Mark Lauteren, CIO, University of South Alabama Health System, Chapter 1

When Mark Lauteren started as CIO at University of South Alabama in the spring of 2013, he had two major goals: facilitate seamless integration of data throughout the system, and improve customer service within IT. Sounds simple, right? Luckily he had one major factor on his side — the organization’s willingness to change. In this interview, Lauteren talks about what it took to clean up a fragmented IS department, the gargantuan effort taking place to create ‘one patient, one record,’ why his team doesn’t ‘just say no,’ and the never-ending chess match CIOs must play to keep data secure. He also discusses what it was like to replace a long-time CIO, the mentors who taught him well, and why he takes time to give back.

Chapter 1

• About USA Health System
• Converting to Cerner Millennium to create “one patient, one record.”
• From IT to IS: “We’re not about technology; we’re about providing services.”
• Upgrading the “aging” infrastructure
• Focus on customer service — “We never say no.”
• Hiring the first CMIO

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Bold Statements

Even though they are interfaced, we all know that different data can be displayed differently in different systems. It might actually have them on a different payer or might have different allergies. This will get rid of all of that.

We were very fragmented. We had different teams serving different parts of the organization. They weren’t consistently doing things. The organization used to be very command-and-control, top-down driven, so decisions sometimes took a little longer than maybe they had to.

We never say no. We say, ‘Well, we can do that, but this is what it’s going to take.’ Sometimes people like the fact that you’re at least willing to talk to them and understand the tradeoffs.

By having that dedicated physician champion, there will always be a physician in the room, and that person can go back out and communicate to the physicians what are the tradeoffs. We’d always like it if everything was cut and dry or black and white, but in reality, we all know there are shades of gray in almost every decision.

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

Lauteren:  No problem. Thank you.

Gamble:  So to give our readers and listeners a little bit of an idea, can you tell us about University of South Alabama Health System?

Lauteren:  We have two hospitals, including a medical center that’s a tier 1 trauma center, the only burn center in the area here in the Central Gulf Coast area. We also have a Children’s Hospital, which is the largest neonatal care center in the area, and the only Children’s Hospital in this part of the Gulf Coast area as well. We also have a medical school through the university. We have about 170 employed physicians, and at anyone time, we’ve got about 270 physicians going through our medical school. We also have a cancer center — the Mitchell Cancer Institute is the premiere cancer institute in the Central Gulf Coast area.

Gamble:  Do you have other offerings in terms of ambulatory care?

Lauteren:  That’s the 170 employed physicians. They have multiple specialties from primary care to cardiac, you name it. We’ve got lots of different specialties with those 170 employed physicians.

Gamble:  As far as where you’re located, you said you’re near the gulf?

Lauteren:  Yeah, we’re in Mobile, Alabama, which is in the Central Gulf area. One way to look at it is we’re between New Orleans and Pensacola. Pensacola is about an hour and a half one way and New Orleans is about two or three hours the other way. So, we’re right in the Central Gulf Area, which is what they call it down here, or as the Alabama folks call it, Lower Alabama.

Gamble:  And you’ve been there about two years or so?

Lauteren:  I’ve been here almost two and a half years. My predecessor had been here 43 years. So I’ve been bringing in different ideas, new ideas and just trying to continue to carry the organization forward.

Gamble:  That’s something we’ll definitely want to get into in a little bit. But just to kind of further lay the groundwork, what falls under your preview for as far as IT functions?

Lauteren:  I have IT functions for the entire health system — that’s from the analysts to everything. I don’t have the data center. Our university provides the data center and network telecom, but I have all the other IT functions within the health system. So for ambulatory, both hospitals and the Mitchell Cancer Institute, we have IT folks that support all of those from application to design.

As far as applications, our primary acute care EMR is Soarian, and our primary acute care rev cycle is Invision. Then on the ambulatory side we have NextGen as our primary EMR and rev cycle, and then for the oncology area for the Mitchell Cancer Institute, we have a product called Varian. And then we have a few others. We have right now a hodgepodge of five EMRs and three different rev cycle systems, and like any health system, we’ve got about 200 other assorted applications that we support.

