Chapter 12: Information Systems as a Service Provider
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Next Ms. Houston notes that she plans to retire in three to four years, and by that time she would like to see efficient data entry for nurses and computerized systems for physician documentation, as well as completion of the project, Institutional Bar Code for Patient Safety. All of these initiatives, she says are key to safety and productivity. They are also tangible and achievable goals. As she looks back on goals already accomplished, she pleased to have started the hematology laboratory for patients and also gratified with the success of the Perioperative and Critical Care Informatics group that she directed from ’06 to ’09. MD Anderson faculty and staff are quick to ask for new technology, but the challenge is getting them to actually use it, Ms. Houston says.
Identifier
HoustonDA_02_20120727
Publication Date
7-27-2012
City
Houston, Texas
Interview Session
Topics Covered
The University of Texas MD Anderson Cancer Center - An Institutional Unit, Program; The Administrator; Institutional Processes; Devices, Drugs, Procedures; Building/Transforming the Institution; Professional Practice; The Professional at Work
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.
Disciplines
History of Science, Technology, and Medicine | Oncology | Oral History
Transcript
Tacey Ann Rosolowski, PhD:
Absolutely. Yeah. That makes sense. Yeah. I want to make sure that we are hitting everything. You mentioned that as you advanced through these different positions, some of them were simply re-naming the position you have already. I just want to make sure. You were the Director of Enterprise Applications from ‘99 to ‘05, and then there was a change to Director of Perioperative and Critical Care Informatics. What was that change like or was it really a name change?
Deborah Houston:
It was probably a name change. What happened was—that was in 2005, is that when I put that?
Tacey Ann Rosolowski, PhD:
Yes, 2005-06.
Deborah Houston:
We had changed. I was in my new job. The Perioperative Enterprise for the Institution got developed. They consolidated people from the operating room, and there was a new Perioperative Enterprise. They wanted to have their own IT Department. It was like, “No. You’re not going to have your own IT Department.” We gave them a group of people, and they needed somebody to report to, so they came to me.
Tacey Ann Rosolowski, PhD:
Why did they want that? Why did they want their own IT service?
Deborah Houston:
Because the physician that was in charge of it was from surgery that has their own—parts of the institution has their own IT support groups. They wanted their own, so we showed them they didn’t need their own—that we could provide that. Lynn Vogel was the Chief Information Officer and was like, “No, we’re going to do that differently.” We met, and they needed to report to somebody, and I had no one reporting to me at the time. I knew those people, and I knew the position, so they reported to me.
Tacey Ann Rosolowski, PhD:
I am just curious. Why is it that certain divisions within MD Anderson have their own IT system?
Deborah Houston:
Not their own systems. It is mostly support (talking at once) staff. Well, some of them have their own because they actually have big systems, like Radiation/Oncology has a group. They support their systems, but like the Division of Surgery, the Division of Cancer Medicine, they have their own people. A lot of it has been over time because, potentially, Central IS have not been able to provide them the service that they wanted—that the physicians expected. A lot of it has been to provide that special service to physicians—the things that they want immediately. They want their own thing. They don’t care what anybody else wants, you know. That has been allowed to occur. The institution as a whole now is sort of looking at that, and we are absorbing people back into Central IS. I think that will continue. We just brought in the Diagnostic Imaging people. We brought in the--the lab people are coming in—the Lab Department. We brought in the people—we have people in physical plant facilities. We had people in Human Resources. We have people in Finance. They’ve all been consolidated. The business side of the house has already been consolidated back into Central IS. We are now starting to bring in the clinical side of the house.
Tacey Ann Rosolowski, PhD:
Is there an advantage that you see to that—of consolidating everything?
Deborah Houston:
I think economy of scale standards. We go out to try to deploy something across the—we have automated tools that will send updates across the network. If they have the computers configured differently, which they do, it doesn’t work. Then, you have to manually send—somebody has to go out and manually do it. They are using equipment that is not potentially—appropriate is probably is not the right word, but that may not have been approved for use within the institution. We don’t know they’re using it and all of a sudden everybody wants it and it is something that we’re not ready to support. We get called about it, for example. Viruses can get into the network. That has happened. Just things like that.
Tacey Ann Rosolowski, PhD:
Yeah. I mean, I was—yeah, I was just kind of curious.
Deborah Houston:
However, we need to be able to provide the support to those physicians who want a custom film reader attached to their reader because that’s what they need for their specialty or they need help in incorporating images into their presentations or they need video of procedures put into—we need to be able to provide that service, if and when we absorb that from a department. That’s going to be a challenge.
