Three years ago, the University of Missouri Health Care and Cerner teamed up to develop the Tiger Institute for Health Innovation, an initiative designed to improve the delivery of care across the state through data exchange and patient engagement. In this interview, Joanne Burns, who plays a key role with both organizations, talks about how the partnership has benefited both parties, University of Missouri’s path to Meaningful Use, and the challenges of juggling multiple priorities. She also discusses how she works to make sure IT’s goals are closely aligned with those of the organization, and why she has set the bar high for all vendor relationships.
- Creating an IT innovation group
- Cutting out the middle layers to build trust
- U of M’s atypical vendor relationship with Cerner
- Juggling multiple projects
- Avoiding being swallowed up by Meaningful Use
- Aligning IT’s goals with those of the organization
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They weren’t assigned necessarily to any one application group or technology group. They are the group that is able to be pretty agile in their ability to move to meet the needs that we’ve identified for the organization.
If we’re trying to solve a problem in the critical care area, we’ll partner with the physicians there and spend time actually rounding with them and working with them to understand their workflow so that we cut out as much of the middle layers as possible.
In a typical vendor relationship, you have a scope document and a whole bunch of other things around it that you’re basically tied to, whereas with this, we are committed to outcomes together and we have shared successes and shared challenges.
There are a lot of priorities, between Meaningful Use, ICD-10, the changing landscape of healthcare, and reimbursement. And I think we can get swallowed up with those and forget that those should be a means to an end — they shouldn’t be the end.
We make sure that with IT, we are closely aligned with the organizational strategic goals and objectives, and that we’re in lockstep with them so that we’re all working on the same page.
Gamble: That really is on the cutting edge. And I know that it’s a goal of many organizations looking forward. But this is the future of healthcare, and I think it’s a great to be getting in on the ground floor of that.
Burns: Yeah, we’re very, very excited about it. And just more and more everyday we have discussions about it. We are actively recruiting for the position right now. And we really believe it’s going to be a significant role within our organization and it’s going to tend to grow. So we’re sort of, as I said, retooling our IT organization a little bit to more of a focus of getting data out versus getting information in. Looking at how do we get data out and then actually format it, and then on the patient side. And I think we’re going to continue to see those.
The other piece that we’ve done, and this was trying to just really facilitate adoption, is we set aside within our IT department an innovation group. Day in and day out their role is to think about innovation and how do I innovate differently from a provider standpoint or a nurse or pharmacist standpoint — really a group that thinks about that. So they weren’t assigned necessarily to any one application group or technology group, or whatever. They are the group that is able to be pretty agile in their ability to move to meet the needs that we identified for the organization, with the goal of identifying a problem we’re trying to solve and rapidly solving it. The other piece of that is as we identified an area that was having a problem that we were trying to solve, we would embed one of our analysts within the department so they got to really understand the department. So it wasn’t just sitting with a group in a conference room taking down a list of requirements. It was really embedding themselves within in to understand it and try to figure out creative ways or innovate ways to solve the problem.
Gamble: Okay. So within the innovation group, do you have different positions kind of represented as far as physicians and nurses, things like that?
Burns: You know, within that innovation group it tends to be more analysts, and by analysts, I mean basically a workflow analyst, if you will. Somebody who was looking at workflows or challenges that are there and really engineers to solve problems. We partner, so it’s not to replicate the clinicians or the nurses within that group — we actually partner with the people we’re trying to help solve problems. So it’s more of a joint collaboration and partnership to solve the problems than it is a handoff or a case where we’ve got a physician who thinks they know what’s going on there. Really, if we’re trying to solve a problem in the critical care area, we’ll partner with the physicians there and spend time actually rounding with them and working with them to understand their workflow so that we cut out as much of the middle layers as possible.
Gamble: I would imagine that that receives a pretty positive response from the clinicians just in terms of having them be able to show you their workflow and show you exactly what they go through.
Burns: Yeah. And a lot of time, they think they know what they want. But I think what we realize is that when we get there and we work with them and collaboratively identify solutions, that it works a lot more seamlessly. And then I think the other piece of that is we found that because of really embedding this group with them, what we can do is, they can now identify where there is a challenge, and literally the next week, we’ll come back with, ‘Well, here are some ideas for how to solve that.’ And literally, it’s kind of this iterative but very rapid process. So they get this sense of credibility or trust with IT that they may not have had before where we’re not just kind of deploying stuff and going back and then we’re on to the next project. We’re actually in there on a regular basis with them.
