Chapter 17: Building Collaborations and a Discussion about Education and Electronic Health Records
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Description
Ms. Villejo first talks about working with the head of Public Affairs, Steve Stuyck [Oral History Interview], to build collaborations with care providers and leaders within MD Anderson. She then goes into detail about how Patient Education dovetails with the institution’s move to bring in EPIC, electronic health records.
She explains how electronic health records can identify the educational/informational materials required as a patient’s diagnosis and treatment evolves. She explains that executive leadership was interested in hiring a vendor to provide educational materials [Gemmi]. Patient Education performed a ‘gap analysis’ to discover significant overlap between their materials and the vendor’s, so the vendor was unnecessary. [redacted]
Identifier
VillejoL_03_20150605_C17
Publication Date
6-5-2015
City
Houston, Texas
Interview Session
Louise Villejo, MPH, MCHES, Oral History Interview, June 05, 2015
Topics Covered
The University of Texas MD Anderson Cancer Center - Building the Institution; Institutional Processes; Devices, Drugs, Procedures; Building/Transforming the Institution; Multi-disciplinary Approaches; Growth and/or Change; Obstacles, Challenges; Technology and R&D; Collaborations
Transcript
Tacey Ann Rosolowski, PhD:
Yeah. I mean one of the questions that was going through my mind was given that it was hard to—or it was work to communicate to people in the institution exactly what is the service you’re offering both to them as content professionals and then to patients. And so a logical question would be well, who were your big allies, who were your big collaborators. And it sounds like there were some really key people around the institution who were working in similar ways.
Louise Villejo, MPH, MCHES:
Absolutely.
Tacey Ann Rosolowski, PhD:
Is there anybody we’ve missed talking about who was a collaborator?
Louise Villejo, MPH, MCHES:
There were so many. As I mentioned, when we had multidisciplinary patient education committees in each clinical area, that in itself was a great builder of awareness for the clinical staff, because we had a meeting every month. We had about fifteen people come into those meetings. We had the clinical medical director. Usually another doctor. The nurse manager, which is now the center administrative director. We had Nursing Education. We had Dietary, Pharmacy, Chaplaincy if it was appropriate, Social Work. So we sat in these meetings with all these people every month to develop the patient education program. So that was a great builder of awareness of what resources we could bring to the table and how we could help support the work they did every day.
Tacey Ann Rosolowski, PhD:
And I’m sure also just demonstrated that no, you were not going to be heavy-handed and try to control content. You were there to massage the form of the content but not tell them what their business was.
Louise Villejo, MPH, MCHES:
Absolutely. But I still—I mean one of the things that I do—and Steve was great about this too. With every time we had a new division head, clinical leader, senior VP, we got on their agenda and gave them an overview of the program. And that I think needs to—I mean that continues to this day. I’ll send it to you. I have a packet. My orientation packet. And I march around the institution and meet with all the leaders, and all my new bosses, and give them an overview, because really everybody sees a different part of the elephant. So they might see oh, patient education develops a lot of great materials. Well, that’s a big part of what we do, but it’s also a small part of what we do. And I think with Epic coming along, it’s really raised awareness of the whole program. But also the comprehensiveness and depth of the program. Because for example with Epic, which is our new electronic health record, when they were planning it they had developed alliance, and I don’t know how far they went in the contract, but we had a vendor. So they were going to purchase the services of this vendor for patient education resources. And so we weren’t really in that level discussion but then were brought in right away. And so we were asked to do a gap analysis. They had about—
Tacey Ann Rosolowski, PhD:
What does that mean, gap analysis?
Louise Villejo, MPH, MCHES:
Well, they had about 3,000 documents in their database, and we have over 3,000 documents in our database. So what do they have that we don’t have and we have that they don’t have? And what’s the gap?
Tacey Ann Rosolowski, PhD:
Got you.
Louise Villejo, MPH, MCHES:
So [ ] in our office, [ ] the associate director, really went through and looked at most of those materials. Now of course because they’re a vendor for a lot of different types of hospital, they had well baby and orthopedics and just a lot of different topics that we might not use, maternity and all those things. And then of course all of ours is very specific, and very specific to MD Anderson what the needs are that we have assessed over all these years. So what she found was there was probably only about 500 materials they had that we could use and we didn’t have. And so one of the things that they said they were going to be able to do was integrate our materials into their system so that they could then be brought up in Epic. So if the doctor tells you, “Well, I want you to get a mammogram,” then that piece, the information about that, I’m going to have this test done, the information would load into your record. So it has to do with metatagging and so forth. And so they said they could do that. And then when we gave them the materials to test it we never really got anything back. And then luckily what was decided is that when they saw the gap analysis and saw what we had, what they had, they said, “We don’t really need them.” I mean those 500 documents that they had that we didn’t have, I mean we didn’t have them because nobody had ever asked for them. So why spend all that money? They can’t even integrate our materials. And of course we were reaching out around the country to find out how this had been implemented in other areas, in other institutions. And I didn’t see anything that had really gone well as far as taking that institution’s documents and loading them up into somebody else’s infrastructure. They would wrap their branding around it and then it just really wasn’t nice and clean and very specific.
Tacey Ann Rosolowski, PhD:
So let me just ask you. So how would this work? So I come in. I’m a—I don’t know—throat cancer patient. And so the physician or someone is entering material, information into Epic. And so would Epic automatically like keyword and like bring up health education materials specifically for me? You’re nodding.
