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.
- MUS1 – planning to attest at the end of this year
- The physician practice strategy — McKesson & Cerner?
- The importance of making rounds
- Medseek for a physician portal (perhaps a patient portal down the road)
- Making sure docs don’t see all the data, just the right data
- The importance of a sound infrastructure
- Implementing virtual desktops
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I will have to admit, we’ve not been very smart in our ambulatory world. But we’re very lucky in that we have a wonderful CMIO in place today. He has grabbed CPOE by the horns and he’s very anxious to help us get where we need to be with our physicians, and he’s done a really good job with that.
If you sit in your office, you don’t know what’s going on. You have to know the people in your facilities. And it’s not even just leadership. Leadership is very important, but I force myself to remember to make rounds.
We learned that they don’t want to see all of the documentation that the nurse does; they don’t need that, but there are certain pieces they do need. So we spend a lot of time doing a redesign to pull in exactly what they need without bombarding them with things they don’t need.
You cannot do anything without that infrastructure. I don’t care how well you plan; I don’t care what applications you have — if your infrastructure is not sound, then it’s not going to work. And believe me, that’s coming from the voice of experience.
We spent a lot of time and a lot of money looking at what we had. At one point we thought that we needed to rip things out and start over again — that ended up not being the case, but we did spend a lot of time doing analysis, adding access points, and getting stable.
Guerra: In terms of your CPOE journey, I read you’re planning to attest at the end of this year.
Sims: For stage 1, yes, we’re going to attest for the end of 2012.
Guerra: So you’re on track for that?
Sims: We are on track for that. We’re feeling pretty good about that right now.
Guerra: Are you rolling out Cerner in the owned practices?
Sims: I shouldn’t say this, but we probably are. My practices don’t know all that yet. We have a meeting next week actually to start the first discussion around what we’re really going to do in the ambulatory world. We’ve played with that but we had so much on the plate that we just haven’t addressed it. I will tell you that we are finishing up an implementation of Practice Partner with McKesson in three of our primary care areas, so that won’t come out likely anytime soon, but we do have those other practices that we know that we have to do something for. The one thing that we do have on the table with Cerner is their mini-HIE product called HealthyHub that we’re about to implement. So with that we can get the data that we need and share the data relatively easily while we decide what we’re going to do with the rest of the house.
Guerra: That’s interesting. So you’ve got McKesson going in in three of the practices?
Sims: Three of the practices, correct. That was a decision that was made prior to this arrangement.
Guerra: And now you’re looking to possibly roll Cerner out in the rest of them?
Guerra: Oh boy.
Sims: Yeah, it’s interesting. We’re going to have an interesting life over the next few years.
Guerra: Do you see headaches down the road?
Sims: I do. I do see some headaches there. I will have to admit, we’ve not been very smart in our ambulatory world. We haven’t been. But we’re very lucky in that we have a wonderful CMIO in place today, Timothy Bode. He’s the leader of our hospitalist practice. He has grabbed CPOE by the horns and he’s very anxious to help us get where we need to be with our physicians, and he’s done a really good job with that.
Guerra: Practice roll-outs are probably very resource-intensive and I’m just thinking of the expectations of a physician in their practice. They need a lot of help. Am I right? Those are pretty intensive projects, right?
Sims: They are intense. They really are intense, and it’s not an area where they have a lot of resources to help them, so you’re right about that. We struggle at times. When we struggle for resources, it’s there. I had an interesting personal experience just recently. I went for my normal yearly checkup to one of our physicians who was the second in that rollout, and I had to sit down and promise him — a lot — that it was going to be better. So I have to go back for lab work, by the way, and I’m not going back with the needle involved until I can fulfill those promises.
Guerra: You have to check the helpdesk logs and see what’s coming from that office before you go over for your checkup.
Sims: That is very true.
Guerra: That’s funny. But it’s good though that you go there. It forces you to face it. The worst things CIOs can do is start hiding in their office. You have to stay out there; you have to take the knocks and the bruises and keep on fighting.
Sims: That’s my mantra, absolutely. If you sit in your office, you don’t know what’s going on. You have to know the people in your facilities. And it’s not even just leadership. Leadership is very important, but I force myself to remember to make rounds. We had an interesting occurrence at our biggest hospital about two years ago when we constantly had issues with equipment not working. So I went down and the CEO and I rounded, and it was a very sobering experience to find out that equipment didn’t work, why it didn’t work, and why they were having issues. So I do believe that any CIO really needs to do that.
Guerra: Right. You see people using expensive equipment that doesn’t work — they’re using it as trays.
Sims: Exactly. And it’s so easy to sit back and say, ‘They’re just not doing what they need to do.’ They have a few other things on their plate when that COW or that WOW doesn’t work. They don’t have a lot of time to stop and figure that out.
Guerra: Sure. And they don’t even feel like putting in a ticket. They just figure, ‘it doesn’t work, someone will report it. I don’t have time to report it.’
Sims: Someone will find it, right.
Guerra: Let’s talk a little bit about what you’re using MedSeek for.
Sims: We are implementing — we’ve not actually implemented MedSeek yet. The first thing we’re going to do with them is a physician portal, so that’s our first step. Probably we’ll look at a patient portal later; our CFO is very interested in that, but our goal with our physician is ease of access. We’re actually implementing VDI right now — virtual desktop, and with that single sign-on it’s very easy, and then the portal is the other step in that, so they’ve got one-stop shopping.
