Cara Babachicos, CIO, Community Hospitals and Non-Acute Entities, Partners Healthcare
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 2
- The current clinical landscape — “I think we have every vendor represented.”
- Sharing best practices
- Creating a blueprint for the Epic rollout
- State-of-the-art IT at Spaulding
- System upgrades — “We try to stay ahead of the curve”
- Big data plans with Health Catalyst
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There are always communication challenges, and I’m constantly trying to make sure I’m representing my sites and my folks as best I can and that I always know what the ongoing issues are.
We have people who are experts in that one particular product and we’re trying to say, can we put in this interface engine? Let’s say that one of our sites doesn’t have one at all — can we leverage it and also try to share staff more effectively?
I think over time we’re going to get even stronger in terms of how we align with one another. I think it also creates a little bit of a family so that we can talk about things.
What we’re trying to work on is how we can best standardize our clinical documentation for all our points of contact and our transitions of care so that we can be an example for how we want the Epic System to look going forward.
I think MU and some of the work we’ve been doing with genetics and research over the years have always pushed us to do more with the data we have and to leverage repositories. It’s now just trying to do a lot more ‘what if’ analysis.
Gamble: As it stands right now, are the hospitals that fall under Partners on different systems? I know that some of them have homegrowns, but what is the picture right now?
Babachicos: So at Brigham, I would say most of the Brigham and Women’s Hospital is homegrown. In terms of their underlying technology, a lot of it is written in cache, which happens to be the same language, if you will, or database that is in place in Epic. So there are some synergies there in terms of some of the development work. Faulkner is a community hospital and they actually run the Meditech System as their primary information system. With Dana-Farber, as the relationship stands kind of with them, they actually have a lot of homegrown systems as well as some vendor products. Mass General has a combination. They use some of our homegrown products for the EMR, but they also have vendor products.
The community hospitals, for the most part, run different versions in that they are different instances of Meditech. They’re not all on one shared server. North Shore Medical Center runs the Siemens legacy product. McLean’s specialty hospital, McLean Mental Health Hospital, actually runs Meditech Client Server for the mental health product. And then homecare runs Cerner, and the nursing homes are on Keane. I think we have every vendor represented within Partners in one way or another.
Gamble: Okay, so obviously it’s going to be a big change going to Epic. I would think it would be even more difficult to make this kind of change happen if there wasn’t somebody in your role, and instead, you just had these separate site CIOs. Was this maybe one of the motivations for creating the role of somebody who oversees the CIOs?
Babachicos: There are still CIOs at Brigham and Mass General, just to be clear. For the community and the non-acute entities, I think it does help organize things and make things more effective in some ways. There are always communication challenges, and I’m constantly trying to make sure I’m representing my sites and my folks as best I can and that I always know what the ongoing issues are. It’s kind of a learning exercise as time goes on to make sure you understand what the key points are and that you’re always thinking of all the other moving parts. When we’re on one common system, it’s going to be a lot easier, absolutely, but we’re also looking for a ton of opportunities to share what we do now.
One example of what’s going on is at the community hospitals, we haven’t hired or we don’t have any security officers in the same realm that we do at the academics. The CIOs at the sites were often the security officer when there was a breach or an incident that took place. Now we’ve hired some designated folks and we’re using a shared model. For instance, the person we just hired last week is going to be across Partners Continuing Care. They’re going to represent both the Spaulding Network and homecare, learn the cultures of both, get assimilated into the organizations and help with training, and guide and then take the lead as project manager if there is a breach. The same holds true with Newton-Wellesley and McLean — we’re hiring a second role that will actually be a shared role across both of those sites.
We’re looking for opportunities to manage some of the Meditech architecture more efficiently across our sites. We’re looking at leveraging common interface engines and sharing our staff more effectively over time to leverage our interface engines in that a lot of our sites have them. We have people who are experts in that one particular product and we’re trying to say, can we put in this interface engine? Let’s say that one of our sites doesn’t have one at all — can we leverage it and also try to share staff more effectively? Then even how we’re going to model our analyst support, because there will be a lot of legacy system work we need to do as we are also gearing up for the new vendor products. How do we share and consolidate some of our analysts so that they all feel like they are learning the new system while also supporting the old system? Hopefully, it will help retention overall and make people feel good about what they’re doing.
Some of this is still in the works, but I think over time we’re going to get even stronger in terms of how we align with one another. I think it also creates a little bit of a family so that we can talk about things. There might be an issue that’s hard for one of the sites to deal with where when we come together and talk openly amongst ourselves. I think it helps feel like you’re not alone in this and that we can often hear what other sites are experiencing or what some of the staff are experiencing, because you can imagine that if you know Meditech or Siemens and the these other systems, you have some initial angst about how you’ll fit in to the new world. They will fit in, but it’s trying to create that road map to help people understand how we’re going to be bridging both systems over time and moving to a common system. I think that helps too.
