Laishy Williams-Carlson, CIO, Bon Secours Health System, Chapter 1

It’s funny; sometimes the most pivotal moments in one’s career occur when least expected. For Laishy Williams-Carlson, the moment came when news of the Anthem data breach hit shortly after she was promoted to corporate CIO at Bon Secours Health, and she was asked to provide an update of her organization’s cybersecurity strategy. What she had realized, however, was that she wasn’t as equipped as she would’ve liked to address the issue. But instead of covering this up, Williams-Carlson chose to be honest with the board, and found that it helped build a level of credibility she may not have otherwise achieved.

In this interview, she spoke with healthsystemCIO.com about the major projects on her team’s plate, from the “never-ending” journey to implement and optimize Epic, to the “huge shift in thinking” required to move toward population health, and what she believes is a critical element when merging cultures. Williams-Carlson also talks about why she believes her finance background serves her well, what changed her feelings about the role female executives play in advancing other women, and why she believes diversity in leadership is so critical.

Chapter 1

• About Bon Secours
• Merging IT cultures — “It starts by finding a commonality.”
• Focus on ‘why,’ not ‘how’
• Adding small practices without acting like “big brother”
• Providing “seamless care” across the continuum with Epic Connect
• The “never-ending” rollout: “There are days when I want to say, where is the finish line?”
• Focus on interoperability

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Bold Statements

One of the best ways to start is to find out where you have commonality. A lot of times, I think we forget that we’re all focused on the same ‘why’ and sometimes we get wrapped around the actual about the ‘how’ and the ‘what.’

It’s easy to focus on hospital acquisitions and big buildings, and forget that every time you employ a physician or acquire a practice, there is a culture that begins working with our culture.

There is that polarity between trying to be nimble and fast to respond to our providers’ needs — and, more importantly, our patients’ needs — while also meeting all those other requirements.  It’s quite a challenge.

There are days where I just want to say, where is the finish line? And then you realize there is no finish line. Even in places where we have it implemented, we need to be focused on continually improving what the solution does.

We went all in, and we feel like that’s the best, easiest way to have integration and interoperability.

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

Williams-Carlson:  My pleasure. It’s nice to talk with you.

Gamble:  I think the best way to start is to get a high level look at Bon Secours, just to give our readers and listeners a bit of an idea of the organization.

Williams-Carlson:  We are a Catholic health system. I think like all other health systems, we’re very focused on transitioning from what has traditionally been a hospital-based system to a system that more fully embraces the spectrum of care and is focused more on ambulatory services. We have locations that we organize into what we call local systems, something like a region, from New York down through Florida. We don’t necessarily acute care presence in all of these locations, but our two biggest local systems are in the Commonwealth of Virginia in Richmond and in Hampton Roads.

We also have pretty robust presence in South Carolina and Kentucky, and we have a skilled nursing facility in Florida, which just successfully and safely weathered Hurricane Irma, so a lot of our business continuity plans that we had done previously got put to good use. We also have a mission presence in Peru, and our sisters were started in Paris, so we have congregations there and we have facilities in Ireland as well.

Gamble:  And this is an organization that clearly has seen a lot of growth largely through M&A. One thing that I think must be interesting is the idea of bringing these different cultures together, and can you talk about what that experience has been like?

Williams-Carlson:  Yes, and we continue to bring cultures together. If you’re familiar with Epic, they have a service offering called Connect in which health systems can offer leverage their Epic talent and the computer instance that they are using and offer it to other providers or health systems who otherwise might not be able to afford to implement Epic on their own. And so, not only am I continually amazed by the cultural differences within my health system, now that we’re offering some of our IT solutions outside of our organization to another Catholic health system as well as another not-for-profit, it’s clear that there are even more profound challenges in dealing with those cultures.

I think in all of those discussions, one of the best ways to start is to find out where you have commonality. A lot of times, I think we forget that we’re all focused on the same ‘why’ — serving a community, improving the health status of those we serve, etc. — and sometimes we get wrapped around the actual about the ‘how’ and the ‘what,’ and forget that we’re all focused on the same ‘why.’ And so I find that sometimes when cultural conversations get very hard, as they typically do, it helps to refocus on the ‘why,’ and that’s helped us a lot with the Connect implementation. What are the common goals that we have around improving patient safety or bringing communities together to improve health status? Where do we have commonality more so than being focused on where we have differences of opinion?

Gamble:  Right. And with the work you’re doing with Epic Connect, you’re dealing with organizations that are very different in size and scope. Obviously, there’s no one size fits all approach, and so I’m sure it does have to be approached differently depending on the organization.

Williams-Carlson:  It absolutely does. And in fact, just last week we had a meeting with two of our customers. One is a three-hospital health system that is going live on the solution within a few months and the other has been live on it for a while and it’s a standalone hospital, although a very robust community-based hospital. Sometimes the single standalone hospital will say, ‘Hey, not everything you’re talking about that needs to be rolled out across the health system makes sense to us or applies to us. We’re a standalone hospital, so how are you going to address our needs?’ So it’s absolutely balancing a lot of different needs.

Gamble:  And then there are the acquisitions as well. I imagine something like that has to be approached really deliberately so it doesn’t come off as like a takeover, which is probably a fear that a lot of people have.

