When people see Norma Tirado’s title, they often do a double take. But while it may seem unusual to serve as VP of both IT and Human Resources, to Tirado, the dual role makes perfect sense in the world, especially in today’s turbulent health IT world, where change management expertise is as good as gold. In this interview, she talks about Lakeland’s “fast and furious” Epic rollout — an initiative that required significant buy-in; how she is able to balance the two roles; what it takes to retain staff and build a high-performing culture; and why achieving Stage 7 means so much to the organization and the community.
- About Lakeland HealthCare
- Speed-to-value approach with Epic rollout
- Consultant expertise vs keeping intellectual property in-house
- Getting docs to buy in — “The timing helped us. They knew MU was coming.”
- Implementation hype cycle & “the valley of despair”
- Shifting into optimization mode
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The way we targeted that was to say, let’s try to get to Stage 7 as quickly as possible so that we know that we’re utilizing the system — not at its maximum capacity, but close to the way that it needs to be utilized to bring value to the organization and to the patient.
We put them through a very intense process to make sure that those who wanted to be in the project knew what they were heading into and how intense and how difficult this project was going to be, and what was expected of them.
We warned them, this is what’s going to happen. We’re going to be really excited, and then we’re going to start finding problems and you’re going to be disappointed.
We want to deliver better patient care, no matter where we are. If that is your purpose, then you’re more willing to share both what goes well and what doesn’t go so well so that we can, at the end of the day, have better outcomes and better care delivery.
Gamble: Hi Norma, thanks so much for taking the time to join us today.
Tirado: Thank you, Kate.
Gamble: To start off, why don’t you give us a little bit of background information about Lakeland HealthCare — what you have in number of hospitals, where you’re located, things like that?
Tirado: Lakeland HealthCare is an integrated healthcare system, small to medium sized, in Southwest Michigan. We’re a not-for-profit healthcare system. We have about 443 licensed beds. We have three hospitals and 30 ambulatory clinics. We have almost 500 providers and over 4,200 associates and we have also in the last couple of years have become a teaching facility, so we have residency programs.
Gamble: Do you have physician practices that are owned by the system and affiliated?
Tirado: We have both. We have about 30 clinics that are owned by the hospital and then there are a number of affiliated clinics we work with. A number of the physicians are part of our medical staff.
Gamble: In terms of your location, you’re in Michigan, and I guess it’s considered the southwest area of the state.
Tirado: Yes, southwest area of the state, right on Lake Michigan.
Gamble: That doesn’t sound like a bad place to be.
Tirado: It’s a great place to be, especially in the summer — not so much in the winter.
Gamble: I imagine. In terms of the clinical application environment, you had a pretty fast and furious implementation of Epic. I wanted to talk a little bit about that. You did a big bang implementation in acute and ambulatory to save on labor costs and get to the optimization phase quicker. All of that make senses, but I wanted to talk about how you achieved that. Can you walk us through that?
Tirado: Sure. I came to the organization in 2010, and at the time, when we looked at the IT systems in the organization, we were pretty far behind. We knew that with Meaningful Use coming, we needed to try to get implemented as quickly as possible. We also decided that since it had taken us so long to make the decision to invest in the electronic medical record, we would take a speed-to-value approach to implementation, and we felt very strongly that to get to that, we needed to implement quickly and then optimize as quickly as possible. For us, the way we targeted that was to say, let’s try to get to Stage 7 of the EMRAM Stages of HIMSS as quickly as possible so that we know that we’re utilizing the system — not at its maximum capacity, but probably close to the way that it needs to be utilized to bring value to the organization and to the patient.
Gamble: I was able to attend your presentation at HIMSS so I have some background, but let’s walk through that for the people who are listening. You had said that you wanted to use consultants to be able to show the value of that EHR and justify the spend, but that you also wanted to make sure you were using your own in-house staff. Can you talk a little bit about that and the team you put together?
