It’s one of the most overused buzzwords in the industry, but when it comes to understanding what ‘big data’ actually entails, Kirk Kirksey believes there’s a gap the size of Texas. “If you want to see big data, come here,” says the CIO, who shares his thoughts on the ‘holy trinity’ of high-level analytics, the model UT Southwestern is developing for academic medical centers, and why he believes we’ve just scratched the surface of big data. In this interview, Kirksey also discusses what his team is doing to provide IT support for the organization’s three missions — education, research, and patient care; being an early Epic customer; what he believes we can learn from history; and why “culture eats strategy for breakfast.”
Chapter 1
- About UT Southwestern
- Centralizing IT operations
- From Perot to UT Southwestern — “I was really interested in working with the EMR.”
- Keys to change management
- Phased implementation vs big bang
- Mapping out the next 18 months
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Bold Statements
At that time they had multiple competing organizations, no unified email system, several networks, and several data centers, and so we proposed that the university should consolidate all of these operations into a single organization
We were on the bleeding painful edge. We had a couple of early starts and stops. We learned a lot, and from there we just kept going. But it’s proven now to have been a very, very good decision for us.
We didn’t do a big bang. We phased it in. A lot of people advised us not to do this, but we decided we were going to just gradually phase it in, and I’m glad we did that. It took longer, but at each phase we had strong success and strong support.
We had this idea that if we could win the nurses and the nursing staff and the clinical staff, that would serve us to win over the physicians, and that is, in fact, what happened.
There is a move to integrate genomic data with the EMR. Certainly we’re interested in research there, but that type of big data requires large storage, much different networks, and high performance computing capabilities that your typical hospital or healthcare system won’t have.
Gamble: Hi Kirk, thank you so much for taking the time to join us today.
Kirksey: It’s my pleasure. Thanks for having me.
Gamble: Sure. Why don’t you give the readers and listeners an overview of the organization — what you have in terms of hospitals, affiliations, things like that?
Kirksey: University of Texas Southwestern Medical Center is part of the University of Texas system. We’re one of the six health components, as they call us. We see patients, but we are really an academic medical center. Our health system is part of a larger organization with a larger mission. Our three missions are patient care, teaching, and research. We’re not your typical community hospital or standalone hospital; we’re integrated with those three missions. In terms of healthcare, we have clinics and we have an ambulatory practice of, depending how you count them, 40 or so clinics. In 2005 we bought two hospitals close to our campus and we’re currently building a new university hospital that will open in November 2014. We are not a large health system, although we do have the soup-to-nuts ambulatory and inpatient environments.
Gamble: What were the hospitals that came on in 2005?
Kirksey: Zale Lipshy University Hospital and St. Paul University Hospital were combined and purchased and then integrated into our complete health system.
Gamble: What is the connection or affiliation with Children’s Medical Center Dallas and Parkland Memorial? What type of relationship is that?
Kirksey: They are strong affiliates. A lot of their physicians are faculty members of the university so we have contracts with both of those institutions to supply a number of physician and management services at the clinical area. We’re strong affiliates with those. They are two strong partners that we have for patient care.
Gamble: Talk a little bit about the UT Southwestern Information Resources — how that came about and what that department does.
Kirksey: Well, that’s a long story, but I’ll keep it short. In the early 90s, I worked for Perot Systems and we actually had the contract to do the information technology when Zale Lipshy University Hospital was built. It was a standalone hospital. After that, I came and did a contract with UT Southwestern. At that time they had multiple competing organizations, no unified email system, several networks, and several data centers, and so we proposed that the university should consolidate all of these operations into a single organization called Information Resources. I was hired as a Perot Systems employee and had a team to come to the university and make that consolidation. I’ve been in this job about 22 years, but three of those years I worked as a Perot Systems employee and then came to work for the customer.
It’s been an interesting journey. Now, Information Resources is the central computing organization for the university. We cover three missions. We cover all the clinical systems; research and education systems; and administrative systems, as well as the infrastructure help desk — audio/visual, medical TV, telephony, data networks, and wireless, that sort of thing. The Information Resources organization is about 450 people today.
Gamble: How did that come as far as making the transition to UT Southwestern while participating in this project?
Kirksey: At that time — and in IT terms that was a long, long time ago — I was really interested in working with the electronic medical record and integrating patient results because of the problems I had seen. I had been in healthcare all my career, either working in a hospital as a technician or on the IT side, and I was very interested in the electronic medical record. At that time it was in its infancy, and so really the university committed to me that they were interested. They had the funding to back it and so I chose that path because I was most interested in the work that was to be done here and in the commitment by the management.
Gamble: And I’m guessing from your resume that you never looked back.
Kirksey: I never looked back. I’m very happy with the decision. It’s been a great career and a real honor to work here.
Gamble: Obviously then you were part of the early journey to go electronic.
