When it comes to health IT, Wanda Sims is no rookie. Over the past two decades, she’s held roles on both the vendor and consulting sides, and as a result, she’s developed a deep understanding of how the game is played. Some of the key lessons she’s learned are that the success of an implementation is contingent upon strong leadership, and that each organization needs to find the formula that works best for them. It’s why she made sure to have a CMIO who isn’t afraid to take on a CPOE implementation, and why Baptist Health has embarked on a non-traditional outsourcing agreement with Cerner. In this interview, Sims talks about those experiences, as well as what her organization is doing to determine the right physician practice EMR strategy, why CIOs need to get out of the office, and the work her team is doing with HIEs and portals.
- About Baptist
- The organization’s CPOE journey
- Running McKesson Star for financials, Cerner (outsourced) for clinicals
- Implementing CPOE, targeting a June 5 go-live
- Breaking down outsourcing’s challenges
- “We’re 10 months into it and, right now, we’re happy with our decision”
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The physicians have an interesting life right now in that their goal is to go and talk to their physician partners and have them understand exactly where we are and that CPOE is not going to be as bad as they think it is.
My site director and I spent a lot of time when he first got here on understanding how this was going to work, and still, we work on it almost every day. I have no problem at all; if I need to talk to someone down there, I just go do it. Now if it’s a big issue, then I certainly talk with Will and let him know what’s going on.
IT Works is relatively new for Cerner and they were not, I think, really knowledgeable about what it’s like to work in a facility 24 hours a day. That’s not the way they’ve typically done business. And as part of that, there are politics along the way and there are feelings that have to be managed to accomplish what you want to accomplish.
We made a real concentrated effort to introduce this team and say, ‘give us a chance to do things the right way, we can do that.’ So I feel that we’re in a good spot today. I believe the circumstances worked well for us because Cerner had something that they needed to make work and we needed to have that same thing, and so it ended up being a good marriage.
Another attractive thing that they offered was the fact that every employee in my shop other than the management team stayed here. So we didn’t lose any of the depth that we had in the past around all of our applications because at this point, they don’t just support the Cerner applications; they support everything in the house.
Guerra: Good morning, Wanda. Thank you for joining me to talk about your work at Baptist Health.
Sims: Good morning, Anthony. You’re very welcome.
Guerra: Alright, let’s talk a little bit about the health system. It’s a bit of a complex thing going on there. Lay it out for me.
Sims: I’d be happy to. We are a fairly complex system. At a high level, we have three acute care facilities running about 689 licensed beds. Our largest hospital is Baptist South with 454 beds; it’s a large regional tertiary center. As part of that there is the Crossbridge Behavioral Health unit, which is about 60 beds. Baptist South’s focus is cardiology, orthopedics and general and trauma surgery, so they’re very busy. We also have Baptist East, which is a 100-bed general services facility, and then we have a tiny — they don’t like for us to call them tiny — Prattville Baptist, which is a community hospital running about 85 beds. We have a surgery center and we are in the middle of bringing on a cancer center, so we are relatively busy.
Guerra: And now what is the health care authority for Baptist Health, is that a corporate structure?
Sims: It is a corporate agreement with the University of Alabama at Birmingham (UAB) and that actually works very well for us. That’s been in place, I believe, since about 2005. On a day-to-day basis, we’re not involved that much. The good thing is, for instance, we’re in the middle of CPOE implementation and we’re able to talk to UAB and have resources there who come down and help us through that process if we need them. So they’re kind of our big sister up the street, but on a day-to-day basis we don’t interact that much.
Guerra: Alright, tell me a little bit about your ambulatory situation. You mentioned a cancer center and surgery center. Do you have owned physician practices of one, two, 10, or 15 docs, those types of things?
Sims: We do. I believe the count today is 11 practices. We have 41 full-time physicians in those practices, I think about 13 PRN MDs and we have the gamut. We have primary care, we have gastro, and we have the general surgery center and family medicine. We have a small residency group, we have wound care, we have a neurology group, and I believe a palliative care group. We have a hospitalist practice that has about 28 physicians in that area.
Guerra: And you also have the traditional independent physician practices that are referring their patients in?
Sims: We do. We have a little over 400 physicians in the Montgomery area that we deal with on an affiliated basis.
Guerra: What about competition — are there major hospitals in the area that you vie for those doctors to send the patients over?
Sims: Actually, we’re in a relatively good spot there. We have one other smaller hospital in town, I believe about 150 beds. So the competitive environment right now is not that bad for us. Obviously we want to do everything for the community, but we do share a bit of that.
Guerra: Let’s talk a little bit about your implementations. You mentioned CPOE; let’s talk about the acute care side first. What are you putting in there? Tell me about that project?
