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.
- HIE work (internal vs external)
- “At the end of the day, it all comes down to viability — somebody has to pay”
- In the process of “thinking about thinking about our financial system”
- Sims on leadership — reflecting on lessons from a rich career
- “I’ve seen all the games played, so I know how they’re played”
- Avoiding death by meeting
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I believe that we, as a system, have to be able to share data internally the best that we can. And I don’t have great confidence, to be very honest, that we’re going to have a viable HIE outside of that anytime soon.
Early on we had a lot of vendor conversations around, ‘Let us do this for you.’ That’s gone away; I don’t hear that today. I think the entire HIE environment has gotten relatively quiet over the last six to eight months.
That gave me the background to do what I do today because I understand year-end and I understand month-end. I understand all those things that we deal with. It’s given me a full perspective for what I have to do today, because I’ve seen all the games played and I know how they’re played.
Some things can be very political. They can be very difficult to process, but you always need to speak the truth. And you don’t want something plastered in the newspaper that you’ve said that may not be the truth. So always be honorable, and things typically will work out for the best.
We have meetings that will go on forever, and at the end of that meeting, nothing’s accomplished. My mantra is, you come in with an agenda, you go through that agenda, you leave with a task list, and you have someone appointed to each item who’s supposed to do follow-up.
Guerra: Let’s talk a little bit about your HIE work. You mentioned Cerner’s Healthe Hub product, but I also see that you’re a member of some state and local HIE work groups. Tell me about your work — what Baptist is doing, and then your overall thoughts on how the government is handling the HIE program. Some say it’s a little too fast and loose out there with all these state HIEs competing with each other and some going out of business. But give us your thoughts.
Sims: Well, it’s been an interesting journey. When I first got to Baptist about four years ago, I was invited to a meeting downtown with some of our local folks and it was around HIEs, so we worked for two years on a local HIE. It went nowhere, and it came down to funding. There was not funding for it. So then the state was working on an HIE at the same time and eventually chose Thompson Reuters and continues to work with Thompson Reuters. At this point, the two systems — Baptist and Jackson Hospital here in town — are to be the first two hospitals that actually connect to the state HIE. So that’s one thing.
We now have the Healthe Hub, which is going to allow us to basically have our own private HIE that will give us a chance to connect to anything that does come about, whether it’s the state or whether it’s another local HIE. It’s interesting to me right now; I’ve always worried about the state getting an HIE and having it be viable. I still continue to worry about that because if you read any Alabama newspapers, we have tremendous issues with Medicaid funding, as I think most states do. Well, the state Medicaid agency is the agency running our HIE. So I worry that that’s going to happen. We’ll know that fairly quickly. I believe that we, as a system, have to be able to share data internally the best that we can. And I don’t have great confidence, to be very honest, that we’re going to have a viable HIE outside of that anytime soon. We will be ready to participate when we do, but that is a concern.
Guerra: And you, as a health system and as a CIO, don’t want to place a bet on the wrong horse and waste a whole lot of time and money.
Sims: Exactly right, because at the end of the day, it all comes down to viability. Somebody has to pay, and we want to make sure that if we’re going to spend dollars, that it’s something that’s going to benefit our physicians. It seems to me that there is a lot of jockeying to be able to say, ‘I have this wonderful HIE out here; it’s great.’ But what does that really mean? We also have a local one in the state that’s looking at images only and that again is a fantastic idea for a small population, but I’m not sure that we want to invest money just for that. So we’re going to be whole inside the system, and at that point when it becomes the smart thing to do, we’ll be ready to join anything that makes sense.
Guerra: Right, slow and steady. Keep your eye on what’s important, right?
Sims: You know, we are so darn much on our plate right now, we’re going to do what we absolutely need to do and then we’ll be ready. But we have to focus on what’s in front of us right now.
Guerra: Do you get pitched a lot by different HIE entities asking you to join them?
Sims: We have three in the state right now that I get pitched by, but that’s about it. Now early on, that was not true. Early on we had a lot of vendor conversations around, ‘Let us do this for you.’ That’s gone away; I don’t hear that today. I think really the entire HIE environment has gotten relatively quiet over the last six to eight months.
Guerra: Right, well maybe some of that initial government grant money is gone and now things have quieted down.
Sims: I think that’s exactly where it is. It all now has come down to sustainability — who’s going to pay for this?
Guerra: Right, interesting. I’d like to talk about your career a little bit, but are any other projects you want to talk about that are going on in your shop?
