As a mother of six, Laishy Williams-Carlson knows a thing or two about multitasking and prioritizing — and she better, because of the 18 hospitals that are part of the $3 billion Bon Secours Health System, 14 are implementing Epic. And as Williams-Carlson has learned, dividing her time between the hospitals that are already live and those in the earlier stages is not easy, especially since the facilities are spread out across the Eastern seaboard. In this interview, Williams-Carlson talks about dealing with different cultures at different hospitals, maintaining the delicate balance between security and access needs, the benefits of having a financial background, and the importance of having go-to people on the clinical side. She also discusses the challenges in dealing with physicians who use different systems, and why conference calls can never replace face-to-face interactions.
- Integrating the independents
- Subsidizing Epic & Allscripts
- What about the one-offs?
- “I can honestly say I love what I do”
- Looking to Stage 2 — anticipating direct electronic reporting
- Braving healthcare IT’s perfect storm
- “We’re not slowing down for a long time”
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While you’d think there would be a lot of similarities between deploying an instance of ConnectCare to an employed practice versus an independent, what strikes me are the number of dissimilarities. You’re not under the same corporate umbrella.
We want them to be able to work without barriers in our hospitals when they’re admitting patients there. So we’re talking with them about a couple of different data exchange scenarios and trying to find one that works best for them and for us.
I can honestly say that I love what I do. It’s so stimulating. It’s so much fun. I like that I’m working on a project that is at the soul of what our organization does as a healthcare provider. And it is something I look forward to doing each day.
I feel like we got to the tier-one level—and not without a lot of hard work, but it’s just really neat when you feel like IT is making such an impact on your organization’s ability to provide great care for patients.
What scares me is just everything coming together at the same time—ICD-10 and what we need to do to position ourselves for ACOs and some of those decisions that we’ve already made, and throw in a little Stage 2 of Meaningful Use and a couple of hospitals that still need to go live and you realize that you’re not slowing down for a long time.
Guerra: Let’s touch on one more technical issue. The independent physicians that are referring patients into your facilities—I would imagine there are on every EMR under the sun and a lot of them are on paper. How are you planning to hook them up with the Epic inpatient system?
Carlson: We actually are offering our Epic Solution for our independent practices. We have one site that’s live in Richmond and one huge urology site that will go live at the end of this calendar year in Hampton Roads. And while you’d think there would be a lot of similarities between deploying an instance of ConnectCare to an employed practice versus an independent, what strikes me are the number of dissimilarities. You’re not under the same corporate umbrella, so things like how you do release of information or just technical standards that make sense for us within our corporation but not might make sense for a smaller practice, all have to be revisited. So we are offering our ConnectCare instance under all of the federal guidelines and so forth, of course somewhat subsidized to practices, and we hope that takes off, because we see that as the best way to integrate with us.
We also are subsidizing an Allscripts offering because that is a bit less expensive than our ConnectCare offering and quite a few practices have taken us up on that. And then we work with MedVirginia Health Information Exchange to make sure those Allscripts implementations are sharing data with us on their patients coming back and forth. We’re real concerned about reaching out into our markets and helping those practices get their Meaningful Use money and get onboard with the electronic medical record implementation, but more importantly, sharing data about our respective patients so we’re providing good care.
Guerra: What if I’m a physician that sends patients your way and have for a long time, and I’ve got something else. I’ve got Greenway, eClinicalWorks, NextGen, etc, and I’m perfectly happy on it. I have no intention to switching, and I say ‘Laishy, I would like to integrate or be able to see into the system or be able to have information go back and forth just like I was on the Epic Ambulatory Product.’ How do you deal with that?
Carlson: Each instance is kind of unique, and let me give you an example of that. My answer is that it depends on the practice. Where we’re going to implement in Hampton Roads, there’s a very big independent practice of over a hundred docs that does have a NextGen instance that they’re running, and of course we want them to be able to work without barriers in our hospitals when they’re admitting patients there. So we’re talking with them about a couple of different data exchange scenarios and trying to find one that works best for them and for us.
