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Jennifer Stemmler: (Intro) I love pulling feelings out of a decision because then it pulls me out of the decision and it makes this about what is the right thing to do based on the data set you're looking at.

I'm Sarah Richardson, a former CIO and president of this week Health's 2 2 9 community development where we are dedicated to transforming healthcare at one connection at a time.

Our keynote show is designed to share conference level value with you every week. Now let's jump into the episode

In this conversation, Jennifer will share the strategic decision making, change management approaches and key lessons learned in executing a project of this scale, ensuring not just the successful implementation, but a sustainable and growth oriented future for Adventist Health. Thank - for joining us today, Jennifer.

Sarah Richardson: I'm so excited. I'm so excited too because you have one of likely two of the largest implementations occurring across the country for Epic, and I wanna jump into some of the decision making process and strategy that it's taken to get there.

And let's start with key drivers behind Adventist Health's decision to transition from Oracle to Epic.

Jennifer Stemmler: Well, first thank you Sarah, for allowing me to have this conversation. I remember when we first started talking I said to you. I'm not doing anything special. Lots of people have implemented Epic., Nowhere am I the expert.

Yeah, we are doing that. So I'm excited to have the conversation. I think if we just jump into what led to the decision rewind back. It felt like a little bit of a saga. Going through several iterations with our senior leadership team back then, our executive cabinet team, when we first approached, looking at what are we gonna do with Cerner we are sitting on an over 22-year-old

instance of Cerner that has just been added to expanded, moved shift for a long time. And so we knew we needed to do something. So we used a pretty structured framework to develop a business case and proforma eventually. But in the beginning one of the options was keep Cerner, do nothing.

Focused on the future. So something that we knew we could sustain a pretty sizable growth in our revenue cycle. We had some pretty significant challenges and still do, we're still on Cerner with revenue cycle today and felt like one of the core constructs in the time and a place when we were operating back then our margins are smaller.

And it was prohibiting some of our growth strategies that weren't a typical m and a activity. So I think using that building a selection criteria based on that. Walking our executive team through and then ultimately our corporate board through three cycles over a period of 18 months. We ultimately did end up getting a unanimous approval from our board to move forward with Epic last year actually, we signed our agreement with Epic following that corporate board meeting in April and have been full steam ahead since then.

Sarah Richardson: What role did Epic play early in some of the decision making processes? How did that shape your strategy and even getting some of that board approval?

This is how we think Epic can help you, and these are some things you need to sort out and figure out. And one of the ways that they really showed up strong for us was at one point during this. I'll call it my soap opera saga with should we do this? Should we do this? Yes. No. We were considering a community connect installation with another provider, and Epic came in and really helped us articulate the facts.

Is that a great decision? Who has gone before you? What else would you do? So they brought in some key experts to help us really articulate. To our executive cabinet where we should think about the pros and the cons without ever telling us, you should do this or you should do that. So I'm sure all of you that work with Epic Share probably a very similar story.

Sarah Richardson: Yes, and to your point, it was an iterative approach. I mean, 18 months. What I appreciated about you sharing that with me when we first started chatting is how thoughtful the entire organization was about the decision making process.

So what were some of the guiding principles that you set in place during that pre-planning phase to ensure not only usability upon launch, but also buy-in upon launch?

Jennifer Stemmler: So we did two things. We sat through probably three, maybe four months of every week me sitting with executive cabinet to draft what are the core objectives we're trying to solve and like, let's name it, let's articulate it.

Sometimes I say the technology part is the easy part. It's everything else that goes with it and the operational readiness that's required. So we ended up sitting down and creating five core objectives that we ended up taking on a roadshow with our internal organization. 'cause a lot of people thought, oh my gosh, we're gonna implement Epic.

That's a huge investment and why now? And so we had to come up with a really core set of things that we would point back and say, this is what we're trying to achieve for the organization, and we will come out on the other side and achieve it here. And so those five objectives became the underlying detail behind the mantra one system, one experience made for more together.

we were not that. So Cerner was built for every single hospital, every single different way until Sunday. And so we were really focused on creating a really standard approach. So once we had those core set of objectives that we were, after we launched the program, and then we got into building what I shared with you, Sarah, the benefit realization scorecard which has been amazing.

We've used that to really. I was worried about, Hey, how can I build something like this and not be in every meeting and say, oh, don't make that decision. Wait, make this decision. And so that benefit realization scorecard ended up defining a framework that we had owners with objectives and decision guardrails, escalation points when things went outside of that.

