Theresa Meadows, SVP & CIO, Cook Children’s Health Care System, Chapter 1

Twenty years ago, Theresa Meadows took a rather big risk: she said to the CIO at her organization, “I want your job.” The courageous move paid off, and she gained a mentor that helped steer her toward her ultimate goal. Now, Meadows serves as Senior VP and CIO at Cook Children’s, one of just a few integrated pediatric health systems in the country. In this interview, she talks about how Cook Children’s is partnering with vendors to make EHR systems more pediatric-friendly, what they’ve done to dramatically increase portal usage, and the groundbreaking work her team is doing with medical homes. Meadows also discusses the tricky transition from nursing to IT, how her nursing background has helped shape her leadership strategy, and the mistake CIOs can’t afford to make.

Chapter 1

• About Cook Children’s
• Focus on ambulatory growth — “It’s critical to our overall system strategy.”
• Meditech in hospital, athenahealth in physician practices
• Upgrading to Meditech 6.1
• Enabling mobility — “Clinicians are always in motion.”
• Telehealth pilot
• MU reporting metrics — “They’re still mostly very adult-driven.”

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Nurses, doctors, and lab techs are always in motion; to have something that’s static and stuck in one place is really not conducive to their workflow. So I’m very excited about mobile opportunities, and it’s good to see our partners really embrace moving in that direction.

It also has an added layer of complexity to any kind of IT project when you’re constructing a building which has lots of other IT and doing an upgrade at the same time. It’s probably a little risky, but also can be very rewarding.

We see a good opportunity to follow up with kids for specific disease states at home. So we’re really excited about what telehealth can bring to that population, and hopefully that will begin to allow more and more use of that technology.

We saw Meaningful Use as something we were already striving for before the regulations came out, so for us it’s more about being prepared, and if there are penalties that begin with the Medicaid population, then we will be prepared for that.

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

Meadows:  Thanks so much, Kate. I really appreciate the opportunity.

Gamble:  Great. So to get started, can you just give our readers and listeners a brief overview of your organization, in terms of what you have for hospitals and where you’re located, things like that?

Meadows:  Cook Children’s Health Care System is located in Fort Worth, Texas. We’re a large, not-for-profit pediatric integrated delivery system. What that means is we have the ability to see our children really from beginning to end. We have a large hospital as part of our health system, 400-plus beds with a 100-bed neonatal intensive care unit. So a very large hospital that we take care of really sick kids in. We also have two joint ventures that we do with ambulatory surgery centers in different areas of the Fort Worth Metroplex.

We have a large home health business. That’s a little bit unique in that our home health company really only provides services to kids who need special care in their homes, which also includes durable medical equipment as well as prosthetics. We actually make some of our own prosthetics, which is a pretty neat process for our kids. We have a large physician network; we employ around 350 physicians, which are comprehensive of primary care and specialty care, with about 80 locations now. The number continues to change on a regular basis. We’re growing pretty steadily in our ambulatory areas. We probably will add six or seven more clinics in the next year coming up.

And then our last bit of business that we support is actually a health plan. We have a Medicaid health plan that supports the state of Texas for Medicaid and CHIP eligible patients. So that includes kids, but it also includes adults, maternity care and some of those things. The health plan has about 120,000 members — so not an extremely large health plan, but a good mid-sized health plan and that particular business continues to grow as well. So a very diverse group of populations that from an IT perspective we support, which brings a lot of fun and unique challenges for me and our team here at Cook.

Gamble:  I can imagine. What is the size of your staff approximately?

Meadows:  We have about 200 people on staff, which is probably large. Our primary EHR system is Meditech, and people think that’s pretty large IT shop for a Meditech hospital, but it’s because we have all those other business lines that we have to support. So we’re an average mid-sized IT shop.

Gamble:  Meditech is in the hospital?

Meadows:  Meditech in the hospital, and then we’re athenahealth in Ambulatory, so all of our physician practices use athenahealth for practice management and electronic medical record.

Gamble:  And what version of Meditech are you on?

Meadows:  We are on 5.6.6. One of our big projects this year coming up is we’re going to be converting to the 6.1 platform of Meditech.

Gamble:  What kind of timeline are you looking at?

Meadows:  We actually are kicking off the project in June. It’s about a 12-month project, so it’ll go from June of this year until August of next year. That’s probably one of our major initiatives since that is a big transition from our current version of Meditech. It’s almost a new platform. And so our teams will be fully dedicated to that process for the next 12 to 18 months.

Gamble:  That is a pretty big jump. What was the rationale behind doing it that specific way?

Meadows:  It’s interesting because here at Cook, we always like to have lots of initiatives going on at the same time, so part of the reason we chose this timeframe to do the upgrade to the Meditech 6.1 platform is we are in the process of building a new tower at our organization. Part of that construction process includes all new laboratories, all new emergency department, all new surgical suites, a new heart center and two more inpatient floors, so it’s a fairly significant construction effort that we’re doing at the exact same time we decided to upgrade Meditech.

The reason we decided to upgrade Meditech is because in some of the areas like our OR, the current version of Meditech really didn’t meet our needs as far as what we needed for the peri-op documentation pieces. The upgraded version allows us to, when they move to their new OR suites, be fully automated and not have any more paper documentation. So it was really critical to us moving into the new space that our OR suites were able to take advantage of full computerized documentation and charge entry. So that was really the driver for us to do the upgrade now versus wait.

One other unique thing about the upgrade of Meditech is it allows us to become a more web-based mobile platform for our physicians and nurses. We continue to see more mobility we see our clinicians be a lot more mobile in the new environment, and we think going to that new version of Meditech will really support that additional mobility, especially when we add another hundred thousand square feet onto our organization. It’s really a big, big jump for us, we need to be mobile.

