Like many organizations located near New Orleans, East Jefferson General Hospital faced an enormous test five years ago when Hurricane Katrina ripped through the area. Thanks to a dedicated staff, the 450-bed hospital was able to remain open throughout the ordeal, so it made sense that Jim Burton’s first priority as CIO was to ensure that in the event of another disaster, patient records would always be available. Now, Burton is taking it a step further and working to create an environment in which data isn’t just available; it’s robust and useful for clinicians.
- About EJGH
- Disaster recovery a top priority
- “Build it new rather than trying to touch it up”
- The hospital selects Cerner IT Works
- Aspen Advisors helps with the selection
- Dimensional Insight for business intelligence
- When bringing in a consultant makes sense
- From Phoenix direct to Cerner
- The ins and outs of outsourcing
I started realizing that disaster recovery wasn’t going to transform this organization; there had to be something more dramatic. One way was just storing information; the other way was helping it transform itself—for quality, for security, for business, to attract physicians.
I’m a big believer in enterprise and partnerships. I don’t want 15 corporations that basically do the same thing; I want a few key partners that will do the things I need and do them best.
When you’re negotiating, it takes a consorted effort for a long period of time. I didn’t have the time to focus on this, and I wanted to make sure that that the people that had worked for me weren’t buried so much in the detail that they couldn’t see the forest through the trees.
There are two types of people: people who do their job, and people who try to keep their job. And in some cases, some CIOs don’t want to give up what they consider to be power because they feel it will dilute their influence.
Guerra: Good morning, Jim. Thanks for joining me today to talk about your work at East Jefferson General Hospital. You are now in Louisiana, and that’s going to come up at different parts of the interview when we talk about disaster recovery.
Burton: Sure. And we are in Metairie.
Guerra: Metairie, Louisiana, correct?
Burton: Yeah, just outside of New Orleans.
Guerra: Okay, so 450 beds, 650 physicians; I’m assuming most of those are admitting, not employed?
Guerra: Do you have any employed docs?
Burton: We have some; it’s growing. Part of our strategy is to pick key special leasing and bring them on board.
Guerra: Okay. But, it’s a really a community hospital model right now.
Burton: Absolutely, it is. The idea here is that we focus on a lot of the generalities. We have an affiliation with MD Anderson as far as cancer.
Guerra: Okay, can you give us more of an overview of the organization before we get into specifics?
Burton: Sure. I think one of the key things that drew me to East Jefferson was that during Katrina, it was one of the few hospitals that stayed opened during the entire disaster. I mean it was catastrophic down here, and the people stayed and really focused on the patients. In some cases, their families had to move away, and in some cases, their houses were destroyed. But they were still there taking of their patients, and I thought that was incredible. So when I heard about the opportunity, I was very interested in seeing if I could link up and bring some skills down to really push this place to the next level.
Guerra: So you started down there fairly recently—about a year ago?
Burton: About 10 months ago now.
Guerra: And when you came in, you wanted to give a fresh eye to everything, so you brought in Aspen Advisors to assess the situation and look at the outsourcing agreement. Take us through that a little bit.
Burton: Sure. What happened was when I came on board initially, the major thrust was disaster recovery, and putting this organization in a position where they never had to worry if the water came in the door that the information was destroyed. And so I had to put out an RFP for that before I got here. When I got here the first week, I actually flew to some of the respondents from the RFP to see what their hot sites looked like. So when I went there, I started realizing that disaster recovery wasn’t going to transform this organization; there had to be something more dramatic. One way was just storing information; the other way was helping it transform itself—for quality, for security, for business, to attract physicians. There had to be something more dramatic. It became more of a project to build it new rather than try to touch it up. So I went to each of the vendors and asked them for their thoughts on what they could offer me to help transform the organization. I spent a day with each one, and I went through my vision—what I saw as the weaknesses, and whether they saw that as well. Some of them had been involved with this account for a long time. I wanted to know what they saw in the future and what they could offer me.
