Chapter 10: A Reality Check for Information Systems: Building Systems for Teams
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Description
In this segment, Ms. Houston talks about the role she has served “an interpreter” in building information systems at MD Anderson. She explains that her 27 years of experience in patient care have enabled her to represent users’ needs in Information Systems. When information services are planned, she understands how work flows in clinical situations, how providers integrate record-keeping and data entry into their work day, and how they relate to screens and the organization of applications. While Director of Enterprise Applications in Management Information Systems (’99 – ’05), she also set up a class for technical staff about cancer, so they would have some idea of the real life situations that Information Technology users at MD Anderson deal with. Ms. Houston also notes that on first joining IT she sometimes heard, “What’s that little nurse doing here,” and won respect by performing well also noting the increase in numbers of women in the field and change in attitude. She then expresses concern about how her skill set will be replaced after her retirement, given her unique view and the respect and collaborative networks she has built over the years. In a discussion of ClinicStation software, she gives an example of her ability to facilitate users’ understanding that technology may not be the solution to their problems if what is needed is a change in work process.
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; Character, Values, Beliefs, Talents; The Administrator; The Leader; Institutional Processes; Devices, Drugs, Procedures; Building/Transforming the Institution; Portraits; Professional Practice; The Professional at Work; Diversity at MD Anderson
Transcript
Tacey Ann Rosolowski, PhD:
Right. You mentioned a number of times the skill sets that you don’t have. What have you discovered that you have brought to this particular role that makes you so valuable in it?
Deborah Houston:
I think I brought the realistic—I hope—I brought the realistic face of this is what users that take care of people—patients—need the system to do and been able to say, “No, a user does not want to go between three different folders to look at one thing,” or kind of the mechanics of how the system is going to work. How many applications is somebody going to have to go into to take care of a patient? Then sort of a reality check on the way people navigate through screens on a computer. Does it make sense? Is it worded correctly? Have they thought through the logic? Not that I can program it in the back-end, but does it make sense that you have to have height and weight entered first before you get down farther or the way the physician gets some kind of an alert of an error in what he has done before he gets to the bottom, signed it, and has left the application. You are trying to streamline the way the applications work.
Tacey Ann Rosolowski, PhD:
You bring the really detailed knowledge of how it operates at the bedside.
Deborah Houston:
Right, and I have also worked both with surgical and medical physicians and had some exposure to other—radiation and that kind of stuff—in an outpatient, so I’ve seen how—granted, it’s been a long time since I have actually worked clinically but, at least, I have some knowledge of what they’re talking about and what they’re doing. One of the things I did years ago when I was in MIS was I set up a class. I don’t remember what I called the class, actually, but it was sort of a class for the technical people in department about cancer and about—kind of medical things. It is like you speak a totally different language. Yes, you work at a hospital and you’re over here doing a very important thing to help make cancer history, working in this building, doing your IT thing, but you need to understand what that means to the people across the street that are the actual patients. I did—like kinds of cancers. When they hear things, you know, “what’s the difference between a surgical and a hematology patient?” When you hear people talk about that—what’s a solid tumor versus a liquid tumor? When they are in meetings they don’t fall asleep or they, at least, understand what people are saying. I did a one-day kind of thing for everybody—types of treatment. What is surgery? What is radiation? What is chemotherapy?
Tacey Ann Rosolowski, PhD:
What was the effect of that?
Deborah Houston:
I think it gave—well, hopefully—they said they liked it. I hope it gave them more understanding and a greater appreciation for what they were doing. Things like—and IT person calls a disc something different than a person over here in the hospital. You have a disc problem. Your disc problem in the hospital is something is wrong with your back. A disk problem over here is something is wrong with the computer. When you are on the phone talking to people, you kind of have to have a frame of reference, so I think it helped them. We don’t do that anymore, but it was fun when we did it. We did it a couple of times.
Tacey Ann Rosolowski, PhD:
The class?
Deborah Houston:
Yeah. We did it a couple of times.
Tacey Ann Rosolowski, PhD:
Interesting. What do you think gave you that ability to talk to people on both sides of the problem—the technical people and the clinical people? It’s an interesting translational skill.
Deborah Houston:
I don’t know. I will talk to anybody; probably my personality and my lack of fear. I don’t know. I don’t have a problem saying, “I don’t understand that. Can you explain that to me in language—tell me what that really means.” We’ll be in meetings today, and they’ll be talking about “we have this and that” and “we’re going to blah, blah, blah.” I say, “Well, I hope you don’t tell them that way because they’re not going to understand that. They’ll hand out something that is going to be a communication that is going to go out to users, and it’s like, “This just makes no sense to the nurse at the bedside or the physician.” That’s an interpreter, I guess, is what I’ve been over time.
Tacey Ann Rosolowski, PhD:
Yeah. That’s interesting. Obviously, they take you seriously and understand—that take what you say at face value. It needs to be done.
