An Epic Journey at RWJBarnabas Health

Dr. Robert Adamson [00:00:00]:

You need governance, you need structure, and you need an ethics committee behind AI. As we know, with either hallucinations or bias in some of the large language models that are still learning, you actually can make a problem even more worse. And so I go back to always governance and structure when it comes to AI as a strategy, and then patient safety and efficiency

Ben Hilmes [00:00:21]:

From Healthcare IT Leaders, you’re listening to Leader to Leader with Ben Hilmes. Our guest today is Dr. Robert Adamson, Executive Vice President and Chief Information Officer at RWJBarnabas Health. In our conversation, Doctor Adamson explains how, despite the COVID-19 pandemic, he and his team orchestrated the successful rollout of RWJBarnabas Health’s epic program, a $787 million project to unify 14 hospitals, a medical school, and 400 ambulatory locations.

Ben Hilmes [00:00:56]:

Doctor Adamson, it’s fantastic to have you on the show. I’m going to refer to as Rob, as you had asked me to do, but just wanted to kind of start. Look, eight days from now, you are about to finish a massive journey with your, your final epic. Go live here across the enterprise. I’d just love for you to take us through that journey. What are some of the highlights? What are some of the challenges? And. And then kind of maybe land with, what are some of the big wins that you had out of this journey?

Dr. Robert Adamson [00:01:26]:

Yeah sure, and I’m honored to be here. So thank you. Ben. We started this journey sometime in March of 2019, believe it or not, first with the selection process, et cetera, and then I came onto the project in August of 2019. At that time, the goal was to take all 14 of our hospitals on medical school at Rutgers, the Cancer Institute of New Jersey, and 400 ambulatory locations. The goal was to bring all of them off of four different revenue cycle systems, five different registration systems, and six different electronic health records. And so that was probably the biggest challenge in that we were on disparate systems, didn’t talk to each other, and all the policies and procedures and how we did things were different because we had just merged just two and a half years prior with Robert Wood and Barnabas Health. The biggest challenge is if you can think of 2019 coming into 2020, early 2020.

Dr. Robert Adamson [00:02:26]:

We were just getting our work groups together, just getting things together. And then, of course, COVID hit. And so we were at an inflection point where the board of directors had said, we probably should shut this project down and pick this up after that. And I got a call on a Saturday, and I said, I disagree. And they said, what do you mean? I said, I think that’s very emotional, and let’s put some rigor to this. So I said, if 70% of our work groups can remain active, then let’s keep moving forward. I agree the emergency room can’t help us, but what is an interventional cardiologist doing in COVID? Nothing. This is the exact time to get him or her to make those decisions.

Dr. Robert Adamson [00:03:06]:

So we called it the strategic pause of. And it turned out that only 15% of our work groups were truly not active. And so going through that for four months, I wrote a sbar, which is situation, background, assessment, and recommendation. I wrote more than 500 of those because I had to do them weekly to update the entire corporation to say lab is unavailable. But we think in two weeks we’ll make enough decisions to keep moving the ball forward. And then we took all the decisions that those groups needed to do and move them towards the end of the build. And I’m proud to say what we did through that strategic pause was we came out in July of that year with the build finished on time and under budget, and then we went live.

Ben Hilmes [00:03:50]:

On wave one pause there. I’m a little blown away because, one, there’s no playbook for that. Two, that’s a bold move as a leader. We’re going to get the leadership later in the discussion. That’s a really bold move, because if you were wrong, you probably aren’t there today. Those are tens of millions of dollars worth of decisions.

Dr. Robert Adamson [00:04:13]:

Correct. So, to give you an idea, the budget for epic for this project was $787 million. So it is the largest capital project we ever undertook, even bigger than some of the buildings we put up. And so just to give you some scale, that’s awesome.

Ben Hilmes [00:04:30]:

But I love the fact that you said, look, let’s not let emotion drive, lets let the data drive, lets go do the due diligence, do the S 500 plus sbars. That kind of led you down a path that said, this is the right thing. And probably ultimately the best thing. One of the sayings I use a lot is when you get knocked down, lets pick something up. While were down there, this COVID thing really knocked us all down. But it also created opportunity for us to do things we probably wouldnt naturally be able to do. Hats off to you for that. Thats a huge, huge success.

