Tom Bres, VP/CIO, Sparrow Health System, Chapter 1

In 2008, Tom Bres was in his 19th year with IBM, and Sparrow Health System wasn’t heavily focused on health IT. Five years later, Bres is leading the organization through a large-scale Epic implementation as its vice president and CIO. What a difference five years makes. Recently, healthsystemCIO.com spoke to Bres about the organization’s reinvestment in IT, the all-hands-on-deck effort required to go from an environment of paper records and disparate systems to an Epic customer, and the critical role clinicians are playing in Sparrow’s transformation. He also discusses how the organization is leveraging mobile apps to increase patient engagement, Sparrow’s partnership with the Mayo Clinic, and his thoughts on talent management and leadership.

Chapter 1

• About Sparrow Health
• Going live with Epic — “We took on a large initiative”
• Lessons learned from physician practices
• Fighting for funds as the financial crisis hit
• Implementing ProVation Order Sets
• Investing in IT to remain competitive — “It was part of a broader strategic vision”

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Bold Statements

Sparrow for a lot of years had, frankly, underinvested a little bit in information technology. In fact, our inpatient floors in our main hospital were still using paper record systems.

We had an extensive evaluation process where we involved a lot of clinicians, and had really strong physician leadership. Epic was a platform that they were very excited about and still are very excited about.

We had considered actually doing more at once, but we opted to spread out the investment as well as to learn from those practice implementations, and that proved to be a terrific decision because we really did learn a lot.

We did have and still do have as many as five or six physician champions that have been not only strong supporters and advocates of the project, but have really been a part of the project team, helping us build order sets.

Our board and our executive team really recognized back in 2007-2008 that to continue to be a competitive health system; to continue to achieve our mission and deliver the kind of care that we wanted to, IT would need to not just be something that we were adequate at, but that was a competitive advantage for us.

Gamble:  Hi, Tom. Thanks so much for taking the time to join us.

Bres:  Sure, happy to do it.

Gamble:  To give our listeners and readers some background, why don’t you tell us a little bit about your organization? I believe you have the two hospitals, but just give us some information about bed size and what you have in the way of clinics, things like that.

Bres:  You bet. Sparrow Health is a health system that primarily serves the mid‑Michigan area, so it’s about an eight county region in the middle of Michigan. We do have one flagship hospital that usually has a census in the 400s, and then we have three or four other locations: Sparrow Clinton; Sparrow Ionia, which is a specialty hospital; a medical group with as many as 26 practices, a large cardiology practice with about 24 cardiologists that’s licensed for close to 800 beds in total. We’ve been in business for 115 years and we’re a not-for-profit, with a mission to improve the health of the communities we serve which as I said, is mostly mid-Michigan. We’re the market share leader in mid-Michigan and we’re growing and doing well.

Gamble:  Okay. Because we have listeners from all over the country, tell me a little bit about the area. Are you near any big cities or is it fairly rural?

Bres:  Our main location is in Lansing, Mich., which is kind of in the center of the state. If you do the mitten thing that we Michiganders do where you hold up your left hand and you kind of point to the very center of the back of your hand, that’s about where we are. We’re about 90 miles west of Detroit and about 60 miles east of Grand Rapids.

Gamble:  Oh that’s helpful I like that. So when I originally reached out to you, we pushed the interview back because you were scheduled to go live with Epic on December 1. Can you tell us a little bit about how that’s gone so far?

Bres:  It’s gone really well. We took on quite a large initiative when we went live December 1, and then the plans and preparation leading up to that. Sparrow for a lot of years had, frankly, underinvested a little bit in information technology. In fact, our inpatient floors in our main hospital were still using paper record systems. We had pockets of electronic systems in various departments across the health system. For example, we had an electronic system in our emergency department and we had a few different systems in our practices. So this initiative we launched back in 2009 was to not only automate and bring up to date those inpatient floors that were on paper, but also to consolidate and replace a lot of the departmental systems that had previously been in place.

