Providers’ Perceptions: New Orleans CIO Talks IT Challenges of Epic Proportions

“Laissez les Bon Temps Rouler” is no doubt an achingly overused cliché in New Orleans, and HIMSS13 attendees will certainly see it splashed across a wide range of marketing materials on the show floor in a few short weeks. It does seem an apropos choice of words, however, when looking at the recent IT journey of Ochsner Health System, the largest not-for-profit healthcare system in southeast Louisiana. Named one of the country’s “100 Great Hospitals” last year by Becker’s Hospital Review, the system encompasses eight hospitals, more than 38 health centers, and more than 13,000 employees including 850-plus physicians.
Spend five minutes with Ochsner CIO Chris Belmont, and you quickly realize there is a compelling IT story to be told – from homegrown solutions to the system-wide Epic implementation that began nearly 18 months ago; from staffing challenges to acquisition strategy, with a few natural disasters thrown in for good measure. Billian’s HealthDATA recently sat down with Belmont to learn how Ochsner has rolled with the punches, and become adept at making sure good times are always in the mix of hard work.
Billian's HealthDATA: Ochsner began its implementation journey with Epic in late 2011. How is that project going? What remains to be done?
Belmont: “2012 was a crazy year. Our first ambulatory site, and our first set of clinics went live in December of 2011. Last year, we brought up a total of four hospitals, and we have about 750 of our 850 employed physicians live as well. We’re about 80-percent of the way done.
“Next month, the weekend after HIMSS in fact, we’ll be bringing up two more hospitals, and then three months later we’ll bring up our Baton Rouge region, which has about 100 physicians and one hospital. We’ll be pretty much done by mid-year.
“If you look back over that timeline, it’s fairly aggressive to get all that done in such a short period of time. We did it, and we’re glad we did it at the pace we did because it allowed us to achieve a lot of our goals, attest for Meaningful Use, and start moving the organization to a better place from an infrastructure and IT perspective.”
How have patients reacted to the Epic system? 
“They’ve enjoyed having a visit summary, which is integral to meeting Meaningful Use. We’ve also seen positive feedback on the patient portal – we’ve turned Epic’s MyChart into MyOchsner to offer our patients online appointment scheduling, secure messaging and lab results. We want to go deeper into that tool so that patients can become even more interactive with our physicians. I’m eager to see how they’ll utilize the kiosks we’ll be rolling out for check-in.”
Where is Ochsner with Meaningful Use?
“The day we turned on Epic, all of our physicians – around 600 at the time – were eligible to attest for Stage 1, and every facility that has Epic will be on track with meeting Stage 1 and 2 deadlines. Our Baton Rouge facilities, which are still in the process of system roll out, won’t have time to attest for those.
“Stage 3 has me concerned. It consumes a lot of Epic development resources, so sometimes our features are delayed because their resources are focused elsewhere.”
Has the implementation better enabled Ochsner to prepare for coordinated care programs like the Ochsner Accountable Care Network, recently announced by CMS?
“Yes, our ACO was formally approved on January 4, 2013, and so we’re now off and running. There is so much about ACOs that is purely driven by data. You must be able to analyze your patient population. Looking at readmissions is huge right now, even if our patients get readmitted somewhere else. Epic’s support of the ability to drill in and dive into data has worked out well.
“We set up an enterprise data warehouse in 2009. It is homegrown, but based on the Oracle data model, and has been a huge success for us. We’re getting some good outside payer data – that claims data from parties like Humana enables us to see what’s going on with our patients elsewhere.”
Has the recent ROI/value debate around healthcare IT held any truth for you and Ochsner’s experience with it?
“It’s a necessary evil. There are so many things we could not have done otherwise. I feel there is a good ROI. We’re much more agile, and we can affiliate better with other hospitals. We’re rolling out Epic to our community doctors and that’s been a huge success in having an integrated EMR. The data components alone – the granularity - has been huge in terms of quality, revenue cycle management, admissions, etc. We may have had to take a step or two back from a productivity perspective; we’re working through that pipeline right now. We’re working really hard to quantify benefits.”
Is Ochsner planning to purchase or build additional hospitals?
“We’re going to expand more from affiliations than anything else. LSU is working with us to cost and manage one of their facilities. We’ll help them manage a 150-bed facility – our staff, their name. We’re talking to everybody, and everybody is talking to us. That’s just the way the industry is going now.”
Let’s talk a bit about Ochsner’s IT staffing needs. You hired 80 full-time employees for the initial Epic implementation in 2011, and then had Intellect Resources come in and help find additional talent with their Big Break event. Where are your staffing numbers now, and how do you anticipate that changing in the next few years?
“We’re very close to our original plan, which is to swell the HIT staff to 100 then reduce it to 60. We’re right at 100 now. During planning for the initial implementation, we were surprised to find that we needed more trainers. We understaffed the go live at our first site, but we quickly recovered and had Intellect Resources come in and assist with the rest. They helped us push 8,000 folks through a five-month training program that began last June.”
Along with the Big Break staffing event, Ochsner’s award for “Best Hospital IT Department to Work For” from Healthcare IT News highlights the adaptability it seems to have when it comes to workflows. Is that just ingrained in the Ochsner culture, or have you and your staff had to work at it?
 “We have a pretty strong culture here – the difference was the magnitude of this particular Epic project. With Katrina and other natural disasters - we’re not new to change, but something of this magnitude … it’s been a massive overhaul. I brought in a whole new set of players to help us begin this new way of doing business, rather than having legacy players from a legacy platform. I want to make sure we’re driving standards. In the past, we had a culture of accommodation, and that doesn’t scale, especially in dealing with our affiliations.
“In hiring, we went after attitudes, not aptitude. We’ve got hard workers, but we have a lot of fun. It’s a lot of pressure, though. We are having retention issues. They’re experts, and so they are highly marketable.”
Speaking of natural disasters like Hurricane Katrina, disaster recovery was once again on people’s minds in light of Hurricane Sandy late last year. Did you have any wisdom to impart to facilities impacted by the storm?
"We’ve had three major events – Katrina plus two others in the last six years. We’re getting good at disaster recovery, but I’d rather be good at something else. We’ve beefed up our disaster recovery. We have a hot site where we keep Epic and several other mission critical applications in Nashville.
"We have talked to a lot of people about our experiences - after the tornadoes in Joplin, and after floods in the Midwest, for example. We give three or four talks a year on our disaster approach."

Several Ochsner executives will be on hand at HIMSS13 to discuss their healthcare IT and disaster recovery experiences:

* Dr. Lynn Witherspoon, System Vice President and Chief Medical Information Officer of Ochsner Health System, discusses Emergency Preparedness and Disaster Resiliency, with a focus on the use of IT as support, on Sunday, March 3, from 11:00 a.m. - 12:00 p.m.

* Warner Thomas, CEO of Ochsner Health System in New Orleans, keynotes at HIMSS13 on Monday, March 4, from 8-9:30 a.m. Session Details

Billian's HealthDATA is a proud sponsor of Its recent interview with Belmont is an insightful complement to our Providers' Perceptions profile: "HIStalk Interviews Chris Belmont, SVP/CIO, Ochsner Health System."