare leadership business partners and how much of it is visible to them? >> I think that our leadership team have an appreciation for program management and project management, especially with the large scale enterprise initiatives. We've seen the fact that many departments have now got project managers, which is a good thing. I don't think that project management can be centralized in one group for an institution of our size being a $7 billion institution. So the fact that project management is being adopted in all of these departments across the whole system is good. >> Looking forward now, where do you think that the IT challenges of the future are for a healthcare system? >> I think that the challenges we are going to face are really around telehealth and care coordination in the near future. I think that telehealth is a very disruptive technology in the sense that consumers or patients are really going to want healthcare 24/7 and whenever they want. And that is not necessarily a paradigm that our healthcare system currently works under. So I think that that's going to be an enormous change. I think that the incentives are not necessarily align also for the physicians for telehealth. So I think that, that will be a huge change management program that will need to be reviewed at Mount Sinai as to how quickly we adapt that technology, I think. Secondly is population health and care coordination. How do these care coordination and care management tools truly integrate with the platforms that we have, the electronic medical record? What is the legal medical record when you have this tool where a lot of patient information is being recorded by care navigators? And I also think that interoperability is going to be another arena that we need to see substantial change in. Recently, we've seen that Epic as a vendor have changed their entire strategy. Previously, they would charge for records being exchanged from other electronic medical records, that wide Epic to Epic, that were charging around $2.35, and per patient record per year. And if wasn't for the pressure of the federal government, that would still be going on. And I think that we're going to have to see the federal government take a more activist role in interoperability for that to move forward. >> I'm a little surprised to hear somebody within the healthcare industry welcome intervention by the federal government, but I understand where you're coming from. Sometimes, the individual players don't have the ability to set the rules of the road in the way that the government does. >> And there's no incentive really for the vendors to exchange clinical information at all. And I think that it's really up to, now, the federal government to come up with the standards and the methodologies and enforce set on the vendors. I've heard the argument that the interoperability standards should have been worked out before the government gave the federal incentives regarding meaningful years. But we've probably would still talking about the interoperability standards, all of these years later. And quite frankly, the electronic medical record implementations at all of these sides has improved patient safety. >> In terms of other things, piece of advice that you would give tomorrow's healthcare leaders in the use of health information technology to advance their goals, what do they need to know? >> I think that being a continuous learner and making sure that you keep up-to-date on technology is really important. I think that being a partner to the clinical informatics team, if you have a clinical informatics team at your institution, is also very important. >> Great, thank you very much for your time. >> Thank you, Bruce.