Gamble:  We’re just seeing so much as far as the mobile trends and moving toward that mobility for docs, and I don’t think that’s going anywhere anytime soon.

Meadows:  I don’t either. I think it’s going to continue to accelerate, which I’m excited about, if we can finally provide clinicians with a workflow that works how they do. They’re always in motion. Nurses, doctors, and lab techs are always in motion; to have something that’s static and stuck in one place is really not conducive to their workflow. So I’m very excited about mobile opportunities, and it’s good to see our partners really embrace moving in that direction, so I’m very excited about the opportunities with the new platform for Meditech.

Gamble:  And like you said, not having to go in and kind of retrofit, but having the new buildings with the latest platform certainly makes sense.

Meadows:  It does, but it also has an added layer of complexity to any kind of IT project when you’re constructing a building which has lots of other IT and doing an upgrade at the same time. It’s probably a little risky, but also can be very rewarding. And so I think for our clinicians, it was the best choice for us moving forward.

Gamble:  You mentioned that you have athenahealth in ambulatory, and that’s for the employee physicians?

Meadows:  Yes, pretty much all of our employee physicians at all of their 60 or 70-plus locations use athenahealth, and as we bring new practices on, they also use sthenahealth for their EMR and practice management.

Gamble:  It’s interesting, you talk about that significant ambulatory growth and that’s something that we’re seeing all over the place and I would think is a huge priority, especially when you talk about an organization like yours that really has the gamut of care for pediatric patients and is able to offer that every step of the way.

Meadows:  Absolutely. The ambulatory strategy is critical to our overall system strategy. More and more care is being done either in the home or in ambulatory settings, and so having home health and a large physician network I think really helps us progress. As care changes, we’re going to see more and more outside the hospital, and being poised to be able to do that is really important for Cook.

Gamble:  What struck me as interesting was when you talked about having the large home health business. I wonder if this is something that we’ll start to see with more pediatric health organizations.

Meadows:  I think so. As we start to push things more toward the home, I think you’ll see a growth in home health. It may be a different variation of home health services. We’re exploring telehealth to the home, so being able to do follow up visits and some of those things versus sending a clinician to the house to take care of those problems. I think you will see more telehealth. We actually have some things that we’re going to be doing in the near future to do some pilot initiatives. In the state of Texas, all patients have to have at least one face-to-face visit with a caregiver before you can perform telehealth services in the home. And so we see a good opportunity to follow up with kids for specific disease states at home. So we’re really excited about what telehealth can bring to that population, and hopefully that will begin to allow more and more use of that technology.

Gamble:  So that’s a near-term priority?

Meadows:  It is. We actually have a working group right now and we have a physician who is our medical director of digital health and he is going to actually start doing telehealth visits to the home as a pilot group and as part of his service offering. So we’re really excited about that new adventure.

Gamble:  What about with medical homes — is that something you’re looking into at this point?

Meadows:  We are. Actually, what we’ve done here at Cook is we have created what we call neighborhood clinics. We have six neighborhood clinics today and they’re in the underserved areas. We want to start creating medical homes for these kids who may not have access to resources that people who are insured would have. Most of these medical homes that we’ve created are for Medicaid populations or indigent populations. And we have seen great success creating these medical homes and putting technology in and through the use of athena, we’re able to track these kids and have them on certain care plan.

A lot of the population has asthma, and so we have all our kids in these clinics using asthma action plans through athena and documenting that care. And then throughout, if that kid shows up at any of our locations, we can see the documentation that’s occurred through that medical home care.

The other unique thing that we’ve done is in one of our locations, we actually have the first dental clinic as well. We offer dental services to the underserved and so they can really go and have a full medical and dental visit at our location. Many diseases start with how oral care is performed, and so we feel that’s really critical to the success of some of our medical homes. It’s been really interesting to see the kids that come in. They can actually do all of their visits in one location, which has been very, very nice to see.

Gamble:  Okay. So I wanted to get into Meaningful Use a little bit and first actually ask how you are positioned at this point.

Meadows:  We are working towards Meaningful Use on the ambulatory side and on the inpatient side. On the ambulatory side, almost all of our physicians in our physician network have qualified for Meaningful Use dollars. Most of them are in Stage 2 reporting period now, and athena really took the time to build the Meaningful Use process into their product, and so for doctors to really achieve the metrics that they need on the ambulatory side, it’s been quite simple for them to do. We’ve had great success with our doctors being able to achieve those requirements through just normal documentation in the EMR on the athena side. We’ve gone through a couple of audits for Meaningful Use on the ambulatory side, and all of those have passed with flying colors when they’ve really looked at each doctor individually to see did they meet the criteria or not. So we’ve been very pleased with that implementation on the ambulatory side.

On the inpatient side, we only applied for Medicaid Meaningful Use dollars and that is really driven by what the state provides, so we are in what they call phase 1-plus reporting period. So we’re doing our second reporting period for stage 1 Meaningful Use, and we intend to proceed with stage 2. The jury’s out with Stage 3; we’ll just see.

The jury’s out with stage 3, we’ll just see. Because even in stage 2, a lot of the metrics still are very adult driven, so we report on a lot of metrics where we have zero denominator because those diagnoses would not occur in a pediatric facility. Have the pediatric metrics got better? I think over time they have. They’ve matured, but they’re still mostly very adult driven. But we saw Meaningful Use as something that we were already striving for before the regulations came out, so for us it’s more about being prepared, and if there are penalties that begin with the Medicaid population, then we will be prepared for that. But a lot of it is good care, and so we want to make sure that we’re providing that care to our patients.

Chapter 2