Theresa Meadows, SVP & CIO, Cook Children’s Health Care System
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 2
- Pediatric EHRs & the functionality gap
- Partnering with athenahealth & Meditech
- “We really worked hand-in-hand to build that pediatric functionality.”
- Challenges with dosing, growth charts & vaccine schedules
- Harnessing the power of texting
- Innovation in focus — “If we lose sight, nobody will have their eye on the ball.”
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Bold Statements
We’ve shared our content. We’ve shared our builds. So hopefully people don’t have to relearn this every time they go through the process, because it takes a village, and to redo something from scratch every time really does not make sense.
Things like growth charts and weight-based dosing and vaccine schedules — those are the things that pediatricians and specialists live and die by. And so not to have those things in the EHR is very frustrating.
As we go through this patient engagement transition, people need information at the right time. It’s great that it’s in a portal and it’s sitting there, but if I don’t need it, I’m not going to go in and look for it.
I encourage my team to always be thinking: is this an innovative approach? Is there a new way to go about this than the standard? But it is hard — it’s very hard, because it is the thing that gets left on the cutting table.
Gamble: It’s interesting what you said about what Athena has done because we’re starting to see some information come out from studies. The Journal of American Medical Informatics Association did a study and more than half of respondents said that EHR systems don’t have the necessary functions for pediatric care. Luckily it looks like the tide is starting to turn, but it seems like this has been a challenge for a while for pediatric organizations.
Meadows: Yes, it’s been a huge challenge and I will site one of my bandwagons that I’ve been on is really trying to partner with our EHR vendors, because the systems are designed for adults — that’s just the larger population of people that use medical care. And so we here at Cook have really made an extra effort to work very closely with our primary EHR vendors to ensure that our pediatric needs are being met.
One of the things that we do here is we meet quarterly with Athena executives and Meditech executives to talk about what things are working well from a pediatric perspective, and what things are not working as well as expected, and how do we work together to help with the design of that content or the design of those needs to ensure that all pediatric providers can benefit from the work that we’ve done. With Athena, we were their first pediatric customer, so a lot of their pediatric knowledge was driven from our implementation. We really worked hand-in-hand with them to build that pediatric functionality. And I’m very pleased with the outcome, because I believe they listened and they’ve been able to use that knowledge with their other customers that have pediatric populations.
Meditech has been just as good too. We’ve worked very hard with them especially around medications and dosing, which is where the biggest issues come in the EHRs. There’s a lot of custom medication dosing for kids; working on that with both of the vendors has been extremely rewarding, and I think they’ve learned as much as we’ve learned from them, so it’s been a good experience for us. But I would recommend to anybody who struggles to partner with your vendor, because that has made a world of difference, us just talking more frequently about the needs.
Gamble: It’s really interesting. I’m sure that there are both benefits and challenges in being that first pediatric customer, but seeing the difference this can make for other organizations too is huge.
Meadows: Absolutely, and we’re an organization that if we’ve done something, we’re always willing to share with others. We hate for people to recreate the wheel. And so with Athena and Meditech, we’ve hosted lots of people who’ve come and we’ve shared our content. We’ve shared our builds. So hopefully people don’t have to relearn this every time they go through the process, because it takes a village, and to redo something from scratch every time really does not make sense.
Gamble: In reading some of the other data that’s come out recently talking about recommendations or asking that EHRs be able to incorporate some of these pediatric-specific functionalities like vaccine schedules and management tools that reflect the requirements, it’s got to be a little bit frustrating for you, because this is something that really should have been done from the beginning. But I guess it’s better late than never.
Meadows: Yes, it is frustrating, but it’s good to see progress. Because things like growth charts and weight-based dosing and vaccine schedules — some of those key metrics are the things that pediatricians and specialists live and die by. And so not to have those things in the EHR is very frustrating to those clinicians who are trying to take care of kids. So it’s nice to finally see some of those changes come to fruition. Some it’s just being persistent. You have to be persistent for what you need and what you want, and that would be my recommendation — if it’s something that’s important to your organization, be persistent.
Gamble: Absolutely. In terms of patient engagement, obviously that there’s more unique aspects to having a pediatric population. I wanted to talk about your strategy there as far as staying engaged with the patients and patient’s families.
Meadows: Sure. We’ve done a couple of things. I think a lot of times we focus our patient engagement strategies on patient portal and how do we get more people to interact with the portal. Portals are important, and I think there needs to be locations for patients to see the necessary information that they need, but we’ve also done some really unique patient engagement strategies that revolve around texting, for example.