Deborah Houston:
Well, I know when I first came into IT, there were some of the directors that had been in IT forever. It was like, “Why is that little nurse in here? What is she going to provide? She doesn’t know anything about IT.” I didn’t claim to know anything, which I think was beneficial because I didn’t try to make something up—act like I knew.
Tacey Ann Rosolowski, PhD:
Right.
Deborah Houston:
Even today. I will be over and one of the VPs will come in my office and say, you know, “This doesn’t work.” I say, “You think I know how to fix that? Let me look, but let’s call for info. Let’s call and get somebody—.” I’ll give it a shot, but I don’t know how to fix anything, usually.
Tacey Ann Rosolowski, PhD:
With your comment about the directors when you first came into IT, you’re kind of broaching an issue I wanted to talk about, which is how many women were in IT when you joined and what was it like operating as a woman?
Deborah Houston:
The woman that was my boss. My boss was a woman. She was the director of MIS.
Tacey Ann Rosolowski, PhD:
And what was her name?
Deborah Houston:
Susan Perry. At the time, she was the only director. I’m just trying to remember, but she was the only woman. Then we had—there were a couple of other people that came in—not jobs like mine, but were like project manager kind of jobs that were women. Today, we have--. IT is a pretty male-dominated profession. Today at the director level in IT, we have—there’s three of us.
Tacey Ann Rosolowski, PhD:
Out of?
Deborah Houston:
Out of twelve, I think it’s twelve. Patty Layne is the Director of Project Support and Coordination Services, which is kind of our project management office. Leslie Smith is the Director of Clinical Applications and Support. Patty is a lab technician by background. Leslie is a nurse by background. That’s nice. Then we have one other—one associate director that is a nurse, that’s in the desk-top network group. We have several managers that are nurses, so there’s a few, but most are men.
Tacey Ann Rosolowski, PhD:
How did you get that message—“what’s that little nurse doing here, what could she know about—?”
Deborah Houston:
You could tell. You could tell, just by body language-the way they—. My mother used to say, “Don’t tsk and roll you eyes at me.” The way they would like—when you would say something. They wouldn’t take your comment seriously or whatever.
Tacey Ann Rosolowski, PhD:
What was the process of turning that around?
Deborah Houston:
You just keep after them—say something and your boss supports your or, “Yes, that’s a good idea. We’re going to do that.” You’re taken seriously by more than that person. You’ve proved them wrong.
Tacey Ann Rosolowski, PhD:
You kind of had a coalition since your boss was a woman and—
Deborah Houston:
And my boss’ boss wanted me to come into the job—that was their boss, too.
Tacey Ann Rosolowski, PhD:
Is the attitude a little different now?
Deborah Houston:
I think so.
Tacey Ann Rosolowski, PhD:
Yeah.
Deborah Houston:
I think so—with women in general, yeah. I think my role in IT was very different. I think now having someone come in like me with absolutely no IT experience would probably be more difficult. One of the things—I have talked to my previous boss before he left, and we need to think about it—what are we going to do when I retire because I’m not working forever. What is the plan to replace someone in this job? If that is not the plan, what are we going to do to have this kind of service within the IT division for the clinical areas of the hospital? We have a few years, hopefully, to kind of figure that out. There isn’t anybody, I don’t think, in the division today that if I were to get hit by a bus that could walk in and take—do what I do. There isn’t anybody. It’s terrible to—it sounds very self-effacing to say that, but there isn’t anybody that has the knowledge of how stuff is kind of fitting together—because of the background I had when I came into IT and—it is not just my clinical knowledge—my old clinical knowledge—that is of help now. It is the past ten years in IT, or however many years I’ve been here, fifteen I guess. As we have added departments and added applications and knowing the background of that and the plan for how that is going to fit—we don’t have anybody else here that knows that and has kept up with—. Patty and Leslie are probably the closest, but in their jobs that they are in today, they are not as familiar as everything else out there. That’s just—the respect and the collaboration I have with the people in the clinical and operation side of the hospital is something that’s—that takes time and effort and we just don’t have anybody. That’s something we’re going to have to address over the next couple of years. We will.
Tacey Ann Rosolowski, PhD:
What do you think are the key pieces? What you’re describing is sort of the irreplaceable or the difficult—?
Deborah Houston:
No one is irreplaceable. (Talking at once).
Tacey Ann Rosolowski, PhD:
It sounds like you’ve got this very unique set of perspectives and a certain level of people are—at that level. I’m just wondering, what is the key piece? Is there kind of a culture that’s been established about the installation of electronic records, and you need to know that culture? What is it about?