Guerra: So that will give them a window into the Cerner product.
Sims: Not only Cerner, but with any other thing that they might do when they sit down to help that patient, they’ve got one place — whether that be their journals, their e-mail, whatever, they have one place to go.
Guerra: Now tell me, and this is probably going to be a silly question, but when you’ve got different applications that you want to see into as a physician, why do you need something like a MedSeek? Why do you need a portal? Why can’t you just see directly into the application you want to see into — what does the portal do for you?
Sims: The portal gives you one place to go to log in, and then you have that icon access to each one of those rather than going and bringing up individual pages to get where you need to go. It is just all about speed. So we push to them as much as we can to have them sit down and see it without searching for it. It’s all about speed for them, but also having the appropriate data that they need.
The one thing we know is that we spend so much time collecting data. The question now is what the heck do we do with it? I had an interesting conversation last week around the same issue in that in the ER, it’s all about speed, obviously. So when the physicians sit down now and look at their in page, which is their Cerner page, to see what they need to see, it became apparent that they weren’t seeing nursing documentation. And as we had the conversation, we learned that they don’t want to see all of the documentation that the nurse does; they don’t need that, but there are certain pieces they do need. So we spend a lot of time doing a redesign to pull in exactly what they need without bombarding them with things they don’t need. So our goal is to give them exactly what they need in the fastest possible way.
Guerra: The goal over the last few years has been to get the data off paper, get it electronic, and get it to the physicians, and I think we’re quickly swung beyond that to a point where now it gets the right data—not all the data, but the right data.
Guerra: Because too much data, even if it’s accurate data, is just as bad to these folks because they don’t have the time. They don’t want to see it all. They’ll be just as turned off with the product if it’s got too much data.
Sims: That’s exactly right, and they won’t use it. It will slow them down and they won’t use it. So we spend a lot of time now, we have a whole team who’s looking just at data and we’re quite happy in that Modern Healthcare named us one of the top Thomson Reuters hospitals. That is about quality; it’s all about quality. And going forward, we’re only going to be paid on quality. So in order to continue that, we have to have the right data.
Guerra: Right, because if you give them data they want, that theoretically improves clinical outcomes.
Guerra: So with MedSeek, I’m curious about the investment in something like that. You mentioned your CFO, and I know nobody wants to throw money around that they don’t need to. So I whatever imagine you sitting there and you’re saying, ‘Here’s the environment we have. We need a piece that simplifies this for the physicians. We need to make that investment what we’re currently have will not work for them.’
Sims: Exactly, it’s too cumbersome.
Guerra: So then you look around and you found MedSeek and you’re putting them in. I was reading a quote by you and you mentioned in the context of this particular product the infrastructure that you need to support the model of care — this is part of that infrastructure?
Guerra: So to make it all work, you need that underlying infrastructure. Any more thoughts around infrastructure, network storage, all these kinds of, let’s say, non-sexy things that people don’t like to think about and talk about but they provide the foundation that you need?
Sims: If I’m going to talk about what needs to be done today, you cannot do anything without that infrastructure. I don’t care how well you plan; I don’t care what applications you have — if your infrastructure is not sound, then it’s not going to work. And believe me, that’s coming from the voice of experience. Our network, our wireless infrastructure was not was it needed to be. We spent many, many hours going through meetings, and every meeting started with, ‘wireless doesn’t work.’
‘My equipment doesn’t work.’ And it didn’t work. You could push a WOW or a COW or whatever we’re calling them today down the hall, and depending on where your access point was, you dropped. Well, in that clinician’s world, that was really bad. And to be honest, some of our IT people would say, ‘Yeah, it dropped for a second, but it came back.’ Well, what happened is that they totally got thrown out of the case that they were documenting at that point because they dropped.
We had our FirstNet, which is our ER system, go-live at one of our smaller hospitals. We were all standing there waiting for that moment five minutes before our network went down. It doesn’t inspire confidence in what we’re trying to do. So we spent a lot of time and a lot of money looking at what we had. At one point we thought that we needed to rip things out and start over again — that ended up not being the case, but we did spend a lot of time doing analysis, adding access points, and getting stable.
Now, along with that, as I said, we’re about to implement virtual desktop, which is a totally new environment for us. It allows us to do a couple of things. One of the biggest issues that we had around security was desktops, obviously. Every desktop had different things on it. So now we’re going to be able to control our environment from IT and also give them a platform that allows them to have easier access to the system because we’re tying single sign-on to that. But that cannot be stressed enough. I was at a site visit at East Jefferson and their CMIO said something to me that I’ll never forget. Until you have a meeting with your clinicians that doesn’t start with, ‘My equipment doesn’t work; the network doesn’t work,’ you’ll never get where you need to go,’ and that is so true. Luckily that’s not where we are today.
Guerra: So that’s one of the things that when we talk about all these programs and measures and Meaningful Use stage 2 and 3 and all these things, it’s important that policy makers understand that there’s a lot of stakes-to-play stuff that has to go in here.
Sims: That is absolutely true, and it’s costly. It is costly, but it’s an investment that has to be made.