Sims: Well those are our big ones. One of the things that we know we have to look at is our financial system. We’re in the process of thinking about thinking about that. If you look at our big glossy picture on the wall that talks about what applications are there — and it’s color coded, we’re fairly stable on the clinical side of the house. But we have (McKesson) Star Financials and then many bolt-ons around that to make it work; so we’re going to look at that.
My next meeting this morning, by the way, is the final delivery of our ICD-10 assessment, so that’s a big one obviously that we have to keep our finger on. I think we feel like we’re relatively okay there, but we’re watching that. Then the rest of it is just day-to-day. We have a lot of applications that we own for Cerner as part of our alignment and we’re looking at our roadmap deciding what we need to do and when; FetaLink with monitoring for our baby is a big one that we’re looking at. So there are a lot of things there, but again, we’re trying very hard right now to look at CPOE, look at where we are at the end of that, and then what makes sense to focus on next.
Guerra: Are you looking to get off Star possibly altogether?
Sims: Possibly, yes.
Guerra: Would Cerner at least get a first glance because there might be some benefits to being on the same platform?
Sims: They will get a glance. Cerner does clinicals very well, and I’ll just leave it at that
Guerra: All right, so that’s what’s going on there. Let’s talk a little bit about leadership. You have certainly one of the more interesting careers in the sense that, like I said, you were with HBOC, FCG, and Cerner, and now being CIO at a hospital you probably know a lot of people and you’ve seen a lot of things done well, and I’m sure you’ve seen a lot of things done poorly. But just take me through your career a little bit and some of what you would see as the major learning points or periods of time when you really absorbed some lessons that have stuck with you.
Sims: It’s been an interesting career. I started out in a hospital in the business office world, and then found consulting and did my stints with vendors. My First Consulting days were very, very informative. A lot of what I did was go into implementations that had not go well, do an assessment of where they are or where they were, and then make recommendations around what needed to happen. It’s interesting to me that if you look at those, almost every one of them had to do with leadership. It was basic blocking and tackling. It was understanding the scope when you went in; it was making sure that you had the right resources on the project; and it was making sure that you had the right support from senior leadership to get the project done. I probably learned more from those kinds of things than any place else.
Also one of the important things that I always remember from my First Consulting Group days was a comment from Jim Reep, and that was, ‘When you go in, don’t say what your client wants you to say; say what they need to hear, which is not always easy.’ And also, ‘Speak the truth. Even if you know it’s going to be in the newspaper tomorrow, say what needs to be said.’ And that’s what I try to live by, because I think you have to approach things in a very honest way. You have to tell people on occasion, in a productive way, what they don’t want to hear, and that’s been interesting. The vendor world, again, was a very interesting world for me. I think that gave me the background to do what I do today because I understand year-end and I understand month-end. I understand all those things that we deal with. It’s given me, I think, a full perspective for what I have to do today, because I’ve seen all the games played and I know how they’re played. It’s what makes it a very interesting day-to-day job.
I love the CIO job, by the way, I didn’t know if I was going to do that. This was my first, as I often kid, real job where I came into an office every day. I had not done that for a long time. I had been a travelling road warrior, and I’ve found that being in a place like this which is so big and so busy with so much going on, that getting to know the people, getting their trust and to help them through the rough times — I really, really enjoy that.
Guerra: You mentioned a comment made by a gentleman — did you say his name was Jim Reep?
Sims: Jim Reep, the founder of FCG. So he was the founder of FCG, probably an industry legend, right? It’s a little bit before my time.
Sims: I am a bit older than you.
Guerra: Well maybe just a year or two. So you mentioned that, and then you mentioned two points that I just want to make sure I have clear: say what people need to hear, as opposed to want they want to hear, and speak as if it were to be in the newspaper. Tell me a little bit more about that point — what do you mean by that?
Sims: When you’re in a conversation and you’re trying to help something along, you’re in a process, and some things can be very political. They can be very difficult to process, but you always need to speak the truth. And you don’t want something plastered in the newspaper that you’ve said that may not be the truth. So always be honorable, and things typically will work out for the best.
Guerra: Right, always pretend that a lot of people would be looking at your comments or your statement, and that you would want to stand behind it if it came to light.
Sims: That is absolutely correct.
Guerra: And you mentioned the games that get played — month-end and year-end. We all know about those pressures that get on certain vendors, especially publically traded vendors, at periods of time when they’re more susceptible to negotiation. Would you put it that way?
Sims: Oh yeah. ‘We have this deal for you and it’s only on the table through the 31st of the month and then it’s gone.’ I don’t think so.
Guerra: Buy two and get three.
Sims: That’s exactly right.
Guerra: So have you had conversation where you’ve said, ‘Now come on, you know who I am. You know I’ve been on that side.’