When we started, as I mentioned, back in 2009, our initial focus was in our primary care practices. Our Sparrow Medical Group is about 24 practices, most of which are primary care practices, and so we started there and launched our first practice in August of 2010 where we implemented Epic systems. That’s the EHR system that we chose. We had an extensive evaluation process where we involved a lot of clinicians, and had really strong physician leadership. Epic was a platform that they were very excited about and still are very excited about.

And so August 2010 is when we started, and we rolled out a new practice about once every two to three weeks through the course of the end of 2010 and 2011, and then around the middle of 2011is when we launched the hospital-based project, which ultimately led to the December 1date that you mentioned. On that date, we went live with EpicCare across all of our inpatient locations. We also launched Epic’s ASAP module in our emergency department, Radiant for radiology, and all the revenue cycle components, and we did this in all of our locations at once — the main hospital in Lansing as well as our four affiliate sites. It was quite a large event and as I mentioned, it went really well.

Gamble:  All right, so a lot there. The decision to start with the physician practices — was that almost like a test-run? Were there some takeaways you were able to take from starting on a much smaller scale?

Bres:  It was. That’s a great question, actually. That’s a big part of why we did it that way. Part of it was to be careful financially as well, and to spread out the sizeable investment we needed to make to do all these things. We were making these decisions back toward the end of 2008 and beginning in 2009, which you might remember was when the financial crisis was at its peak. We had considered actually doing more at once, but we opted to spread out the investment as well as to learn from those practice implementations, and that proved to be a terrific decision because we really did learn a lot. We built our relationship with Epic and were able to understand them and their capabilities even better, and so it was a really good approach where we could apply the lessons that we learned in the practices to our inpatient implementation. And that also included surgery, so all of our operating rooms were also part of that December 1 event.

Gamble:  As far as the whole selection process, you mentioned that you involved the clinicians. Did you have physician champions? How did that process work?

Bres:  We did have and still do have — depending on the point of the project over the course of the last three to four years — as many as five or six physician champions that have been not only strong supporters and advocates of the project, but have really been a part of the project team, helping us build order sets. For example, we selected the ProVation order set tool as a part of this December 1 event. Leading up to that, we built 250 order sets via that tool and so we had a lot of involvement in leadership from the physician champions as well as our entire medical staff leadership. Some of those same individuals had an active role in the selection of Epic, but it was a lot of the various departments as well, and section chairs. It was a process that took many months to get the insight and input from as much of our medical staff community as we could.

Gamble:  I can see why you would want to choose Epic when you’re going live in so many different departments and wanting that one system throughout. But when you talked about the timing with the economic crisis, was it a bit of a tough sell to invest so much money in the system?

Bres:  It had to be reviewed and considered carefully, that’s for sure, but it really was part of an even broader decision to make more significant investments in information technology. Our board and our executive team really recognized back in 2007-2008 that to continue to be a competitive health system; to continue to achieve our mission and deliver the kind of care that we wanted to, information technology would need to not just be something that we were adequate at, but a competitive advantage for us.  So yes, the Epic decision certainly, and the cost of any kind of a project like that, is significant and has to be justified, but this really was part of a broader strategic vision that we wanted to be really good at leveraging technology and successful in using both what we had and what we were investing in.

Gamble:  Right. So probably a little bit unfortunate with the timing, but I don’t think there’s any organizations that weren’t really impacted by that.

Bres:  I don’t know that that necessarily slowed us down or that we would have made a different decision, it was just that being the financial crisis and the economy in 2008, because as I said, we had a lot that was a part of this with the practices first and then all the modules that we ultimately did implement in all the locations with Epic. And so it was just another factor that helped to make it an easy decision to start with the practices and get that experience. There were just so many times when we were in the inpatient build of that application when we would reference, ‘hey remember when we did this with the practices’ or ‘remember when this or that happened,’ and we wanted to do it a little bit differently. So it really did prove to be a good way to apply some lessons learned to the bigger event that we went through on December 1.

Chapter 2