It’s not often that a CIO uses the word ‘joy’ when describing the moment they entered the IT world. But for Tamara Havenhill-Jacobs, it’s precisely what she felt when she was tapped to help guide a radiology IS project. But although she had found her path, the journey from nurse to CIO hasn’t been without its share of bumps, bruises, and lessons learned.
Recently, healthsystemCIO spoke with Havenhill-Jacobs about her team’s core objectives at Bozeman Health, including moving to the cloud, improving user experience, and making optimization a priority. We also talked about how Bozeman is working to grow physician and nursing informaticists, her constantly evolving leadership philosophy, the enormous benefits of having a leadership network, and what it takes to help others realize – and reach – their full potential.
- About Bozeman: an “independent, locally-owned” system based in SW Montana
- Infor’s cloud-based ERP system
- Improving user experience by “pinpointing the gaps”
- Cross-system optimization – “Are we taking advantage of the things we can do?”
- Customization vs standardization
- From clinical to IT – “It was a happy accident.”
- Less focus on technical, more on engaging & communicating effectively
It’s going back and doing one-on-one training with some of our providers to make sure that not only are they aware of everything that’s available to enhance their experience with the EHR, but that we’re giving them tips and tricks based on what we’ve observed in their use.
With everything we look at, we take the perspective of, how do we apply guiding principles so that we don’t make decisions that deviate from where we’d like to be from a standardization standpoint?
It was what I call a ‘happy accident’ that I ended up moving into information technology. It’s a perfect blend of everything I loved about the clinical and operation worlds, and everything I know and love about IT.
In so many ways, our job as CIO is to be able to tailor the message to our audience; to know them well enough to understand what’s important for them to hear, and how we can best communicate that.
Gamble: Let’s start with a high-level overview of the organization — what you have in terms of hospitals, medical groups, things like that, and where you’re located.
Havenhill-Jacobs: Bozeman Health System is an independent, locally-owned and controlled integrated healthcare delivery system based in southwest Montana. We’re the largest private employer in Gallatin County with more than 2,000 employees. We have 270 medical providers that represent over 50 clinical specialties.
Gamble: I would imagine the population you serve is geographically dispersed.
Havenhill-Jacobs: It is. But interestingly, we’re undergoing a period of significant growth. The population of Bozeman is around 50,000, and it’s projected to almost double in the next 5 to 7 years. Montana State University is located here, so there’s a lot of growth coming with the student population, and there’s an innovation center being built. The other factor is quality of life. We have a very healthy, very active population here.
Gamble: In terms of the EHR, what type of system are you using?
Havenhill-Jacobs: We’re using Epic. We’ve recently implemented a new ERP system from Infor — it’s the latest version, which is cloud-based. There were a handful of organizations that went live with it the same time we did, including Akron Children’s.
Gamble: Had Bozeman previously been using cloud-based solutions, or was this a new initiative?
Havenhill-Jacobs: It’s a fairly new initiative for us. Because of our size and the area in which we’re located, I think it gives us an advantage in terms of not having to provide physical space. There are also staffing opportunities that come with using cloud services.
Gamble: And what about the physician practices – are they on Epic as well?
Havenhill-Jacobs: They are. Our entire health system is using the same Epic instance. Like many organizations, we’re spending a lot of time looking at how we can optimize the system to support efficiency, standardization and workflow, while also improving the provider experience. We’re doing complementary things like providing scribes, both physical and virtual, to help with that experience.
Gamble: Let’s talk about optimization. What’s your strategy there?
Havenhill-Jacobs: We recently hired a new system director for applications and informatics. She actually worked for Epic earlier in her career, which is helpful. Her approach is focused on assessing whether the workflows we put into place are, in fact, supportive, and serve to enhance the experience for patients and providers. It’s also identifying areas we need to look at — whether it’s revenue enhancement or from performance or operational standpoint — so we can pinpoint those gaps and determine how we might best organize those optimization efforts.
In many cases, it’s going back and doing one-on-one training with some of our providers to make sure that not only are they aware of everything that’s available to enhance their experience with the EHR, but that we’re giving them tips and tricks based on what we’ve observed in their use of the system.
