It’s one of those things that seems so obvious after the fact. But when you’re in the thick of it, it can be hard to see. Physicians at Baptist Health felt they didn’t have a voice in the decision-making process, which resulted in mounting frustrations. The solution? To create governance councils that help educate users about product functionality, as well as how customization requests can impact other areas. The result? An increased understanding of the need for communication, and why some decisions can’t move forward, says Tricia Julian.
In this interview, she talks about the organization’s aggressive strategy to move to an integrated system, how that initiative has enabled Baptist to build “key partnerships between operations and IT,” and how her team is navigating the tricky balance between customization and optimization. Julian also reflects on her first year as CIO, and how her previous experienced helped prepare her for the role.
- The careful balance of user satisfaction – “We’re careful about how much we customize.”
- Governance councils to help make “more informed decisions”
- Participation in patient panels
- Operations & IT working together – “We’re one big family in terms of trying to take care of the patient.”
- Baptist Health’s “tremendous turnaround”
- Consumer engagement – “We still have to be looking forward.”
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If we go too far away from their foundational development, when they release their next major set of product enhancements and functionality, we would be hampered to roll it out.
The physicians who joined these service lines have gained strong awareness about the inner functionality of the products, and how making a change may cross over out of their discipline to their colleagues. That awareness is allowing them to make more informed decisions.
The hospitals have asked our IT team to be part of those panels with the patient so that we could specifically talk with them about their experience and if there’s anything that they’d like us to do to help strengthen it.
We’re one big family in terms of trying to take care of the patient, so we wanted to bring all the various perspectives and expertise to bear to really think about how we deliver to the patient what they need.
I’m very pleased with the IT team for really thinking through how to navigate that situation in such a way that we still deliver the technology to our user community and to our patients the way they need, but also are able to pause some of the projects where needed.
Gamble: I’m sure it was really critical to have a solid governance structure in place. When you described the schedule of the Epic rollout, it seems like it was intense for a while there.
Julian: Yes, it was. We’re all glad it’s in the rear view. But today, to your point, there are circumstances that emerge where Epic is functioning as it’s designed to, but there may be a desire to configure it differently — to customize a workflow to respond to Baptist Health needs. We’re careful about how much we do customize, and the reason for that caution is we know Epic is constantly developing new functionality in their products, and so if we go too far away from their foundational development, when they release their next major set of product enhancements and functionality, we would be hampered to roll it out if we’ve done too much customization for Baptist Health. There’s a lot of cycle time that would be required to test that capability.
With that said, what we seek to do is pause to assess if that enhancement is a must do, and then if it is, to gain the support from the service line to explain to their user community about the enhancement that’s coming, help us vet out that the design and configuration that’s been requested is the optimal one for their service line, and then ultimately help us gain the approval needed to move it to production.
Gamble: And then if it’s decided that it is not in the best interest to move forward with a request, is there a process in place for making sure that’s communicated?
Julian: There is. They’ll help us with the service line communication for sure, and then we have overarching Epic governance councils. There’s a physician governance council, and there’s a multi-disciplinary governance council which is meant to recognize nursing, our therapies, rehab, and all the disciplines that rely on the product. We’ll take decisions that come from service lines to those governance councils to allow even those who are not necessarily directly involved with the service line to have awareness about decisions that are being made and changes that may be coming.
Gamble: Right. There’s a lot in place to try to make these systems as usable as possible, but at the same time you have to do what’s right for the entire organization.
Julian: True statement. And what’s beautiful is that the physicians who joined these service lines have gained strong awareness about the inner functionality of the products, and how making a change may cross over out of their discipline to their colleagues. That awareness is allowing them to make more informed decisions and understand the need for the communication, and why some of these decisions need to be slowed down a bit for more input before we move forward.
Gamble: What do you consider to be the biggest priorities on your plate right now?
Julian: As we approach 2019, we have activities underway right now to start planning for the 80 applications that will come live when we bring Epic Live. At Baptist Health Floyd, we’re working to get everything in motion to prepare for their go-live in the summer of 2019. That’s a major initiative that requires all of the IT teams. Right now, the infrastructure team is nearing the end of their project, which will finalize in October of this year. They will have gotten all of the connectivity from a networking perspective in place such that Baptist Health Floyd will be operating on the same infrastructure as the other seven hospitals.
At the same time we’ve been planning the Floyd integration, Epic 2018 was released in February. And so we embarked on a 6-month project to test that functionality and prepare for a go-live here at Baptist Health. We want to come live on Epic 2018 in November. We just went live on Epic 2017 in March, so there was a 6-month project leading up to that. My team really didn’t get much of a reprieve before going heads down to start work on Epic 2018.
Gamble: Wow, it never stops.
Julian: That’s on the application side. And then our networking team is doing a lot to look at design. We’re doing a wide area network redesign, and that’s going on in parallel with these other activities. We’re doing some phone system replacements on in our hospitals, and we’re moving to single-platform voiceover IP. We also have a cyber program that’s underway, with many tasks and activities just to continue to solidify our security stance. So there’s a variety of moving pieces and parts that we’re aligning.
