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.
- Getting big bang implementations out of the way
- The push for device integration
- Going green across the organization
- Stage 6 recognition is another step in the journey—not an end
- Not being “on an island”
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We’re trying to provide or deploy new capabilities as needed or just in time. So we’re trying to do a lot of changes on a regular basis. And the organization is actually able to really keep up with that and tolerate that, versus kind of holding all the stuff up and then deploying it one time in a big bang.
We’re just going to keep moving. And obviously, I think the criteria is probably going to shift a little bit, but we’ve got our radar as to what it is right now and where we are at, and we’re moving toward it.
We talked about the relationship that MU and Cerner have and how we’re really trying to leverage a partnership versus just a typical vendor relationship. We described that to them and said, ‘this is what the expectation is going to be. And here’s really what our goals are. Are you sure you want to sign up for this?’
I tend to look at it as an external benchmark that validates the work we’ve done and our direction. It’s not the goal in and of itself, but it’s what it represents to us. We would be marching down this path anyway if there wasn’t a HIMSS Level 7.
Leveraging the power of both organizations gives me confidence that we’re going to get through it. And there are enough people and support broadly so that I don’t feel like I’m out on an island by myself trying to figure out how I’m going to do ICD-10, Meaningful Use, and all of these things. There’s a lot of people and a lot of brain power.
Gamble: When you talk about the five-year strategic plan, is that something where as the CIO you’re able to give a decent amount of input as to what IT’s needs are what the capabilities are at a certain time?
Joanne: We have an ongoing kind of assessment process of where we’re at and what we’re doing. And that’s more of an ongoing thing versus an annual thing. What we’re trying to do is really keep innovating. We’ve been looking at it that after we got, you know, some of the big things done that we needed to get done such as CPOE, electronic medication administration records, e-prescribing — all of those pieces, that now we’re really trying to do no more sort of huge big bang kind of approaches. We’re trying to provide or deploy new capabilities as needed or just in time. So we’re trying to do a lot of changes on a regular basis. And the organization is actually able to really keep up with that and tolerate that, versus kind of holding all the stuff up and then deploying it one time in a big bang. So we’re kind of doing an ongoing assessment of where are we at and how are we going.
And we usually set some goals of where we think will be. For example, HIMSS Stage 7. We’ve got several different strategic initiatives going on around paper-lite and assessing some different things that we’re doing across the board on that. And so we actually believe that as a byproduct of that, it will be at HIMSS Stage 7 by the end of the year.
Gamble: Okay, and that’s another thing I wanted to touch on. But first, in terms of Meaningful Use, how are you positioned? Have you attested to Stage 1?
Burns: Yes, on the inpatient side. And we’re in the process of doing it for the eligible providers. We did that probably in June of last year on the inpatient side, June or July.
Gamble: So then you got in for the extended deadline for Stage 2?
Gamble: That’s nice in that it gives you a little bit of a breather, even though it doesn’t seem to be your philosophy to want to put things off.
Burns: Well, you know it’s funny, as we were going through that and starting down that path, a number of us had a discussion, and it was definitely brought up as, ‘Hey, this could put us at risk on Stage 2.’ And I was like, ‘You know, we’ve got to keep moving. We just can’t sit back and figure out where the government is going to land on things. Stuff is in flux.’ So we’ve forged on. And then we got that little bit of a reprieve. So I was very pleased about that.
Gamble: It’s interesting though. In one way, I could see thinking, ‘we’ve got the momentum now, we almost want to just keep going toward it and finish it.’ But I’m sure it’s nice to have the time.
Burns: Yeah. And like I said, we’ll keep moving. It doesn’t mean that any of our plans have really shifted at all. We’re just going to keep moving. And obviously, I think the criteria is probably going to shift a little bit, but we’ve got our radar as to what it is right now and where we are at, and we’re moving toward it.
Gamble: For this year, what would you say are really the biggest goals that you’re looking at — the big projects? You mentioned ICD 10, so that’s something that’s high up on the radar, but any other really big projects?
Burns: Yeah. We’ve a big push on the device integration and I feel like that’s sort of the next frontier as well. We are really doing a fair amount around device integration with the EMR so it automatically uploads all the data. We’re doing a lot around device tracking and looking for some economies of scale around leveraging if we know where our devices are and can actually inventory them better, can we do some different things around our inventory of devices? We’ve obviously got eligible provider Meaningful Use. We’re entering into some patient-centered medical home projects and demonstration projects. We’re going pretty aggressively after a paper-lite strategy trying to decrease the amount of paper and get green within the organization. And there are several different initiatives under that umbrella theme. We’re doing a lot around mobile communication and computing as well and deploying a mobile communication network.
Gamble: You definitely have a lot on your plate. When you’re talking about paper-lite, is that something that’s going to be a multi-phased initiative as far as rolling that out?
Burns: Yeah. We’re currently looking at, and have been looking at, what’s the use of the paper, really broadly across the organization. And we have partnered on this with Xerox for Managed Print Services. And what was interesting in our discussions with Xerox as we were starting to enter into this agreement was that we really talked about how our strategy is to get to less printing. And it’s an interesting thing for a printing company to actually partner on trying to get to less paper. They’re all in for that. That’s really what their Managed Print Service is. And they believe that they can get us there, and more economically. So Xerox is partnering with us on that. That’s one aspect of it.
