Cara Babachicos, CIO, Community Hospitals and Non-Acute Entities, Partners Healthcare, Chapter 1

There are many people who will pass up an opportunity if the timing isn’t right or the circumstances are less than perfect. Cara Babachicos is not one of them. Her philosophy is to take every opportunity and roll with it, and it has served her well. In this interview, Babachicos talks about her role as the voice of community hospital CIOs at Partners, the massive Epic rollout that will require “all hands on deck,” the challenge of selling users of homegrown systems on a vendor product, and the push for shared best practices across the system. She also discusses Partners’ big data plans, her passion for teaching and helping to build the health IT workforce, how consulting opened doors for her, and the importance of balance.

Chapter 1

• Her role: “I represent CIOs at the table”
• Partners eCare
• Consolidating data centers
• Epic selection — “It was one of the quickest decisions we ever made.”
• Getting buy-in from users of homegrown systems
• Planning a large-scale implementation — “All hands on deck”
• Upgrades and enhancements for ICD-10

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I’m representing them at the table. Rather than have six different people at the table, I aggregate a lot of their concerns and listen to their needs and try to negotiate on their behalf.

Rather than asking the basic questions like, ‘Does your admission system have a save button? Do you store demographics?’ — the basic stuff that just wastes a lot of paper — we cut to the chase and really tried to ask the key questions.

We let the audience hear how we reached our decisions and how different vendors were rated in different categories and such. It was actually one of the better processes that I’ve participated in.

We looked at the fact that they were able to implement a vendor system and do well with it, and said, why can’t we do the same? I don’t think we could have settled on a vendor product that wasn’t in a large academic medical center and have arrived at the decision as easily as we did.

It’s a massive update that will happen across all of our organizations on the same day, and it’s going to require a lot of coordination and a lot of people trained and ready to go on testing. All hands on deck will be necessary.

Gamble:  Hi Cara, thank you so much for taking the time to speak with us today.

Babachicos:  Thank you, looking forward to it.

Gamble:  To start off, let’s give the listeners and readers a little bit of background. Why don’t you tell us a little bit about Partners and about your role there?

Babachicos:  Partners is a large integrated delivery system located in Boston, Massachusetts. It’s comprised of two academic medical centers — Mass General Hospital and Brigham and Women’s Hospital, as well as community hospitals and non-acute sites, and a physician network. We now also have our own insurance company. In terms of my area of responsibility, I am CIO over the non-acute sites as well as the community hospitals at Partners. I actually manage CIOs. I’m in the role where there are site CIOs that report to me and they’re managing the day to day, whereas I’m representing them at the table. Rather than have six different people at the table, I aggregate a lot of their concerns and listen to their needs and try to negotiate on their behalf, and also bring them in, when necessary, to the discussion. It makes the process more efficient overtime.

I’ve been in this role for about two years. Prior to that, I was the VP and CIO over the Partners Continuing Care Group, which is comprised of the Spaulding Network of rehab and long-term acute care facilities, as well as some nursing homes in addition to Partners Healthcare at Home. So my role has expanded over the last several years.

In terms of Partners, we are the largest employer in Massachusetts. We have a really big inbox, if you will, or look-up system. So whenever you try to email someone, you have to be careful; if someone has a pretty common name, you have to be really sure you’re choosing the right person, because there are a lot of John Smiths, let’s say, in our email system because we are so large.

Right now, I’d one of our biggest initiatives at Partners is we signed a contract with Epic to put in Epic System across all of our sites. We are actually calling the project Partners eCare. That’s how we’ve called Epic throughout Partners, and we are hoping to have our first live system with full clinical and revenue cycle installed in June of 2015.

Gamble:  That was obviously a big story when it came out. Now just going back a little bit, Partners is unique in that unlike some of the other large health systems across the country, you do have CIOs at the individual hospitals. As far as with your position, what is the reporting relationship? Do you report to or work with Jim Noga? How does that work?

