Clinical, Technology Expertise Can Help Land Consulting Jobs

Joe Lassiter is president and managing adviser of The Robertson Group in Portland, Oregon. The clinical informatics advisory firm has certified, licensed nurses and pharmacists who specialize in workflows and technology solutions for patients in all care settings. He sat down with me to discuss the ways that pharmacists can combine their clinical skills and information technology expertise to provide effective, efficient, and safe patient care.

Paterini: Welcome, everyone. Matt Paterini here with The Nontraditional Pharmacist, part of the Pharmacy Podcast Network.

Joe, welcome, and thanks for joining us.

Lassiter: Thanks Matt. I really appreciate the opportunity to be here. It's so nice to be able to give a voice to these nontraditional career paths in pharmacy and be able to get that out to the audience, students, career practitioners, or whoever wants to learn more about things that don't involve direct patient care. I really like to consider a lot of these things involving indirect patient care. So, what we do at the end of the day still enables patient care.

Paterini: Let's start with career paths. Can you talk about your background, where you started in pharmacy, and how you got to where you are today?

Lassiter: Thanks, it's been a journey, that's for sure. And I would say, just before I get started, I would do it all over again. It's been fascinating. I graduated and went to St. Louis College of Pharmacy, one of the few independent schools of pharmacy left, and when I graduated, they still had a 5-year bachelor of science in pharmacy program, so, I went from high school right into pharmacy school. While my friends were having fun rushing fraternities at major schools, I was studying organic chemistry and just digging right in. I was definitely regretting things at that time, but looking back, it's been a great opportunity, great school, and I've made some lifelong friends that I still keep in contact with.

After I achieved my bachelor of science in pharmacy, right about the time I was graduating, the profession decided to convert to the all-PharmD program, which at the time, I didn't really know how that affected me, but decided the best course, after getting some advice from my mentors, was to just start practicing. I then started practicing and then quickly realized that although I enjoy patient care, I thought I could have more effect on a population-health level or looking at what happens in practice across all patients, rather than dealing with patients at the clinic. That will probably be a theme throughout my career. I have really enjoyed my patient care part of it. Sometimes, when I lecture the students I feel like they think, "Oh you were just not good at it, so, that's why you moved into something else." But I really, truly enjoyed it, and it's where you can make a difference, I think is what it comes down to.

I then returned to the College of Pharmacy and got a master of science in pharmacy administration, and my focus there was managed-care pharmacy. St. Louis had Express Scripts in its back yard, so, I had several colleagues there and got involved with Express Scripts, working with pharmaceutical business development. I think that was kind of the first taste of entrepreneurship for me in pharmacy, learning to work with the pharmaceutical companies to design clinical programs for Express Script's patients and learning the power of technology and how the data that we had on the patients could be harnessed, measured, and evaluated to see what we could do to make a difference for patients.

After that, through a course of adventures, I moved through a couple of different academic medical centers and got the opportunity to be part of an informatics team at the Oregon Health and Science University in Portland, Oregon, where I'm still currently located. My director of pharmacy at that time said, "Hey, we're going to do this thing called Epic, and I have a position for an informatics pharmacist. Do you want to do that?" I was doing patient care at the time, and I said, "Uh, I don't know anything you just said.”

Another thread throughout my career is that when people give you opportunities, take them. It rarely doesn't work out. I think it's always worked out for me. I immersed myself in that, learned all about electronic health records, Epic as a vendor, interfacing technology, informatics, etc. and just ran with it. At that point, I became much more passionate about the field. I finally looked to myself and I thought that, "Wow, you know, if I saw a patient and adjusted their antibiotic dosing, then I could maybe get a patient a day/every couple of days, and how many patients is that over the course of my career? But if I write this clinical decision support rule with an electronic health record, and then every provider that looks at that patient and uses that information to treat those patients, it's much more powerful to me." And, so, as I said before, I thought that's where I can make a difference.

