Nurse’s Call: How A Common Language Has Translated Into Better Care At Children’s Health

When an organization has accomplished as much as Children’s Health has, others want to know what’s in the secret sauce. And so when approached with this question, SVP and CIO Pamela Arora lists a few key ingredients: strong collaboration between clinical and IT, a desire to always keep improving, and someone who can tie it all together.

In this case, that someone is Chief Nursing Informatics Officer Debra Schumann. Although she assumed the role just two years ago, Schumann, who spent more than two decades on the front line, has been playing the part for much longer, and has been a key catalyst in Childrens’ emergence as one of the top pediatric providers in the country.

“Nursing leadership here is constantly pushing to improve clinical care through the use of IT tools, and it makes a world of difference, because even if we have a smooth implementation, if the tools aren’t being used correctly, the organization, and frankly, our patients, aren’t getting the benefits,” says Arora.

But thanks to the hard work put forward by leadership, including CNO Mary Stowe, CMIO Chris Menzies, and others, Dallas-based Children’s Health has achieved countless accolades, including HIMSS Stage 7 recognition, a HIMSS Davies Award, and ANCC Magnet status since 2009, all of which are critical components it its mission to “make life better” for a growing pediatric population.

Achieving that, according to Arora, means moving beyond the hospital walls to create a connected community and “meet patients and families where they live, work, play, and go to school.” The first step in this journey came nearly a decade ago when Children’s made the decision to implement Epic across the 3-hospital system and its 20 pediatric group practices. Then, the organization expanded on that concept by building a clinically integrated network through which providers can share data and leverage analytics to improve the care of chronic disease patients.

And it didn’t stop there. A number of other initiatives have been launched to help close the loop, including a telemedicine program through which school nurses can communicate with (and receive prescriptions from) primary care physicians, house calls for low-acuity patients, and a tele-NICU program.

“All of this weaves together what we’re doing from a vision of connectedness in the community, and leveraging technology to enable that,” notes Arora. The challenge, of course, comes when it’s time to connect all the data dots. “Every single one of these care delivery mechanisms has a technology underpinning, which means clinical and business folks need to work with IT so we can make it as smooth an experience as possible, especially for those patient families.”

This is where having clinical leaders engaged and at the table comes into the picture. According to Schumann, Children’s has five shared governance councils that support Magnet status, one of which is a Clinical Informatics council. What this does is ensure that technology initiatives are “being vetted by people who are taking care of patients and can provide feedback as to whether something’s going to work or not,” says Schumann. “We have great dialogue in terms of how changes are implemented.”

And by getting input from leaders in different departments, it creates what Arora calls a “cross-pollination,” which can go a long way toward making sure everyone’s needs are being met and there are no “lopsided solutions,” she notes.

What’s Schumann’s role in all of this? Simple. Translating technology for clinicians, translating clinical speak to the IT team, and working with both sides to ensure that any technology being implemented is going to help, and not hinder, those on the front lines. “I look pretty critically at any technology that’s coming into the organization — how it’s going to impact the nurses, respiratory therapists, and physicians, and how can we make sure it’s going to support them in taking care of patients,” she notes.

In addition to participating in Office of the CIO meetings (during which Arora hears from all of her direct reports), Schumann works closely with Stowe, Menzies, and other leaders to keep them abreast of any changes and to communicate any concerns. Through rounding, phone conversations, and participating in various committees, she’s able to take the pulse of the end users and help alleviate workflow concerns, says Arora. Perhaps more importantly, Schumann is able to help decipher whether a new tool is needed, or if workflows simply need to be adjusted, something a CIO can certainly appreciate.

“The beauty of what she does is helping understand what an IT tool can and can’t do, which in turn allows for more rewarding outcomes when you get a system in, because you don’t have false expectations,” says Arora. And in some cases, it can even lead to cost savings. “We can show a really strong business case on our return with the EHR deployment, and that is largely due to clinicians not just checking the box, but asking how they can use the tool better.”

To the team at Children’s, ‘optimization’ isn’t a buzzword, but a key measure in the success of the EHR implementation — something that must be continuously assessed. And so, in addition to making tweaks along the way based on user feedback, Children’s embarked on a two-year initiative to determine how well the Epic solution was working.

“We had been live on Epic for six years by the time we realized a lot of our workflows had changed and we’d grown tremendously,” says Schumann. “We wanted to make sure we were getting the most out of our EHR that we possibly can — we had a gut feeling that we weren’t.”

After a thorough evaluation, during which clinical leaders worked with the vendor to examine workflow processes, Children’s ended up with “a much more streamlined product,” says Schumann.

It’s precisely why Arora is strong a strong believer in optimization, and why she advises any organization that implements an enterprise EHR to plan on revisiting frequently. “There’s a huge benefit in doing a soup-to-nuts effort of looking at all the workflows in the EHR even years after they’re gone live — especially years after they’ve gone live,” she says. As organizations mature, some of the processes that were initially put into place are no longer necessary, and others that were left out are now required.

It’s a lot like when one is buying a home and must make certain choices without first having lived in the house, says Arora, who compares the CIO role to that of a realtor, with clinicians and business staff being the buyers. “They’re the ones who live in the house — as IT professionals, we need to remember that.”

As Children’s continues to grow, Arora’s team will focus on keeping the house running smoothly while further exploring areas like population health and patient engagement to help improve the delivery of care across the continuum. The secret to continued success? The same formula that has served the organization thus far, says Arora: bringing together different disciplines to work together.

“We’re stronger together. It’s really that simple. It’s a mindset that requires people to check the egos at the door. When things aren’t going smoothly, instead of saying, ‘this is all wrong,’ we have dedicated clinicians saying, ‘how can we help make this better?’ If you have that mindset, you’re always going to be moving to a better place.”