Setting them off and letting them go through decisions with guardrails and framework, but then mapping it to that scorecard so we knew, all right, we're starting to think about this massive change. If we want to go after that means, yes, we want to do that in Epic, but that requires a policy change or a procedure change or something else in order to get that full benefit.

The level of detail going into just the conversation is such a win ahead of time when it comes to the OCM perspective of something of this magnitude. And I love what you shared previously that your slogan from all of this work created an on time, on budget, on Epic, on US perspective. That's powerful. And how has that mindset also helped shape the accountability across verticals separate from just the scorecard?

Jennifer Stemmler: It's a core requirement, so we called it, or maybe I didn't. It was our CEO Kerry Heinrich called those that mantra, our immutable assumptions, meaning we must meet that. Or else, you know, or there's something that needs to trigger.

So whether it be every opening slide of a governance deck or every town hall or roadshow that we do, that shows up. And the reason why that becomes important, you can really, if you think about it, tie every decision that goes off track to one of those things and things like on budget, as simple as that may sound.

We've got a very tightly controlled budget process right now, and anything that is a deviation on a specific line item immediately goes up through an escalation track based on budget as a component that it's violating, or if a particular work group makes a recommendation to do something that's not foundation, which of course, that's already started to happen.

every part of that structure and organization, which are led by operations folks or clinicians is able to understand that the decisions that they're making need to be in line with that. Because they're all bought into on time, on Epic, on budget, on us. The on us piece I think is the best part.

And I think, Sarah, we probably chatted about this one because you and I both know being in this industry, most of the transformation actually doesn't come from the technology. It comes from the operational change that the organization actually achieves. And so that's why we added the on us at the end.

We will never actually see the transformation on the other side, whether it be in the net revenue lift we're looking for, or the clinician experience change or the patient experience change because the technology alone can't do it. And so we added the on us at the end, and that's kind of been our cheerleader stance.

Every time we get in one of these rooms with operators is, Hey guys, we have no k knight on a white horse coming to save us. We are the team that is going to do this. So let's roll up our sleeves. It's on us to get this change on the other side.

Sarah Richardson: It reminds me of the Carl Sagan quote from Pale Blue Dog.

Jennifer Stemmler: That's a great question.

I love data. I'm kind of a data geek and I love pulling feelings out of a decision because then it pulls me out of the decision and it makes this about what is the right thing to do based on the data set you're looking at. There will always be feelings involved, but I think when you we're moving everyone's cheese with this program, and so I think it would be insensitive to think that's not a factor,

And clinical says this, based on a case management function, maybe making this up, we needed a council that was made up of a cross collaborative, high level executive team that was tied into that on time, on budget, on Epic, on us. To make those rational decisions and wrestle with it together when we had something that was tough.

So just this past time we met and one came up. The way that our team uses that group and the processes in place, we've got a very standard two slide format , it's an SBAR format, which we all know but then it also includes a cost model attribution as a second one. And that's where data comes into both.

We wrestled with cardiology and structured reporting. And we love our cardiology friends, but our chief clinical officer, highest clinical position in the company is a cardiologist. He is a very big supporter and has been for on time, on budget, on Epic, on us, and said We will implement Cupid for structured reporting, both invasive and non-invasive, because we made that decision.

Well, of course, when the work group wrestled with it, they said no. We're gonna keep our CVIS custom thing that we've all built. And it was all based on feeling. And so what we did was we brought it to this group and said, here's the impact of that decision. Here are the number of sites, the number of decisions.

Core cardiology's core service line. Tied it back there in our benefits scorecard. It ended up, the advisory council said no, and then how do we get the right people engaged? How do we put the plan together? So there's a whole set of other things that happened after that. I would not call the decision final 'cause we all know how those work.

But you'll have to check back in with me and see how Cupid and cardiology went using data. With a very emotionally charged decision from a group that felt like we get to make the decision.

Sarah Richardson: I'm not laughing because of the, just, I've been there with anesthesiology and some other teams where, you know, 10 rounds of decision making.

You make a decision, you do it, and there's always like this strife that comes around. But you've got these 77 work groups and this council flowing in. How are you managing the internal tension around the transformation? And I'm just curious about some of the biggest lessons learned in aligning teams, because to your point, the decision can be made with data.

Jennifer Stemmler: It's interesting and I wouldn't say we've completely cracked the nut. I think what I will say is I've encouraged my team to be, and it's how I lead generally anyway, be open, transparent, authentic, and show up with curiosity.

And so if you come into a conversation where you feel like there is no way on God's green Earth, we are gonna do that. You have to step back as teams connect with each other as you have my IT team, the cardiologist in the group, Epic, our other third parties that are included, really come together with a construct of we need to be curious.

