Like many CIOs, Jackie Lucas believes Meaningful Use is the right thing to do because it’s moving the industry forward. But she also believes the planning and execution of such a major initiative left something to be desired. Lucas would have liked to see a more holistic, layered approach to health IT that addressed workflow concerns — something more like the deliberate strategy that she has tried to implement at Baptist Healthcare. In this interview, Lucas talks about the challenges community hospitals face in adopting CPOE and meeting quality measures, the experiences she has had in maintaining multiple vendor partnerships, and what healthcare CIOs can learn from other industries.
- T-System in the ED
- The need for speed
- Moving up the IT ladder
- Leveraging an accounting degree
- Learning from other industries
With all the change that’s coming in health care, we’re looking at things like how are we going to automate our emergency departments and how are we going to do it quickly. And then you have Meaningful Use and the need to get to that 30 percent CPOE that we all focused on in the first round.
The T-System project is going very, very well. It’s been very positive in our organization. Our physicians feel good about it, and we are going to benefit from being able to do that rapid deployment and pick up some of the CPOE numbers.
When we went to the partnership with McKesson in 1998, we knew how much money we were going to be investing, and we had to say, ‘Okay, how do we invest this wisely? How do we take advantage of the technology? We need to do one implementation for five hospitals instead of five implementations.’
It was a great foundation for me because I got to really experience nursing without being a nurse. That foundation has been incredibly valuable, and I’ve been able to take that and put it together with the accounting side and be able to really see both sides.
It allows me to have access to people that are with Disney and Walmart, and be able to tap into that knowledge; to go to a webinar or a conference and be able to talk to folks and learn what they’re doing outside of the industry. It helps me balance that need outside of health care to talk about networking or cloud computing or security.
Guerra: Let’s go back to the application environment and talk about the decision to go with T-System. I know McKesson does have an ED product, so is that something you looked at, and how did you ultimately decide to go with T-System? And then let’s talk about the integration you’re going to get between T-System and McKesson.
Lucas: We were already using the T-System process and paper in the majority of our hospitals, so our physicians were already trained on the product and felt very good about it. So with all the change that’s coming in health care, we’re looking at things like how are we going to automate our emergency departments and how are we going to do it quickly. And then you have Meaningful Use and the need to get to that 30 percent CPOE that we all focused on in the first round. So we looked at the T-System product because we are already had that process with our physicians. Our physicians said, ‘We really like the T-System process. We already know it.’ So we looked at the product and said, ‘You know, this could really make sense for us and we can implement it very quickly. And it will help get to Meaningful Use.’ And we do a number of the executives at T-System; we worked with some of them in the past. We said, ‘Well, these are folks that we’ve worked with before.’
So you really had to put those pieces together and say, ‘this was a winning situation.’ You really can’t look at our decision and say it was T-System against McKesson, because that’s the way we approached it. We have a very large partnership with McKesson. We have a lot of their products; they’re our pharmacy distribution vendor, so we have their automation products in the pharmacy. We really looked it more as, ‘What’s the real fit here with the pressures that we’re facing with Meaningful Use with trying to automate?’ We have one of the busiest emergency departments in state here in Louisville at Baptist Hospital East. So you’re looking at that, and you’re looking at what’s really a good fit for us and what leverages what our physicians already have been working with and their processes.
So it was really more that question. I think it’s that decision that an organization has to look at and say, ‘What’s my best fit in an area?’ I know it’s a little bit of the best-of-breed mentality, and we still are very much on the partnership philosophy. But we do look at T-Systems as one of our partners now. So it wasn’t so much, ‘Okay, let’s look at these two products and pick between them.’ It was more, ‘This is a good fit. This will work very well in our environment, and it’s a win in our environment. I don’t think anybody else could say, ‘Oh, they picked this and that means this.’
Guerra: Right. So we talked about the speed at which change is happening and I read that you’re taking advantage of a rapid deployment program to roll out the system to one hospital per month as supposed to the average, which was 12 to 16 weeks. So we’re talking about speed here. I guess that’s something you don’t do unless you have to. What are your thoughts around stepping up the tempo and making sure everything still functions properly?