I did that for a while successfully, then did a stint in academia. The reason I did that was because a local college here was starting a new pharmacy program and wanted to launch a whole new pharmacy administration program that really embedded these principles of indirect patient care throughout their whole curriculum. They are a 3-year accelerated program, and they have pharmacy management/pharmacy administration that's woven through all 3 years. And that includes informatics, so, it's exciting for me to be part of a curriculum development that would now affect all students that came through the program.

I then hopped over to the wonderful University of Michigan Health System, and I will say I definitely drank the Kool-Aid, the blue Kool-Aid. Michigan is just a wonderful organization to be a part of. I helped implement Epic there, and the reason I took the opportunity was because there were wonderful mentors available to me at The University of Michigan, and it was the last chance for an amazing academic medical center like Michigan to make this big of a change, as we’re getting over this wave of implementations, and to be a part of that was very powerful to me.

After that happened, I switched over to consulting a little bit and joined The Robertson Group as a pharmacy consultant and their first chief pharmacy officer. My role there is to do some pharmacy development and to fully flesh out what it meant to do informatics consulting. I did that for a couple of years and switched gears and took over the company when the founder/owner retired and decided that she had had enough pharmacy for her career and gave me the opportunity to lead a company, which has just been absolutely amazing. And that leads us to present day.

Paterini: Wow, that is a phenomenal story. A couple of things I loved what you said there—when you get opportunities to take them, because they do not always happen. And also, your point on direct patient care versus indirect patient care and doing things that yes, you can impact individual patients 1 on 1, but if you were to make an implementation on a larger scale, now you are impacting patients on an even broader scale. I like that mindset.

Lassiter: Thank you. And I think that one of the things I think you'll ask later on, not to jump the gun, is to think a little bit about where pharmacy practice is going, systems level thinking, and those systems skills are something that can provide value to pharmacists for the entire medication process. Contrary to what a lot of people think, we're not just thinking about the dispensing part of it, we're thinking about their education, the monitoring, and things like that. Pharmacists naturally have the ability to take a leadership role in systems thinking in health care organizations.

Paterini: Let's first discuss The Robertson Group. Tell me about the company.

Lassiter: So, there's a lot of consulting companies out there. Larger companies like Deloitte, Accenture, KPMG are the big names that are known to folks. They do consulting on a wide range of things, everything from health care auditing to lean practice improvements and things along those lines. The niche that we focus on is using technology to better people's practices. And, so, everybody that works for our group is somebody who's practiced before, a pharmacist, nurse, pharmacy technician, lab technician, etc., and then they learn the technology side of things, and they learn to bridge the gap. I started to notice in health care, as did my mentor Nan Robertson who founded the company, that there was just this gap between IT and clinical operations and clinical practice. When they did these large implementations or large technological changes, it affects the whole organization, whole business, changes management/culture, and there wasn't really somebody to help who could really understand all those moving pieces.

And I think clinicians are the best poised to do that.

We provide advisory service to organizations who need help accomplishing those projects, and that can take its shape a bunch of different ways. So, for example, 1 of our recent clients was implementing a new module on their electronic health record that affected oncology patients. Their chief pharmacy officer said we need pharmacists help us manage this. Their IT group was leading the project, but because, as we know, oncology patients are an at-risk population, very important, very costly, very narrow therapeutic index for these agents, she really wanted pharmacists to help them bridge the gap. And, so, we played a role in helping provide project management, helping provide expertise about how the build should exist, helping provide end user training, 1-on-1 training to the pharmacists, nurses, and providers. Those kind of projects are really exciting, because, as we talked about before, this project was maybe a year project, but it has lasting implications forever. This is how they're going to treat patients until the next best thing, right until we have implants in our eyes and something like that, but for the near future this is how they're going to treat patients. So, to be able to be on an opportunity and to design a safe and efficient system upfront is really a powerful example of how we can work together with our clients.

Paterini: How did The Robertson Group start?

