Kevin Lynch has made his way through the top three public health systems in the country. And at each system, he’s overseen an EHR overhaul—each one bigger than the last.
That’s how he ended up in New York last fall. Lynch had just finished orchestrating an enterprise EHR implementation at Los Angeles County Department of Health Services, the second-largest public health system in the U.S. Prior to that, he was at the third-largest public system, Jackson Health System in Miami, where he oversaw a similar transition as the system's CIO.
That left just one place for him to go. Late last year, he was named CIO of NYC Health + Hospitals, which is in the midst of its own Epic installation. There he’ll oversee a $764 million project that spans more than 70 different care locations, including 11 hospitals, at the nation’s largest public health system.
That challenge, and the potential payoff, is what drew Lynch to New York, with the help of some recruitment efforts by Mitchell Katz, M.D., who was the director of the LA County Health Agency before being named CEO of NYC Health + Hospitals in September.
“What drew me here is the mission-driven capability to be a part of improving patient care from a health information technology perspective,” he says. “I’m a health information technology professional, but I never actually get to treat or touch the patients. Being involved in a transformation like this where you’re putting the largest public health system on an enterprise electronic health records system that will bring value to the patients we serve throughout New York City in a very meaningful way—I think that’s what made the attraction.”
In an interview with FierceHealthcare, Lynch said he wants to shave some time off the system's 2020 completion date and explained how he plans to use his past experience to navigate the rest of the rollout.
FierceHealthcare: NYC Health + Hospitals CEO Mitchell Katz recruited you to join him when he left LA County for New York. What was his pitch to you?
Kevin Lynch: He recognized the fact that I have a capability of going where things are needed and where there are big transformation projects like the second-largest public health system in Los Angeles County. Before that, I was at the third-largest public health system in Miami, where I did a similar thing, and they had recruited me to Los Angeles because of that.
Not that everything was perfect in LA, but we had reached a level of stability where they had implemented the EHR and were well on their way of optimization. And there was a great need for this in New York City and the ability to make a difference.
Meeting with the people and the leadership and a very committed and very passionate team here that is really interested in making this clinical transformation happen. Those were all strong influences for me coming here.
FH: What can you take away from those experiences in Miami and LA that you can apply to this system’s EHR project?
Lynch: As similar as they are, they are completely different. They are definitely large public health systems and there’s a certain weight that comes with that.
I think the key is making this a clinical transformation rather than a perceived information technology project. In both Miami-Dade County and Los Angeles County, I credit the success of those implementations to the clinicians who took ownership of the EHR systems. They owned it. This is a clinical transformation that rests on an IT platform.
I’m supporting the project with clinicians and people that own the EHR system: doctors, nurses, clinicians, radiologists, registration and scheduling folks. Making it a clinical transformation rather than an IT project is the key.
FH: How do you get your arms around that with a system as large as NYC Health + Hospitals?
Lynch: There are three things that have to be a part of that: Developing a strong governance model that helps make the appropriate decisions; good solid project management that is structured and disciplined in nature, so we understand the milestones and we keep to our timelines; and the right infrastructure. We need the right PCs, networks in place and wireless coverage. We need the right IT infrastructure in place so this product can stand on top of it and we can use it effectively across all 70 clinical locations.
Getting a governance model that will help make better decisions on the strategic direction we go in. There are many health information technology projects that are brought forward and they all have value, but we have to be able to strategically decide which ones are the priority project. Arguably, getting the EHR up across our system in a uniform way is, I feel, one of these highest priorities.
It’s a great undertaking. When I say “great,” it’s great big and it’s of great importance. That’s what comes with the large public health systems. It’s overwhelming. There is a scary factor to it, but you have to be able to take this one step at a time and ensure you have all the right things in place with project management.
FH: Where are you with that EHR implementation project right now?
Lynch: Three of the 11 acute care centers are currently on the enterprise version of the electronic medical record. That makes eight more facilities, but there are actually only six different versions of legacy clinical information systems because two are on one instance, another two facilities are on another instance, and the remaining four are on single instances.
The approach is in waves. If you take the time to do a good design, it leads to a good build. And a good build leads to a good test, and good tests lead to good training, and good training leads to good implementation.
FH: What’s your end date for completion? Are you on pace to hit that deadline?
Lynch: It’s scheduled to be live at the end of 2020. We’re looking at that project plan to see if we can do better than that time frame. I wouldn’t want to go past that date. I think there is a risk in waiting with the legacy systems in place right now. They're aged and they are not as good as far as feature functionality and continuum of care because of the siloed systems out there.
The sooner we get up the better. I feel confident we can be live by 2020, but we are looking and how we might be able to do better than that time frame. Hopefully, we can shave some time off that.
FH: How do you manage the hospitals on the new system with those on the old legacy system? What's your approach to balancing those two systems at the same time?
Lynch: You have keep these legacy ships floating as you’re building that new boat. You have to maintain those legacy resources and balance the work effort. There will be resources that want to tug against that and providers that say we need to upgrade legacy systems because while we’re waiting to get on the new system we’re losing these functionalities.
But you have to measure that because if you put resources into adding functionality to the legacy systems that we will be getting rid of, it takes away from the time frame of getting up on the new enterprise electronic health system.
That’s where the governance strategic direction has to be strong and clear, and we’ve gained the confidence of our clinicians and end users that we can successfully make this conversion.
If there’s a burning platform out there that is just not working, we’ll have to address that with resources, but I would say, generally speaking, we have to dedicate our resources and prioritizations to getting everyone up safely and efficiently on the new EHR system, and keep development and any new functionality to a bare minimum with those legacy systems.
FH: You mentioned that you saw the EHR transformation in LA improve patient care. How so?
Lynch: The best part of my job is seeing the efficiencies that both clinicians and patients are realizing. When patient Kevin Lynch goes to the ED at facility number one and then has a clinic visit at facility number two, and then I end up in an ED at a third facility with a similar heart condition or diagnosis, the providers in the third facility can’t even see the clinical information in the first two facilities because they are on separate legacy systems.
As the patient, I can say, “But I was at your other hospital—can’t you call them and get that information?” It’s not that easy.
A provider might have three different logins and have to remember how those three systems are configured. Or I might have to bring a pile of papers from one facility to another. That’s what they would do: package up a pile of papers and send it over to the other facility, which is very poor patient care.
It’s frustrating for providers, too. They want to provide the best care and don’t want to be handcuffed with the limitations of the clinical systems and legacy systems we’ve been using. When you get an enterprise system, a patient can go to any one of those 70 different locations the provider can see everything in every other encounter I’ve had in NYC Health + Hospitals. So, it makes their job so much easier.
It seems in this day and age that should be a standard, and it will be here. But until we get there, we’ll still be dealing with those legacy systems.