Gamble: Do you also have specific groups or committees focused on improving user experience?
Havenhill-Jacobs: We do. A number of committees were established after the implementation to help drive optimization; some of them span multiple sites, and some are within specialty areas. Our CMIO leads and participates in a number of those, along with our analysts and informaticists. And many of them are focused on a specific module. For instance, we’re going a lot of optimization with OpTime [Epic’s operating room management system], especially with preference cards. And with our transition to the new Lawson system, we’ve engaged in a new Group Purchasing Organization.
We’re working through a lot of cross-system optimization. Each of those module-based areas have groups that focused not just on which optimization opportunities are available, but which ones are coming down the road. We did an upgrade last fall, and so a lot of our focus has been on whether we did the best job possible with training and education. Are we taking advantage of those things we can do within the system, whether it’s something that we can build or something where we can partner with another organization?
Gamble: Is it a challenge to focus on optimization and make sure users are getting what they need without over-customizing?
Havenhill-Jacobs: It is, because you want to be standardized. That’s the goal. In my own experience, I started working with Epic implementations back in 2003 or 2004, when I was with larger systems. What I found is that those organizations have struggled with the fact that so much of what was done early on was customized, and so you couldn’t benefit from – or even utilize – the new features that come in with the upgrades, because they didn’t fit with your system.
With everything we look at, we take the perspective of, how do we apply guiding principles so that we don’t make decisions that deviate from where we’d like to be from a standardization standpoint? We want to avoid having to deal with problems in the future.
Gamble: And of course there’s no secret sauce there. But what are some things you’re doing to avoid that scenario?
Havenhill-Jacobs: I think it’s pulling the appropriate stakeholders together — and that includes users and individuals with expertise — to talk about the impact of the options that exist, and the standardization benefits of coming to an agreed-upon determination workflow, process, or protocol. It’s trying to facilitate this conversation with all the right folks in the room so that everybody actively has a voice and is able to advise on the risks and benefits.
Gamble: Looking back at your career, you have some clinical background. I imagine that experience has helped shape the way you approach things.
Havenhill-Jacobs: It absolutely has. It’s interesting; when I was doing clinical work early in my career, I liked it, but I didn’t love it. It was what I call a ‘happy accident’ that I ended up moving into information technology. It’s a perfect blend of everything I loved about the clinical and operation worlds, and everything I know and love about IT. I believe it gives me a unique opportunity to have conversations with people and become engaged in the provider space, the clinical space, and the operational space, as well as with my peers and staff in technology.
Gamble: Having worked in that space, do you have best practices you can offer to CIOs who don’t have that background on how to build strong relationships with clinical leaders?
Havenhill-Jacobs: I think the opportunity we have as CIOs — whether we have a clinical background or not — is to really develop those relationships; to be curious about the work that is happening, and go to that work. Go spend a day in a clinic and watch the work so that you get a good sense of what it is that they do. Because when you step into those different worlds, you’re able to understand how different departments communicate with each other. In so many ways, our job as CIO is to be able to tailor the message to our audience; to know them well enough to understand what’s important for them to hear, and how we can best communicate that. It’s understanding people.
Gamble: I’m sure it’s not something that happens overnight, but instead has to develop over time.
Havenhill-Jacobs: What I’m seeing, at least in healthcare, are fewer CIOs who are purely technically focused or who come from a technology background. I’m seeing more CIOs who have had the time and experience to develop insight into how to have those conversations and engage effectively. I’m seeing more CIOs coming in with backgrounds in clinical or operational areas who bring in a different perspective.
For the staff that work within IT, it’s a growth and development opportunity when a leader encourages them to think differently and think broadly from a clinical or an operational perspective about what they’re bringing to the table. It helps elevate them in the area of expertise they bring into the conversation.
Gamble: We are definitely seeing more of a variety in terms of where CIOs come from, which is very interesting.
Havenhill-Jacobs: It is. And I don’t believe it’s a weakness to come without specific technology experience.
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