Chris Belmont, VP & CIO, University of Texas MD Anderson Cancer Center, Chapter 1

Why would a CIO want to lead a major Epic rollout after having recently completed the task at another organization? For Chris Belmont — who was asked this very question by his son — the answer was simple: it was a chance to do it better, using the knowledge gained the first time around. In this interview, Belmont talks about how an implementation is like having a child, the two biggest challenges in a major transformation, and how an organization can benefit from disruption. He also discusses MD Anderson’s Moon Shots program, the work his team is doing with IBM’s Watson, how he hopes to improve the patient experience, and the importance of mentoring.

Chapter 1

• About MD Anderson
• PeopleSoft ERP
• From best of breed to Epic
• “Transformation is disruptive.”
• Staffing up with rapid response teams
• Have’s & have-not’s – “You have to be careful not to create a parallel culture.”
• “You can never have enough communication”

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Bold Statements

Transformation is disruptive. It also gives our organization a chance to look in the mirror and say do we need to continue doing things the way we do? So we’re also going through a lot of process improvements.

I think we’re going to be just fine if we learn from others and apply some of the industry best practices and continue to just pay attention to the details.

We had to sprint to get these people hired and in place for their new jobs and onboarded and with places to work and those things prior to them going into training. Your Epic timeline is very dependent on your ability to staff up and get people certified.

Our challenge as leaders is to make sure they understand that they’re part of a bigger picture. And you constantly have to do that. It’s just not saying, ‘hey guys, now go up and do your thing.’

You don’t just blast out everything. The people in the business office don’t really necessary care what’s going on in some of the clinical areas and vice versa, so you have to make sure it’s easily accessible and relevant.

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

Belmont:  Good morning. How are you?

Gamble:  I’m doing great, thank you. To give our listeners and readers some background, can you just give us some information about MD Anderson Cancer Center — how the organization is set up and what you have in terms of hospitals and other facilities, things like that.

Belmont:  I’d be glad to. First of all, MD Anderson is one of the premier cancer centers in the world. It’s based in Houston at the Texas Medical Center, along with other facilities. We’re one of the healthcare organizations related to the University of Texas, so we have some sister hospitals here in the state. About a third of our patients come from the Houston area, another third of our patients come from Texas, and then the other third come from the rest of the world. We’re specialized in cancer care, although we do provide many of the same services that a full-service organization would have — obviously not at the same level or scale.

Our oncology services are premier. One of the things that we focus on is we huddle around diseases, so instead of having a general oncology group, we have centers specific to specific cancers. For example, we have a breast center and a prostate specialty, so we’re very focused, and we have teams that are focused just on those specific diseases.

As far as the information systems go, our organization is approximately about 900 staff and includes quite a few consultants that are doing some backfill work while we’re going through a transformation which I’ll talk about in a minute. We probably supporting about a thousand apps. Like many other organizations, we’re looking to manage our portfolio a bit better. We probably we have too much redundancy and duplication, and I think we have an opportunity not only to reduce cost, but drive out some of the complexity and improve the user experience by more or less standardizing managing that portfolio a little tighter. As with everybody, it didn’t happen intentionally, it just grows that way. That’s part of the transformation we’re talking about.

As far as big projects going on, we’re coming off of a major ERP implementation with PeopleSoft and that’s improving. We had some speed bumps post-go-live like many organizations do, mainly around getting the data back out of the system — the system is functioning fine, but can we get the reporting done properly. So that’s drastically improving.

Our biggest project of late is, like many other organizations, we’re moving our core clinical applications to the Epic platform. Prior to that, we had, I would say, a best of breed environment — some of it homegrown, some of it commercially available. A lot of it had to be customized just because we’re a specialty cancer center.

I would argue that prior to now, or a few years ago, there was not a system that would fit our needs appropriately. We feel that now Epic has matured and that we’ve matured and modified as an organization, this is the time to do it. Our homegrown EMR served us extremely well. It was built around a service-oriented architecture platform, and I think some of those components will continue on and complement Epic very well. But that transformation is disruptive. It also gives our organization a chance to look in the mirror and say do we need to continue doing things the way we do? So we’re also going through a lot of process improvements, taking the opportunity to modify the way we do business, drive additional standardization into the organization, and standardize our reporting and lean out some of the processes we have.

The information system side of things, frankly, is the easy part. I think the change management piece and the process improvement piece are the most difficult. We started on the Epic journey in the fall of 2012, and we won’t go live until March of 2016. The software processes — the implementation of the systems themselves — are working. The challenge now is how do we drive change to an organization that has operated independently probably since its existence. But it’s encouraging. We have a great deal of engagement from our staff, from the institution in general, and from our executive team as well.