And so after the evaluation and discovery periods, we came upon Cerner IT works, which is a complete outsourcing model that goes beyond that because it’s from a software vendor. So you’re not only getting the software, you’re getting the services, you’re getting their disaster recovery, and you’re getting remote hosting, staffing, etc. It’s very complete. When I went out there and saw the Cerner Data Center, it was amazing. It was one of the best data centers I’d ever seen.
So Aspen was involved because I wanted to make sure that I had some expertise to help me evaluate what the options are, to do a fair evaluation of each vendor, and then to help me negotiate. I wanted someone objective so it didn’t get into personality disputes or anything like that, and someone who had been around a lot. Aspen is built on very senior people, which I appreciate rather some organizations that have one senior person and a whole bunch of newbies.
Burton: And so you have kind of their school for learning, where these folks came in and they already had the knowledge and they did a tremendous job for me. So I felt like I got a fair deal and Cerner got a fair deal. It was a very tight contract as far as SLAs, measurements—those types of things that we need, as well as products, and it’s a long term relationship. So that was that piece of it and Aspen helped me with that, as well as some other work here.
Dimensional Insight helped me with analytic tools and to be able to extract the information—a lot of the software and packages and stuff like that. They helped me put data in, but they don’t help you extract it in a way in which the customer can use it. And so one of my VPs actually found Dimensional Insight at a show and had mentioned it. At first I was suspicious, because when someone who knows nothing about IT offers you something, you always wonder what they’re seeing.
But I did go for a site visit; I went to their user conference, and what I found is an amazing product that was much better than I could have imagined. So it really impressed me because I consider everything to be like a stool, and that was another leg on the stool. I’m a big believer in enterprise and partnerships. I don’t want 15 corporations that basically do the same thing; I want a few key partners that will do the things I need and do them best and know that we’re both committed to each other as long as they’re delivering.
And what I found is that establishing a true partnership with vendors for as long as they are committed to you brings out to a level of trust in which they are really going to go out of their way to make you successful; even much more so then if you’re just a product buyer.
Guerra: Tell me a little bit more about what specifically you are using Dimensional Insight for.
Burton: We’re using it for our business intelligence. So we’re using a diver that can give our staff access to timely information when and where they want it, so they can do the jobs better and improve the quality of patient care. For example, in surgery, we’re doing some reports in surgery right now to analyze some of the products that have been used. We are using it in finance to look at certain metrics that are needed in order to make sure that we’re hitting our budgets and everything. It’s a tool that is multidimensional. And really, once you build the framework, it’s just extracting the data. Initially we had Dimensional Insight do some consulting work to build some reports for us and do some extraction, but it’s easy to learn, so we’re expecting over time to be able to do a lot of that ourselves and expand what we’re doing.
Guerra: Let’s go back to Aspen just for a minute. I looked through your LinkedIn profile, and it says you’re with FCG. I think a few of the folks over there at FCG, did you happen to know anybody from your past experience and that’s why they came to mind?
Burton: Yes, I actually know all the people who are in Aspen, either by name or by dealing with them, and I have great respect for them professionally. Guy Scalzi was the former CIO at New York Presbyterian, so he’s well known throughout the industry, and other folks there also have a breadth and depth of expertise which I knew I could trust. The one thing about FCG was that it was focused on health care, so I knew I wasn’t getting someone from the banking industry to come out here and try to explain to me how health care works.
Burton: They’re an amazing company so I was very impressed with them.
Guerra: You mentioned the idea of having a partner at the table to do the negotiating for you. I don’t know if that’s a good cop-bad cop type of thing where you can bring them in and let them do the tough stuff, so then you still get to keep that nice relationship with the vendor. Tell me a little more about that.
Burton: It was more like bad cop-bad cop, you know what I mean?
Burton: So I think the idea was to always keep it objective. I mean, we had the business of keeping things running at the same time that we’re trying to do major evaluation that’s going to change the future of this organization; it’s changing the direction and transformation. And I really wanted someone who could focus on it, whose expertise was that. I mean, Guy Scalzi and his crew built an outsourcing practice from scratch, so they knew outsourcing to such a degree that why wouldn’t I want to use their expertise?
