Bobbie Byrne Talks About Epic

Bobbie Byrne, MD, CIO, Edward Hospital & Health Services

Before she joined the staff of Edward Hospital in late 2009, Bobbie Byrne had never once thought about becoming a CIO. But when she was approached by a recruiter who told her that the organization wanted a physician, she was immediately intrigued. The move turned out to be fortuitous; just a year into her tenure, she led the way as the organization migrated to a new platform that would provide an integrated patient record. In this interview, Byrne talks about the process of selecting a major IT system, what it takes for an organization to make IT its top priority, and how her experiences as in the clinical and vendor worlds have shaped her role. She also discusses the state of HIE in Indiana, what she really thought of the ICD-10 delay, and her concerns about the IT workforce shortage.

Chapter 1

Chapter 2

“I have to prove my worth at every interaction”
Replacing every department system in the next year
Not letting projects sit on the back burner
Data warehousing strategy — “build, deploy; build, deploy”
Waiting to attest until they’re live on Epic — “It’s the right thing to do for the organization”
Seeing MU as a bonus, not a driving factor

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Bold Statements

I have to constantly be saying, ‘Yes, I’m a clinician, but let me prove to you the ways that I really am thinking about your workflow; the ways that I’m really thinking about your time, your efficiency, your patience, and the types of problems that you’re seeing day-to-day.’

I don’t think we would have ever chosen to do a major Lawson ERP implementation at the same time we’re doing a big clinical revenue cycle implementation, but I think actually every department system is changing in the next year.

I’ve seen it where you spend an enormous amount of time building and designing the data warehouse, and then you get four or five years into it and you’re really not able to get a lot of value. So I was very lucky to have an outstanding data warehouse architect and she and I were on the same page of ‘let’s start small and start gaining the value.’

We’re in a process where we’ve completed putting in all of our legacy systems and now the team is going to do the switch so that as we start getting data out of Epic, they can put that into the data warehouse and then continue to be able to cross and look at that data — not only against legacy data, but against all the other systems that are feeding in there.

Gamble: Do you feel that because you have that clinician experience it benefits you in some way; maybe in being able to relate to clinicians and being able to say, ‘I’ve been in your shoes.’ Do you find that that’s helpful?

Byrne: People ask about that a lot. I think it helps at the beginning. It gives you the benefit of the doubt; it allows you to short-cut things. It just happened yesterday where I was having a conversation with some individuals on my team and I made a comment about physician rounding workflow and they sort of pushed back and I said, ‘No, no, I know what I’m talking about.’ And we were able to kind of short-hand the conversation as opposed to kind of continually speculating about what physicians might want. So that can be very helpful, but I don’t think that clinicians — or anybody for that matter — is so simple-minded that they would say, ‘You’re a clinician, I’m a clinician. Therefore I’m going to agree with everything.’ I have to prove my worth at every interaction. So I have to constantly be saying, ‘Yes, I’m a clinician, but let me continually prove to you the ways that I really am thinking about your workflow; the ways that I’m really thinking about your time, your efficiency, your patience, and the types of problems that you’re seeing day-to-day.’

And then there are a lot of times when I’m like, I’m a pediatrician. I don’t really understand the stresses that an orthopedic surgeon has. I don’t know what they’re trying to do when they come out of the operating room. I mean, I have a sense that they’re trying to get into the next case; they’re trying to make sure patient one is stable while they get they working on patient two, but I don’t really understand that. And so I say, ‘I don’t really understand how that works. Let me make sure that I have a partner who can help me with that.’ I’ve seen physicians be terrible communicators of IT and physician who are great — it’s the individual as well.

Gamble: Okay so we talked about Epic and how you have the first go-live around the corner. I know that’s pretty a consuming project, but what are some of the other big projects that you have on your plate now and in the near future?

Byrne: It would be absolutely fantastic if Epic were the only project that was going on. That would be easy — I’d be knocking off at 3 o’clock every day. I’m kidding about that, of course. But the other big project we have going on is a Lawson implementation. I don’t think we would have ever chosen to do a major Lawson ERP implementation at the same time we’re doing a big clinical revenue cycle implementation, but I think actually every department system is changing in the next year. And we used Meditech for a lot of those functions previously, so with the departure from Meditech, we needed to find some things for the general ledger — for materials management, for accounts payable, etc. That’s a very significant implementation that’s hitting finance and materials, but it also hits every department around charging, OR, pharmacy, etc. So as they’re turning over their major clinical systems, they’re also turning over their supply system as well. So that’s going on.

We have another very significant ongoing project around data warehousing. We’ve been working on that for several years and have really started to see some of the benefits of the investment in the data warehouse, so that continues to grow, and now as we switch to Epic and Lawson, there is a fair amount of work that needs to be done there. We’re going to turn over our fetal heart rate monitoring system just as part of the integration with Epic, but again, fetal heart rate monitoring is a very unique situation with all of the data integrity and data preservation that happens there. So that’s pretty significant.