Williams-Carlson:  Actually, it’s been a while since we’ve had an acquisition. There’s been a couple of instances in the last few years where we’ve joint-ventured with others and one scenario in which we continue to supply IT services though we’re not still the sole manager of the health system. That’s particularly nuanced when you’re continuing to provide what you built intentionally as very standardized IT footprint for the purposes of security and economies of consistency, and suddenly, some of those tenets that made great sense you have to rethink how they apply with the new majority partner. So that’s been challenging as well.

Gamble:  Sure. Looking at the history of Bon Secours, obviously, there’s been a lot of change and growth to the point where it became the health system. I’m sure that’s been an interesting thing to be a part of, just in terms of how the leadership strategy changed as it became an organization that owns, and manages, and has joint ventures. I imagine that can pose a challenge.

Williams-Carlson:  It sure does, and one area where we’re continuing to grow robustly is expanding our provider network. Every year, we continue to add physicians to our network and employ more and more physicians as we roll out our Epic solution which we call Connect Care. Sometimes I think it’s easy to focus on hospital acquisitions and big buildings, and forget that every time you employ a physician or acquire a practice, there is a culture that begins working with our culture. I think of particular interest is the small, very entrepreneurial practices — when they get added to our network, I’m sure we come across as very dictatorial and Big Brother-ish, in most cases, with great intentions and very good outcomes.

I think one of the reasons providers are looking to become parts of networks and employees is that it’s so difficult to keep up with all the requirements for cybersecurity and the new payer models and so forth. In some cases, we find that they haven’t maybe attended to them the way they should have. So when we bring a lot of policies and procedures and practices, it can feel a little overwhelming to those smaller groups and very different to more informal cultures. Again, it’s focusing on the ‘why,’ so it’s not just a bureaucracy; it’s practices and policies that are ultimately put in place for our patients’ safety, because cybersecurity is a patient safety issue. But yes, it can make for some big challenges for those providers.

Gamble:  Right. I imagine there are all kinds of processes in place whether it’s certain types of town hall meetings or boards or just opportunities that they have to voice those concerns.

Williams-Carlson:  Apparently so because I certainly hear lots of feedback about our IS policies and procedures, through all those venues and more. And email, of course.

Gamble:  Right. I guess people really need to know that they’re being heard.

Williams-Carlson:  Yeah, I think there’s always going to be a tension between the desire to do things quickly and simply, with the practicalities in this day and age of vendors that need to be vetted, connectivity that we need to make sure is secure, legal language included in a document with a vendor that holds them accountable for cyber incidents and so forth. So there is that polarity between trying to be nimble and fast to respond to our providers’ needs — and, more importantly, our patients’ needs — while also meeting all those other requirements. It’s quite a challenge these days.

Gamble:  Sure. Now, are all of the hospitals on Epic at this point?

Williams-Carlson:  All of our hospitals are on Epic, and all of our providers, except those most newly acquired are, for the most part, on Connect Care. We share a common instance and that’s part of the beauty of it — our system really supports that seamless care from anywhere across the healthcare continuum. As we continue to grow our CINs and expand our provider network, we’re continuing to deploy Connect Care in our practices.

Gamble:  Right. So in some ways it’s like a never-ending rollout, I guess.

Williams-Carlson:  It is kind of like a never-ending rollout. There are days where I just want to say, where is the finish line? And then you realize there is no finish line. Even in places where we have it implemented, we need to be focused on continually improving what the solution does. Our first sites that went live have been live for over 10 years and we had a rollout where it was one done, and then the next, and the next. It lasted a few years, and now the tension in the organization is carving out resources, and emphasizing where we can improve the application versus bringing it to the next provider and the next. So yes, it’s a never-ending journey, but I think that’s okay, ultimately.

Gamble:  As far as offering Connect to outside organizations, is that something that started relatively recently?

Williams-Carlson:  For us, yes. It’s something we embarked on within the last two years or so.

Gamble:  That’s something that we’re just starting to see more as an option for a lot of organizations. It certainly makes sense for certain organizations.

Williams-Carlson:   It does. Actually, prior to when we formally stood up our program called Good Health Connections, which we’ve had great success with, we were offering our Epic record to independent or affiliated physicians who weren’t part of our employed medical group, but still wanted the value of Connect Care. It’s a little confusing. We call it Connect Care, which is not to be confused with Epic’s Connect program. It’s all good. It’s all about being connected.

Gamble:  Right. And this goes back to what you alluded to earlier with really looking at the whole spectrum of care, and I’m sure just being able to more easily exchange data and improve outcomes.

Williams-Carlson:  Yeah, our Epic footprint is pretty large in terms of the number of modules we use. It’s pretty much easier to describe which Epic modules we don’t use instead of those that we do. We went all in, and we feel like that’s the best, easiest way to have integration and interoperability. Beyond that, we use Care Everywhere and we also have other approaches to interoperability.

Outside of the ambulatory space, I think we’re close to the end of a rip-and-replace approach when you partner with someone. We’re pretty heavily penetrated with robust EMRs in our country; now we need to be more focused on how do we integrate those disparate solutions than replacing them.

I think on the practice side, there’s still a ways to go. We really find that what works best for us, for physicians we employ, is to get them up on our instance of Epic. It helps with other workflows across the continuum.

Chapter 2