Gamble:  Right. And the five different EMRs at which facilities? The physician offices?

Lauteren:  Different ones. As I said, for the ambulatory side, we’re primarily NextGen, for the hospitals, we’re primarily Soarian, but on the Children’s side, we also use a product called OB TraceVue and then we also use a product called Crib Notes in neonatals. We’re in the process of migrating off of all of those over to the Cerner Millennium Product. Early this year we signed a contract to do that and by June of next year, we will have migrated if not all then almost all of those onto the Cerner Millennium Product, and that will be both acute care ambulatory side and rev cycle.

Gamble:  So obviously that the goal there is to have a better flow of information and not to have to deal with the hodge-podge, as you said.

Lauteren:  Yes. When I came in, one of the biggest complaints we had of our customers was that they had multiple systems. They would have five or six different systems they would interact with in a day — and that’s just the regular physicians, not counting folks that went into a lot of specialties. We had a lab system from a different vendor. We had a radiology system from a different vendor. All of these different systems. Now, people will have one interface, one patient record.

Actually, one patient, one record is our goal of the project, as well as to improve quality and profitability. But the big thing is one patient, one record, which we believe will drive everything else and it will make it a lot easier for physicians.  They’ll look at the record in the ambulatory setting. For example, you have a surgeon who sees the patient the day before their surgery. They look at the record in the ambulatory setting, then the next day, they come into the hospital and they look at the record and it says different things. Even though they are interfaced, we all know that different data can be displayed differently in different systems. It might actually have them on a different payer or might have different allergies. This will get rid of all of that.

Gamble:  And for you coming in, did you know this was going to be on your to-do list and a big priority as far as getting this together and making the selection to have one integrated system?

Lauteren:  That was what I wanted to do. When I came in, there were a lot of things they told me they wanted me to try and drive. One was to improve our customer satisfaction within the organization of IT. We call it IS — Information Services. We changed the name. We’re not an IT department; we’re not about technology. We’re about providing services. So that’s been one of my focuses, and the other was they wanted seamless integration of their data. And as we looked at how we would do that and the disparate systems we had, we realized there was no way to do it. It was just a matter of how can we come up with the money to do it, and Cerner was able to talk to us. We actually had a long-term contract with Soarian with the Siemens, so we really didn’t have a choice on the acute care side. On the ambulatory side, we were into a year-to-year contract so we had some flexibility on with NextGen. We had no flexibility on the acute care side, but when Cerner bought Siemens, they came up with some terms that we could live with, let’s put it that way.

Gamble:  Right.  And when you said that one of the goals was to improve IS customer service, was that one of the big issues that kept coming up just as not having that integration?

Lauteren:  One of it was integration, a part of it was that within IS, we were very fragmented. We had different teams serving different parts of the organization. They weren’t consistently doing things. The organization used to be very command-and-control, top-down driven, so decisions sometimes took a little longer than maybe they had to because the managers were empowered to make those decisions. It was also an aging environment in the infrastructure, and we needed to make some changes do some upgrades to the equipment so that they weren’t constantly having to find the machine that worked or explain why do these different things not work with each other, because some were very old. So we spent a lot of time upgrading infrastructure and doing customer service training for desktop and end-user support folks, and just changing attitudes about how we respond. We never say no. We say, ‘Well, we can do that, but this is what it’s going to take.’ Sometimes people like the fact that you’re at least willing to talk to them and understand the tradeoffs. Once they understand the tradeoffs, they may agree that it’s not a good idea, but at least they understand tradeoffs versus maybe just saying no to everything that would come to the door. We’ve made a lot of changes around customer service. We actually do regular surveys now. Every six months, we send a survey out to the entire leadership of the organization asking how we’re doing, and those numbers have trended up over the years since I’ve been here and hopefully they’ll continue to trend up.

Gamble:  So you had some pretty clear goals going in to this role.  As far as going to Cerner Millennium, what did you say was the date you’re looking at?

Lauteren:  June 6 of next year is go-live date at this point given everything works out, D-Day.