So what I keep telling my program leadership team is don't be afraid to realize where we've got a failure point in that process and suggest a change. We've got plenty of room and a long road ahead where we should be able to say, okay, this really isn't working. We're not seeing the benefit on the other side.

Or We can't see it. We're looking ahead two years and we think this isn't gonna play out well? Raise your hand and say something and let's make that change. And we've had to do that especially in different example with value-based care. We are aspiring to be this great value-based care shop in California and in Oregon and other markets.

That tension is very healthy tension. And I would say we really do have to leverage a lot of the relationships that we've had in the past with pre Epic to really say, Hey, let's just sit down and put Epic to the side for a minute. Let's figure out what does Adventist Health want? What does Adventist Health need?

Not today 'cause we're living in today, but in 2, 3, 5 years down the road and getting really the accountability and the rigor around doing that rather than just talking around each other and going and end around and talking to someone else to get them on your side. I mean, that's the way that things were done in the past, and we knew that we couldn't operate that way.

Jennifer Stemmler: that's a great question. You really are hitting the nail on the head with where my role as the CIO really gets to be very critical in trying to guide this from the 30,000 foot level, knowing that if I rewind time back to when we created the business case and the proformas and everything that I walked the board through.

So what we've done is we've built what we're calling an enterprise applications team, and instead of it being called third parties, 'cause it sounds like the, you know, misfit island. And so we created an enterprise application team to select standard apps that go alongside of Epic, where Epic is not the native solution.

So we're doing it in both ways. So all in on Epic. That's the on Epic fundamental, you know, immutable assumption. We've licensed the everything possible from Epic and so we're gonna implement those things and if you are suggesting a solution work group that would overlap with that, then it automatically goes and escalates up through that governance process because then it's impacting my benefit realization on App Rat on the backend.

The, the cardiology one was a small one, the CVIS one. But we've had other large conversations to wrestle with and I ,and look, we're not done. But on the other side, like we did that homework in advance because we knew that the conversations would happen and we knew that we had to get there. Now, on the flip side of that, as we look at innovation, I love that question, Sarah.

'cause I've wrestled with this. I am an innovator at heart. I was just in a conversation earlier this week on, okay, well if you're only implementing Epic, then aren't you missing out on the innovation that's outside of Epic? That was kind of the core conversation topic, and I said yes, and I also would just offer a different opinion that.

A lot of the health system friends that I talk to are trying to implement those kind of one at a time, right? 'cause they already have a platform. And probably third parties 'cause they're smart. And so because we're just gonna leap ahead and start with that core set of epic functionality, we're going to jump into things like AI with a partner that clinicians tend to trust more than maybe a third party that's not a trusted EMR product.

So I think it's an and not, or we're gonna go all in on Epic, but we're also going to look at third parties that really are complimentary to that innovation space.

Sarah Richardson: Well, and using the criteria that you've established to decide if there is a third party solution or an additional solution that is better than or provides the insight we need, that Epic does not, you may not wanna wait two, three years until Epic does have it, or if they have it and you like something better.

This process you have created has actually matured the organization. It is decision making. If you've been alternative for 22 years, then I'd have to believe that the rigor around decision making was probably not where it is. With the decisions that you're making with Epic Zero, you're like, it wasn't there.

Jennifer Stemmler: You're touching on the things that maybe I wake up at night thinking about, which is my brain is already focused on, we're there, we're on the other side.

Now what? Because I want to try and hardwire some of this now so that we don't get there and then ask, oh, now what do we do? And so I love your point. I do think that you are right in your assumption. We had pretty much zero when it came to really structured governance around the EHR and I mean, so much so that we had to stand up specialty work groups.

So I think what we've tried to enforce is they own it. Not me because , at the end of the day, they want the outcome. Of course I do too. But giving them, what I've realized is really creating that shared need so that they can actually be the ones to lead that charge. In the end, that's what we're trying to build.

Because they need to own the change, which means they need to be invested in keeping that really tight governance process and every time we. Have a decision or some path that's going to go both ways in the road. We talk openly about our current Cerner situation and say, well, do we want to live in a place where, you know, five of our markets do it this way and one doesn't this way and one here.

So AI is changing the way that we all interact as humans when we bring this back to our work groups and say, don't you wanna be able to really quickly take advantage of those features and functions? You can't have a system that needs to be so highly configured and tested that it takes us so long to take changes and adopt that we just can't get there.

I said, guys, that's where we're at right now. So we don't wanna do what we've done with Cerner. And so hoping that a lot of this rigor and accountability and that it's on us and we are the calvary that's gonna save Adventist health that will last as we get past go live.