Gamble: I’m sure it will really help to have that kind of a support system, especially as you move closer to the Epic implementation, and can have those shared best practices where facilities and leaders can learn from each other.
Babachicos: Exactly.
Gamble: So I feel funny asking what the other major projects are because it probably doesn’t get much bigger than that, but what are some of other pressing priorities for you right now? In terms of Meaningful Use, where do you stand?
Babachicos: With Meaningful Use, there is some variability across the different sites. Some of my sites are further along than others. The non-acute sites are not actually eligible at this point for Meaningful Use, and so they aren’t working on that same paradigm. At a lot of the sites we’re still putting in systems in order to meet Meaningful Use requirements, knowing that some of these systems might not persist over the long haul, but some of this is work that was already underway. For the non-acute sites, I would say that we are pretty advanced in our use of advanced clinical systems. So even though there haven’t been the same drivers, if you will, with Meaningful Use and healthcare reform pushing it, we’ve been putting in CPOE, electronic med administration records, and nursing notes and physician documentation for years.
We’re trying to keep along that path without actually outlaying a lot of capital — leveraging what we already have and trying to operationally improve it where we can and install it if it’s been purchased and just not done at this point, because we believe that will actually help people understand more when we try to move into Epic. It will get your head around working on an electronic system.
The other thing that we’re trying to push from a clinical documentation perspective is more of a longitudinal care plan. So as part of Partners Continuing Care, we have a very large representation of the non-acute sector, with rehabs and long-term acute care, nursing homes and homecare. What we’re trying to work on is how we can best standardize our clinical documentation for all our points of contact and for our transitions of care so that we can be an example for how we want the Epic System to look going forward. We’re trying to create a comprehensive document that can move from site to site and be absorbed into their standards of practice that will persist and can be handed to Epic as how we would like to see our documentation look going forward, which I think will benefit everyone.
And then you have the typical architecture stuff like Windows 7 and making sure we’re all moving off the old Microsoft platforms and on to the new. We’re looking at server costs and trying to virtualize wherever we can and trying to reduce costs. Over all that are the security challenges that come at us day to day related to encrypting our devices and our desktops and making sure we are doing the right thing with PHI. There are always projects of that nature as well that we try to do to keep ahead of the curve where we can.
I’d say those are probably some of the bigger projects. Another one very large project that just went live is the Spaulding Hospital in Charlestown, which was just built. A lot of really cool technology was put in place. The CIO who manages that site, John Campbell, did a great job of putting in voiceover IP and digital media, and then leveraging the data center model so that we’re now using the Partners Data Center. I think all those things combined are just great wins we’ve done across the different teams, and there are more of coming as time goes on.
Gamble: When you talk about things like CPOE that were already in place and the longitudinal care that has to be a nice validation that you are on the right path, even before the federal initiatives came down. I’m sure that’s something that’s a nice win also.
Babachicos: Definitely. I think it helps with communication. It helps with transitions of care. And the more we can try to standardize that documentation, I think it will overall be much more beneficial for the patient.
Gamble: In terms of analytics, what are you looking at in that area? Have you started down that road?
Babachicos: Yes. There’s a lot of work going on in our analytics warehouse. You may have seen in the news that we just signed with Health Catalyst to do a little bit of analytics. But we have a lot of different repositories to date, and so over time, we hope to aggregate the repositories into more of an analytics warehouse. But it’s going to be a gradual process with Epic. There are a lot of different ways you can do reporting in Epic. Some of the terms I’m not all that familiar with, yet but you have Workbench, you have the standard reports, and there are also warehouses you can leverage. We’re working a lot on trying to define what will the end user experience look like — what will business analysts do on a day-to-day basis? What will their workload look like, and how will they leverage common data sets? What will be built for them versus what they’ll have the ability to build on the fly?
Now that we also are starting to own an insurance company and work in that arena, there’s probably a whole new set of data points that we now can start to map and understand as time moves on. I think Meaningful Use and some of the work we’ve been doing with genetics and research over the years have always pushed us to do more with the data we have and to leverage repositories. It’s now just trying to do a lot more ‘what if’ analysis and analytics related to clinical care. But I don’t have a deep understanding of much more beyond that at this point. I think there’s more to come in terms of those initiatives that will come out of IT.
Gamble: It’s a really interesting area. What you mentioned about the insurance piece, that’s really going to be a game changer for the whole organization.
Babachicos: Potentially, I think we also have to look at what that means going forward and how it will work for us, because at this point it’s not health insurance that we’re offering to our employees or anything like that, so we’ll have to see how it all plays out. Partners, I believe, is self-insured, so we do some of the administration of our health plans, but we still have all the big carriers that we offer as health insurance for employees.
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