Tacey Ann Rosolowski, PhD:
Why is that going to be a challenge?
Deborah Houston:
I think it’s going to be a challenge because it’s going to be one-offs in some instances that will be seen as being hard to support. It’ll take longer and longer and the physicians will get more and more unhappy. That’s not what we want. We have to approach it that we are going to provide you service better than you had before.
Tacey Ann Rosolowski, PhD:
Does the image work—the images and video—does that provide a particular challenge for some reason, or are there just special services in general that are a challenge?
Deborah Houston:
I don’t think that there’s special services that are a challenge. No. The video is not a challenge. It is just a matter of how you do it and how accessible. Are they getting the right permissions for use of those videos? Have they got the patient’s permission to video the surgery before they go showing it on the big screen at the ASCO meeting or the surgery conference or whatever? My assumption is yes, they have.
Tacey Ann Rosolowski, PhD:
It can happen. Certainly, yeah.
Deborah Houston:
The Periop—that was the job we were talking about. That was one of the jobs I had was specifically the director of that group, along with other stuff I did, so I called it out because it was a little different work.
Tacey Ann Rosolowski, PhD:
Sure. Was there anything else from that period that was—?
Deborah Houston:
I think that’s probably the main one.
Tacey Ann Rosolowski, PhD:
The main one? So then in ‘09, am I reading this—oh, yes. So from 2005 to the present—am I reading that correctly? Okay. I see. I’m sorry. So from ‘05 to the present, you were also the Director of IS Clinical Operations and Projects.
Deborah Houston:
Right, and that title changed. That’s my current title, but originally I was the Area IS Director for Clinical Operations. We got rid of the area. It’s the same job.
Tacey Ann Rosolowski, PhD:
Okay. So, was there a responsibility change with that at all?
Deborah Houston:
From?
Tacey Ann Rosolowski, PhD:
How is the role that you serve now under that title different from the other directorship roles that you served, or is it pretty much the same?
Deborah Houston:
Well, when I left being the director of MIS and, basically, have been doing what I am doing now—pretty much the same—with some addition/subtractions of activities. I initially started working primarily with the project work—the clinical projects, trying to get people funding and get a handle on that. Over time, I have absorbed different kinds of things, like the Perioperative Group for a while and, now, they’re in another area. I have reporting to me now the Institutional Bar Code for Patient Safety Project where we’re—going to be implementing bar coding for medication administration and specimen collection—that kind of thing—reports to me.
Tacey Ann Rosolowski, PhD:
Could you talk a little bit about that? How exactly does that work—the bar coding?
Deborah Houston:
How is it going to work?
Tacey Ann Rosolowski, PhD:
Yeah, I’m just curious because I was talking, I think it was Janet Bruner [Oral History Interview] that was talking about how everything in Pathology is bar coded—
Deborah Houston:
Right, today. Today. They already have a lot of bar coding (talking at once).
Tacey Ann Rosolowski, PhD:
I wondering if that is a similar kind of thing that you’re going to be working with—that you’re trying institute.
Deborah Houston:
Kind of, but what we’re going to do is on the front-end. They are working on it—they have the bar coding—they’ve got the specimen and they are processing it in the lab.
Tacey Ann Rosolowski, PhD:
Right.
Deborah Houston:
What we’re doing is when you are a patient and you walk into the hospital, you’re going to have an arm band put on you, regardless of what you’re here for, that has your name and bar codes on it. So when you go to the lab—to the diagnostic center—if that’s the first thing you go in the hospital or when you come into the clinic or if you go in as an inpatient. The first place you visit, they are going to put an arm band on you. Most people, that’s the lab or x-ray. When you do that—when they scan that—they are going to verify who you are. You’re Tacey. Here’s your name. You’re going to verify that. They’re going to slap it on you. ClinicStation has your picture because we have your picture in there. We are going to know that’s you. We’ll slap that arm band—slap it—attach the arm band to you—the wrist band to you—
Tacey Ann Rosolowski, PhD:
Gently apply—
Deborah Houston:
Yes, gently, gently apply, and then when you go to have your lab drawn, the technician is going to scan the bar code. She’s going to know that’s you. She’s going to scan her badge. It’s going to say she’s drawn the blood. She is going to draw the blood. No—yeah. She’s going to do that. When she scans that, it is going to print the labels that you have ordered for the day on a little thing—well, in the clinic it’ll probably be a little machine, but if you’re in the hospital, she’ll have one of those little things like the Avis guy—print out your labels. She is going to draw your blood, put the label on the blood before she leaves the room, so we know your blood has your name on it and it goes to the lab. Then, it processes through the bar coding within the lab. It’s not she brings your blood out and puts it here and she’s got my blood over here and misses—mixes them up.