Deborah Houston:
I don’t know that it’s the culture of installing systems or anything. I think it’s the relationships that you’ve built up over time and the ability to go out there and talk to people and figure out what people need versus what they want. What do they really need and help them identify what is the real problem they’re trying to solve? Everybody thinks a computer system is going to fix their problem—whatever it is. From the parking is too expensive, a new system will help us get people in and out of the parking garage faster, for example. A new scheduling system is going to make our physicians show up in clinic on time and be more productive. That’s really not the issue. A new something is going to help us transport patients faster or whatever. Sometimes there is a solution for that and sometimes it’s not. It’s a process change that people need to make. That is something that I have learned over the years is that it is not always the application. An example, a very recent example, we have installed an application for electronic prescriptions. A lot of people—you go to your doctor’s office and instead of giving you a piece of paper, they go to the computer, they put it in, and your prescription goes to CVS by your house. You go to CVS, and it is ready. You’re not having to go twice to the pharmacy. We have installed a system, built it, installed it within ClinicStation, so the physicians go use the application they’re used to all the time, ClinicStation, and order a prescription. It works. There’s lots of things wrong with it or it’s not perfect, but it’s a commercial product we installed, embedded within our EMR. It is a product used by thousands of doctors, thousands of hospitals, and doctor’s offices throughout the country. It’s not, you know, Joe Blow’s system. You have doctors that go in and do it. Then, you have other people that can write prescriptions for doctors. In your doctor’s office, probably his secretary calls in your antibiotic prescription for him. He probably doesn’t do it himself. There’s a role—it’s called a provider agent—for the nurse or whoever to, on behalf of the doctor, she is ordering a prescription for him. Then, there’s a clinical role where if she orders it it has to go to him to sign first before it goes to the pharmacy. The other one, it goes right to the pharmacy. We installed it. In the inpatient area, the nurse just—they don’t every write prescriptions, so she has the clinical role where she can see what he is doing, but she can’t really do anything with prescriptions. In the outpatient role, they have been calling in prescriptions and faxing prescriptions for the physicians forever, so they have the provider agent role. We finally got that resolved. What is happening is the physicians are telling the nurses, “Well, he’s here, and I’m here.” He’s saying go send a prescription to whatever, instead of doing it himself, because that’s what he’s done for years and that has been accepted. We have now had all these issues about the system doesn’t let us do this. The system is letting the nurses do what they want. It is like, it isn’t the system. It’s the process behind the system, which finally this week after many meetings and many—they finally understand that. They are wanting to change things in the system that will then obstruct care of the patient, yet it is the process that they have behind it that was old behavior that they didn’t change.
Tacey Ann Rosolowski, PhD:
Have you been part of suggesting how that process can change?
Deborah Houston:
To some extent, but it is sort of—as opposed to suggesting how it will change, I feel like I have been able to bring reality back to the table. It is like, “We don’t want to be able to have the order go to the pharmacy before the physician signs it. No. We can’t do that.” It is like, okay, what do you do today. If you don’t have you prescribe it, what did you do today? How did you get a prescription to the patient if the physician called you and said, “Order the nausea medicine for the—.” Do you want the patient who is throwing up at home to have to wait two days for the patient to sign the prescription before they can get their medicine? Well, no we don’t want that to happen. Then they have to have this role, that kind of thing. What if the nurse is writing prescriptions without talking to the doctor? Well, what do you do today? Is that happening today? What are you doing today for that kind of behavior? If you find that out? That’s what I’ve been doing as opposed to saying, “This is what you ought to do.” That’s what I try to do. That’s one of those things that you do well and things you don’t do so well—I think one of the things I do relatively well is get the people at the room and at the table to help facilitate those kind of discussions. Sometimes, I go to meetings and it’s like, yes, we can change the system. We can talk to the vendor, and we can maybe change the system to do this, this, this, and this. If it’s something we’ve built, yeah, we can change it. Then, it’s like be careful what you wish for too. Sometimes they ask for things, and it’s like have they asked all the right people. They will make a change for one area that really negatively impacts somebody else. We try to make sure we’ve got all the right people to talk to.
Tacey Ann Rosolowski, PhD:
You spend a lot of time in meetings?
Deborah Houston:
I spend a lot of time in meetings. I spend a lot of time in meetings. My nephew, when he was little, one time said, “Aunt Debbie, what do you do all day?” I said, “I go to meetings.” He goes, “That doesn’t sound very fun.” It’s like, “It’s not.” Yes, I spend a lot of time in meetings for various reasons—listening to complaints; then, getting the right people to fix whatever the issue was or address the issue.
Tacey Ann Rosolowski, PhD:
Yeah, I mean, it’s the kind of role—people come to you when they’re really psyched and think they have a solution and, then, they come to you when it’s blown up in their face.
Deborah Houston:
Yeah, both. They do. They come to me with, “How do we make this happen?” or “This is what we need. Is it reasonable?” or “This is a pile of you-know-what and it doesn’t work.” That’s the piece that I try to prevent from happening—to make sure we did it right the first time.
Recommended Citation
Houston, Deborah A. and Rosolowski, Tacey A. PhD, "Chapter 10: A Reality Check for Information Systems: Building Systems for Teams" (2012). Interview Chapters. 893.
https://openworks.mdanderson.org/mchv_interviewchapters/893
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