Lassiter: Nan Robertson, who is a pharmacist by training and a mentor to me as well, worked for Kaiser Permanente, 1 of the first organizations that adopted Epic Corporation, based in Verona, Wisconsin, and their new electronic health record. So, they were almost a pilot site. For those of you who know Kaiser, it's regionally based across Oregon, Washington, California, and throughout the country. At the time, she was the systems director of pharmacy and lab director, overseeing labs for the Pacific Northwest. After she went through that implementation, which was many years, she thought, "Wow, people are really going to need help with this." This was the first wave of implementation and adoption of technology. She hand-picked a couple people from Kaiser Permanente who she thought would be able to go out and help other people do this work and just set up shop inside her own house. She bet on a horse. Because as we've seen in the last 10 years, that was in 2004, and as we've seen in the last 12 to 13 years, that adoption has continued to be very important. We even have federal stimulus packages to get people to adopt in health information technology, so the demand is definitely there.

Paterini: Describe your role specifically at The Robertson Group, and what other teams are there involved in the business?

Lassiter: We're a very small business. I like to say that part of what I do when I'm recruiting is I'm a unicorn hunter, because if you look at people who have experience in crafting their craft and then also know informatics and have experience practicing that and also have the wherewithal to be able to be parachuted in a special team into a client site and be able to help them solve their problems, really narrows our field down right there. I think one of my long-term strategic goals is to help grow more people to do this, not necessarily that they work for us, but this is what the profession needs. We're a small- to medium-sized business, and so, because of that, I wear many hats.

As the president, I'm in charge of the overall fiscal and operational responsibilities for the entire organization, in addition to development, new client development, marketing, all those sorts of things. I also do consulting, as well. So, I not only do consulting myself, but I also manage our other consultants, who are really fantastic. They don't need managing. They just need maybe somebody to bounce ideas off of. If you look at a traditional consulting organization, usually there's different levels of consultants and teams, so, when we do team-based projects, I help coordinate and make sure we achieve our goals.

Paterini: Where is The Robertson Group heading? What is next?

Lassiter: So, you always need to keep moving. If you're not moving and changing and adapting to what's going on, you're not listening to what your clients are saying and the environment. We've really focused on a couple things. Our bread and butter is advisory services, doing these things for our clients. We have really focused on the West Coast of the United States and on Epic. Now Cerner, which is the main competitor to Epic and other information technology companies, has really come to rise. They were recently awarded large contracts with the Department of Defense, and so, we're going to start to do more Cerner work. We want all these systems to operate together. Epic should be able to talk to Cerner and to whatever vendor comes up tomorrow. I think that's really important that we're out there in the environment and encouraging that. The other arm of our company that we're starting to launch is advisory services for software companies. What I started finding in my travels is that as great as the electronic health record is, and it has become the operating systems of the hospitals, there stills needs to be things to plug into it. Epic, and Cerner, and these companies aren't going to come up with everything. There's going to be other products that are needed. So, we started to talk to some select partners and see if we can be an advisor to them, to help them develop their product and see what happens, based on what our clients are really asking for and what we know about patient care.

I think there's a lot of really wonderful motivated people out there whose mother had an adverse event to a medication, and they decided to develop an app on the phone that helps you track your medications, but that doesn't mean it's something that our clients are asking for or that we need or that they understand how to develop it in the right way. So, we can leverage our expertise to be able to help them help our clients in the future. We're looking at a bunch of different partnerships right now. A lot of people ask me if we're ever going to develop software. And who knows. I think that would be really fun to be able to develop something from the ground up.

Paterini: Is The Robertson Group hiring?

Lassiter: Yes, we are in a constant state of hiring based on the flux in the market. I'm always happy to connect with people. I think really what it's about today, and not to be

cliché

, but it's really about networking and developing relationships. I have a bunch of people, and I keep a running mental list and also a running OneNote list, of people I need to keep contact with. The majority of our workforce is our employees, but we also retain some subcontractors that specialize expertise in certain areas. For example, we've done some work recently with helping people manage their formularies. While that may seem a little bit tangential, really it's about managing information and getting that information to clinicians so, that they can make decisions. And so, really, that's informatics. But we don't have somebody on staff who is a formulary expert; we have the informatics expertise. So, we can work with the people we know to help add their expertise to our team. And, so, I'm always looking for great people like that. For folks who are more classically informatics trained, and by that, I mean either doing a residency or have experience out in the field, please do e-mail me at Joe@TheRobertsonGroup.org. I'd be happy to talk to you more. I'm on Twitter as well (twitter.com/JoeLassiter) and on LinkedIn (LinkedIn.com/in/joelassiter). And I'm very involved in the American Society of Health-System Pharmacists. I would be happy to talk to anybody at the upcoming ASHP Midyear Meeting, which I'm sure we can find some way to find each other amongst 20,000 people. It's just great to with network people and to hear from folks about what they're seeing out there in the marketplace.