We have done co-development project with a startup company called Patient EXP, and we’re using modern technology such as social media and texting to really engage the patient at the right point in time in the process. A good example is if you have a child who’s coming in for a radiology procedure that requires some sort of prep the night before, the time that the parent needs that information is not three weeks before the procedure occurs, because by then you’ve already forgotten what you need to do the night before. The time that I need that information is the night before the procedure or the day before the procedure, so I have time to start preparing the child for the test the next day.
And so we’ve created what we call a behavior engine where we use HL7 messages that are floating in the environment to actually generate texting to the parent at the appropriate time. There’s a rules engine built in that says, if I schedule my appointment today for May 1 or June 1, two days before I’m going to text the parents with a link to the prep instructions. We did this in radiology specifically and we were able to monitor the results, and what we saw was patients who got the link via the text message actually clicked on the link and read the material 100 percent of the time, whereas the same content had been on our patient portal probably for 10 years and it had a 2 percent usage rate. So we know that sending people information that’s quick and mobile and easy to use at the right point in time engages those patients. We had over a 6 percent increase in people who actually showed up prepared for the test the next day.
So it definitely can make a change and engage the patient in a different way. I think as we go through this patient engagement transition, people need information at the right time. It’s great that it’s in a portal and it’s sitting there, but if I don’t need it, I’m not going to go in and look for it. We have 1,000 use-case examples we’ve created in this rules engine to actually send texting and we’re monitoring the results of those texts, so we know what’s working and what’s not working as we go through the process. So that’s been a really fun project.
Another study that we did is at the end of the visit, we actually sent a thank you note with a link to patient portal; 25 percent of our portal activity is driven from that link that we sent. So we know we can increase portal activity by sending that link at the end of the visit and saying, there’s important information for you to look at. There are a lot of unique things you can do to drive portal usage where your portal is not the single point of patient engagement. So I think there’s still a lot to learn in the industry, but looking for unique ways to do it, I think, is where we need to be — more innovative ways.
Gamble: Right, and being able to leverage the technologies that people really are using. Using that texting functionality at the right time seems to really be the key to finding success there.
Meadows: Absolutely, because everybody is in sort of a right now mentality — you don’t want it until you want it, and so as long as we’re in the now mentality, we have to give you the information when you need it. It’s a really interesting dynamic to watch the statistics on how you can change behavior, because ultimately, what we want out of patient engagement is behavior change. We don’t want people just looking at the portal, we want them taking their meds at the right time. We want them to exercise. We want them to do different things, and it’s all about behavior modification. And that’s really what we’re focused on. It’s how do we change parent and patient behaviors, because that’s what will increase our engagement with the organization.
Gamble: Right. What would you say is the key to staying on top of the technologies and tools that people use and use well? I’m sure difficult because it’s ever-changing, but how do you try to stay on top of what tools work with the patients?
Meadows: One of the things we’ve tried to do is put in a process of evaluation. We don’t have an innovation team here, but we do encourage innovation by looking for creative ways for projects. Like the project with the texting — initially, it was driven by the fact that we didn’t want 12 different systems texting the patient. We wanted one voice to the patient, and that’s what really drove that initially. And then what we found was we can really impact behavior and engage the patients with this technology. Sometimes you don’t always know what you’re going after until you have it. So I would encourage everybody to have some portion of time — and I know we’re all busy — to continue the innovation. If I had a concern about healthcare, it would be that we’re going to lose our thought process around innovation because were too busy trying to meet Meaningful Use requirements, or we have so many system upgrades, or we have a lot of regulatory pressures around security and different things that we will lose sight of the need to be innovative in these tasks as well. And so I encourage my team to always be thinking: is this an innovative approach? Is there a new way to go about this than the standard? But it is hard — it’s very hard, because it is the thing that gets left on the cutting table if you’re trying to manage a lot of things going on.
Gamble: Right. And without even looking at the innovation piece, just the prioritization challenge is something that we hear so much. It has to be so frustrating for CIOs.
Meadows: I think part of my job is innovation as well. If we have the right teams, we can set aside some of the CIO time to really begin to look at innovation and look at ways that innovation can fit in the strategy. So I hold some of that accountability with me and our CTO to really help find innovative ideas and then work with the team to how do we incorporate those things. Because if we lose sight, nobody with have their eye on that innovation ball.
Gamble: Yes, exactly.
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