Keeping a Hospital’s IT Systems Healthy

As the only Level 1 trauma center within 100 miles of metro Atlanta, Grady Health System says, “Atlanta can’t live without Grady.”

But when its information network was in the kind of distress that no doctor could fix, Debbie Cancilla came to the rescue.

“We were not in a good place here,” says Cancilla, who took over as Chief Information Officer/ Senior Vice President in November 2008. “It was obvious there was just a lot of work that needed to be done. This poor facility had been underfunded for years and years and hadn’t had any capital infusions.”

Cancilla began a two-year overhaul of the entire technology platform.

“Lights off, lights on and it was a new day at Grady on Nov. 1,” Cancilla says.

Before she could even start on the equipment, Cancilla had to bring the human element up to speed. “We didn’t have a strong leadership team in this department,” Cancilla says, “so one of the first things in ’09 that we needed to do was to figure out who our managers were going to be and get folks in here that were competent, capable of doing the work and willing to commit to the challenge. Today, Grady has a solid team with a proven track record.

“Because it truly for these past two years has been like The Amazing Race.”

At first, Cancilla wondered what she had gotten herself into following 14 years at the Erie County Medical Center in Buffalo, N.Y., the last seven as CIO.

“After about 90 days I said, ‘Oh, I think I need a plane ticket back,’” she says. “But you hang in there and stay committed and you keep your focus. And here we are today.”

Cancilla quickly realized that Grady’s poorly-built systems from the 1980s had to be replaced.

“The clinicians were miracle workers here,” she says, “because they were going to 14 different little systems to try to piece together information to provide care. They knew it wasn’t the right thing and not where they wanted to be, but they did it.”

The IT staff wasn’t happy, either. “You can’t sleep at night because every night you’re getting called because something’s crashing,” Cancilla says. “Everything was so old and in such a state of disrepair that it became obvious we’ve got to work on the foundation first.”

Shoring up the Walls

The first year, with help from partners, they ripped out the entire network and replaced it -- every switch, router, cable, network control component and strand of fiber. Revamping the network infrastructure exposed problems with the phone system, also vintage 1980s –

As part of the whole network upgrade, Grady unified voice and data, and in November 2010, Grady’s network team completed the challenge by finished the new VoIP solution after an eight-month rollout.

Cancilla says it was also obvious that the clinical and revenue information systems were either out of support, constantly offline or not giving staff what they needed to care for patients. Grady’s CEO and Board of Directors gave Cancilla’s team the funding to replace the whole system, a $40 million investment over five years.

In November 2010, EPIC software was fully deployed to all clinical areas including the emergency department, ancillary services, the operation room, and majority of clinics. The EPIC revenue cycle software also went live at this time. 

Clinical adoption was outstanding. Doctors were putting all their orders in online, electronically documenting in the chart,  e-prescribing, and electronically communicating -- and nurses were using bedside medication administration by scanning patients and medications to ensure patient safety The success of their adoption was clearly aligned with the involvement of Grady’s Physician Champions and Nursing Leadership. Grady was ready for change.

To get ready for the “big bang go-live,” 12,000 training seats had to be filled starting in August 2009, a “logistical nightmare,” Cancilla says, which required 15 training rooms and 18 hours a day of training to accommodate all shifts. Our training team accepted the challenge.

“Tell a surgeon you need to sit in class for 21 hours,” she adds. “It wasn’t easy, but through the ongoing support of our Physician Champions, this was a reality.”

Cancilla, who has about 170 people on her team, including the EPIC folks, says she had never before seen the level of adoption that she saw at Grady. People from outside Grady tell us we done something pretty fantastic.

The IT team was hands-on, whether at the patients’ bedsides watching the use of technology or in the emergency department watching patient flow

“I think it’s an important element of deploying,” Cancilla says. “You have to be there immediately to answer questions and to help get them over the initial fear and apprehension of these new systems.”

True Character Emerges

Cancilla says she often thinks that a person’s true character comes out in times of challenge or big risk “You have to think about your words, you have to think about your actions,” she says. “Although you’d like to say, ‘Oh, I’m leaving early today because I just can’t take it anymore,’ you hang in there, and you do what you need to do and you learn how to manage yourself. Your awareness of your own commitment becomes heightened.”

Cancilla arrived in Atlanta after spending her whole life in Buffalo. She graduated from Daemen College, a, liberal arts school, with a business administration degree. While at college, she worked part-time at Marine Midland Bank (now HSBC) and stayed at the bank for about 13 years, first as a teller.

Discovering she had a passion for IT and recognizing the opportunities, Cancilla began in the systems department at Marine Midland as a business analyst. She worked on million-dollar projects including solutions for mortgage banking, relationship management and ATMs.