Tacey Ann Rosolowski, PhD:
Right.
Deborah Houston:
When you’re getting a medication, we are going to scan your bar code, scan mine as the nurse. It is going to bring it up in the computer that you have these four medicines to be given. I am going to have the medicine here. I am going to scan the package and it’s going to tell me, yes, that’s the right medicine at the right time—at the right dose and everything. I’m going to give it to you, or it’s going to scan the pump, the bag of IV solution, and the pump that you’re going to put it on, and it’s going to program the pump to administer it correctly. It’s then going to turn around and document in the chart that you’ve got the drug at the right time.
Tacey Ann Rosolowski, PhD:
I was just going to ask because it would be linked with ClinicStation (talking at once).
Deborah Houston:
Right. It will be in ClinicStation. We are using a commercial product from Cerner Corporation—Cerner Bridge is the name of the product that’s a bar coding system. We will be using it for specimens, for medication administration, and for blood administration. That’s—we’re in the process. We’ve selected the vendor. We’re in the process of finalizing that.
Tacey Ann Rosolowski, PhD:
Wow.
Deborah Houston:
So, part of the project is getting the equipment that we need in every patient room, so those computer arms and all that will have to be installed in every patient room. Scanners, the equipment for the lab techs—
Tacey Ann Rosolowski, PhD:
Training.
Deborah Houston:
Training, yeah. Patient education, as well as staff education, because patients need to understand what we’re doing.
Tacey Ann Rosolowski, PhD:
Making sure you tell people not to just look at the bar coding—look in their eyes once in a while.
Deborah Houston:
And to know that you’re scanning the bar code on you, so it’s got some—called check digits—some special prefixes on the bar code, so I know you’re scanning an arm band—wristband—and not a label you’ve put over here on another piece of paper.
Tacey Ann Rosolowski, PhD:
Interesting.
Deborah Houston:
Nurses can think of all kinds of work-arounds. Then that project—that’s the commercial product side. The fourth arm of that is a home-grown thing we’re developing for Pathology for specimens from the operating room. It’s not blood. You’ve done a biopsy in the clinic. You’ve got a piece of tumor from surgery or whatever—it’s going to do that, as well. Same thing. Bar coding.
Tacey Ann Rosolowski, PhD:
Wow.
Deborah Houston:
Medicines will be administered, for example, using bar coding wherever we give medicines in the institution.
Tacey Ann Rosolowski, PhD:
I see why you call it Institutional Bar Code for Patient Safety.
Deborah Houston:
Yeah. It’s a big initiative. We’ve been working on it for a while.
Tacey Ann Rosolowski, PhD:
How many years?
Deborah Houston:
A couple. (talking at once) It’s going to take another couple of years to be fully rolled out.
Tacey Ann Rosolowski, PhD:
What other projects are you working on right now?
Deborah Houston:
Well, EMR development because part of that department now reports to me in my general job, that kind of thing. The project managers and the business analysts and the support deployment group report to me. It’s the people that have the customer facing part of the EMR, not the developers and programmers in the back and the testing people. It’s the people that are out there with the users.
Tacey Ann Rosolowski, PhD:
What are you hearing from them?
Deborah Houston:
When is it coming? When are we going to have more functionality? Why does it work like this? I don’t like it. Positives and negatives. Those are the main things. A new—recently, the Diagnostic Imaging IT group now report to me. They are working on an upgrade to the Radiology Information System. Then, I have 4 other people that report to me that are sort of like department liaisons or division liaisons for IT that kind of do what I do for the clinical—whole clinical area—they do for a particular group. I have one that works with Diagnostic Imaging. I have one that works with the Regional Care centers. I have one that works with Global Oncology, and one that works with primarily the outpatient/ambulatory operations areas. They have been very helpful, because I don’t have to worry about Diagnostic Imaging, because I know that Mike [Adams] is going to tell me when they have issues or when they need things or I can have him follow up on it. I don’t have to do it.
Tacey Ann Rosolowski, PhD:
And Mike’s last name is?
Deborah Houston:
Adams.