Sims: That is the biggest one on our plate right now. My shop is actually Star with McKesson for our financial side of the house and we’re implementing Cerner CPOE. All of all our clinical products are Cerner. Baptist has been a Cerner shop, since I believe about 2001. We were one of the very first remote hosted sites with Cerner. It’s an interesting journey, Anthony, which we’ve been on over the last year, just to give you a little bit of background about IT at Baptist. The IT shop at Baptist has been outsourced since I believe in 1998. It was a McKesson shop for quite a long time. Last year, we made a decision to change that and we’re now a Cerner IT Works client; they’re our strategic partner, and we’re about 10 months into that alignment.
It’s been an interesting project since we’ve done that. We have come a long way in those 10 months. We have three physicians who gave up parts of their practice to come and be on our CPOE team. We didn’t think that was going to happen; we were quite concerned about that. But they have worked diligently. They finished their order set review in February. We’re in the middle of training right now, and our goal is to go live across the house — total system — which is a first for Baptist, on June 5. The physicians have an interesting life right now in that their goal is to go and talk to their physician partners and have them understand exactly where we are and that CPOE is not going to be as bad as they think it is. So we’re quite happy with where we are with that project right now, but as you can imagine, it is all consuming.
Guerra: Did you essentially insource what was outsourced or did you just outsource it to Cerner instead of McKesson?
Sims: That again is an interesting story and I have to tell you, in my mind, it’s a study about leadership. It is all outsourced to Cerner; having said that, about 90 percent of the employees downstairs in the shop are employees who’ve been here for almost 10 years. They were with McKesson at the time; they are now Cerner employees, and the management team obviously is from Kansas City. So it is all outsourced to Cerner at this point.
Guerra: So those people were working for McKesson in your shop, physically, and now they’re working for Cerner in your shop, physically.
Guerra: So their paychecks just change where they came from, but their receipts don’t change.
Sims: That is exactly right. It’s been interesting too, and as I said, it’s a study on leadership. We have one young gentleman I’m so proud of. He started out as a helpdesk resource then was a desktop resource when this change came about. He now is a project manager, he’s leading several projects, and I’m just so proud of him. He’s really done well and he is in an environment now that allowed him to do well.
Guerra: I’m curious about how this works in terms of chain of command issues. I picture you sitting in your office and something’s going on with the folks downstairs and you attempted to just go downstairs and talk to them, but they don’t technically work for you anymore — they’re working for Cerner. Do you have to remember or sort of remind yourself, ‘I need to go to the Cerner person because these are Cerner people now.’
Sims: That is an interesting thought process. My site director and I spent a lot of time when he first got here on understanding how this was going to work, and still, we work on it almost every day. I have no problem at all; if I need to talk to someone down there, I just go do it. Now if it’s a big issue, then I certainly talk with Will and let him know what’s going on and that I believe we have a problem. For instance, we’re working with the state to be an HIE partner with them. There was an email this morning from one of my project managers talking about his plan, and I sent an e-mail back explaining that I did not agree with the plan. I copied Will as well, and we’re going to talk about that today.
We have a really good, healthy, open relationship. I think the fact that I had worked with those people for about four years helped — I had gotten to know them well. So it really has not been a problem. It’s interesting; it’s been more a problem for some of my Baptist team members, although I only have two other Baptist team members in my IT shop today. They felt a little threatened, I believe, by that process, and we’re working through that.
Guerra: Yeah, that’s exactly what I was thinking. Let’s go over for a few points just for the listeners, tell us who Will is, I assume he’s the site director.
Sims: I’m sorry; Will Oliver is my site director.
Guerra: So he works for Cerner?
Sims: He works for Cerner, correct.
Guerra: I know this from doing a little research for the interview but you worked for Cerner for four years, correct?
Sims: I did. It’s interesting; this is my first gig as CIO. I spent a lot of time in the consulting world and I did for Cerner for several years. I worked for McKesson as well in the HBOC days, so I could come in and talk both ways.
Guerra: And you worked for FCG, so you’ve been with some of the legends of the industry.
Sims: I have. I have to tell you, my FCG days were very, very fun. I did three years in Europe with them as well, so it was a very, very good experience.
Guerra: And we’ll get back into that a little bit later. Let’s stick with Cerner for now. And you mentioned — which I totally get — that it might be more of an issue for your former employees, or the Cerner employees, popping up into your office and you having to somehow loop Will in when the situation warrants it without making those employees feel like they’ve done something wrong.
Sims: Exactly. The thing that I’ve found, and there is one gentleman particularly that I had exactly that conversation with — I’m quite happy to talk to them, the door’s never closed; however, if it is what I perceive to be a chain of command issue, I won’t do that. I make sure that they bring Will in first, and then we’ll have a conversation if necessary.
Guerra: Have you had interesting talks with Will about the nuances of how this should work?