Paterini: We try to stress that a lot, too. It is as simple as making a personal connection with someone, talking about what you are interested in, where your skill set lies, where you might be able to bring value to a team, and seeing if there is a fit. A lot of times you do not need to send a formal resume in; you do not need to send in a formal application for a job. It is just classic networking, and that can really go a long way.

Lassiter: Absolutely, and that's something that's important, too. A lot of times people think consultants are the experts in the room. But really, as an outside person, you can listen to all the voices, and you can provide a lot of value based on your experience and drawing all those things together. You don't have to be the smartest person or the most knowledgeable. I think that holds people back. They think they want to be a consultant, but they just don't know everything right now. Well, I hate to break it to you, but that's not going to happen.

Paterini: What advice would you give to people who are looking to do something different than what they are used to? What advice would you give to those people who might want to make a change but do not really know how to do that?

Lassiter: That's a great question. I think it's really about finding where your fit is, and where you hit the nail on the head is where can you provide value? Some people talk about doing what you're passionate about, and I think it's really where you want to give back and something where it doesn't necessarily feel like work. I mean, there's always things that are going to be challenging to you, but really, we all got into this profession for a reason. And the reason we got in this profession, as I suspect for most of us, is to give back. So, it's finding about the way you can give back and make a difference in our patients' lives. I think there's a lot of opportunities at sites right now. Take the onus at your site, say, 'Hey I may not be on the informatics team, but perhaps I can be on a committee that talks about how to implement these things.' Maybe you can study some of these certifications on your own time and get some expertise and really then say, 'Hey look. I have these qualifications. Give me the chance.' My experience is that most sites are really willing to grow their own people. They'd rather do that than hire external people. So, take every opportunity at your site that you can, and definitely take advantage of it. Look for mentors. Again, I know it's

cliché

, and mentoring, as you said, doesn't have to be something formal where you sit down and type out questions and ask each other things. It can be as quick as, 'I had a mentoring call today, which was about 30 minutes, and we just kind of caught each other up.' I actually call it co-mentoring, because I learned as much from the folks as I hope they learned from me. People are really willing to share their time, much more than you would think. I think early in my career, I thought these people aren't approachable, but that was all in my own mind. People were very willing to share their time and expertise.

Paterini: Where do you see the pharmacy industry heading?

Lassiter: I think we're in a really interesting time in our profession. As your viewers may know, all the pharmacy organizations have kind of banded together and are seeking out provider status for us as a profession. And I think it's important. At the end of the day, what we're seeking is really, a very administrative thing, getting added to the Social Security Act that we be called providers. We're already doing the work, but I think that formal recognition, and making sure that in every state we're operating as a provider and we're taking ownership of medication use, is really where it needs to go. We'll always have a relationship with the product, because that's just what we do, but at the end of day, we help patients achieve medication use outcomes and we need to think like that. I think pharmacists are well poised to straddle the conversation about clinical care and the economics of health care as well. Some of our colleagues in other professions really don't get that training over the course of their clinical career or don't get exposed to that. I think that's where we're going as well.

And technology. The use of technology. We shouldn't be using technology just to use technology. It should be solving problems and allowing us to do things, such as spending an hour counseling the patient, or reaching out to a caregiver and making sure they understand the medication or the regimen and harnessing all that information to see what's going on. How are people really taking these medications, and what differences can we make? I think this idea of systems thinking, population-based health, accepting all the factors in health care. The political, the economic, the clinical factors are really what we need as practitioners moving forward.

Paterini:

Joe, thanks so much for your time, and thanks everyone for tuning in to The Nontraditional Pharmacist. Please follow us and sign up for our newsletter.