And then we’re trying to make sure that that we keep going on some things that maybe would be tempting to push to the side. So we’re making an investment in SharePoint and how can we use SharePoint more efficiently for communication and for connectivity between groups and to our patients and to our consumers. And so we’re trying to maintain some focus on SharePoint as well. I’m sure we have a few other things going on that I can’t think of right now.

Gamble: Well still, that sounds like a lot right there. And the data warehouse project — what kind of phase is that in right now?

Byrne: There may be some phasing of data warehousing that I’m not aware of. I’ve seen it where you spend an enormous amount of time building and designing the data warehouse, and then you get four or five years into it and you’re really not able to get a lot of value. So I was very lucky to have an outstanding data warehouse architect and she and I were on the same page of ‘let’s start small and start gaining the value.’ So clearly there’s just some infrastructure of setting up and doing some of the transfer, but as we continue, we’re not going to do a build phase and then go into a utilization phase. She would build something, and we’d deploy it, then build-deploy, build-deploy over and over again so that everybody continues to see the value and they say, ‘The next thing I want in here is I really want to get my OR data in.’ Or, ‘let’s get our patient satisfaction data in,’ so that it provides a little bit of value yesterday, more value today and even more value tomorrow just as we can continue to feed other systems in.

So right now, we’re in a little bit of a process where we’ve completed putting in all of our legacy systems and now the team is going to do the switch so that as we start getting data out of Epic, they can put that into the data warehouse and then continue to be able to cross and look at that data — not only against legacy data, but against all the other systems that are feeding in there.

Gamble: That seems like a really smart way to do it so like you said, you’re not waiting so long to get something out of it; you’re able to get a little bit out of it and then more and more as things progress.

Byrne: The other piece is that like everywhere else, it’s hard to justify the FTEs unless you have some benefit. So I was able to start with one person and then have the team go to two people because I said, ‘If you give me another person, we can start moving faster.’ And then I’m able to go from two to four, and now we’re going to probably add two more people. But if you just say, ‘I need six people before I can give you any value,’ nobody in my organization would support that. They’d say, ‘Forget it. We have better use for six people.’ Whereas if I can say, ‘Wow, look at how one person can do; can you imagine what two could do? And now can you imagine what four can do?’ So it’s a lot easier to gain buy-in for the investment by taking this kind of approach. And honestly, this is where the partnership comes in. I’m not a data warehouse person; if I didn’t have a really strong architect who I could work together with on this, it would never have gone anywhere. It’s the kudos to her.

Gamble: Alright, so in the midst of all of this, how are you positioned for Meaningful Use? Have you attested to Stage 1 yet? Is that something you’re looking at?

Byrne: We have not attested yet. We could have attested for our ambulatory physicians on Allscripts, but we chose not to because there was really actually no incentive to do so — as long as we attest this year, we’ll still have the full money for all of the physicians. And we were concerned about switching systems in the middle of attestation and thought that because if you miss a year, you get less money, and we didn’t want to take that risk because of missing on year two or year three.

For the hospital, I know that they have certified Meditech Magic and there are hospitals that have attested for Stage 1 on Magic. The amount of implementation we would have needed to have done on Magic in order to qualify for Stage 1 was too much. It was just too much of a gap and we didn’t want to put that implementation investment into a system that we were going to move away from, so we’ll go live on Epic and then we’ll attest.

It makes us a little bit of a laggard on the timing for Meaningful Use, which is unfortunate because I’m pretty competitive and I don’t like to be at the end of anything, but our finance and our board is completely fine with it. They see Meaningful Use as a bonus for us doing the right thing and doing the things we were going to do anyway. This was not a driving factor. It’s a decent amount of money but it’s not enough money for us to do stupid things for the hospital so they had a pretty good attitude about it.

Gamble: It just seems to make sense to me that if you know you’re going to migrate to another system, why not wait if you can and deal with the Epic system for Stage 1, and that maybe puts you in a better spot for Stage Two.

Byrne: Right, I think so. I mean, I think we could have squeaked by on Stage 1 on Meditech, but then, depending on the timing and how we did it, we would have potentially had to, in a single year, change systems and move to Stage 2. And since at the time we made the decision, we didn’t even know what Stage 2 was going to be—we didn’t even have the hints because the MPRM wasn’t out yet—we just thought that would probably just be too difficult to do. It’s hard to move a hospital; it’s hard to move quickly. There are a lot of people; thousands of people need to be involved.

Gamble: Sure, especially with the number of physicians you’re dealing with.

Byrne: Right.

Chapter 3

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