Sims: Absolutely. You know, the most interesting conversations I think that we’ve had, and I think one of the important things, is that IT Works is relatively new for Cerner and they were not, I think, really knowledgeable about what it’s like to work in a facility 24 hours a day. That’s not the way they’ve typically done business. And as part of that, there are politics along the way and there are feelings that have to be managed to accomplish what you want to accomplish, and that was new. So we spent quite a bit of time talking about how we get things done. There are certainly things that can be done faster, but you have to get buy-in and you have to move them along the right way, and that’s been difficult. So we spent a lot of time talking about that. We’ve talked about the fact that Cerner can learn as much from us as we can learn from Cerner, and we treat the relationship that way.
Guerra: It’s a really fascinating dynamic. It’s an interesting one and pretty unusual from what I hear from most of the CIOs I speak to. Most CIOs have employees who are their own — if there’s an outsourcing relationship, I think, oftentimes those people are working for the outsourcing company and they’re offsite.
Guerra: The fact that they’re onsite creates such interesting dynamics. One of the things I was thinking of was the fact that physicians could probably care less who these people are working for; whether they’re working for you or they’re working for Cerner, they just want problems solved. And when they want to talk to someone, they’re going to talk to them and they’re not going to be put off. They don’t want to hear that.
Sims: Absolutely not, exactly. One of the things that helped here, as I said before, is that the IT shop here had been outsourced for a long, long time, so that was not new. I will tell you that one of the reasons I was asked to come in was because we needed help there. We really were not in a good place. So what we had to do is build up confidence in our shop again. We had a lot of that to do, which I think we’ve been successful with at this point. So we had some interesting dynamics and things that we needed to do to even convince Baptist that we were okay to go forward with CPOE.
We’ve done a lot of introducing these people to the Baptist people out in the hospital—the people who don’t see us every day. We made a real concentrated effort to introduce this team and say, ‘give us a chance to do things the right way, we can do that.’ So I feel that we’re in a good spot today. And again, I believe that the circumstances worked well for us because Cerner had something that they needed to make work and we needed to have that same thing, and so it ended up being a good marriage.
Guerra: Let’s talk a little bit more about the benefits. I think we’ve touched on the challenges, and I don’t want to make it seem like it’s an impossible situation, because you’re certainly saying you feel like you’re in a good place. Tell me about deciding to go down this road. You obviously saw some benefits; tell me about those.
Sims: It’s interesting, and it was an interesting decision. I remember well the day I went to my senior leadership team and said, ‘let’s look at Cerner for this service.’ I didn’t know if I was going to get thrown out of the room or not, to be very honest. We were very, very deep into our roadmap to get Cerner implemented and finished. We were having issues with that. Cerner came in and talked about the things that they could offer us — the processes where they could help, the associates that they could bring onsite. That was attractive. Another attractive thing that they offered was the fact that every employee in my shop other than the management team stayed here. So we didn’t lose any of the depth that we had in the past around all of our applications because at this point, they don’t just support the Cerner applications; they support everything in the house. It was very important that we could keep that. We had done a very intense review of what all of our options were, and at that point, I felt that I had several options. One was to bring it back in-house totally, one was to outsource to another vendor, and another was to redo what we were currently doing. And Meaningful Use at that point became a reality as well, so I did not believe I had the time to recruit a shop, bring it totally in-house, and accomplish what we needed to accomplish.
Guerra: It just wasn’t going to happen.
Sims: Exactly. So looking at what we had to do, looking at the Cerner apps, because we were totally Cerner at that point in the clinical arena, looking at what we needed to accomplish, this seemed to be a way to get that done. And through the process with Cerner they made that very attractive. So that was our decision. And as I said, we’re 10 months into it and right now, we’re happy with our decision.
Guerra: Is there anything contractually in place that keeps those people in your facility — because now they’re Cerner people, and if Cerner had a pain point somewhere else, could they shift their resources temporarily or as long as they needed to?
Sims: No, we’re first. We are absolutely first. It’s interesting you said that, because we had a conversation around one of our young gentleman yesterday who wants to do more than just work in one shop. Cerner would add an attractive alternative for him as a career path. And while we’re very happy to have that happen if we’re in a spot where we can allow that to happen, it doesn’t just arbitrarily happen. And we’re very adamant about that. As I said, I worked for Cerner; I know some things to ask for, and that was one.
Guerra: You knew the inside baseball.
Sims: It’s interesting, and it’s often beneficial. I know a lot of people there, so that’s always helpful.
Guerra: Well you know a lot of people at a lot of places.
Sims: I do, my folks around here kid me that I’m never on a conference call when I don’t know at least one person.
Guerra: I’m telling you, you are not somebody that people would want to cross. Your rolodex is probably scary.
Sims: I try not to be too scary.
Guerra: That’s right. You have that southern calmness about you, right?
Sims: Exactly, that’s beneficial as well.