Chapter 09: Information Systems at MD Anderson
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Description
Ms. Houston begins this segment by briefly describing what led her 1997 decision to shift from nursing into Information Systems after agreeing to serve on MD Anderson’s Computer Based Records Project. She then talks about how Information Systems has fit into (and driven) the 2005 restructuring and combining of Departments. She notes that much of her role involves serving as a liaison between Information Services and Clinical Operations and gives the example of working with critical care providers while implementing the Picis system to do preoperative evaluations and various kinds of documentation. She also notes that Information Systems was first perceived as a “top down” initiative, but after the 2005 restructuring, this shifted as “clients” within the institution requested services and support. She explains how IS is funded and how she helps Dr. Thomas Burke, M.D., Executive Vice President and Physician in Chief, prioritize the IS projects funded. She describes some of the challenges of satisfying the requests for IS support. They have funds, but a great deal is already committed to ongoing projects. With the case of Infection Control, for example, they have funds, but not enough people to implement and support a new IS initiative, and contracting this support would increase the price.
Next, Ms. Houston describes the challenges that come from MD Anderson’s desire to always have the newest, most cutting-edge products. In Information Systems, this can mean purchasing newly developed software that may not be ready for full-blown use. The challenge of working with MD Anderson: patients have one record that follows them across inpatient and outpatient care, so providers can keep track of all procedures and drugs given. Chemotherapy administered in the hospital must be added to treatment given in the Ambulatory Care Clinic to avoid exceeding safe dosages. Ms. Houston then talks about how unique the laboratory systems are at MD Anderson and the high volumes of tests they perform, all of which have to be tracked by computer-based patient records.
Identifier
HoustonDA_02_20120727
Publication Date
7-27-2012
City
Houston, Texas
Interview Session
Topics Covered
The University of Texas MD Anderson Cancer Center - Building the Institution; Institutional Processes; The Administrator; Professional Path; Professional Practice; The Professional at Work; The Business of MD Anderson
Transcript
Tacey Ann Rosolowski, PhD:
Okay. Well, we were starting to talk about your work in information technology. You talked about how you made that switch. We were starting to talk about the various projects that you worked on to start installing the first electronic record system. You talked about the first system you used and now the one that you—then the one that you switched to. Oh, I meant to say you had said that maybe you weren’t so sure about whether you should use product names. If you want to just leave them out, we can always put them in the transcript later on—
Deborah Houston:
Okay.
Tacey Ann Rosolowski, PhD:
If you’re concerned.
Deborah Houston:
I don’t—
Tacey Ann Rosolowski, PhD:
If you’re concerned about that, we can handle it that way.
Deborah Houston:
Okay.
Tacey Ann Rosolowski, PhD:
Yeah. What I wanted to get a sense of was how you went—you went from coordinator to the Director of Enterprise Applications and then Director of Perioperative and Critical Care Informatics. Then, finally to the position you hold now, Director of Information Systems/Services?
Deborah Houston:
Services.
Tacey Ann Rosolowski, PhD:
Clinical Operations and Projects. I wanted to get a sense of your career track through the information systems, and what were the big projects that you worked on—
Deborah Houston:
Okay.
Tacey Ann Rosolowski, PhD:
—to help push MD Anderson into the twenty-first century.
Deborah Houston:
Electronic Age.
Tacey Ann Rosolowski, PhD:
Yeah.
Deborah Houston:
Like we said previously, I came to IS sort of as a lateral move, and they created a title. With that title, sort of, became—I was over, at the time, it was called the computer-based record project. Then, when we put that first vendor project on hold, it’s like I needed something to do, so I started managing all of the various clinical applications that we had in the department. That was kind of—being more of a manager, again, of people that were working on projects. Then, we had a change—the woman that was the director left the department. Then I got a promotion to the Director. We called it, I think, Enterprise Applications.
Tacey Ann Rosolowski, PhD:
Uh-hunh (affirmative). Management Information Systems (talking at once).
Deborah Houston:
—Information Systems, yeah.
Tacey Ann Rosolowski, PhD:
That was ‘99 to ‘05.
Deborah Houston:
Yeah. That was the old—the department had changed names. Management Information Systems was a large department and, again, I was managing the managers and the staff that were working on all the various clinical applications and, at that point, administrative applications.
Tacey Ann Rosolowski, PhD:
Now, when you saw clinical operations—
Deborah Houston:
Clinical applications like the critical care system we were installing, the system that does patient registration, working on a new system for pharmacy, working on a new system for lab, those kind of things. Administrative applications would be things like PeopleSoft—that is our human resource application—that kind of thing. The MIS Department was quite large. We had a restructure back in 2005 of the IS Department Division. Our CIO at that time left—a different CIO than the one that had brought me to IT. He left. We had a new CIO, and we reorganized the way IS was configured, so the MIS Department as a whole, got actually split up.
