Q&A: Ed Marx on 'the largest implementation of Epic in public health'

'We will probably have eight go-live events over the two years'
By Michelle Ronan Noteboom
08:03 AM
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Healthcare IT News recently caught up with Ed Marx, former chief information officer of Texas Health Resources, who resigned from the organization April after a seven-year tenure.

Marx has served as the governor-appointed chairman of the Texas Health Services Authority since 2010 and in was named the 2013 John E. Gall Jr. CIO of the Year by CHIME and HIMSS. He is now affiliated with The Advisory Board Company and its subsidiary, Clinovations.

Q: Tell me about your current role with The Advisory Board and The NYC Health and Hospitals Corporation.

A: I was hired through The Advisory Board. They have had a longstanding relationship with HHC. The Advisory Board acquired Clinovations about a year ago and HHC hired Clinovations to help implement Epic and provide IT leadership. So I am contracted with The Advisory Board through Clinovations, on loan to HHC to help the hospital corporation. Our number one area of focus is implementing the Epic electronic medical record.

Q: And how is that going?

A: It's going well. It is the largest implementation of Epic in public health. It is the largest public health system in the country. They take care of everyone, regardless of the ability to pay. We have a desire to be world class. Part of that is implementing the electronic health record and doing it well and becoming a world class institution. There are more world class institutions in New York City. It is hard to compete against them, but we think we can. Despite the fact our payer mix is quite different than theirs, we still believe we can compete with them on a quality and safety basis. We are trying to be a world class institution even though we are public health.

Q: How big is HHC?

A: It is 11 hospitals and a $7.5 billion health system, so it is huge and it's very complex with lots of outpatient facilities as well. They are also implementing Epic in the ambulatory setting.

Q: What is the status of the implementation there?

A: We go live April 1, 2016. That is our first go-live and it will take about two years to do them all. Out of 11 hospitals they have eight networks that include physician offices and other ambulatory-type sites. We will probably have eight go-live events over the two years. Right now we are finishing the build, getting training ready, a lot of testing; we are pretty much ready to go.

Q: While you were at Texas Health, the organization faced some very public crises. What did you learn about leadership from those experiences?

A: When you are in crisis and when you are leader, I think that that is when you really earn your pay. Anyone can lead when everything is fluffy. But leadership is really tested when things are in crisis. One thing that was reinforced for me was that you don't panic. You take a breath and (maybe) that means you need to take a breath and put out a statement that says, "Things are pretty hectic right now, I need some space, I am working it, and give me space to get this thing right." And that is what we did.

At one point a few years ago we took Epic offline and I was very transparent and told everyone we have taken Epic offline and we understood the negative implications of the decision. But I said, "Here is why we made this decision. I can't tell you why it happened that we had to take it offline. I can take some guesses but I don't know. But if you give me some space I will get back to you with full disclosure."

A lot of time in crisis we have knee-jerk reactions and we think we'd better come up with a reason quick. And that reason is usually wrong. I learned in my combat medicine training that it is never the entry wound, it is always an exit wound. That is nothing more than a flesh wound. But until you roll the soldier over on their back, then you see where the real damage is. That is how it is in crisis. If you take a knee-jerk reaction and respond too quickly, you may lose credibility.

Q: As you look back at your seven years at THR, what do you feel were your biggest accomplishments?

A: I think bringing together teams that were able to do amazing things. That is probably the biggest thing. Without the team, everything else couldn't have happened. The other things, like winning the Davies award – it wasn't about the award itself. What it means to get the award means we have implemented the technology in such a way that we materially transformed the quality of care that we gave to the community that we serve. But without the team it wouldn't have happened. That is the biggest thing. Texas Health just won another award as a Forbes 100 best company to work for and as the top healthcare employer in the country. We did some amazing things together as a team.

Also, developing leaders. It is never about one person, so it doesn't matter how good or how average I might be. If I don't develop that team and individual leaders then that team will be so limited in what it can do. But we did so many amazing things because of so many other leaders that stood up.

Another thing, we were leaders in the country with global health, with business intelligence, with social medical, and population health. We were leaders in four key areas and it all goes back to having the right team in place.  

Q: Most recently you have worked with private healthcare systems. What are some of the unique challenges of implementing a new healthcare IT system for a public health system compared to what you experienced at THR and University Hospitals?

A: The mission is different because we treat everyone regardless of the ability to pay. The other unique thing since it is New York, we serve over 100 or so different languages. It is very diverse. Think about that from an operational viewpoint, whether it is an electronic medical record or otherwise; it is a lot to contend with with all those different languages.

There is a whole other layer with public health, another level of oversight because it is public. I am not saying it is bad. In fact, it is actually a good thing because it ensures we are being good stewards with what has been entrusted to us. You could argue that there is not as much money in public health as there is in the private sector. The budget I worked with at Texas Health was a lot bigger than the budget I have to work with at New York City, just because one is public and one is private. The access to investment dollars is a little harder. From an IT perspective, they have not had the same level of investment that you might find in the private sector.

Q: What are you most looking forward to with this HHC project?

A: With New York, on a professional basis, it's the ability to impact and help transform the best city in the world. I saw Bono from U2 in New York recently and he said each of his band had lived in New York at one time or another and it is the greatest city on earth. A lot of people feel that way. So it is the opportunity to impact the greatest city on the earth. From a professional point of view, I have done for-profit, I have done non-for-profit, I have done academic, I have done private sector, but I have never done public health.

But here is also a personal angle: my dad is 82 years-old and was a Holocaust survivor and the only country that would take him after the war was the United Sates. My dad came here and went past the Statue of Liberty on Ellis Island and got adopted by the city of New York and the surrounding area. They took him from a young teenager and developed him to a man. After he became an American citizen he said he always wanted to go back to New York to give back. He spent 25 years working full service in the army, but was never stationed in New York. So when I got the call about going to New York, I called my dad and said I get to fulfill that dream you had of giving back to the city to New York.  

Q: How long do you expect to be at HHC and what happens next?

A: I hope to stay with HHC through the Epic implementation. After that, who knows?