A couple of other things are happening with the organization that are putting an interesting twist on things. Obviously we do a huge amount of research. Our 19 petabytes of data is growing consistently due to the genomic information and imaging information and the number of images that we capture. So how do we manage that, not only from an IS and a technology perspective, but from a big data approach in driving good data governance and understanding where the data is and making sure that we leverage it across the institution, and not just in a silo? That’s one of our other major initiatives. And then what analytic tools do you put on top of that and how do we expose it and make it easy to access, but also highly secure? You’re the same thing that probably any other organizations have as far as challenges, but I think we’re going to be just fine if we learn from others and apply some of the industry best practices and continue to just pay attention to the details.

Gamble:  I wanted to step back a little bit. There are so many great things you’re working on, a lot of interesting stuff. I wanted to talk a little bit about the Epic implementation. Now when did you start at MD Anderson?

Belmont:  I started in MD Anderson in September of 2012. So I’m finishing up what’s been a pretty good sprint to get to know the organization.

Gamble:  Right. So at that point what was the status — had Epic have been selected at that point?

Belmont:  Yeah, Epic had been selected as vendor choice, and they had actually gone through the contract negotiations and we were just working through the Texas procurement processes. So in my first month here, I actually had to go with the president and ask for the significant funds related to this project. But it was well done. I think the project was well set up and underway when I got here. The team was not put together yet. Since then we had to hire almost 200 folks — about 60 percent of those are coming from information services, about 30 percent are coming from operations, and then we’re sprinkling in some additional new hires and very few contractors and consultants.

Gamble:  That’s something I think would be an interesting process to put together a team of that magnitude. What was the strategy there as far as what you were looking for?

Belmont:  This is my second time doing this. I did it previously at Ochsner in New Orleans very successfully — it was a little faster, a little more aggressive timeline, but again, I think it was very successful. The same process was applied here.  It’s a team sport, so it’s not an IS project. We always want to say — especially CIOs — that these are not IS projects. This is not. Again, the IS piece is the more predictable side of things. But when we decided to go into this, the first thing we did was sit down with our HR leadership and said look, we need a rapid response team here. They dedicated quite a few resources, and we had to sprint to get these people hired and in place for their new jobs and onboarded and with places to work and those things prior to them going into training. Your Epic timeline is very dependent on your ability to staff up and get people certified, and so getting that number of people on board with the management structure and everything in place was almost like a small start-up. But the organization responded aggressively. Our HR team stepped up fantastically, as did our legal team and some others.

Gamble:  When you said it’s like a small start-up, I would imagine that gives you the opportunity to try create a certain environment rather than going back and having to do that culture change.

Belmont:  It is. The challenge here is that when you bring this team on board, it’s really for a finite period of time. Even though it’s somewhat of a start-up, it’s still a project at the end of the day and it will dissolve back into the organization at some point in time. So you have to be careful not to create a ‘haves and have-nots’ environment. You have to be careful not to create a parallel culture. They’ll all fit together. These 200 folks have a dedicated floor in our building, so they generate their own culture, and our challenge as leaders is to make sure they understand that they’re part of a bigger picture. And you constantly have to do that. It’s just not saying, ‘hey guys, now go up and do your thing.’ It’s constant because they just generate their own gravity more or less. So that’s a constant challenge.

And then others in the institution, especially the folks working on the Legacy platforms — the non-Epic platforms, you have to watch them as much because those systems have to function flawlessly until Epic is available. In our case, it’s over two years. You can’t create this Epic ‘have and have-not’ environment. I encourage anybody that’s going through this to pay a lot of attention to that, because it could get you in a lot of trouble and actually impact the institution during the Epic implementation — right when you don’t need disruption.

Gamble:  Right. That’s a really interesting point. There are so many interesting things in terms of change management. It seems like you can’t have one strategy across the board. You have to have different ways of dealing with different situations.

Belmont:  You bring up a good point, and I think it’s the key thing to any significant transformation project. I personally feel that the two most important aspects of a project of this type is the change enablement or change management piece, and communication. Sometimes you lump those two together, but the reality is you can never have enough communication. There’s always a different mechanism, and even if you blast it out there, there’s always somebody that doesn’t read it, and you’ll surprise them on the day that go live. But more communication is better, and getting it to where it’s relevant and personal is a challenge as well. You don’t just blast out everything. The people in the business office don’t really necessary care what’s going on in some of the clinical areas and vice versa, so you have to make sure it’s easily accessible and relevant.

One of the key hires, I feel, is our communication folks and our change enablement team. We have a total of about eight folks doing that and setting up the town halls. Right now we’re going through a series of grand rounds where we’re bringing in colleagues from around the industry that have done Epic before and talking us through it. We’re using the grand rounds approach that most medical institutions have to bring in these special speakers. The attendance has just been amazing, and I think the benefit will help us through this transition.

Gamble:  Right. There are so many things you have to keep top of mind.

Belmont:  Yeah. And it’s nice to listen to people that have been through it because you’re kind of in the moment and you feel like though this is so disruptive, but the reality is people that are on the other end of it will tell you that it’s a nice feeling.  And I’ll tell you that. I’ve done it once before and it works just fine.

Chapter 2 Coming Soon…