Nancy Richards: Putting Enterprise Content Management in the Hospital

While everyone else seems to be talking about digital medical records, Nancy Richards is actually doing something about it. She’s playing key role in helping her employer reduce its carbon footprint. Since going “live” with its green initiative in early spring, Swedish Medical Center has already digitized two million pages of paper—and it’s just getting warmed up. You’ll learn more about those efforts in the November/ December issue of this magazine.

For now, AIIM’s Carl Frappaolo, who recently sat down with Richards, provides a snapshot of her equally-successful ECM initiative. Frappaolo is AIIM’s vice president for market intelligence.

Frappaolo: Nancy, why don’t you begin by telling us exactly what you do?
Richards: I am currently working in the IT department of Swedish Medical Center in Seattle, Washington, and my title is Enterprise Content Management (ECM) Systems Architect. The Swedish system includes three hospital campuses, a freestanding emergency department, home health, and approximately 70 clinics in the greater Seattle area. We provide healthcare throughout the community and region, with a number of patients from out of state and outside the country.

Frappaolo: ECM Systems Architect: What does that really mean?
Richards: I am one of the believers in the philosophy that institutional knowledge management stems from correct information management. This is my third enterprise installation of content management solutions, and I was asked to join the organization to facilitate the auxiliary content needed to support the implementation of the electronic medical records system that we were installing throughout Swedish. Much like any other business operating system, there’s extraneous or external content or information that you want to be able to collect or incorporate into the knowledge base that isn’t easily or readily available from within the system. In this application, that includes documents like health insurance cards, signed consent forms, advance directives; it might also be external lab reports. Any non-system-generated patient health/medical record information.

Frappaolo: What was the impetus to go beyond just the information management itself?
Richards: The organizational approach was just “get the scanned document in so I can access it from the system.” My approach was to build an infrastructure that would be sufficient to support an enterprise content management (ECM) solution. I wanted to make it easy to transfer from the electronic medical record environment into the enterprise environment. To do that we needed to build architecture that was able to support solutions that are repeatable, dependable, and deployable. The objective was for the organization to understand that content management is in fact knowledge management, not just electric paper.

Frappaolo: When you came to Swedish, how much of this was already in your head and part of your game plan?
Richards: I came into the organization with full concept and intention of doing what I’m doing now. The manager who recruited me was focused on the electronic medical records (EMR), however, she fully recognized that the enterprise approach was the longterm goal. I was fortunate to have been recruited by someone who was familiar with the previous project/ deployment that I was leading. I did not understand all of the nuances or the finer details of the requirements that Swedish would offer, obviously. The organization is appropriately very, very focused on the deployment of EMR. We are still helping upper management at Swedish grasp the full meaning of ECM.

Frappaolo: I understand that one of the keys to your success was not to focus on the content itself but rather the business processes. Do you consider that a best practice?
Richards: I believe it is. I believe that, on a scale of 100, the document and/ or the content itself has perhaps 20 percent to 40 percent of the value. The business owner has a stated goal: I want to get space back. I want to be able to share the content. I want to stop the photocopy and interoffice mail distribution. That’s 20 percent to 40 percent in my estimation, a SWAG on the returnon- investment equation. The next 60 to 80 percent is comprised of, “Now what can I do with that intelligence?” And “How can I data mine that?” And “How can I enhance any other steps of the process that could be either ahead of that or behind the actual processing of the content/document/data, either for data capture, data mining, or for business intelligence opportunities?”

Frappaolo: Who do you report to?
Richards: I have had a couple different supervisors during my time at Swedish. My current boss is one of three application managers in our organization. We run a medium-sized operation of more than 7,000 employees.

Frappaolo: How do you survive as a team of one?
Richards: That is a bit of a misnomer. I am the only SME (Subject Matter Expert) on ECM or records management; but we have the full support for our technical aspects such as the network and servers and security, etc., so I really think that my role is more of a SME/project manager. We have really great vendor relationships for those high-water marks or specialized deployment requirements. Understand that just like project management, which a lot of this really is, you are matrixed. And you need collaboration. The only way I can achieve buy-in working with the directors is to get them to the "ahhah moment". And they only get ah-hah when they get the WIIFM (what’s in it for me). What business objective can the ECM solution provide for them—with the least amount of cultural impact— and cost, of course.

Frappaolo: How many ah-hah factors do you think you’ve had with directors?
Richards: Oh, it’s a constant ah-hah and those are lower-case ah-hahs. There are never capital, bold, underscore ah-has. That is just the nature of ECM. And part of that is because this is infrastructure. If somebody comes along and says “Hey, I‘m going to get you brand new telephone wire,” You say, “Why do that? We’re wireless.” And then I’ll say, “Yes we are, but we still have network cables that we run these things on. And I’m going to get you a superior, new type of cable. You’ll love the color. It will carry things faster. It will do all of that.” And they said “Gee, that’s great—let’s do it!”