Babachicos:  I report to Jim Noga. The CIOs for McLean Hospital, North Shore Medical Center, Newton-Wellesley, the Spaulding Network and Partners Healthcare at Home all report to me.

Gamble:  How often would you say that you meet with them? Are there standing meetings or does it depend on what’s going on?

Babachicos:  There’s always a standing meeting — or at least I try to always have a standing meeting once a month where I bring them all together and we talk about some common topics or we bring in speakers that benefit us all. In addition to that, I usually have at least once a month, if not more often than that, a meeting with each one of my direct reports, and then on an ad hoc basis, they call me. Sometimes I talk to each one of them every single day, whether it’s by email or phone. Today I actually will talk to all but one of them, so it depends on the day and what’s going on, but we’re always in touch — always communicating one way or the other.

We don’t all sit in the same physical building. The site CIOs sit at the site, which is important, or they at least have site representation. What we’ve found over the years is that the sites are pushing more and more on the space and trying to get IT off of the physical premises. We just built a new building for the Spaulding Boston site — we relocated to a beautiful new building in Charlestown — and there was no space for IT. It actually doesn’t even have a data center anymore. So there’s some small swing space, and when I’m there to have an executive meeting, I hang out in the executive wing and use my wireless devices as best I can. Our data center was actually relocated to the Partners Data Center. We have a long-term goal across all of our sites to move to one of our Partners Data Centers so that we can streamline and try to reduce some of the costs at the sites.

Gamble:  You mentioned before about the Epic implementation, Partners eCare. From what I can remember, it seems like that was a fairly long, in-depth selection process. Did you have a role in that? Can you talk a little bit about that process and about taking the time to choose the best system for Partners?

Babachicos:  I’d actually have to say that our decision to go with Epic or to make a decision about our clinical system was probably one of the quickest decisions we’ve ever made at Partners. Being a very large organization, you can imagine it takes a long time to get decisions made. Gary Gottlieb, who is the president of Partners and is a physician, basically set up the dates and the timeline so that we all knew we had about three or four months to make a final decision. As part of the clinical steering committee that was charged with this task, we knew we had to work quickly to do a fair assessment of the various vendors in the marketplace and get the right engagement of stakeholders across the system, which was very tricky, because you can imagine when you have some homegrown systems that are very particular and very specialized, it’s often hard to try to sell a physician or other researchers or others on why they should go with the vendor product when they have a very well adapted homegrown system.

So it was a lot of trying to get people on-boarded, doing the vendor selection, and doing the RFP. We actually did request our concept document, so instead of doing an RFI or an RFP, we did what was called an RFC. We basically put together some key concepts that we wanted to make sure were discussed and accommodated for in the contract and then the demos and the site scripts. So rather than asking the basic boring questions like, ‘Does your admission system have a save button? Do you store demographics?’ — the basic stuff that just wastes a lot of paper — we cut to the chase and really tried to ask the key questions.

We engaged a consulting firm to walk us through this process, and we looked at a lot of research that was out there. I don’t want to necessarily mention the periodicals and stuff that we used, but we used a consulting vendor. We looked at different studies. We did some site reviews. We traveled to a lot of sites and looked at two vendor systems that we kind of narrowed down to. We did a lot of simulation or days in the life where we had the vendor on site demonstrating how everything would talk to one another. I was actually even part of a model we had things called Decision Day where four of us were actors and had to represent different stakes. I had to represent that I was for one vendor product and talk about why, and then my three colleagues had to be advocates for other vendors and show the pros and cons. Then we let the audience hear how we reached our decisions and how different vendors were rated in different categories and such. It was actually one of the better processes that I’ve participated in and one of the better exercises I’ve been involved in a long time.

Gamble:  That’s a really interesting way of doing it. I can see the benefits of that. When you’re talking about homegrown systems, that can’t be an easy sell to convince physicians to move over to something that’s integrated. What was the response like?

