Quality care for all New Yorkers—despite declining subsidies

The nation’s largest public health system, NYC Health + Hospitals, needed to transform the health system to continue serving one of the densest and most diverse patient populations in the country.

A new, highly capable electronic health records system (EHR) was at the core of NYC Health + Hospitals’ transformation plans. Not only would the new EHR help the system’s 11 hospitals operate more seamlessly and efficiently as a system, most importantly, it would help NYC Health + Hospitals achieve its goal of transforming into a high-performing system for all patients—by providing a high-quality experience and better access to care for all New Yorkers.

Here’s how Advisory Board partnered with NYC Health + Hospitals to pull off the biggest EHR implementation and go-live at a public institution.


NYC Health + Hospitals
  • Public safety net health care system of New York City
  • The nation’s largest public health system
  • Serving a population of more than one million people
  • Live on new Epic EHR at two facilities and home care as of April 1, 2016


Enlisting the help of an army of people

We believe in the importance of investing in top talent to get the job done.

Advisory Board helped fill NYC Health + Hospitals’ bench of experts that could pull from years of experience in health IT and EHR implementations, like Edward Marx who is currently serving as NYC Health + Hospitals’ interim CIO. We also helped identify internal top performers from both the operational and clinical sides so we could enlist their support in this monumental effort.

We then created an unstoppable Governance Committee that consisted of NYC Health + Hospitals clinical and administrative leadership, Epic experts, and Advisory Board leaders to guide all decision-making and strategy surrounding the EHR.

From here, Advisory Board guided the Governance Committee to identify top performing individuals across the organization to contribute to the build and design of the new EHR. Hundreds, if not thousands, of people from across the system contributed to these meetings in various ways, leading to a successful first-phase implementation that boosted the staff’s confidence in the Governance Committee’s ability to lead subsequent phases.

Edward Marx

Edward Marx
Senior Vice President, Advisory Board Consulting
NYC Health + Hospitals Interim CIO

Standardizing EHR workflow around best practices

Workflow needs to follow the patient’s journey, not the other way around.

Our team visited each hospital within the system to meet with key clinical and administrative leaders, and worked with them to craft workflows that were specific for specialties, individual clinicians, and patients.

EHR workflow

With better, more efficient workflows in place, and a unique identifier available for each patient, it’s now becoming easier for NYC Health + Hospitals providers to move patients throughout the system and share information where it’s needed.

 Test results are easily accessible, treatment plans are clear, and communication between providers is streamlined across the continuum of care—all leading to fewer errors, frustrations, and care delays.

Instilling trust with radically transparent communication

A new EHR platform is a big change—but it doesn’t have to be scary.

The new EHR brought change across the entire organization, disrupting every day workflows for all users. It was more important than ever to demonstrate to staff that the time invested in this project would be worth it. This called for constant, transparent communication, even when it was uncomfortable.

Advisory Board hardwired a broad spectrum of communication points across the health system—everything from mass communications like monthly town halls and newsletters, and also facilitated regular one-on-one meetings to round out an intentional open door policy. Nothing was ever sugarcoated, and successes were celebrated. As a result, staff truly trusted our ability to guide them through such a large implementation project, and perhaps even more importantly, they knew they had a voice throughout the process. 

Planning ahead for post go-live optimization

Go-live is a milestone, not the finish line.

In the months of planning, Advisory Board worked with NYC Health + Hospitals leaders to not only manage the actual go-live day, but also the weeks following the big event. We helped administration set achievable staged productivity goals for the immediate weeks following go-live, and helped them craft a long term strategy for continuing to optimize the EHR to deliver its best capabilities in a way that worked at NYC Health + Hospitals. Staff on the front lines of the go-live saw this as a vote of confidence in the success and longevity of the system, and a commitment to an effort to make the EHR work for them.

Learn more: On-demand webconference

The Road to the Largest Public Health EHR Implementation

In this on-demand webconference, Advisory Board’s Preston Raulerson and Edward Marx, NYC Health + Hospitals interim GO Chief Information Officer, share lessons from the largest EHR implementation and go-live in the history of municipal health care.

Watch the presentation 



quality and safety scores from Leapfrog, up from 50% on the same metrics before go-live

After hitting their initial go-live goal on-time and on-budget, NYC Health + Hospitals has already seen reductions in care variation, as well as the resulting cost savings and increased patient safety for the community.

Perhaps the most impressive result to date is the improvement in NYC Health + Hospitals’ Leapfrog reports, a study that assesses quality and patient safety. Prior to implementation they scored at roughly 50%, and now regularly score 90-100% on the same metrics. Leadership is now pivoting its attention toward optimization to get even more value out of their technology investments.

There is no more miscommunication. There is no more misinformation. Most importantly, when the patients are in dire straits, we could help them immediately, and that, we thought, was the best of the best part of Epic.

Ann O’Connor, RN
Head Nurse
NYC Health + Hospitals/At Home

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