Q&A with Karen Marhefka, Part 1: “The Tools Are Great, But It’s an Enormous Amount of Change.”

Things have changed quite a bit since 2012 in healthcare IT.

When it comes to EHR implementations, how much has really changed since 2012? There’s one way to find out: by taking on a similar initiative in today’s world and comparing notes. Last spring, Karen Marhefka had the chance to do just that when she accepted a CIO with a medical group that was rolling out Epic. For Marhefka, who had been through an extremely similar situation with UMass Memorial nine years ago, it felt like déjà vu at its finest.

There were, however, a few major differences. This time around, Marhefka was in perfect spot from a career standpoint; she had just completed her Doctorate of Healthcare Administration and was looking for an opportunity to channel her passion for helping organizations with implementation and optimization efforts.

And of course, there was another key factor. “Health systems know so much more. The vendors know so much more,” she said. “It was like we all graduated with PhDs in how this works.”

A year after her arrival, the rollout is rolling along smoothly, thanks to the “intense amount of planning” put forth by leadership, and the decision to utilize a phased approach, according to Marhefka. During a recent interview, she talked about how RWJBarnabas is working to merge cultures; how Epic is nudging her team toward standardization; and why it’s critical to focus more on operational change than technology change. She also opens up about what she learned during her time with Liz Johnson, and why powerful people need someone watching their blindside.

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Key Takeaways:



* Planning an Epic build during a lockdown requires “an intense amount” of coordination and communication, particularly since even vendors were figuring out how to navigate a new situation.

* The one advantage Marhefka had joining an organization during the Covid-19 pandemic is that the team had already established “a nice cadence” working remotely, which took one task off her plate.

* The difference between migrating to Epic in 2012 and 2021 was tremendous, Marhefka noted. “Health systems know so much more. Vendors know so much more. It was like we all graduated with PhDs in how this works.”

* Although many organizations favor the “rip off the Band-Aid” approach to implementing an EHR, Marheka believes it has “little pros and a lot of cons,” and prefers a phased go-live.

* The Epic rollout is forcing RWJBarnabas to look at standardization much sooner than it would have. And although some are champions for that, others prefer a more methodical approach. The health IT leaders’ job is to “marry that together.”





Q&A with Karen Marhefka

Gamble:  Let’s start with an overview of the organization. Can you provide some information about RWJBarnabas?

Marhefka:  Sure. Robert Wood Johnson, which is a very large health organization, merged with Saint Barnabas Medical Center, also a large organization, a while back. They merged as two large health entities, predominantly merging their acute care offerings, along with two prominent medical groups. One was primarily associated with Robert Wood Johnson, and the other was primarily associated with Saint Barnabas. Those medical groups combined into one very large group and added another entity, Rutgers New Jersey Medical School, to form RWJBarnabas Rutgers Medical Group.

Those are the entities that make up this combined medical group, and it’s growing every single day, whether they’re buying large or medium practices, or independent providers are joining existing ...