Babachicos:  First of all, you have to get a large part of the committee and the steering committee engaged as stakeholders and decision makers — the people that we took on the site visits who had a lot of skin in the game if you will; people who had the most concerns about trying to move from a specialized product to a vendor product. We had a mantra at one point that rather than talk about the haves and the have-nots — because there are facilities at Partners that we consider the more privileged in terms of the systems that they have, while some that are not as well interfaced — we wanted to have a system where we would all have about 80 percent of what we needed initially. We tried to set the bar low to say listen, initially, we need to create a foundation and a starting point, and as we adapt this product over time, it will become better and better for all of us.

We also engaged them in a lot of the dialogue. I think one thing that we did that was really important and helpful is we looked at our peer sites; sites that we consider prestigious and that are kind of along the same lines of the research that we’re doing and the medical care that we provide, such as Cleveland Clinic and a lot of larger IDNs out there. We looked at the fact that they were able to implement a vendor system and do well with it, and said, why can’t we do the same? I don’t think we could have settled on a vendor product that wasn’t in a large academic medical center and have arrived at the decision as easily as we did.

Gamble:  You said that the goal is to have the first go-live in June of 2015. Where was that going to be?

Babachicos:  There are a couple of different ways we set this up. So initially, just to talk about the scope of the work that we did as a steering committee, we were charged with trying to find a clinical system to put in at Partners, and at the end, we signed a contract for a revenue cycle and clinical system, or the full Epic suite. We decided that trying to do a lot of the interfacing and trying to marry two disparate systems together would not have as much value added as trying to put one system in across the board. So that’s the first piece where the scope changed. There are two installs that are happening before June 2015. They’re actually putting in just Epic revenue cycle at Newton-Wellesley and at Mass General, in the Mass General family. Then the first big bang, as we call it, which is where we put in both revenue and clinical, will be for the Brigham and Women’s Faulkner Family, and that will be June of 2015.

Gamble:  I imagine that when you’re talking about a rollout out of this magnitude, there are several phases that have been mapped out.

Babachicos:  Yes. There are a lot of phases. So for example, we looked at all of our sites across Partners and said, how we roll this out? How do we do it in a way that it kind of fits? There are a lot of facilities that are closely dependent on one another or part of a family, so rather than saying, ‘do we do the academics first or do a community hospital first — how do we go about it? With the clinical system, I think one of the things we were very aware of is that if we were going to get a lot of physician buy-in and we wanted to use the clinical groups strategically and really kind of leverage them for what they had to bring to the table, we should let them see the benefits of all their work early on. So we made a decision to do an academic medical center as our first install for the clinicals.

That being said, there are a lot of different ways we’ve created families; we have the Brigham and Women’s family and the Mass General family, but we’ve used that term loosely in that there are some facilities rolled up into the family that are really not that closely aligned, but they might have some shared medical practices or outpatient buildings. Partners Healthcare at Home, which is also one of my sites, will go early on — they will go live shortly after the Brigham Faulkner Family. We felt that as an overall way of approaching it they needed to have some clinical documentation in hyperspace and other modules in order to really value sharing the documentation that will come out of homecare and the referrals that will go back and forth. And then we also have the physician practices; at this point, we are installing those within the family that will be going live, so the physicians associated with the Brigham will go live at the same time as the Brigham family. And then toward the end, any facilities that we purchase or acquire or merge — whatever term we want to use — will be at the end of the install so that we can do what’s right by all the other facilities that have been waiting so long for one common system.

We’re also doing a 2012 to 2014 Epic upgrade, and some of that’s important for ICD-10 as well as to get some of the key enhancements that are needed at some of our facilities. So it’s going to be a lot of moving parts for sure, and it’s going to change how we operate and how we think about even the updates. Now it’s a massive update that will happen across all of our organizations on the same day, and it’s going to require a lot of coordination and a lot of people trained and ready to go on testing. All hands on deck will be necessary from that point forward.

Chapter 2