Ben Hilmes [00:05:04]:

I’m excited that you’re about to the end of the journey coming out of it. What are you hoping to achieve? What’s some of the big takeaways?

Dr. Robert Adamson [00:05:12]:

Yeah. So when I was first asked to lead this project, I needed to know the why, and so I was asked that very question, and it was very simple. As a clinician, I’m a pharmacist by training. And so as a clinician working in intensive care units my whole career, I wanted to make sure that having a unified health record would provide our patients with a voice. If I had so many patients, then that would come to me and say, well, you had a surgery on your stomach. What was it? I don’t remember. What pills are you taking? I don’t know. What doctors do you see? I don’t remember their name.

Dr. Robert Adamson [00:05:47]:

Now, with epic having a unified record, I have access to anyone that they have ever had an epic encounter. And in the state of New Jersey, once we go live this weekend, we’ll be about 80% epic as a state. So there’s a high likelihood that the patient has a portability of their record, a care continuum that only can be done in the epic space. And so I really wanted to make sure that we gave our patients a voice. And then it also arms our clinicians to have the kind of information he or she needs to give and deliver the best care. Whether it’s the emergency room, the hospital, the ambulatory space, it didn’t matter. So for us, for the patient, I wanted desperately to give them a voice. And for this health system, I wanted us to be nimble in the marketplace and then be able to deliver excellent care, along with having the best tool in the world to do so.

Ben Hilmes [00:06:36]:

Well, that’s profound, but it’s really, it’s moving, and I think a little bit is why we all get into this profession of healthcare, because it’s personal. It’s too important to stay the same. All those catchphrases. I’m curious. $787 million spend a incredible why? What are you guys doing to the 80%? Epic as a state? That’s pretty incredible. Are you guys doing anything at a state level, in partnership with even your competitors, to talk about the value of that unified record or what you guys have accomplished and what that means for a consumer?

Dr. Robert Adamson [00:07:16]:

Yeah. So I guess what happened was there are a lot of horrible things that happened through COVID. One of the really good things is it broke down barriers. And one of the barriers was, yes, we’re competitors in the state, and we didn’t really share our information the way we should have. And so what happened is COVID forced us to make decisions that we fundamentally probably knew were the right things to do. But politically, we just couldn’t get the powers to be, to release the records. Now, what’s happened since COVID is every one of our competitors who are on epic shares bi directionally the records, so that when a patient goes from our facility to theirs, they’re not impaired or impinged by having embargoed information. It’s something if they say, I’d like to get my record, we share that right away, so that if there’s a referral and those kinds of things, we haven’t done anything in terms of capacity management, which was one of the things in COVID, which was an issue.

Dr. Robert Adamson [00:08:14]:

We’ve been doing it what I would say intra system, but not inter system, unfortunately, and we haven’t been able to do that yet. I am actually very emboldened by the fact that we have an innovation center in New Brunswick that’s going up at the state level, where four or five of our competitors are going to be housed in that one building, where we’re going to be doing innovation for the state as those innovations flourish. One of the things that we have is a really great chassis that the members of that group are all on epic. So if we were to come out and do something collectively for our state, we’re poised to do that because we’re all on the same medical record.

Ben Hilmes [00:08:51]:

That’s absolutely fantastic. And kind of the second order effects of some of the work you’ve been doing, which I think is fantastic. It’s kind of conference season. I’ve been going to UGM, Workday, Oracle, CloudWorld, vendor after vendor, supplier after supplier. Every one of them has a common theme, AI.

Dr. Robert Adamson [00:09:13]:

I’m not familiar with that.

Ben Hilmes [00:09:15]:

I don’t know, it’s this new thing, but it seems to be pretty important. And it’s interesting in the time in Verona, one of the challenges, and it’s not unique to epic, but all of the vendors, their biggest concern is the rate of consumption of the innovation and how do we get our clients, our customers to adopt the things we’re doing. You have a lot of applications across your health system. I used to be at a health system in a similar role as yours and we had 2000 applications. And so you’re trying to figure out how do I maintain leverage, optimize, et cetera. What’s your strategy? How do you think about taking on adopting, deploying innovation specifically? With the rapid growth of AIH at the forefront, you’re probably getting questioned every week by it. Your leadership, certainly your board is talking about it. What’s your plan?