Sims: I actually have had those conversations where I’ve said, ‘Don’t tell me that. I know the deal.’ They hate me when I do that but I do it. I always say it with a smile on my face and it works very well.
Guerra: Now you were consultant that became a CIO. I know CIOs that have become consultants, so people like to try the other side. Obviously the big difference is the lifestyle change. You have the travel and all of its positives and negatives when you’re a consultant. You also have that attitude of, ‘I’m going to do my best to here and I get to move on. I don’t have to live with these headaches forever,’ which can be seen as a positive.
Guerra: And then there are people who settle into a place and say, ‘I like being able to own this and not have to move on.’ I would imagine it’s always an adjustment going from one side to the other, so tell me how that’s been for you. You said you’re very pleased, but do you ever just miss jumping on a plane, or is that totally something you’re happy to leave behind?
Sims: It’s interesting, on occasion I like to think that I’d like to go jump on a plane again, but I don’t miss it a lot. I did early on, and I’ll be very blunt. I noticed that all my frequent flier miles are going away and that panicked me just a bit, but at the end of the day, I don’t miss it a lot right now. I like the fact that we’ve accomplished a lot here. I think we’ve done a lot of really good things for Baptist Health, and I like seeing that happen. One of my consulting terms was ‘covert project management’ — when you’re in the background and you’re helping things to happen, but you don’t have to be out front saying, ‘Boy, look what I did.’ And I enjoy that a lot. So at the end of the day, I’m quite happy here. My son is a pilot; we talk about that all the time because he’s flying now and I’m not, but I think that’s okay.
Guerra: Right. You mentioned your son before we got on the line. You said you were talking to him this morning and he thought you were always in meetings.
Sims: He did. That’s the joke in the family — that I don’t anything, I’m always in meetings. And that’s probably not very wrong.
Guerra: Well, let’s talk a little bit about that, because that can get problematic, right?
Sims: It can.
Guerra: Too many meetings, meetings that are too long, and I’m sure there certainly not all meetings you’re running. You’re being asked to attend meetings. You’ve seen meetings held poorly; meetings held well, meetings that you didn’t need to be in, meetings that you should have been in and that you weren’t invited to. So just give us some thoughts around doing that well.
Sims: Well, it’s very interesting. One of the things that I like to do — and this goes back to my consulting days — is meeting facilitation, because we do have meetings that will go on forever, and at the end of that meeting, nothing’s accomplished. My mantra is, you come in with an agenda, you go through that agenda, you leave with a task list, and you have someone appointed to each item who’s supposed to do follow-up. That’s what you do.
It’s interesting that one of our hospitals now has a person who helps them with Lean. He’s totally dedicated to that practice and he’s been very effective at helping them look at meetings. They actually mandated about six months ago that they only do meetings on Wednesdays. Wednesday is their meeting day. The rest of the time if they have something that really has to happen quickly, they’ll do a huddle. They’ll get the smallest number of people together that they really need to make that decision. They stand up in the hallway and say, ‘Okay, this is the issue. What are we going to do?’ And then they go do it. So that’s been an interesting process as well, but we constantly try to say, ‘Not so many meetings.’ And if you have to have a meeting, make it a productive meeting.
Guerra: I’m sure you’ve had those days where you look at your calendar and there’s no room to actually do anything because you’re in meetings all day so you can’t move anything forward. You’re not even going to get your e-mail.
Sims: That is exactly right, and at the end of those days, many times I think, what did I really do today or what did I accomplish? And unfortunately, it was not much.
Guerra: Everyone says — and it’s true — that multitasking in the sense of trying to bang out some e-mails or dispose of some of your e-mail burden in a meeting means you’re not hearing what’s going on in the meeting. But if you’re in meetings all day, you’re under such pressure to move some things along.
Sims: That is exactly right. I talking to a friend of mine last night; I have two iPhones and an iPad and I walk around with those most of the time. I’m not sure that’s a productive to do it, but unfortunately that’s where our world has taken us right now. I have learned, though, that there are times when I just have to turn it off, close the door, and focus on what I need to work on. It’s too easy to get drawn into that world.
Guerra: Absolutely. I think that is about all I had for you today. Is there anything else that you wanted to touch on?
Sims: You know, Anthony, I think we have run the gamut today.
Guerra: Well I can’t tell you how much of a pleasure this was. I’ve really enjoyed it.
Sims: It’s been a pleasure. It’s always fun to talk about our lives.
Guerra: Alright, well I hope we get to talk again soon. Thank you again and have a wonderful day.
Sims: You’re welcome very much.
Guerra: Be well, Wanda.