Kirksey: I guess it dates me, but the answer is yes. I started sort of dipping my toe in it while working in Saudi Arabia at the King Faisal Hospital as a programmer, and that was an attempt to write a comprehensive system for a hospital. At UT Southwestern, we went the vendor route. Before the electronic medical record, we built a very large clinical data repository that consolidated patient information from Parkland, the University, and St. Paul and Zale Lipshy when they were independent. It wasn’t really electronic medical record, but it was used for treatment.
From there, at the University, we selected Epic around 2001, and began implementing those at our clinics. At that time, we didn’t own hospitals. When we first purchased Epic and started installing it, we had no idea that we would ever own a hospital, but that developed in about 2004 and 2005.
Gamble: So you were kind of ahead of the game in a way.
Kirksey: We were on the bleeding painful edge. We had a couple of early starts and stops. We learned a lot, and from there we just kept going. But it’s proven now to have been a very, very good decision for us, I think.
Gamble: When the hospitals were purchased in 2005, did they get on Epic right away?
Kirksey: No, they didn’t. They had their own IT organizations. Both of them had IT organizations at the time, and so the mechanics were that we absorbed those IT organizations and then we spent about two years doing the blocking and tackling, integrating them into the HR system, ripping out networks, and making a consistent infrastructure. As part of that we did an IT strategic plan that was about $100 million. Part of that was implementing our EMR into hospitals. So the actual implementation of the EMR in the hospitals did not start until about 2006 or 2007.
Gamble: One topic that’s of great interest is change management. Can you walk us through what it was like to introduce these hospitals to Epic to get them to a different system, and how you managed that change?
Kirksey: St. Paul had a proprietary, in-house written form of an electronic medical record. Zale Lipshy did not at the time. Our physicians were strongly associated with both of those hospitals, and I think our key to that change was we really had strong physician support and strong physician leadership in this area. We had a strong physician team. We had done well installing Epic in our clinics, and we had a lot of credibility doing that. That really served us well. Also, we didn’t do a big bang. We phased it in. A lot of people advised us not to do this, but we really decided that we were going to just gradually phase it in, and I’m glad we did that. The trade-off is it took longer, but at each phase we had strong success and strong support. And so I think the physician leadership and this decision to phase it in served us well to get these implemented and part of the culture here.
Gamble: It’s interesting when you think about the debate between going big-bang or phasing it in. The obvious benefit to a big bang is you’re talking about less time involved but it seems to me like there’s also a lot of risk and a lot of pressure — not that there isn’t pressure all time, but a lot of added pressure. Do you think that’s the case?
Kirksey: I do think it’s the case. We had this idea that in terms of the physicians and CPOE, we would do that last. And then if we could win the nurses and the nursing staff and the clinical staff, that would serve us to win over the physicians, and that is, in fact, what happened. We went with nursing documentation first. The nurses were strong supporters, and that went a long way toward winning over our physicians and getting strong support, just from the physicians on the floor.
But there’s always that trade-off. The big bang it costs less if you’re using consultants. If you phase it in you’re going to spend more time and money with professional services things like that. But if you look at the long run, I’m not sure you end up saving any money by doing a big bang. If it doesn’t go well, you could be in a lot of trouble.
Gamble: Right. We know how rarely things go exactly as planned.
Kirksey: They never do.
Gamble: Yeah. It’s not good to have no room for error, right?
Kirksey: No, it is never good not to have a plan B, C, and D.
Gamble: At this point, in terms of the clinical application environment at the hospitals, do you have Epic pretty much across the board or do you have a few other systems in different areas?
Kirksey: No, we pretty much have Epic across the board. Epic was not mature in several areas early on. For example, we waited for their ophthalmology module. We are not going with their lab module so our laboratory information system is not Epic, but we’re pretty much Epic across the board. Of course, like everyone else, we’re focusing on Meaningful Use and ICD-10, and our new hospital that’s opening — that’s our strategic plan for the next 18 months. It’s what we’ve been doing for the last two years, so we’re getting ready for that.
Those three things have consumed us, but, as I said in the beginning, research is one of our key missions. We’ve spent a lot of time in the last year or 18 months integrating our clinical research mission with Epic. We have integrated our clinical trials management system, Velos, with Epic, which is very important to us, since we do a lot of research here. We’ve been doing a lot of work building up the research side and research computing in the last two years. That’s been a major effort for us.
Gamble: Like you said, having the teaching and research components, I would imagine there’s even more of a need to have enough data capacity and data to be able to provide the data to clinicians at the point of care.
Kirksey: Yeah, you’re exactly right. That’s been a big focus. Of course on the science side, there is a move to integrate genomic data with the electronic medical record. Certainly we’re interested in research there, but that type of big data requires large storage, much different networks, and high performance computing capabilities that your typical hospital or healthcare system won’t have. We have to build that. In the last year, we’ve completed building very, very large dedicated network pipes to super computers in Austin so our scientists can ship and store data there and process it on those super computers down there and we’ll continue to expand that program in the next year.
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