Dr. Robert Adamson [00:10:13]:

So the first thing they’ll ask me is, what’s your AI strategy. That’s like asking me, what’s your Internet strategy? It’s a tool. And so basically what we’ve done is we’ve just put together our strategic plan. And what I did, Ben, is we took all of the strategic themes. There’s four of them. It’s customer experience, modernization, organizational enablement, and organizational resiliency. And as we went through this, it collapses to almost anything you can think of in the it space fits those four themes. What’s interesting is we took the tactics that feed under each one of those strategies, and I took anything that’s empowered by AI.

Dr. Robert Adamson [00:10:53]:

It has a symbol next to it. And the message was, you don’t have an AI strategy. AI is a tool that actually can enable your strategy, and you have to have an overall strategic plan of which this tool can actually either accelerate the velocity of either adoption, efficiencies gained, et cetera, et cetera. So where I looked was for specific areas that I thought were the right use cases. I’ll give you one specific example. In the radiology space, we know that a radiologist can read any one of our films, if you will, or images. However, if there’s something egregious or really horrible, I don’t want them waiting to get to film number 39. I want that moved right to the top.

Dr. Robert Adamson [00:11:37]:

And we actually put in artificial intelligence to do that. We did that for two reasons. One, it’s a patient safety issue, because I want to make sure that we get those horrible, horrible outcomes right at the top of the list, because time is of the essence, time and tissue, etcetera. Second thing is, as we know, there’s a national shortage for radiologists. And so if I can make a radiologist 45% more effective and more efficient, I can do it two ways. I can either make a modest investment of about a half a million dollars so that we can apply AI and that large language model on there so we can find those images, or I can go out and spend $20 million and get more radiologists that don’t exist to do the exact same thing. So I look for what I call gross mismatches. What I find in the AI space is people trying to solve problems that actually aren’t real or really marginal.

Dr. Robert Adamson [00:12:29]:

So I look for things that actually are patient safety and mostly efficiencies as a health system. And those are the two that I think capture what we’re about. And so our roadmap is if it doesn’t fit patient safety or efficiency, it doesn’t mean we won’t do it. It just means it’s going to be lower on our list to do AI and functionally AI really well. What I don’t see a lot of my colleagues focused on, they’re focused on the tool, the solution, because it’s sexy. But I always remind them, do you have governance for AI? Well, you need governance, you need structure, and you need an ethics committee behind AI, as we know, with either hallucinations or bias in some of the large language models that are still learning, you actually can make a problem even more worse. And so I go back to always governance and structure when it comes to AI as a strategy and then patient safety and efficiency.

Ben Hilmes [00:13:24]:

I love that. And you actually answered my follow up question, which is, what’s the rubric, right. And how do you determine what gets to the top of the list? So you guys have done a nice job of overly used, but people process then the tech.

Dr. Robert Adamson [00:13:40]:

Right.

Ben Hilmes [00:13:40]:

So the governance, the ethics committees underlay below that is a really tight rubric that you use to dictate kind of where you’re going to go. And then ultimately you leverage the tools. Our listeners are going to really appreciate kind of that perspective because I think everybody’s struggling with, where do I even start?

Dr. Robert Adamson [00:14:00]:

Right?

Ben Hilmes [00:14:00]:

Yeah. So you guys are big and you’re getting bigger, kind of start to pivot into a leadership, you know, dialogue. But for you, I mean, you, your career’s grown rapidly. You started out trained as a pharmacist, and I want to come back to the journey from pharmacist to CIO because I’m sure there’s an interesting tell there. But help me understand, as you guys grow, leading at scale is different than just leading a small team. And we talked to a lot of folks that lead big groups, some that lead small groups. How have you been challenged to now lead at just a massive scale and one that’s going to continue to grow? How do you put that into some kind of mental framework?