My feeling is that you use the experts when you need them. You get the best you need, and they move on to other things that they can help you with, or on some days, they’ll be brought back to your organization to focus on things. And so that was what I really wanted them for. I have no problem being a bad cop, if that’s what it is. I wanted to use their expertise and metrics and negotiation skills on pricing. When you’re negotiating, it takes a consorted effort for a long period of time. I didn’t have the time to focus on this, and I wanted to make sure that that the people that had worked for me weren’t buried so much in the detail that they couldn’t see the forest through the trees.
Guerra: Right. You were an outsource shop, correct?
Guerra: And you’re still an outsource shop, so you’ve gone with Cerner IT works. Which vendor were you using previously?
Guerra: Okay, I’m not that familiar with them, but I think I’ve heard of them. So you went from Phoenix to Cerner. Now I can certainly understand why you’d want to bring someone in for that because outsourcing is a little scary to me. You hear about these arrangements where it is difficult to extract oneself from; that the outsourcer because it has an agenda to make it as sticky as possible, for it to be as integrated with your business and make it difficult to separate. Does that make sense? Are these things that you have to be careful about when you’re forming an agreement?
Burton: Yeah, part of the negotiation is to make sure that you have objective criteria, so that if they’re not delivering, you can get out. For instance, you have SLAs which really measure certain things like calls and things like on-time, on-budget, which you have to really hit the dollars. If you don’t hit them, that’s the minimum bar. But you also have breach, which we put in as well; with certain criteria, if they’re not hit within a period of time, or three times in a year, then we’re able to extract ourselves out of the contract if we want.
So, the idea is to build that in, but I will tell you that part of the challenge that we had is that we were lacking in expertise. We needed the expertise; we needed to buy it. I mean, we’re not a huge—we’re big enough organization here, but we’re not huge compared with other health care organizations. And so what I want to do is leverage skills that I couldn’t afford or couldn’t find in New Orleans, and Cerner was able to give me that. They have 8,000 plus people. They’re a multibillion dollar organization. It’s their product that we settled on for enterprise. It was a non-enterprise strategy that we had when I got here, and we’ve migrated to where basically all our products that Cerner is capable of delivering, we’re using. But for things like Dimensional Insight and PeopleSoft, I consider that part of our enterprise strategy as well—it was a very selected reason for deviation, but I feel very comfortable with outsourcing.
What I did, which is different than a lot of places, is I actually created what I call a DIO group, Division Information Officer, where people are responsible for each line. For instance, I have Bernie Clamon, who’s in charge of the strategy and the contracts and the nonclinical software, so he’s my guardian of that.
I have other people who are basically responsible to work with the physicians. I have a CMIO, Dr. Christopher Barrilleaux, who is in charge of the physician relationships and the technology, and I have Jody Torres for informatics, and then I have a security officer. So the idea here is to not throw yourself into the wind; the idea here is to trust with verification.
Burton: And those people report to the hospital, not to Cerner.
Guerra: Right. It’s very interesting; I wonder if people will usually come from one side to the other with outsourcing. For example, you may see a CIO take a job and in-source something that’s been outsourced, you may see them come in and outsource things; there are philosophies that go into this. Do you think there’s any degree of ego where people don’t outsource things that maybe should be outsourced because they’re afraid of it looking like they’re trying to get something off their plate?
Burton: I do think that you’re correct. There are two types of people: people who do their job, and people who try to keep their job. And in some cases, some CIOs don’t want to give up what they consider to be power because they feel it will dilute their influence. My feeling is we’re brought in to do a job, which is to put the organization in the best possible position for the future. I won’t speak for other CIOs, but in this particular case, the only way this organization was going to make meaningful use, the only way there was going to ambulatory strategy, the only way CPOE was going to be put in, the only way we could become part of an HIE eventually, was for me to do something dramatic. So what I did is what was right for the organization.