Lucas: I think we’re all working in that environment where you have to look at those opportunities. You have to look at your whole schedule and say, ‘How would this fit into our meaningful use schedule?’ And it fit really well. We have not been that concerned about doing the rapid rollout. In fact, our hospitals have felt very good about it. We’ve already got physicians that are trained on the process. So it’s that much easier to implement it with them. So we had to almost stop and think for a minute about rapid deployment. We don’t even call it that. It’s our deployment model.
The T-System project is going very, very well. It’s been very positive in our organization. Our physicians feel good about it, and we are going to benefit from being able to do that rapid deployment and pick up some of the CPOE numbers, adding to what we’re doing in our emergency departments, which are are very large in some of our hospitals. We have well into the high 30s, approaching 40 percent, or maybe a little more depending on the month of our patients that are admitted from our EDs.
Guerra: I’d like to switch gears a little bit for the last few minutes and talk a little bit about your career. I see you’ve been at Baptist for 12 years and before becoming CIO, you were the corporate director of strategic implementations. Can you tell me how you wound up moving into the CIO role—how that came about?
Lucas: I can but actually, this fall I will have been at Baptist for 18 years.
Guerra: Oh, excuse me.
Lucas: That’s okay. There are people who might know me and say, ‘Twelve years? She’s been there 18 years.’ Well, my career goal for many years has been to be a CIO, and I was promoted into the role about five years ago when our prior CIO left the organization. The role I was in prior to being CIO—director of strategic implementations—was a very good role to enable me to make that next step, because I was really focused on our strategy and focused on implementing the really large projects and having to work across the teams almost in a matrix-management type structure in our IT department. So the CIO role was a next logical step from that. I worked very closely with some of our strategic partners in managing a lot of those partnerships in our master agreements and contracts and handling those implementations, budgets, and project management. The program management process I mentioned earlier with our system project owner—I was instrumental in making that happen as an IT director, and we really used that as the foundation for a lot of those strategic implementations with McKesson that we had in the early days, when we were best-of-breed in the mid 90s before we went to the partnership model.
We might, at that time, have had different products in our hospitals. And we did not necessarily try to standardize or implement those in the same way; they weren’t always implemented together. When we went to the partnership with McKesson in 1998, we knew how much money we were going to be investing, and we had to say, ‘Okay, how do we invest this wisely? How do we take advantage of the technology? We need to do one implementation for five hospitals instead of five implementations.’ So I worked very closely to put that together using a team in our IT department that worked with our hospitals. We put that process together and we’ve really used that moving forward. We’re using that with our meaningful use—putting those work groups together. That was something that I was very instrumental in, and it really helped me build a foundation to move into the CIO role.
Guerra: Right. So your educational background—and please correct me if I’m wrong—is in accounting.
Lucas: It is.
Guerra: For many of the CIOs I speak to it’s computer science, and some actually have a clinical background. How is your accounting background been of service?
Lucas: Accounting is one of those fields where anybody who looks at it is going to know that you know how to make the numbers add up. You know how the bits and bytes fit together. It’s been a very good background for me because in IT, you work with a lot of budgets and you work with a lot of dollars. You have to make a lot of pieces and moving parts come together. And I’ve always thought accounting really did that.
I have worked a lot on the clinical side, though and it is really my love in health care. My first position in health care when I got out of college and went to work for Le Bonheur Children’s Medical Center in Memphis, Tennessee (now Methodist Le Bonheur Hospital) was with the vice president of nursing. I worked in the nursing division for almost four years. I worked as a management analyst in the division and I handled the budgets and the FT Reports. If you know much about nursing, you know how many full time equivalents and how many people are involved. I managed the staffing office where you’re providing all the resources to the units and dealing with call-ins and nurse agencies, and home health. We built an acuity system—we were one of the first hospitals, when I was at Le Bonheur, to do billing based on acuity. And that of course, was not in a DRG-type environment because children’s hospitals were exempted in the 1980’s from that.