Dr. Robert Adamson [00:14:47]:

To me, it starts with principles. And so if you can’t give the people you’re a member of the team of. Yes, I’m leading them, but nonetheless, I’m still really a member of the team. And my goal is to give them true north. And so one of the things that I started to do when they approached me to move from clinical operations to potentially into the technical space was I sat and listened for six months and I would sit and listen to every one of their meetings and try to sum it up in a word or two. And eventually I got about 27, 28 words. And I said, okay, now I’m going to sit down and collapse them into maybe five or six principles, and then, if it’s even better, maybe it’ll stand for something. And I have a colleague that I work with here.

Dr. Robert Adamson [00:15:32]:

Her name is Allison. And she said, I’d love to know how to do this. I said, come on, I’ll show you. And we got down to six words, and I said, I wish you could stand for something. And she looks at me and she says, what’s your favorite forward statement? Aspirational. She goes, what do we make it aspire? I said, huh? And these are the six words. Aspire is advocacy. And I tell them, advocacy is an offensive sport.

Dr. Robert Adamson [00:15:58]:

S is for security, P is for people centricity. I is for innovation, R is for resources, and then E is for excellence. And so when we do a meeting, everybody’s agenda is aspire. When we do our goals, they’re organized under aspire. Everyone knows that we go through those six principles, and it basically binds everybody together. It’s specific enough to keep us bound together, but vague enough that gives them the latitude to interpret in their respective division. A person on the network team couldn’t be more opposite than someone who’s building a workflow for a cardiovascular interventional cardiologist. The point is, they both work in it, but differently.

Dr. Robert Adamson [00:16:42]:

And so once you let them know that we are bound by these six principles, we have a logo. Everybody wears it on their hat. All of our things are branded, and everybody feels that way. So you’ll hear them talk about, I have an advocacy topic, Rob, I think this is a great idea for people centricity. And now they went from technical to people, and now we talk about the it family. So it’s been quite a journey.

Ben Hilmes [00:17:07]:

That’s really. That’s really cool how you can get people organized around just a common word, and then how that word can be used to, you know, inspire and do a number of things. 

Ben Hilmes [00:17:19]:

So pharmacist to CIO. Yeah, couple things on that. One, what the heck were you thinking? Two, what have you used in that clinical training that you continue to use today and differentiate yourself as a, you know, as a leader in healthcare and a leader in technology.

Dr. Robert Adamson [00:18:06]:

Yeah. Thank you. So, in 2019, they needed an operational executive to lead the entire epic project. And essentially, I got approached. I was, at the time, I was serving as the chief pharmacy officer for the health system. And so I had made my way up to Chief Pharmacy Officer, and believe me, it was my absolute dream job. I thought, my gosh, my life can’t get any better. I know everything I want to do now.

Dr. Robert Adamson [00:18:30]:

I want to be the Chief Pharmacy Officer. And they said, listen, we need a clinician to lead this technical deployment. We can’t have it lead it. We need an operator to lead it, working with it. And I thought long and hard about it, and I went back to my journey as an ICU pharmacist when I first got approached to run the clinical program in a hospital, leaving patients directly, but then directing other clinicians. And then I thought, well, you know, if I can make that jump, why wouldn’t I make the jump to help every patient, every discipline, and the entire health system using my clinical operations background? So I went through that journey and finally took over and said, okay, I think this is what I want to do. One of the things that came up and epic mentioned this is now the thing that they recommend as best practices when we do our go lives. I run them as a patient safety huddle, not an IT technical, all hands meeting.

Dr. Robert Adamson [00:19:23]:

So every single person in it will get on in their respective lane and say, good morning, Rob. This is ancillary cardiology, ancillary reporting in. Our patients are safe. We have no current patient safety issues. I have two high priority tickets, et cetera, et cetera, that can only come from someone who worries about patient safety because they came from the clinical milieu to do that, it goes that way. The other thing that’s been a great benefit is when the doctors get on a call, and then I get on the call, they go, oh, okay, you’re here. Okay, good. Can you explain to them what we’re trying to do? And I said, yes.