Gamble: I’m sure that having that kind of buy-in really is critical when you are putting in a new system.
Burns: Yeah, it is. Absolutely.
Gamble: Okay. Now, as far as having that experience with Cerner on the vendor side, how do you think that has impacted your role as CIO? And do you think that it has helped in terms of things like managing vendor relationships?
Burns: I think the key thing with Cerner and the partnership that we’ve got with the Tiger Institute is that we really don’t consider it a vendor relationship anymore. It really is a partnership where we all come together to solve the problem. It’s very different and it’s hard to articulate. Like for my role, because of this partnership, I’ve got a dual reporting relationship to Cerner and to MU so that I’m really in the middle of pieces and things to get things done. So it’s a very different relationship then probably either organization has ever had before. So it’s changed.
Now what I will also say is that we’ve got some other strategic vendors that we work with that we’ve got solid relationships with as well. They are more typical vendor relationships. But the Cerner relationship is very different from a perspective of how do we partner to achieve outcomes with both of us getting in together to do it versus a traditional partnership. We are both committed to the outcomes. In a typical vendor relationship, you have a scope document and a whole bunch of other things around it that you’re basically tied to, whereas with this, we are committed to outcomes together and we have shared successes and shared challenges.
Gamble: That’s a tremendous benefit for both sides, I would think.
Burns: It is. From a Cerner perspective, I think we’re learning a lot. We’re learning, really a lot about being this close to a client and being in their shoes. And from MU, we’re learning a lot as well about how do we really articulate what we need to accomplish and lay a path to get there and prioritize.
Gamble: Yeah, that is really interesting. It is a very different thing — obviously a whole different story than if you would have had the experience with Cerner and been working with a different vendor at this point. It’s a different game.
Gamble: Okay. So one of the things you just touched on was prioritizing. And one thing that really amazes me is how much CIOs have on their plates right now. I wanted to just talk about the challenges involved in juggling so many projects and priorities and how you’re dealing with that, especially, like we said before, when you’re just coming back from a break, which probably adds another layer.
Burns: There are a lot of priorities, between Meaningful Use, ICD-10, the changing landscape of healthcare, and reimbursement. And I think we can get swallowed up with those and forget that those should be a means to an end — they shouldn’t be the end. And so the strategy that we’ve taken with all of them is that we’re using them as catalysts to do different things.
So we are trying pretty heavily not to say, for example, that ICD-10 is all that’s on our plan for the next year. We actually started last year and we have different vendors. We have GE/IDX on the revenue side and Cerner on the clinical side. So we partnered with both Cerner and GE/IDX to be really their beta or alpha testing partners for their ICD-10 releases. And the goal with that was, let’s get on with those things so we actually have the platforms that we’re going to be using for ICD-10 versus waiting till the last minute and trying to put that in and take the upgrade when everybody is in crunch time, and then do all the training and all the associated things that we’ve got to do. So we’re really trying to take it more of a view of, let’s actually partner with the suppliers of our solutions versus necessarily just kind of waiting and doing it tactically.
The other piece on some of this is we go through a strategic planning process. We have a five-year strategic plan and then we go through an annual planning process for what are we going to accomplish this year toward our five-year strategic plan. And this is organizationally across the board to say, what do we have to do. So we make sure that with IT, we are closely aligned with the organizational strategic goals and objectives, and that we’re in lockstep with them so that we’re all working on the same page. I don’t want to be doing something that the organization doesn’t necessarily think is strategic. And we’re trying to really leverage IT as a strategic partner and enabler versus as the plumbing.
So we’re trying to take that mindset and that approach. And that’s actually been pretty successful for us. And if we start getting too many things thrown out us, I raise that up and say, ‘Wait a minute, guys, here’s a couple of different opportunities that we’ve got to work on things. What do we think is the most pressing right now?’ And we may have to shift some things based upon that. But it really is done collaboratively across the executives here at the University of Missouri.