Gamble: So there’s really no shortage of priorities. What about consumer engagement? What are you doing there?
Julian: One of the tools Epic presents to clients when they come live is MyChart, which gives patients an opportunity to connect via a portal and be able to see the information that we have in their electronic health record. It facilitates the opportunity for a patient to schedule an appointment. It starts there, and when a patient has the appointment, if there were labs drawn, there’s a communication that reaches out to a patient when those results come back to let them know they can log into their portal to view them. Same with radiology results. Physicians can communicate information specifically to the patient when those lab results come in, and they’ll provide any guidance to the patient through the portal.
Patients can also readily request prescription refills. We have retail pharmacy live with Epic at all of our hospitals. We actually had some hospitals go live on Epic’s retail pharmacy function back in 2016, but as of this March, all of our hospitals are live on it. What’s beautiful about that is if our patients have their medication at our retail pharmacy, then we can notify them, through MyChart, ahead of time if they’re due for a refill. It doesn’t necessarily require the patient to reach out to us, but we’ll proactively get that ready and let them know it’s ready and waiting for them.
Another thing we’ve done is through MyChart, our hospitals have the opportunity to sit down with patients in a panel-like setting to gain feedback about their experience with that facility. The hospitals have asked our IT team to be part of those panels with the patient so that we could specifically talk with them about their experience with MyChart and if there’s anything that they’d like us to do to help strengthen it. We’ve heard some requests for telehealth, and we’re looking at that option in our future. Epic has support for that, especially with the 2018 version. There’s a lot more functionality that Epic is bringing to bear using the MyChart tools for telehealth and remote access between patients and physicians, or nurse practitioners.
Gamble: That’s really refreshing to hear about IT being part of those conversations, which certainly hasn’t always been the case.
Julian: We are very pleased. The Epic project really gave us a chance to build some key partnerships between operations and IT. My prior role before joining Baptist was in an operations role. I appreciated the relationship I had with the director of IT as the COO to be able to pause and talk about tools that might make sense to help streamline care and support the nurses and doctors in being able to give their focused attention to patients. In the spirit of that, we wanted to be able to continue to have that sort of philosophy and approach when we work with our operational team members. We’re one big family in terms of trying to take care of the patient, so we wanted to bring all the various perspectives and expertise to bear to really think about how we deliver to the patient what they need. We have had a welcome response from our operational counterparts, which we appreciate heavily.
Gamble: In terms of your role, you’ve been in the CIO role for about a year or so, right?
Julian: That’s right. Starting in February of last year.
Gamble: Any thoughts on your first year? It certainly sounds like you’ve had a lot going on, but on how was it adjusting to adjust to that role?
Julian: There was a bit of a natural transition in terms of having had the responsibility that I carried with my team for the Epic integration. We were working so closely together across departments and across the organization that my goal in the transition was just to keep up those relationships that we had forged. I continued to present opportunities for us in IT to hear where the product wasn’t delivering and how we could continue to improve the product.
During my first year, the thing I couldn’t have predicted was we had some changes in our overall leadership. Our CEO departed a month after I took over as CIO. We faced some financial challenges that required some hard decisions. It was probably more acclimating to exactly what was going on at that senior executive level, which I had not been a part of, and seeking to sit at that table so I could hear what we were facing, hear what some of the financial challenges were, then come back with that knowledge to my leadership team, and with their help, really define what projects we absolutely needed to carry forward and which ones we could pause in an effort to help with some of the financial needs we faced. I’m really pleased at the outcome that we collectively as a whole at Baptist Health. It’s been a tremendous effort and a tremendous turnaround that is a credit to everybody — every person at Baptist Health took part in that. I’m very pleased with the IT team for really thinking through how to navigate that situation in such a way that we still deliver the technology to our user community and to our patients the way they need, but also are able to pause some of the projects where needed to help shore up the financial status.
Gamble: Not easy decisions, for sure. But in all, it sounds like it’s been a really great first year in that role. And there’s a lot to certainly keep you busy for the foreseeable future.
Julian: There is. To your point about consumer experience, we still have to be looking forward. We’re putting together initial ideas around clinical analytics and data governance. We’re live on Epic Healthy Planet, and so that’s our population health module. We’ve got a lot going on in that space. We have a clinically integrated network, and we have an ACO. The Healthy Planet tool has been a key component to that, so we’ll continue to work with our operational partners as they strategize around ongoing needs with population health and the clinically integrated networks. There’s no shortage of work for sure.
Gamble: I’m sure. Well, that covers what I wanted to talk about for now, but I’d definitely like to touch base again and maybe get more into some of the ACO and population health work you’re doing.
Julian: That sounds terrific.
Gamble: Great. Well, thank you so much. I appreciate your time and look forward to speaking with you again soon.
Julian: Thank you Kate, I appreciate it. Have a wonderful weekend.