Tacey Ann Rosolowski, PhD:
With the Radiology upgrade, what is that involving exactly?
Deborah Houston:
The software that runs our Radiology Information System is being upgraded to a new version, so it’s software installation and data conversion over into that.
Tacey Ann Rosolowski, PhD:
What is the new upgrade allowing?
Deborah Houston:
It’s pretty much the same functionality. It is just fixing some things—a new version of software. Software vendors will have products and they do upgrades, some of them every six months, some of them once a year or whatever. At some point, they quit supporting the old versions. This is kind of like we have to move to the new version because what we’re on—we haven’t upgraded for a while, so what they’re on.
Tacey Ann Rosolowski, PhD:
So it’s kind of more of a maintenance thing?
Deborah Houston:
It is, yeah. It’s going to take some work, but it’s not like they’re going to use something that they’re not used to using. It’s going to have a little bit different look, but it is basically the same functionality they’ve currently got, and that group has had an IS system for several—many years.
Tacey Ann Rosolowski, PhD:
So they’re accustomed to it.
Deborah Houston:
Yeah.
Tacey Ann Rosolowski, PhD:
Anything else that you have ongoing or anything that you are planning that you would like to take on?
Deborah Houston:
My goal—and people laugh at me when I say this. My goal is by the time I retire that I want to see that we have computerized physician order entry and nursing documentation rolled out to the institution. That’s my personal goal, and bar coding—the bar coding project finished.
Tacey Ann Rosolowski, PhD:
Why are those your priorities?
Deborah Houston:
Because I think they’re key to the institution. I think they’re all key to patient safety and staff productivity. It’s going to benefit everybody. They’re tangible. They are things that I think we can achieve. My staff know that’s my goal, and I tell them that regularly. That we’re—I am trying to get there. The next three to four years I want those to be done. Then, I can leave, well, I could leave today. I can leave—retire—knowing I feel like I have accomplished something significant for the institution. It is not that I did it, but I helped get it accomplished.
Tacey Ann Rosolowski, PhD:
Sure. Now looking back here, before you have achieved those goals, what are some things that you’ve worked on that you are really content with—pleased that you go that done?
Deborah Houston:
Oh, gosh. I think the—well, within IT, you mean or in general?
Tacey Ann Rosolowski, PhD:
Both.
Deborah Houston:
I think the lab—the lab that we started for the hematology patients was a big one. That took a lot of planning—the lab supervisor that worked with me on that. That was a big win.
Tacey Ann Rosolowski, PhD:
What did that do for the institution in your opinion?
Deborah Houston:
Well, I think it decompressed the patients in the Diagnostic Center and got lab drawn and results back on those Hematology patients faster. That was good. That’s probably—I think the success of the Perioperative IS Group that we set up and that continues today was a good—a good win.
Tacey Ann Rosolowski, PhD:
Uh-hunh (affirmative). What were some tangible results from that?
Deborah Houston:
I think improved satisfaction of the staff. Consistent desktop—the computers work. There are consistent processes for making sure every day that they’re working and that if one breaks, they get it fixed right away or replaced, that kind of thing. Oh, gosh. I don’t know. I leave everyday feeling like I’ve done something. It’s hard to—but I know there’s a pile left here for me to do when I come back tomorrow.
Tacey Ann Rosolowski, PhD:
That’s not bad—to leave everyday feeling you’ve done something.
Deborah Houston:
Some days I felt like I’ve sat in meetings all day, which is most of the days, but I feel like—I like to feel like I’ve contributed something every day.
Tacey Ann Rosolowski, PhD:
In your view, how quick has MD Anderson been to be experimental with IT and—?
Deborah Houston:
They’re very quick to be experimental. They’re very quick to want to, again, have the best, newest, greatest, biggest, fastest, strongest—whatever. Once they get it, will they use it? Is it really what they wanted to start with? That’s kind of—I think, yes, they are ready to—everybody says they’re ready for it. When it comes down to using it is the other part. It’s the adoption of the technology, which is the struggle for us.
Tacey Ann Rosolowski, PhD:
I think it’s a struggle for everybody—yeah, particularly when people are pressed for time.
Deborah Houston:
And, pressed to do more and make more and—that’s what I hear from the faculty, you know.
Recommended Citation
Houston, Deborah A. and Rosolowski, Tacey A. PhD, "Chapter 12: Information Systems as a Service Provider" (2012). Interview Chapters. 895.
https://openworks.mdanderson.org/mchv_interviewchapters/895
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