Tirado: We set out to put a team together to be able to keep as much as the intellectual property in-house as possible after implementation. I think that at first we thought we could bring consultants because they have experience and they can bring the expertise and they can help us to do this quickly, but then we thought it’s probably better if we train our own people. We approached our leaders in the organization and spoke a great deal about the importance of this project and the need to focus and put some of our best and brightest associates on the project so that we could deliver the best possible product that we could to the organization in that amount of time.
We made sure everyone was certified in their area of responsibility. We implemented Epic, and so we used the same hiring or testing criteria that Epic uses when they hire their analysts. In a 48-hour period, we took a team and we hired about 65 of the maybe 70 some people that we hired at the end for the project, and put them through a very intense process to make sure that those who wanted to be in the project knew what they were heading into and how intense and how difficult this project was going to be, and what was expected of them. We then did hire a consultant, but what we thought we needed to hire a consultant for was to help us identify the areas that we needed to focus on to bring value to the organization from a financial standpoint, and also in terms of improved outcomes for the patients.
Gamble: Did you start in the acute environment or did you start with ambulatory?
Tirado: We did ambulatory first. We did a pilot in August of 2011 and then went live with all of the physician offices in October of 2011, and then in February of 2012 we went live with all of our hospitals.
Gamble: You talked about the speed to value approach and that you were able to achieve this on time and on budget, which is a great achievement. What was required to get buy-in from clinicians?
Tirado: Well, I think the timing helped us in getting that buy-in from clinicians because they knew that Meaningful Use was coming and they knew that there was no escaping going to an electronic medical record anymore. I thank all the pioneer organizations that really struggled through this ahead of us. We brought in a lot of physicians from other organizations to talk to our physicians and clinicians about why it is important, what value they have seen in terms of improving their outcomes, and what are the negative things that they saw. We prepared our clinicians to understand what the cycle was going to be of implementation — where everybody may be excited at first, and then there’s kind of a valley of despair in the process before we actually head back to a more stable environment again. We could pretty much track that.
But we warned them, this is what’s going to happen. We’re going to be really excited, and then we’re going to start finding problems and you’re going to be disappointed. I think it was a change management process to get them excited about the project — what they could expect to see in terms of improvements, and also to warn them in terms of what should they expect in terms of maybe slowing down their productivity a little bit and feeling a little bit uncertain about using the technology. We got a lot of help I think from people who had gone before us.
Gamble: How were you able to do that? Was it just a matter of reaching out to some of the organizations you know and asking people to come in and speak?
Tirado: It always helps to have physicians ask physicians for help. When they do, it’s amazing. We had a physician from a HIMSS 7 organization that came to speak to our medical staff very early on in the process. We had a physician trainer from Kaiser Permanente who happened to be the brother of one of the physicians in our organization. He came in and talked to our ambulatory physicians about the process and then came later and helped them with tips and tricks. He told them a great deal about what to expect.
We had done some site visits and we talked to the CMIOs in some of those site visits and they were willing to share with our physician group. It was very good that we were able to reach out to people that were very willing to help us out. And we’ve returned the favor. We had a number of organizations that came here during our go-live just to see how things go, and came back after the go-live to talk to us about the process. I think Epic as a vendor tries to create those types of relationships between their customers.
Gamble: I would think having people come after the go-live makes a difference, because as you know, it’s not just turning on a switch and everything works fine.
Tirado: That’s right. I think the sheer purpose we all have is that we want to deliver better patient care, no matter where we are. If that is your purpose, then you’re more willing to share both what goes well and what doesn’t go so well so that we can, at the end of the day, have better outcomes and better care delivery for our patients.
Gamble: At this point, are you in optimization mode as far as the EHR?
Tirado: We went into optimization mode pretty quickly. Actually, we had a period of time where we were still bringing on our community offices, our affiliated offices, and that slowed down the ambulatory optimization for a period of time. We have four communities. These are physicians that are not part of Lakeland, but we are working with them to get Epic in their offices as well, and that slowed down the implementation for the ambulatory.
In the acute care setting, I would say the optimization began a few months after, because you have a period of stabilization where you discover new types of errors by using the electronic medical record, and then you have to make sure your systems are working fine and that everything is safe for the patient, and then you can go into optimization. I would say we began optimization probably a couple months after go‑live.