Gamble:  And right now do things seem to be on track for that? What is the big kind of focus in terms of getting ready for that?

Lauteren:  Yeah, things are on track. Cerner has been doing a great job providing the folks we need and the people and the expertise. We’ve gone out and brought in a lot of experts as well contractors to help in areas where we maybe didn’t have the depth, and then of course my folks have spent a lot of time learning the product. And we’ve held our current state reviews. The Cerner process is you do a current state review, which is documenting what you do today, and you do the future state review, which we’re going to have next month with them when they come back and show the best practices. We’ve integrated in some of our practices that they felt we need or told us where we need to get rid of those practices and do the best practice way.

That’s the next major step, and there’ll be a lot of discussion about that and a lot of testing as they developed the implementation. And we obviously are also doing a lot of infrastructure upgrade. We have fairly spotty wireless infrastructure coverage right now. In some areas it’s topnotch, in many areas it’s not, again, because we didn’t have a consistent approach. And so now we’re going to have a consistent approach to all of our infrastructure, and that should make things a lot better for us.

Gamble:  So what still needs to happen as far as getting that infrastructure to where you want it?

Lauteren:  We’ve got bids out to upgrade the infrastructure as far as the wireless and the network switches. We’ve also got bids out for replacement of a number of our workstations and printers and other things that need to be upgraded. Once obviously we make a decision on that, we’ll be rolling that out the next year and then be ready for Go Live.

Gamble:  That’s always interesting looking at a change that big. You talked about training and education. I had seen that your organization does not have a CMIO at this point, right?

Lauteren:  We did a posting a couple of months ago for a CMIO and we’ve gone through the interview process. We’ve narrowed it down to two finalists. We’ve actually held all of our interviews with the administrative team and the physician champions. We had an equal balance of about half administrative interviewers and half physician champions that have interviewed those two finalists, and so now we’re going through the process of deciding which of those two candidates we’ll be bringing on. Hopefully we’ll get them in soon enough that they can help with the implementation.

Gamble:  I can imagine that that can be a challenge not having that position, but it’s just something where the organization just did not have that in the past.

Lauteren:  We didn’t have a CMIO. They’ve never had CMIO. We’ve really relied pretty heavily on physician champions out there. We’ve got a core group of physician advisory group that’s about six physicians that are, I would say, the core group. And then we have probably another half dozen that come in off and on. They represent different parts of the organization and have done a very good job of supporting us, but they’ve all got their own jobs, so to speak, and so they’re limited in how much time they can put in. Now with a dedicated CMIO, he’ll be able to focus on that job. We’ll still use the physician champions a lot and they’ll give us a lot of feedback from different areas, but there’ll be somebody who will be able to 1) as we sit through this design sessions, make sure that we understand the physician needs, and then (2) as we make these decisions, go back and explain to the physicians why we maybe chose A over B or B over C, and why that may be the right thing to do for the organization.

Gamble:  I can really see the need for that especially as physician engagement is such a big priority, and making sure that getting that buy-in right off the bat as you head into this final stretch.

Lauteren:  Yeah. It’s going to be real critical to us. We’re trying to involve our physicians a lot more in this implementation. We rolled out the Soarian product and the NextGen product many years ago — or several years before I got here, and one of the pieces of feedback I got from the physician groups was that they felt that they weren’t involved enough, either in the early design or any of the discussions or any of the critical decisions along the way. Part of that may be that they were involved, part of that maybe that there wasn’t enough communication out to them to help folks understand who was involved from the physician area. So by having that dedicated physician champion, (1) there will always be a physician in the room, and (2) that person can go back out and communicate to the physicians what are the tradeoffs. We’d always like it if everything was cut and dry or black and white, either it’s A or B, but in reality, we all know there are shades of gray in almost every decision, and most times there’s a tradeoff, and you have to understand why those decisions were made the way they were. Having a physician that can explain, ‘Okay, here’s why it was important to go one way or the other and here’s are some of the things we consider’ is huge. Obviously in the end, we want to make sure we’re doing the right thing for our patients.

Chapter 2