Louise Villejo, MPH, MCHES:
Exactly. Exactly.
Tacey Ann Rosolowski, PhD:
Wow, that’s pretty amazing.
Louise Villejo, MPH, MCHES:
So they would say, “We need to get you in and we need to do a CT scan, we need to do an MRI.” And when they put that order set in there then the patient education documents would pull up into that patient’s medical record so that that would be available there. They’re doing tremendous things now with the electronic health records where it’s very communicative. Some of them even have where they’ll call the patient. I see your A1c is increasingly higher. Do you want me to help you make an appointment? Do you need additional information? And it’s all electronic. They have been able to build these things so they’re actually interacting with patients.
Tacey Ann Rosolowski, PhD:
So when you say—I mean it’s a machine interacting with patients or a person is tagged to call?
Louise Villejo, MPH, MCHES:
What do they call, like AVR. It’s voice-activated. So it is not a person, but it’s smart technology that they’ll call you and say, “I see your test results and so-and-so, do you need to make an appointment? Do you have any other questions? Do you want to talk to your doctor?” So they have all these decision trees. It’s amazing.
Tacey Ann Rosolowski, PhD:
Wow, that is amazing.
Louise Villejo, MPH, MCHES:
And I’m sure that we will get there. It’s a very exciting time right now.
Tacey Ann Rosolowski, PhD:
Are you worried about the people piece? If it’s going to be so heavy that the patient is going to be—I mean because I’m sitting here thinking wow, how would I feel if I got nine calls from a machine and was wondering if I was ever going to talk to a human being.
Louise Villejo, MPH, MCHES:
Exactly. And that is exactly what we talked about in some of those meetings. Because if this voice recorder is calling and then we’re calling them about their appointment and then we’re calling them about—I mean there has to be a coordination of all these. And there has to be an easy way. And this is one thing that I know the institution is working on. There has to be an easy way for a patient to be able to get through. I mean there have been some issues that have come up with—I mentioned that patient safety panel that we did. I was on the panel because I had a family member recently here and was having some issues. And so I talked about that. But this other gentleman said he was in this horrific pain. His wife kept calling and couldn’t get through anywhere. So I think they finally brought him into the emergency room. But that is a big issue here that I know that they are addressing. It’s hard to get a warm body sometimes and get to the resources that you need. So I know that that’s a big issue that we’re working on.
Tacey Ann Rosolowski, PhD:
I mean it is exciting that Epic would have the capacity to do this and to give the patient so much more information and a framework in which to understand OK, if this then that, if this then this other thing. But you just—especially when you’re a patient you need that human contact.
Louise Villejo, MPH, MCHES:
Exactly.
Tacey Ann Rosolowski, PhD:
And how do you make sure that’s part of the whole picture?
Louise Villejo, MPH, MCHES:
Yeah. Let me just clarify.
Tacey Ann Rosolowski, PhD:
Sure.
Louise Villejo, MPH, MCHES:
So this was another vendor that came. There’s a lot of vendors that can plug into Epic and provide that service. So this was an example of one of those that I saw.
Tacey Ann Rosolowski, PhD:
Right, but not Epic itself.
Louise Villejo, MPH, MCHES:
But we haven’t really purchased that part of it. But they’re looking at that.
Tacey Ann Rosolowski, PhD:
Do you want to name that vendor that you were looking at?
Louise Villejo, MPH, MCHES:
I’m trying to remember their name. Let’s see. Oh, it’s called Emmi, E-M-M-I.
Tacey Ann Rosolowski, PhD:
Emmi, E-M-M-I, OK. Yeah, interesting.
Louise Villejo, MPH, MCHES:
So I think like anything else it has to be well organized, and somebody has to be looking at the big picture to make sure that we’re not just bombarding people with all these automatic phone messages or e-mails or texts or whatever. But if we structure it right it would be another way to really help people taking charge of their own health and knowing what to do. [redacted] So here’s the director of patient education, the director of Patient Experience trying to strategize on how best to get this patient’s pain relieved. And so when I look at it that way I’m thinking how do people maneuver through our health care system. I know a lot and I can’t figure it out.
Tacey Ann Rosolowski, PhD:
What were the reasons? What would be the reasons? The process reasons why a patient’s pain would not be addressed?
Louise Villejo, MPH, MCHES:
I think that they were definitely addressing it in different ways. It was not being relieved. And I think that some areas are more hesitant than others to call a pain consult. And there are—he has at least three doctors here. I know that obviously one is in charge. But they’re in and out of the room. And one of the things that I did was they have the communication board on there, and they had the three goals for the patient that pain wasn’t on there. I’m like this kid can’t even think. He cannot be activated and engaged and speak for himself. He’s not even conscious, he’s so under the influence of drugs or whatever. But he’s in a lot of pain. So I think it’s just very complicated. And we might be addressing it but then we have experts that can be brought in to really look at that again. And I think some areas do better than others in bringing in a pain consult.
Recommended Citation
Villejo, Louise and Rosolowski, Tacey A. PhD, "Chapter 17: Building Collaborations and a Discussion about Education and Electronic Health Records" (2015). Interview Chapters. 1532.
https://openworks.mdanderson.org/mchv_interviewchapters/1532
Conditions Governing Access
Redacted
