Gene Thomas can tell you the precise date and time his team ‘flipped the switch,’ going from three EHR systems to one. It was a big move, one that Thomas believes has placed the organization on the right track. But it’s also a move that required a great deal of planning and discipline, and came with challenges no one could anticipate. In this interview, he shares some of the lessons learned in leading a big-bang implementation, what it will take to go from stabilization mode to optimization mode, and the many hats CIOs must wear. Thomas also talks about the his team’s big plans for analytics (and what they’re doing to set the stage), his thoughts on patient engagement, and how he has benefited from his previous career experience.
- His career path, from tech to healthcare
- Busted by the dot-com bubble
- “Don’t let the data fool you.”
- Budget constraints
- Data security — “You need to lock down your systems.”
- Interoperability & the square peg
- “It’s not a technology issue. It’s an issue of standards.”
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I was really, really wrong with my assumptions. I got humbled. I got bloodied. I lost some money, because it just doesn’t work that way.
You need to lock down your system pretty tight, and that causes some frustration with users that say, ‘I need access to the outside.’ Sometimes it’s legitimate access; it’s a true need. Sometimes it’s a want. But as CIO, you are constantly battling.
The ability to have your medical record in front of the right clinician in minutes or less is not necessarily a technology issue. As technologists and CIOs, we can do that. This is an issue of standards.
You need to have a robust system if you really want to exchange clinical information. You need to have an integrated system where all of the patient information within your own system sits in one database, and one enterprise data warehouse that simply gives you access to the data that may be needed by some third party.
Gamble: You briefly alluded to having experienced outside of health IT. First off, how long have you been at Memorial?
Thomas: Seven years.
Gamble: What about previously to that?
Thomas: Most of my career, I was not in healthcare at all. I was in pure technology. I worked with the technology side of Polaroid Corporation in the 80s in the electronic imaging group. I went to work for a very small — at that time, 25-person — company in Austin, Texas called CompuAdd. We looked just like a Dell, except that we built a lot of other components as well. Dell and CompuAdd were the first two companies that really built, back then what was called IBM clones. As a matter of fact, we were pretty big competitors with Dell in the mid-80s and 90s and competed with them pretty heavily. We were about four miles apart. I ran sales and marketing there. Back then it was called mail order; today it’s called direct marketing. Same thing, just a cleaner word. Part of the draw there is you base all that on data.
I spent seven years there, a couple of those years living overseas. Then I went to work for a company in Boise, Idaho called Micron Electronics. We were a contract manufacturer of technology products and we were a marketer of very high-end laptop, servers, PCs, and other devices. I was VP Sales and Marketing there as well. I had sales and marketing, product management, product development, customer service, and tech support. I left there in 1999 and really didn’t know much about healthcare.
A colleague of mine asked me to come over to LSU School of Medicine, where they were building an advanced learning center, to help bring some technology to this advanced learning center where there were going to be simulation dummies and things like that. This was when healthcare still was really going full-bore with real simulation, and that’s what got me interested in healthcare. I ran into a physician there who had just barely started a company doing radiology over the internet, which in 1999 sounded pretty cool. So I became CEO of that company and we ran the company and built it up. It was little bit difficult from the venture capital side because we had raised an initial multimillion dollar round. We put up that money to use, built a very robust product, then 9/11 hit and the dot-com bubble. So we wound up with a relationship with our largest distributor. That company exists today. It is now Best in KLAS and is really focused on the B and C market for healthcare.
I really got interested in healthcare, and I’ll tell you that I was reasonably successful with those two other companies, CompuAdd and Micron. When I got to both companies they were very small companies and they both grew to multibillion dollar companies, with 1500 employees in the first company and about 4,000 in the second. And Micron Electronics we had taken public. And so I knew technology really well. I understood data really well. I understood analytics very well.
