After accomplishing what she set out to do at University Hospitals Health System in Cleveland, where she oversaw a major upgrade and full system deployment, Mary Alice Annecharico, RN, decided it was time for a new challenge. So she ventured across Lake Erie to Henry Ford Health System, a large, Detroit-based organization that is transitioning from a home-grown system to Epic’s EMR. In this interview, Annecharico talks about why Henry Ford appealed to her, the path from clinical nursing to CIO, and how her early career experience shapes her current role. She also discusses the importance of knowing what drives an individual, her IT philosophy, and why nurses can make effective CIOs.
- Identifying nurses with IT potential
- Why nurses can make good CIOs
- The Epic install — the planning stage
- No upfront application customization — “We’re going as close to model as we can”
- Enterprise rollouts at the departmental level — some tough conversations
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I think nurses can distinguish themselves. I think that it is a very supportive environment to mentor and train nurses to move in those directions by giving them the experience, and showing them that there are opportunities that can be made available, whether in their organizations or in the industry.
The opportunity for nurses in a role like clinical leadership can transcend if they are able to appropriately and effectively communicate with the business world, into that of technology leadership.
The experience and the large footprint and penetration of Epic in the industry has led it to become a much more robust environment — not just in the clinical space, but also in the business revenue cycle space. So it became a good match for this environment.
We are also, because of this aggressive time frame, utilizing consultancy services that have a broad experiential background and have the competencies that we lack so that we can get ourselves up to speed for the long haul.
This is an environment that has been very used to customization. And in order for us to be very successful here, we have to help move the organization’s thinking from customized to what will work for the long term.
Guerra: You mentioned the prevalence of nurses in leading IT change. Certainly everyone seems to agree now that if you can get clinicians involved in IT leadership, that’s the way to go. Now, there was nothing that were about to identify about yourself that would have made you good candidate or that identified you — you weren’t playing with the latest gadgets and someone saw you and said, ‘hey, there’s a nurse with IT technology.’ So my question is, as a CIO and to your fellow CIOs who are also of the mindset that nurses can really be helpful on the IT stuff, is there a way to identify which nurses might be good candidates to be brought over to IT?
Annecharico: That’s a great question, Anthony. I think there are some characteristics about nurses that can set them apart and help influence a transition into IT from where they are. If they can make good clinical decisions; if they have good critical thinking skills and they can apply them to an environment, whether that’s a clinical or business environment; and if they have a thirst for technology, obviously, that’s one of the angles that will help them transcend. If they have a thirst for understanding and valuing the utilization of data, it’s also another distinguishing mark. But there are clinical informatics programs that nursing has developed over the years, and one of those that I can think of readily is the one for the University of Maryland that has really helped set nurses apart to enable them to go beyond their clinical roles — the roles in which they were trained and educated and from where their experiences is earmarked. It gives them an edge and that probably was one of the distinguishing fields for nursing far sooner than it was for physicians who are also attempting into this field in very productive and powerful ways.
I think nurses can distinguish themselves. I think that also, from the perspective of those of us who have the privilege and opportunities to move into technology areas, it is a very supportive environment to mentor and train nurses to move in those directions by giving them the experience, and showing them that there are opportunities that can be made available, whether in their organizations or in the industry. In the roles that I’ve played in healthcare consulting, a lot of time was taken in developing competencies in new staff to help them develop in their area of their specialization, whether it was informatics or implementation or critical thinking skills and strategic planning and clinical integration; giving the opportunity, opening the doors and leading them to those processes of change until they develop those competencies. It’s the same thing on the healthcare side. I had the opportunity to support and sponsor staff who were not in a clinical field to leave IT and move into nursing roles and going to nursing programs and get their credentials and move into clinical areas. So it’s worked in both directions in my career.
Guerra: I may be going out on a limb here, but do you see a similarity between the way nurses have to communicate with physicians in order to be successful? Physicians are very busy and very demanding and nurses have to handle them a certain way to get the information they need. So do you see that dynamic and that training and that experience almost similar to the way a CIO has to get the other C-suite and clinician leaders to buy into the other IT vision — are there some similarities there that could prepare a nurse for a CIO role?
Annecharico: Absolutely, I think it’s a beautiful parallel that you have described, Anthony. The opportunities are there for nurses who are communicators, who are the bridge between health and disease states, who are the bridge between the provision and planning of care with the physicians and delivery of that care to the patients. They are good communicators and they tend to be able to translate, relevantly, the exchange of data and the exchange of good thought processes into outcomes of care and outcomes of the business. So the opportunity for nurses in a role like clinical leadership can transcend if they are able to appropriately and effectively communicate with the business world, into that of technology leadership. I also feel that because of the interest by clinicians — and that includes physician and nurses as well as lab techs and medical records managers — the migration into the technology space represents that concrete evidence that it’s a communication-by-team event at University Hospitals. And here in Henry Ford, I have numbers of clinicians and staff and physicians who are leading the change for this massive implementation of Epic over a three-and-a-half-year period of time.