Tacey Ann Rosolowski, PhD:
Why was that?
Deborah Houston:
It was a huge department. I mean, it was a big department, so they took the administrative applications and the human resource stuff with some departmental and other department stuff and made the Department of Administrative and Financial Services. The clinical applications became Clinical Applications and Support. We had a new EMR Development and Support Department created. That’s when I changed and took the position I have now, which has morphed in different job wording titles, but sort of a position where I work as sort of a liaison between the IS Division and the Clinical Operations of the hospital. Originally, I didn’t have any direct employees. It was really nice for a couple of years to have no one reporting to me. It was fabulous. I reported to the Chief Information Officer but had an indirect report to Dr. [Thomas] Burke, who is our Executive Vice President and Physician in Chief, and officed in the Clinical Operations side of the hospital, which is where I talked with you yesterday. That allowed me to be aware and know what was going on with all the various clinical areas and be involved in discussions and part of decisions on directions they wanted to go and helped oversee the overall clinical application portfolio for the hospital and the funding and requests for funding for those solutions.
Tacey Ann Rosolowski, PhD:
Could you talk about some specific projects that you found really interesting—just so I can get a real sense of what you were doing?
Deborah Houston:
Well, one of the things we did when I was in MIS and then it completed later was the implementation of the PICIS suite of products for the operating room and intensive care units.
Tacey Ann Rosolowski, PhD:
What was that PICIC?
Deborah Houston:
P-I-C-I-S. It is the system that does pre-op evaluation of patients—the actual during surgery documentation that the nurses do, the anesthesia documentation, and then the post-operative and ICU documentation that the patients need before they go back to the floors. It is a critical care suite of products by a vendor. That had been implemented over several years. It took a while because it was a product that matured over time. That was a big effort.
Tacey Ann Rosolowski, PhD:
Let me ask you this. I mean, because people don’t like change. What was it like to come in—how did it work? You said you were the liaison, so was your role, in part, to design how this product would be introduced to the individuals who were going to be using it?
Deborah Houston:
No. One of the things that we did with our restructuring in 2005—the perception prior to that was that IS was making all the decisions on what we were doing for the customer. I don’t know that that was necessarily true, but that was kind of the perception. The way the process worked now is we have a new governance structure where the users—the business areas—the clinical users, for example, were the ones that made the decisions about what we were going to do related to information systems. If the lab had a problem or wanted a new system, the lab was the one that was driving the selection of the system and the buy-in by the users. Then, the IT staff was there to help with the correct configuration and implementation of the system.
Tacey Ann Rosolowski, PhD:
Who chose the PICIS system then?
Deborah Houston:
Dr. [Thomas] Feeley, who is still the head of Anesthesia and Critical Care—again, who chose it. We’re a state institution. I’ve learned so much over the years. We’re a state institution, so something of that value has to go out to bids. We did a request for proposal that was posted, and we had—I don’t remember how many—venders that responded that you had to then review them all and do true system selection, and then PICIS was chosen. He was the driver of that project and the executive sponsor.
Tacey Ann Rosolowski, PhD:
Where did the funds come for something like this?
Deborah Houston:
The institution has capital funding, and our capital funding goes for building buildings and for IT infrastructure, so every year the institution determines how much money that we are going to have for IT development or IT use. That money comes from, I believe, it is a certain percentage of the margin that we make, and it goes into capital for future—for long-term use. We have been very lucky, even though this institution has a huge appetite for information technology now—everybody wants something right now. We have been very lucky that we have had a large allocation, which is again never enough for what people want. In our governance structure, committees get allocated a certain amount of that money. In my role, I help Dr. Burke, who chairs the clinical committee, to with the committee membership prioritize what is going to be funded and how much is going to be given to each project. That is the basic principle of how we do it today. Based on some projects that take many, many years, like our EMR development, there is a certain amount of money that has to be—you already know you’re going to spend. For example, this coming year, we already know how much we are going to need at a minimum for our EMR development. We have a huge project to replace our hospital information system that does our registration, patient scheduling, patient billing. We know the amount of that—the financial burden of that for this next year. We know the financial burden of a financial system that has been going in and some other systems that are in process. A lot of our money is already spoken for, so the amount of money that we have to do new—brand new starts of projects is limited. Then, you have to prioritize. Sometimes, it is not the money, it’s the people. If everyone is tied up doing these other projects, we don’t have people to do the projects. A department frequently does not understand that, yeah, they want a new system. Infection Control is a good example. They have been on the list to get a new system for quite a while, and they are at the top of the list, but we have not had the resources available to do the project. The funding has been available, but the people have not been. The Infection Control physician and nurse practitioner are not in the position to install hardware and software and configure systems. You have to have programmers and people to do that. We potentially then go the route of we will contract that in and that happens sometimes, but that increases the price because contractors are always more expensive than a full-time employee. We have to—still once it is in you have to support it.