I got into healthcare again by becoming CEO of this radiology company and working with the LSU School of Medicine. I figured, wow, what a big opportunity — disparate silos of data. Very little analytics and mining of that data. There were pockets — the CDC and immunizations and other areas, but very little. So I figured there’s a huge opportunity here and I can probably be successful and also make a difference. I will confess — at this point, I was really, really wrong with my assumptions. I got humbled. I got bloodied. I lost some money, because it just doesn’t work that way. But I got hooked and here I am today.
Gamble: I would assume having the experience you did with CompuAdd and Micron, there have been some benefits that you’ve been able to work into this CIO role, which while I’m sure has some similarities, is also pretty different.
Thomas: On the one hand, it is very, very different, of course. They’ve taught me a lot about the focus on the patient, patient care, and patient quality. I can get that. It’s in their DNA and so it’s now more a part of my DNA, but it’s very different. Yet at the same time, I used to sell to CIOs, so I understand how that works when salesmen come to see me. I understand the contracting side of it very well. And when it comes to the data side, did I do healthcare data analytics? No. Did I understand analytics and data warehousing and databases and structures? Oh yeah, very well. That really was something that helped me integrate pretty deeply. The other side is I understood the business side. I was used to balance sheets and income statements and budgets, and those types of things.
Gamble: I feel like I’m hearing more and more people tout the benefits of having some experience outside of health IT and even healthcare, and just bringing in some of the lessons learned from other industries. Healthcare does have its pitfalls as we know as far as some of the hesitancy to adopt technology over the years.
Thomas: Yeah. To your comment, I attended in September the Health Analytics Summit in Salt Lake. It was actually something crafted by Health Catalyst, but it wasn’t about Health Catalyst. They had about 600 people show up for this conference, and I’ll tell you, in talking to a lot of my colleagues in other institutions, some that were further along than we are and were more mature, a lot of their analytics are BI people that came from outside of healthcare. They came from the finance community. They came from Wall Street. They came from other areas, from oil and gas and energy. So a lot of the analytics talent being brought into certain large group practices or health systems are coming from outside of healthcare.
Gamble: Yeah. You get that different perspective.
Thomas: Well the different perspective, but they also understand the fundamentals of analytics. Don’t let the data fool you. Sources of truth. How do you make sure you understand when data has been massaged, and therefore, you should have a skeptical eye on it — those types of things.
Gamble: As far as when you first became CIO, was there anything you can recall that kind of surprised you about the role or maybe something that wasn’t quite how you thought it would be?
Thomas: How much time do we have? Just kidding.
Gamble: Another big question.
Thomas: Yes and no. When I came over, I came over to be temporarily the Director of Information Systems. A friend of mine was the CMIO and he subsequently left, and that’s when I became CIO. The challenges are certainly on my side, tight budgets. There are tight budgets, and these are things that I knew about that I’ve learned a lot more about in the CIO role. Reimbursement models changing, things are changing within CMS at the federal level and at the state level, reimbursement reductions — the two-midnight rule is a big one. The balance between spending capital and operational dollars and making sure you focus on that ROI and how you provide the tools that are needed — those tools for everything from what you use in surgery cases to what you use on the floors, to what you use in information systems. It wasn’t a surprise, but interesting how constraining that can be. We have a healthy balance sheet. We’re very well financially managed, but the healthcare has always got that unknown of what’s going to happen in the reimbursement model particularly, when a large percentage of your reimbursement is Medicare/Medicaid and uninsured based. There weren’t a lot of other surprises.
One thing that wasn’t a surprise but just became more acute, if you will, even when I was the director, is that there are many, many disparate systems. You have vendors all over the place hitting every area that you can think of, oftentimes without talking to information systems first. So you’ve got a lot of interest in these stand-alone, one-off solutions. Pick your area: respiratory therapy, tissue tracking, bone, etc. There are many, many areas where people walk in with this very one-off standalone solution and they look for that to be integrated in. So as a CIO, you can wind up literally with a few hundred systems that are being managed. And then you get to the technology side of that where some work on this version of Windows, some work on this version of this operating system, some need this version of Internet Explorer, others need this.