But I wouldn’t take anything for those three to four years I spent working in nursing. I sat in the nursing council meetings, learned about primary nursing, worked with the nursing directors every day, and walked many a floor in nursing. And when we were seeing a spike in our patients, which could happen during croup season, I fed bottles to babies and helped out on the floors. It was a great foundation for me because I got to really experience nursing without being a nurse. Not that I wouldn’t want to be one, but I didn’t have that background or education. And I really got to experience it. It was something I just wouldn’t take anything for. And still, when I sit in meetings with one of our hospitals and we’re talking through issues on who’s going to do workflow and how something will or won’t work, I go back in my mind to those days and how all that works. That foundation has been incredibly valuable, and I’ve been able to take that and put it together with the accounting side and be able to really see both sides of that. So it’s been very valuable to me.
Guerra: We have to assume your CFO is spoiled with the spreadsheet you can put together.
Lucas: I can put together some spreadsheets. I could be a challenge for folks sometimes in what I can put together. I add up numbers really quickly in my head, so if you’re going to try to talk to me about numbers, I’m going to say, ‘I’m not sure that’s the right amount. Let’s talk about that.’
Guerra: You can play Excel like a piano, right?
Lucas: I’m pretty good, but we have some people here who are better than me. We have some real masters with Excel in our accounting staff that have built entire programs out of Excel. I’m pretty good at it, but my love is really health care. I’m a fellow in the American College of Healthcare Executives; that’s been very important to me. After I worked in nursing for a couple of years in the nursing division, I moved into hospital administration and worked there for about three years for our chief operating officer when I was in Memphis. Back in old days—the last 1980s—I coordinated a Joint Commission review for the hospital. That was a good foundation too. So, those years have been very valuable to me, and I’m still a member of the American College of Healthcare Executives. So I really do look at myself as a health care executive that works in information technology.
Guerra: It’s interesting that you say that. When I was poking around online, I saw that you’re on a cross-industry round table of CIOs. So I would imagine that although you’re deeply involved in health care, you must think it’s also important to get perspectives from other industries.
Lucas: I do. I am a member of the CIO Executive Council for the CIO magazine group. That’s been a really nice organization for me to be a part of, because it allows me to have access to people that are with Disney and Walmart, and be able to tap into that knowledge; to go to a webinar or a conference and be able to talk to folks and learn what they’re doing outside of the industry. It helps me balance that need outside of health care to talk about networking or cloud computing or security.
And it is very interesting to talk to people in other industries about the infrastructure side of the business, which we haven’t talked about. We’ve been looking at our network across the state of Kentucky, and we have some challenges because we’re going to some very rural areas where carriers don’t necessarily want to invest a whole lot of their services because the return’s not going to be there. So we had some challenges in that area and are making some changes, and I’ve certainly tapped into that council in some of their meetings to say, ‘Hey, what are you doing? Because you’re running across these areas. How does your model work? What has your experience been with these vendors and partners?’ So it has been a very valuable group to work with. And I hope I’ve brought to them some thoughts about how we handle some things in the health care industry.
I did a webinar in the Pathways class that the CIO Executive Council has for rising CIOs and director-level folks that really want to get some extra training. I did a webinar training session for them on admin-Rx and what that was all about, and the challenges of doing that and bringing all those pieces and moving parts together. And that’s our bedside bar coding and our wireless challenges. I had some folks on there from some big organizations. And so that’s one of the nice things about the council—you really can share that information across industries.
Guerra: Well, I certainly think that if we were so inclined—and I’m not going to keep you any longer today, you’ve been very generous—we could talk for another hour about infrastructure, ICD-10, and wireless handheld devices, don’t you think?
Lucas: Yeah, there’s plenty to talk about.
Guerra: But, I’m going to let you go and get on with what I’m sure is a busy day, unless there’s anything that you really did want to add.
Lucas: I think we’re just all working as hard as we can to get to the right place, and I do think all of this is going in the right place for the patient and for the quality of care in this country. With health care reform and all of those things, I think we’re moving the right way. There are a lot of challenges and opportunities. We all enjoy it every day, and we’re moving along. So I appreciate your time very much, and I hope this information was useful to you and the folks who will be listening.
Guerra: It has been useful and very enjoyable, so thank you for your time, Jackie. I look forward to catching up with you again soon.
Lucas: Okay, thank you.