I call it like the Jennifer meter, like what is, yeah, there's an internal conversation with you that you're like, all the data in the world. I still have these moments of like, okay, what needs to feel good in my gut on some of these decisions?

Jennifer Stemmler: it's a really good question. I like to think that I do have an innate ability to read the room and read where people's heads are.

And I do use that often, I actually lead a couple of these work groups just so in the consumer space because my digital background, because I wanna see how is this working? Is operations really going to be able to do this? And the way that I really can see where it's not working.

In the beginning. We were both looking at the ed, welcome and Ed functionality that really makes it very digital focused, and we have zero digital tools in that space today. And just to see the reaction of the work of like, oh, no. We can't do, no, we that we can't. And then Jason and I huddled offline. I said, you know what?

I think we presented it wrong. I think we need to go back to them and help paint the picture of what it could look like. What does good look like? And then walk back their role in getting there. They don't see their role in that space. They see the way that they work today and all of that complexity and just can't see their way onto the other side.

Scheduling is another one. So I think that's really one where I've doubled down with our leader for rev cycle. Our rev cycle executive, and her and I have put our heads together and really said, okay, this is going to be really big and tough and will require a lot of operational change. I don't.

That's gonna get there. Like we have the right people in the room to make sure that they actually build the plan and start to think about, oh, that means we have to change this policy and we have to go to this compliance group, or we need to talk to privacy. I can see them processing the change that's needed, which gives me greater confidence that we'll actually get there on the other side.

It's not just a yes, we approve that building block in Epic.

Sarah Richardson: Yeah, it's not happening to them it's happening with them and they're in it in that mix.

Jennifer Stemmler: That's right. I'm gonna,

Sarah Richardson: I'm gonna fast forward you to, let's just say it's 30 days post, go live, and what does success look like for you at that point? What do you want to be true?

In October of 26?

I think if I get to, when I get to, not yet, when I get to October success really looks like we have at least a handful of examples that'll still be very early on a handful of examples where I have clinicians or operators that feel like this was the right decision. We absolutely made the right decision.

This was really hard. This was really tough. Maybe it was one of the hardest things they've ever done in their career, and we probably will very likely still be in the thick of it. But for 1, 2, 3, a few of those at each of our sites to say, even though this is hard, I see the benefit today, or I see it on the other side.

Once we get out of the stabilization, they can see the hard work and the change that they really put all of their muscle and sweat into, and they can see it pulling through on the other side. That would be success because at 30 days out, we're still going to be in the thick of fixing or.

And say, I know this is hard, but we're doing really well and I can see us pulling through on the other side.

Sarah Richardson: I look forward to the wins that you share and what it took to achieve each of those wins because every single one of them started with a work stream and like how far you will have come.

So I have to ask you this last question because of the magnitude of what you have undertaken is if you could give one piece of advice to another health system considering a similar transition, what would it be?

You own those decisions because in the end, you're gonna have to stand behind them and keeping that mantra of there's no one coming to save us. It is on us. Because building that operational strength and I would call it using that muscle, you will need to use it a lot. And I think making sure you really can go to key leaders and identify, Hey, I really need you to show up in this meeting beforehand.

I really need you to talk about this because it can't be it saying this, it really should be coming from you. Don't abdicate that to a consultant or it because you think they're the expert. That may be true in that space but look, we need you to show up. So I tell my fellow peers that are going through it or maybe considering it to make sure you do that.

I mean, we began with those and we have used those every day on the project. So. Invest enough time upfront in those, they may seem like, Ooh, fun, touchy-feely things. But in the end, we've been able to tie things to it as themes. We've been able to get through some tough hurdles using those. So invest the right amount of time upfront to get your entire executive team, your core senior leadership team to really sit in that space with you and talk about how to create those and how to use those.

Sarah Richardson: I cannot wait to continue the conversation about your journey, whether it's six, eight months from now and you're like, Hey, by the way, here's what we've learned since then. We're still this far away, or it's that post go live perspective. What you're undertaking is a hallmark for anybody in our industry.

Jennifer Stemmler: Thank you. I appreciate it and I appreciate being able to talk to you, being able to talk to our peer group because I have relied on expertise from a lot of people, so if I can be that to anyone that's in the middle or going through it or about to, I'd love to pay it forward and return the favor.

Sarah Richardson: Well, thank you for turning into Keynote. As you heard from Jennifer on time, on budget, on Epic, on Us. We appreciate your time and thanks for tuning in. That's all for now.

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