Dr. Robert Adamson [00:19:59]:

And so then I explain what they’re saying in clinical back to technical, and then I translate it back, and then I finally explain to them how you do that. And I’m watching my colleagues now sort of mirroring that, because when we were doing these things, I said, guys, our thing is always going to be about kindness, empathy, and poise, and that’s how we do our business. And I said, when we have a go live and we have an issue whether it’s, we think the network might be down, or we have an issue like Crowdstrike, or we have issues that are epic related. They know they are not supposed to do anything until they do three things. They got to validate, mitigate and communicate. And so what I always try to do is give people couplets that they can remember as true north. I don’t want to give them a policy and a procedure. No one’s going to remember it and no one will read it.

Dr. Robert Adamson [00:20:49]:

But everybody can remember, wait a minute, did we validate it? Yes. Now we’ll mitigate it. Hey, did we communicate it back to the customer? And so I’ll leave you with that thing in that regard, in that we don’t have end users. I don’t like that terminal. I’m from North Jersey, and when you’re from North Jersey, if you’re a user, it’s a bad thing. And if you’re an end user, that’s a really bad thing. So I said, we’re not going to do that. So they’re all called customers.

Dr. Robert Adamson [00:21:14]:

And it was very adorable to watch the struggle for them. I go, it’s okay, I’m not mad at you. Let’s just try to get through that. And now you hear them use that seamlessly. Now I don’t really hear end users unless it’s a vendor, actually, but internally they’ll do that.

Ben Hilmes [00:21:30]:

That’s fantastic. This has been full of just nugget after nugget after nugget that listeners are going to just love. I’m going to get feedback. They’re going to say, we want more. You should write a book. You should start really thinking about how do you compartmentalize some of these things. One, they’re unique, they come from a different lens. They have been deployed in a different challenging time.

Ben Hilmes [00:21:57]:

A lot of CI, younger CIO’s that haven’t done a lot of these things I think could really, really benefit from a guy like you and the work that you’ve done to inspire them. And they would aspire to be more like you. And I know you don’t do it for you. That’s what’s beautiful. It’s about the patients you serve, the members of your team, the organization as a whole. So just fantastic. Really appreciate you.

Dr. Robert Adamson [00:22:25]:

Well, thank you. I mean, it’s funny, when I get up in the morning, I start my day the exact same way and they all know this. I have 19 vice president’s executives and I pick one of them every day. And that’s what I’m going to think about on the way to work. And at that point, they get their text and they. Did you get yours this week? Yeah. What did he say? That kind of thing. When I think about who they are, what they’re doing, and so on and so forth, and so I worry about the people and the way I got the job, oddly enough, was they asked me what would be my number one focus, and they gave me like a bunch of choices that were all technical in nature.

Dr. Robert Adamson [00:23:01]:

And one person said, he goes, I don’t think you’re going to pick any of those. I said, nope. He goes, I know what you’re going to say. I said, yep, the people.

Ben Hilmes [00:23:10]:

That’s really cool. Well, it’s been a pleasure having you on the show. Look forward to meeting you in person at some point here in the near future. Appreciate the partnership, the work you do with our teams, and look forward to more. So this has been fantastic and I just thank you for your time.

Dr. Robert Adamson [00:23:25]:

Thanks, Ben. Have a great rest of the day.

Ben Hilmes [00:23:27]:

You too.

Dr. Robert Adamson [00:23:28]:

Okay, take care.

Ben Hilmes [00:23:29]:

See ya. There are so many great takeaways from my chat with Doctor Adamson, but here are a few of my favorites. One, Rob took a big risk moving ahead with a major epic deployment during COVID but it paid off. His leadership turned a potential setback into an astounding success. Two, AI can be a powerful tool, but Rob says hospitals must overlay governance and ethics to ensure that it’s used responsibly and safely. Three, I love Rob’s use of the term aspire as a north star for their epic project. Giving teams a simple way to remember guiding principles is a great tool for success. So what did you think? What were your big takeaways from this episode? I’d love to hear from you on our social media channels or drop me an email on our website at HealthcareITLeaders.com

Ben Hilmes [00:24:20]:

Thanks for joining us for Leader to Leader. To learn more about how to fuel your own personal leadership journey through the healthcare industry, visit HealthcareITLeaders.com. Don’t forget to subscribe so you don’t miss any insights and we’ll see you on the next episode.