Tacey Ann Rosolowski, PhD:
Right.
Deborah Houston:
You have to have somebody within the institution that knows something about it before the contractor leaves, so those are the things that I deal with on a daily basis.
Tacey Ann Rosolowski, PhD:
Right.
Deborah Houston:
Fun.
Tacey Ann Rosolowski, PhD:
You mentioned something about the PICIS system. You said it was kind of in flux. I was wondering what that meant and if that’s usual with putting in a system.
Deborah Houston:
Well, a lot of times--I don’t remember how exactly I said it. The software itself—the vendor—the product that we got delivered when we first started that product. If you bought that product today, it comes to you with a set of pre-built templates and things that they didn’t have when we first started. Just like the first EMR product that we used—Cerner—it came without any of that, so we were having to build it, whereas now if you were to select that vendor today it comes in sort of pre-built and then you just kind of tweak it, which is common with software that is newly developed or you are one of the initial users of the software. That’s not uncommon. MD Anderson tends to want to have the newest, the best, the greatest, so we in the past have been willing to take software that is—it is not really ready for full-blown use and work on it.
Tacey Ann Rosolowski, PhD:
Do you get a price break on that?
Deborah Houston:
Sometimes. You sometimes get the ability to have additional features put in that you might not have—influence the development of the product. Frequently, there’s a lot of risks or negative things because it can take longer. It might not work the way you think it’s going to work or whatever.
Tacey Ann Rosolowski, PhD:
Is that a wise decision, you think, on the part of MD Anderson—to always want the newest as opposed to maybe waiting a bit and getting something that is more tried?
Deborah Houston:
I think it’s a fifty-fifty proposition. I think we have been burned, if you want to say that, by going with the best, brightest, coolest, newest features, and we have spent a lot of time and effort, sometimes without anything to show at the end of it. Others, you know, great products at the end of it. I think it just depends on what we’re looking for. The thing to remember is at MD Anderson—everybody says we’re different. We’re MD Anderson. We’re different. We’re different in a few ways that software vendors have to realize. The two biggest things are probably the fact that our patients have one record that follows them through the continuum of care, and the fact that we have chemotherapy ordering. The dosing of the chemotherapy, total dosing of drugs, and the ability to change doses is more complex than ordering antibiotics or pain medicine for somebody. In a general hospital, oncology is not your—it might be a unit or it might be a subset of a unit or you may not even do oncology care—you’re doing general/medical/surgical care. Your system—and most vendors are selling products to those kind of institutions and those kind of community hospitals—100-bed hospitals, 200-bed hospitals, or a med/surg, academic medical center. That’s not what we are, so it makes it difficult.
Tacey Ann Rosolowski, PhD:
Explain to me about—I understand with the patients that have one record that follows them, but what about the issue of chemotherapy and ordering and dosing? How does that influence what the software needs to do?
Deborah Houston:
Well, again, if the system doesn’t follow the patient through the whole care and you have an outpatient system and an inpatient system, you have to assume that the outpatient system—the amount of drug you got as an outpatient—that information can be transmitted to the inpatient system, so you don’t give the patient too much. There are drugs that affect your heart, your lung function. If you get too much, the patient becomes a cardiac cripple or a pulmonary crippled.
Tacey Ann Rosolowski, PhD:
So is that issue of the chemotherapy, is that kind of a subset of the patients having one record or is there something in the software that actually keeps track of the amount that they’ve been—the amount of drug that the patient has been given?
Deborah Houston:
Well, you want the—well, both. You want the software to be able to do that. We can tell you today, pretty much, we can tell you how much drug a patient has had that they got here at MD Anderson. If the patient also gets therapy at home, which a lot of our patients do, you have a bigger problem. The physician is trying to track that through the continued record.
Tacey Ann Rosolowski, PhD:
Interesting.
Deborah Houston:
That’s just one of the things. I mean, again, when you look at systems, a lab system can work in any hospital. We have specialty labs here. Flow cytometry, for example, molecular diagnostic kind of labs that a general hospital may not have. A lab system, if we’re going to replace it, they’ve got to be able to do all of those kind of things or we end up building up something for the specialty lab and have they have to talk to each other—is an example. Then it’s the volume of testing, the volume of things. Can the vendors keep up with our transaction volumes of things?
Tacey Ann Rosolowski, PhD:
What affects that? What affects their ability to do that?
Deborah Houston:
Well, I’m not a technical person, but the way their system is architected, the way it’s programmed, the hardware that it runs on. That’s why I hire those technical people because I don’t—I don’t have a great understanding of that—how fast the computers have to be.
Recommended Citation
Houston, Deborah A. and Rosolowski, Tacey A. PhD, "Chapter 09: Information Systems at MD Anderson" (2012). Interview Chapters. 892.
https://openworks.mdanderson.org/mchv_interviewchapters/892
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