Guerra: Let’s move into some of the Epic stuff. I just picture people listening to this interview who are implementing Epic and saying, ‘come on, get to the Epic stuff; we need help. Talk about the Epic stuff.’ So, first question: you had some Epic experience previously?
Annecharico: I did. However, it was at the University of Pennsylvania, so it’s dated, and it was only on the ambulatory side. I was leading the team that helped with the first pilot of the Epic implementation and the subsequent planning for the ambulatory space. The product, the process, and time has been on the side of Epic because it’s matured and is so much more functional in that space but the relevance to what is happening in the Henry Ford environment is very germane. Again, they looked at Epic 10 years ago and said, ‘we’re further ahead than they are.’ The experience and the large footprint and penetration of Epic in the industry has led it to become a much more robust environment — not just in the clinical space, but also in the business revenue cycle space. So it became a good match for this environment.
Guerra: Describe to me the stage of implementation that Henry Ford is at. I imagine that in your mind, you can break down this whole project into a certain number of phases. What phase is Henry Ford in?
Annecharico: It’s in the planning stages right now. We have signed the contracts as of late November and the implementation, planning, and the staging of the teams is now in place. We have 150 dedicated resources from across the landscape of Henry Ford in training and education right now. We are getting them through the competencies that they must achieve in order to be able to build the system. But that is all happening right now, so we are still in staging and setting the concrete time frames for how we will roll out the project over the three-and-a-half-year period of time.
We are also, because of this aggressive time frame, utilizing consultancy services that have a broad experiential background and have the competencies that today we lack so that we can get ourselves up to speed for the long haul. That is going to be an important segmentation of our workforce, and I think it will help us ratchet up the throttle and get into development mode. We are very purposely going to be utilizing the footprint of all the applications that Epic has developed and will deliver, with the exception of a couple of our diagnostic areas — radiology and laboratory at this time. In order to do that, we are planning to go up with the model version of their modules, meaning that we will not, as is typical of Henry Ford style, be customizing the applications right up front. We will be putting in as close to model applications as we possibly can so that we can maintain this aggressive time frame.
Guerra: That definitely can make things easier on the front end, right?
Annecharico: Well, it will make them easier, but at the same time, Anthony, it will require that we become extremely focused on change management. This is an environment that has been very used to customization. And in order for us to be very successful here, we have to help move the organization’s thinking from customized to what will work for the long term, and help create the footprint of change management that says working with our workforce, these are the goals and objectives of this and this is how we’ve agreed that we will measure our success and let our workforce become part of the metrics that matter so that we can celebrate those small successes as each one of them are incrementally achieved; so that we can utilize the footprint of those small successes along the way to help maintain the momentum and achieve our goals.
We will realize that we are going to have many challenges along the way in establishing a fully integrated delivery system, utilizing at the same time that we’re putting in the clinical components. We are changing our business office operations to be a centralized business office across the footprint of all of our hospitals, which today have multiple systems and are in varying phases of their utilization and integration. So this is creating a landscape of integration across the business and the clinical units in a way that will revolutionize the integration strategy of this organization far faster than what it had been able to achieve with the customized applications.
Guerra: It certainly is the big trend, getting away from the departmental one-offs and customization so you have that integration across applications. But when it comes down to doing it on the ground, sometimes you’re taking away a little departmental system that these people loved and it worked for them, and you’re giving them something that doesn’t work as well for them but is better for the overall organization and the flow. So you definitely need that buy-in from management, because there could be some difficult fights on the ground, correct?
Annecharico: So true, and what we’ve put in place, Anthony, is an incredibly dynamic governance process. We have a charter that represents that you make decisions once and keep moving for which we have distributed investment and involvement at steps along the way. The steering committee is comprised of a composite of leadership across the landscape of the organization, both from a business and clinical perspective, as well as the partnership relationship that IT has with the organization. This is not an IT project; it is an institutional project and is led by the business units, the physician adoption leader, Dr. Michelle Schreiber, MD, and IT. So it is really a triumvirate process that does not earmarked as IT; it is being done for business and clinical purposes. And the leadership team is comprised to support that.
The momentum for all of this is being born by a series of workgroups as well as leadership and advisory groups to make decisions at the lowest level possible and keep moving the agenda forward. I think that will be a distinguishing opportunity for us to be able to leverage what has gone well in those departmental systems that will be changing as well as those departmental systems that we need to create adaptations to so that the single source of truth is the Epic environment, and that we lead the change through focusing on that being the integration strategy.