Frappaolo: So if I understand correctly— and this is probably good news— Swedish hasn’t had a crisis you could point to which forced the ECM solution?
Richards: That is a true statement from my perspective. The clearest call-toaction I’ve seen is that our ECM system is supporting the electronic medical record. That was the fulcrum if you will. That was the paradigm shift where we moved an organization from paper-centric business operations or functions into electronic-centric business functions.

Frappaolo: What does it take for someone like yourself to understand that “My job is not just to use technology to solve a problem but to move business forward and create a new value proposition.”
Richards: I learned that through experience. In the 1990s I was a vendor with huge clients, including AT&T, Federal Express, and a number of the major credit cards. And what I provided was a better way to do business. That was incredibly rewarding, and the relationships I built with clients were awesome, they lasted for years. What I learned from them was how much this meant to them, how much it solved pain or prepared them for other things. In other words, they could use that as a baseline and then launch other initiatives or create other enhancements for their organization. And at that point it became very clear to me that this was a foundational infrastructure activity. And it would be awesome if all IT directors would look at this as basic connectivity.

Frappaolo: What percentage of you is a business strategist and what percentage is a technology strategist?
Richards: It’s an 80/20 rule. I am at least 80 percent business strategy and compliance, and 20 percent technology. I do not have a wrench in my pocket. I’m not a programmer at all. I can do some system administration work. I can do some of those things enough to either get myself out of trouble or to know what’s feasible. In fact, this is the first time I’ve even been structured in an IT department, and it is both enlightening and challenging. I’ve most often been the interpreter between the two sides. That has been my role—how to take a business objective and turn it into a technical solution or vice-versa.

Frappaolo: How can you help others in this field learn what you know from experience about the total value proposition for ECM?
Richards: I believe that anyone in this industry can learn it by networking, certainly by reading, certainly by understanding case studies, but I also believe that they have to ask the next question, which is, “Why did it work that way, what happens next?”

Frappaolo: Does your CIO see the full value potential?
Richards: We arrived at a strategy a couple of years ago based upon a fiveyear plan that included an ECM phased rollout. How that strategy transcends into deployment is the gap. We are pretty much on target—largely due to the acceptance and support of our CIO and management team.

Frappaolo: So you put together this five-year plan. It sounds as if the CIO understood that proposition. Is that correct?
Richards: I proposed the details and general goals for the plan. Yes, I am confident that our CIO and management team can very much grasp and embrace the ECM strategy. I think the difficulties come when there are so many facets of the IT support that require attention. ECM is just not the tallest child.

Frappaolo: Okay. Then why do you think the next leap hasn’t been made at that C level?
Richards: Again, ECM is infrastructure. We in the industry believe that it is the solution to all things. I believe that we need to help paint the ECM story as support and infrastructure. If we are able to show how ECM can make other platforms/programs/ solutions even more effective—and more cost efficient—we will have a great story to tell. I don’t believe it’s lack of awareness. It’s just not at the forefront of the issues that need to be addressed for the organization. But I have to realize that I look at everything through the content management lens; a CIO does not. A CIO looks at things through a number of other lenses and appropriately so.

Frappaolo: I’m going to paraphrase to see if I understand. Number one, it’s important to have multiple points of view in an organization. But it’s also essential to have somebody who is ECM-centric, like yourself, who can say hey, ECM can solve a lot of problems, and there’s a potential role for it in every business process.
Richards: Absolutely. Organizations have specialists for a reason—to provide depth of knowledge on a specific topic—servers/security/networks. ECM is just one of the strings in the guitar.

Frappaolo: That’s a great perspective to have. And I’m wondering how many other organizations have somebody like you in-house—an ECM guru/specialist.
Richards: That’s a good question. I’d like to know. I’m starting to get a handle on it—after more years than I will admit. I am very saturated in the “space”. I head an ECM user group here in Seattle. It’s called the Pacific Northwest Enterprise Content System User Group, and I am on the board of the local AIIM Chapter. I learn a lot from my peers.

Frappaolo: Earlier you said that often the great ah-hahs for companies come when they have a crisis—litigation, disasters, etc. Do you think that that’s the norm? Is that just unfortunately the case in most organizations—that they’re not really going to pay attention to this until they have to?
Richards: I think so. But I also think that’s human nature. I don’t think it applies only to ECM. When do you replace your enterprise resource planning system? When it fails, or when it is so cumbersome that you can’t complete your business objectives, or when it’s taking too much staff time, or when it’s down so often? So I don’t think that ECM is different than any other process or system in that respect. People and organizations respond to need.