The Commonwealth of Virginia just selected it’s HIE vendor, and so that’s one avenue. What we’re going to do is they’re going to get lab results directly into their NextGen record for their patients. They’ll certainly have access into Epic and we’ll be sending other really important things like discharge summaries directly into their record. Beyond that, they’ll get a CCD extract, and we haven’t quite figured out if we’ll do that through Care Epic or through the HIE. I guess the good news is there’s a lot of ways you can go, and the bad news is there’s a lot of ways you can go
Guerra: And you’re talking about hundreds or thousands of independent physicians. That’s a lot of conversations and a lot of scenarios.
Carlson: Yeah and so for a hundred-doctor practice, bringing the data directly into their record might make sense. For practices of 200 docs or more, we obviously can’t do it for all of those, and in those cases we’re very much relying on the relationships we have with Med Virginia and the HIE as a way to share data. There is a really cool thing we’ve done in the Hampton Roads market, which if you’re familiar with it, you might know it has a really intensive military presence with Army bases, Air Force bases, Special Ops, Navy and things like that. I’m not sure if you’ve heard of the VLER Project, but it’s Veteran’s Lifetime Electronic Record. So these guys and gals come back from the war theater and they’re seeing either DOD or VA docs, and then when they get kicked out into private healthcare, we just needed a better way of sharing data. We’re really proud of the pilot work we’ve done with MedVirginia as a service to those folks who’ve already given so much. The least we can do is help them keep their healthcare information all in one place.
Guerra: Right. You know, I speak to a lot of CIOs, and some seem overwhelmed and tired and some seem like this kind of stuff energizes them, and you certainly seem like the latter. You sound happy and wound up and ready to go—is that accurate?
Carlson: Yeah, it’s good that we’re doing this interview at nine in the morning and not at seven at night. I might sound a little less like the energizer bunny then. But I can honestly say that I love what I do. It’s so stimulating. It’s so much fun. I like that I’m working on a project that is at the soul of what our organization does as a healthcare provider. And it is something I look forward to doing each day. There are meetings and bumps along the way where you’re like, ‘Oh my God. Why did I end up here?’ But for the most part, I feel really fortunate.
Guerra: That’s great. Well that’s about all I have for you, Laishy. Is there any other thing you want to touch on and do you want to add before we go?
Carlson: Well I have to brag about us a little bit. We attested for Stage 1 for Meaningful Use in August for about 100 providers and all of the hospitals that were live with the sufficient 90-day period at the time, and we actually got all our checks in the door. It’s real. I think you attest and you’re like, ‘Okay, I’m really hoping that money’s coming back.’ So it was worth about $13 million to us that first round and that was awesome.
Epic was great to work with. Was it easy? No, the reports were just a nightmare. Much harder than I ever thought they would be, but we knew we were at sort of the early stages of making all of these complex reports work. But they were right at our side with us, so that was very gratifying. We’ve recently achieved Stage 6 for those hospitals that are live and got named Most Wired, and I’m proud of it because I think before we started implementing Epic we were a solid tier-two organization in terms with what we were doing with IT. And I feel like we got to the tier-one level—and not without a lot of hard work, but it’s just really neat when you feel like IT is making such an impact on your organization’s ability to provide great care for patients.
Guerra: Just one more question that came into mind. Is there anything in Stage 2 that scares you?
Carlson: I think a lot of the things that were just a test of this that you can demonstrate or a test to that and now we’re doing it for real, it’s all the direction we needed to go in anyway but just the mechanics of doing that kind of concerned me. The quality reporting kicked our butt.
Nothing really scares me. It’s all things that I think we can manage and do well. What scares me is just everything coming together at the same time—ICD-10 and what we need to do to position ourselves for ACOs and some of those decisions that we’ve already made, and throw in a little Stage 2 of Meaningful Use and a couple of hospitals that still need to go live and you realize that you’re not slowing down for a long time.
Guerra: And throw in six kids and a husband, right?
Carlson: Right, yeah.
Guerra: Well Laishy, this was an absolute pleasure and I want to thank you so much for your time today.
Carlson: I enjoyed it too. It’s great talking to you.
Guerra: Alright, I’ll be in touch. I hope we can work together again.
Carlson: Okay, that sounds great.
Guerra: Have a great day, Laishy.