And there’s the security side. It doesn’t surprise me, because we did a lot of transactions in my prior life where we had we had credit information and other credit information on corporations and individuals. You needed to safeguard that, obviously very closely. In healthcare, it’s just the constant potential barrage of threats that come in. So you need to lock down your system pretty tight, and that causes some frustration with users that say, ‘I need access to the outside.’ Sometimes it’s legitimate access; it’s a true need. Sometimes it’s a want. But as CIO, you are constantly battling. You’re turning the dial on constricting access versus loosening access, which is another way of saying managing risk from some type of an evil doer.
Gamble: As far as when you did start at Gulfport, you had pretty interesting timing. I can imagine that it’s been an interesting ride.
Thomas: Oh yeah, it was 2007, we had just really began the ramp up of clinics, and Meaningful Use came. That’s when we decided we were going to meet Meaningful Use stage 1. That was the first big transformational topic that we had to go through, at least while I was here.
Gamble: That’s a nice ‘welcome to the CIO role,’ right?
Gamble: We’ve touched on a lot of the things you’re working on. I didn’t know if there was anything else you wanted to add, but I really appreciate you giving us your time.
Thomas: Certainly, this is important. The only thing we didn’t really touch on much, which is an obvious topic, is interoperability. As patients move, whether it’s temporarily or a vacation or wherever, the ability to have your medical record in front of the right clinician in minutes or less is not necessarily a technology issue. As technologists and CIOs, we can do that. This is an issue of standards.
Interoperability to me is very important. We’ve got HIEs popping up all over the place — state HIEs, private HIEs. We’ve got CCDs that we’re now passing between each other, we’ve got direct messaging. So what I’m really working through on a regional basis is what institutions should we have connectivity with and interoperability with on some clinical level for the benefit of the patient. That’s really important in my opinion, and I think it’s important in many people’s opinion, because it is good for everyone in the continuum, if you will.
And you need systems to do that. That’s the other point. You need to have a robust system if you really want to exchange clinical information. You need to have an integrated system where all of the patient information within your own system sits in one database, and one enterprise data warehouse that simply gives you access to the data that may be needed by some third party.
Gamble: Yeah. That’s such a good point, and it’s something that hopefully what we’ll see start to really take more of that front seat at the industry events and everything like that, because without interoperability, I don’t want to say it’s all for naught, but…
Thomas: That’s probably an over characterization, but I liked the way you said that. That’s what’s frustrating. As a CIO, this is not a technology issue. It’s an issue of standards. My job is to constantly, in some cases, take the square peg of data and put it in a round hole for interoperability, when if all the data we had is standard round hole, this wouldn’t be an issue. We — and that’s Memorial, the nation, and taxpayers — spend a pretty good amount of money to build systems that don’t talk well to each other and buy systems that don’t talk well to each other.
Going back to the early days of technology, a lot of the hardware manufacturers and some software back in the 80s and 90s got together and said ‘look, we’re going to build some standards.’ I’ll make this simple — that’s why we have USB ports. Take a USB device, plug it into any computer, I don’t care who made it, and it works. They agreed even though they were competitors that they were going to have standards.
Anyway, it’s a little bit of a more personal opinion, but it is frustrating because interoperability should not be this difficult. The way you chart a lab, the way you dictate a report — it just should not be this difficult. The way a drug is labeled, we can go down the list.
Gamble: Yeah. It’s something that when you put it like that really should have been established right out front, but I’m really hoping that there will be more emphasis on that going forward.
Gamble: Well, you’ve given us a lot of food for thought, and that’s appreciated. Thank you for your time, but then also for speaking so honestly about your experiences. This what CIOs really appreciate and need to hear is just how everyone else is handling similar challenges.
Thomas: I agree.
Gamble: Well thank you so much. I really appreciated it, and I hope to be able to catch up with you again down the line.
Thomas: You bet, anytime. I’m happy to do it.
Gamble: Thank you, Gene.
Thomas: You’re very welcome. Thank you.