The other aspect is we’re doing a lot more trying to get to electronic display of information where we’re trying to get away from posters and papers being printed and put up in the walls, and different things like that. And we’re deploying a lot more flat screens and doing electronic posters that rotate. We’re doing a lot around trying to decrease the amount of printing. There’s a whole measure; we’ve recently gotten through a lot of print jobs that were historically just printing out reams of paper. We are actually now printing those to a PDF and emailing them to people who didn’t want the paper. It’s a multi-pronged approach, and it’s going to be over a fair amount of time. It’s not just clinical information systems and it’s not just financials. It’s operations, administration, communication, that kind of thing.
Gamble: Okay. It’s interesting that Xerox has adjusted their strategy to be able to fit with the changing trends as far as paper. It’s a smart move by them.
Burns: Well, it is. And we talked about it. We talked about the relationship that MU and Cerner have and how we’re really trying to leverage a partnership versus just a typical vendor relationship. We described that to them and said, ‘this is what the expectation is going to be. And here’s really what our goals are. Are you sure you want to sign up for this?’ And they were really all in, which was a good sign.
Gamble: And you mentioned device integration, what devices are you referring to with that?
Burns: IV pumps, ventilators, beds, monitors. We’re doing a big thing on the general care units where the nurses use vital sign monitors to do blood pressure, pulse, temperature, respirations, that kind of thing. We’re going to be deploying those so that one is in each room. And that’s an infection control measure. But then basically, it’s going to wirelessly connect and upload to the EMR so that the bedside nurses don’t have to actually input those either. It’s done much more electronically and leveraging that infrastructure. We’ve got technology that we’ve got deployed.
Gamble: So a lot of what you’re doing really does come back to the strategy of focusing on what to do with the data once you’ve collected it.
Gamble: Okay. And you also talked about hoping to achieve stage seven by the end of this year.
Burns: Right, or at least be able to fill up the questionnaire that way. That’s our goal.
Gamble: As far as Stage 7 and even Stage 6, is that something that you view as, ‘this is a nice thing to have,’ or do you think that that’s something that can really go far in terms of advancing the organization?
Burns: I tend to look at it as an external benchmark that validates the work we’ve done and our direction. It’s not the goal in and of itself, but it’s what it represents to us. We would be marching down this path anyway if there wasn’t a HIMSS Level 7, but that actually helps define a benchmark for us. It’s not an end. We just think it’s another step in the journey along the way.
Gamble: And I’m sure that it is a nice thing to get the recognition for the hard work that every has put in and get that assurance that you are doing some good stuff.
Gamble: One other thing I wanted to touch on was the unique position you’re in where you do have the two roles or the dual reporting relationship. Does this pose a challenge in terms of keeping up with both positions or do you find that there really is a lot of interweaving between the two?
Burns: They are very much intertwined. I would say that for both organizations, they’re commitment to making the Tiger Institute work is pretty strong. So I get a fair amount of support for insuring we’re doing the right thing. It’s actually less of a challenge than some might think as far as kind of balancing both because they’re more in alignment than not.
Gamble: Right. Now, as far as even just the CIO position right now, with so much going on, does it get difficult to kind of separate the two and established a balanced relationship where you can also make sure you’re either taking enough time away or just shutting off the Blackberry?
Burns: Actually, I don’t have too much of a problem with that. What I would say is that the partnership and the Tiger Institute itself, and really having two very large organizations supporting this, actually in some ways allows me to do that more. And that may sound counterintuitive, but because there is so much support from both organizations to making this successful, I know that if we get into some tough times or something happens where there is an unexpected obstacle that we didn’t expect, usually between the two organizations and through discussions with the different groups, we can usually figure out a resolution, versus if I was out there on my own or on an island. I think that that would be harder.
So I guess in some ways, leveraging the power of both organizations gives me confidence that we’re going to get through it; we’ll figure it out together. And there are enough people and support broadly so that I don’t feel like I’m out on an island by myself trying to figure out how I’m going to do ICD-10, Meaningful Use, and all of these things. There’s a lot of people and a lot of brain power. And collectively we usually all work together to figure it out.
Gamble: So it’s the kind of thing where on paper it might appear as if there are two separate positions. But if that were the case, I’m sure that would be extremely challenging to manage both.
Burns: Yeah. Both organizations are all in to achieve outcomes together. And they’re not different agendas. They really are one agenda. And both are willing to really step up and do what it takes to get there.
Gamble: Are there a number of other people who also kind of spill over into both groups?
Burns: Yes. There’s actually a fairly large group that represents the Tiger Institute, which does that pretty much. And there are a number of people within the organization that comprises that. It’s probably about 140 people altogether that really fall into the Tiger Institute, which represents both really Cerner and MU coming together — the intersection there.
Gamble: You’re definitely not on the island by yourself.
Burns: No, I’m not in the island by myself. And the reality is we’ve got a lot of support from both organizations to be successful.
Gamble: Right. And that’s so critical right now.
Gamble: Okay. Well before we wrap up, is there anything else that you wanted to address, either anything that you’re working on or any of your thoughts on industry trends?
Burns: No, I think we’ve covered everything. I think we’re good.
Gamble: Yeah. You guys really have a lot going on. But I’m glad we’ve got to talk. I think that other people are really going to be interested to hear about the partnership that you have and maybe it’s something that will start to serve as more of a care model.
Burns: Yeah. It would be great.
Gamble: All right, well thank you so much for your time. I really appreciate it.
Burns: Thank you.
Gamble: And hopefully I can work with you again some time down the road.
Burns: That would be great. Thanks very much.
Gamble: All right. Thank you.