Ready for a change, she went to the Internal Revenue Service with thoughts of becoming a CPA. At the IRS, Cancilla was a taxpayer assistant for more than four years, answering call after call. “It was kind of a funny place because I had gone from technology to pure paper,” she says. “You had to look up everything manually and quote page numbers and sections.”

Deciding to scrap the CPA plan and obtain a masters degree in international business, Cancilla also wanted to try a field in which she always had an interest.

“So I took a gamble in healthcare and somebody gave me a chance,” she says. Still working toward the MBA, Cancilla became a computer trainer at Erie County Medical Center, eventually rising to CIO.

Cancilla was recognized as a leading expert in health information technology and she positioned ECMC within the top 10 percent of national healthcare systems for use of technology and clinical systems.

“We had so much fun there,” Cancilla says. “Technology was starting to take roots in healthcare. It was a time when folks were talking about portals and taking all these disparate little niche systems and seeing if they could get them all to work together through common interfaces.”

A Pioneer in Healthcare

ECMC became the first hospital in western New York to implement a bedside medication administration technology like the one now in place at Grady.

“We worked on a big project that allowed us to barcode every single med in the pharmacy, and actually go the bedside and use our wireless technology to scan,” she says, “making sure we had the right patient, the right medication, the right dose, and the right frequency.”

That not only gave the hospital better tracking of meds and increased patient safety, but it also provided better accountability for wasting of medications.

ECMC also was an early proponent of EMRs (Electronic Medical Records).

“We started off by realizing one of the easy technologies was a scanning solution,” Cancilla says, “just getting as much as we could into digitized format, getting as many applications as we can linked to a front end portal.”

She adds, “The vision’s always been kind of a one-stop shop for the physicians.”

Cancilla was one of the seven founding members – four hospitals and three payers -- for a regional healthcare exchange of patient clinical and claims data, called Western New York HealtheNet. “Basically, what we were able to do as a community is to eliminate the use of a clearinghouse,” she says.

Clearinghouses normally cost about 40-45 cents a transaction and the RHIO was processing for under 5 cents a transaction.

“In a career, very few people have the opportunity to install technology at the pace and with the support and funding that we’ve received,” Cancilla says. “I have to mention, too -- I’ve never seen this ever in my career -- the amount of contributions that Grady has received to go through this transformation. The support from the business community is just astonishing.”

Cancilla considers herself a steward of the resources. “They’ve trusted me with a lot of these dollars and a lot of these investments and we’ve proven we can make it work,” she says. “We took Grady from HIMSS level 1 to HIMSS Level 6 within a two-year period.”

Cancilla says funding cuts at Grady will not affect continued progress in technology because they’ve been capital funded. 

“You’re really not going to get your return on your investment until you start optimizing some of the functionality within these systems,” Cancilla says. “So this is a year of great stabilizing and optimization for us before we get aggressive again next year.”

At least there are no more calls at night to report crashing systems.  “It’s probably the happiest point in my life,” Cancilla says. “Things are very, very stable. And it’s a better day at Grady because of the hard work and unwaivering commitment of a fantastic IT Leadership team.”

Secrets to Success:

  1. Commitment. “It’s commitment to the team that I’ve put together. I brought them here with a promise that we were going to make change and if for a moment I started to waver on that promise, I would lose them. And it’s a commitment to Grady. I sat in front of the doctors and I said, ‘I’m going to help you pick this system. I’m going to help you get this system installed.’ And it’s a personal commitment, too. When things get hard and it would be easier to say, ‘I’m really ready for change, I’m wondering what else is out there,’ it’s a commitment take the punches in the gut and the bad days and everything else you have to take to make it a reality.”
  2. Hard work.
  3. Accepting risk. “It’s a dream that you have in the back of your mind, not a wish. You know somehow you’re going to get there, and you understand what the wins and losses are each day as you move forward.”
  4. People. “It’s taking huge pride in seeing the people who work for you and work with you grow and develop. And listening, too, and letting them take risks as well.”
  5. Honesty. “I am atypical. I am not very political. I just believe in saying what you’re going to do and sticking with it. Honesty comes through your words, your actions and your intent. It’s about trying to do the right thing, and I think people then build some trust in you. People see right away whether or not you’re in it for personal gain or whether or not you’re truly in it because you made a commitment to something. And that’s where they start to accept you and accept the fact that you’re really going to help them move something forward.

Debbie Cancilla is Chief Information Officer/SVP for Grady Health System. Atlanta Trend expresses its thanks and deep appreciation to Debbie Cancilla for sharing her thoughts with us.


By Karen Rosen


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