Brian Thomas, VP & CIO, Swope Health Services, Chapter 1

When an opportunity presents itself, smart people jump on it. For Brian Thomas, that moment came a few years ago when Swope Health Services was restructuring its executive team. Seeking to learn more about the business, Thomas asked to take on a 90-day assignment as interim VP of operations, and in doing so, impressed the board enough to earn a new title. In this interview, Thomas talks about what he believes it takes to become a successful CIO, why leaders must “get in the trenches” to better understand user needs, and his philosophy when it comes to innovation. He also talks about how his team is preparing for the ACO world, the dangers of over-customization, and the strong foundation he was able to build during his time with the Marines.

Chapter 1

• About Swope Health Services
• Patient-centered medical home: “It’s a partnership between providers & patients.”
• From paper to paperless with eCW
• Dealing with “squeaky wheels”
• A “structured, disciplined approach” to change management
• HIE challenges
• Interoperability – “We’re just not there yet.”

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It’s comprehensive, coordinated, and accessible for our patients here in the community. It’s a partnership between the providers and the patients, and it really helps patients ensure the decisions they make are in their best interest, and that education is provided to them so they can make those informed decisions.

When you start hearing the same issues surface over and over, you can’t just address those one at a time. You have to start looking at integrating other technologies or connecting with other partners within the system, to give not only a better customer experience for the patient, but also for providers.

You may have a squeaky wheel or provider that wants something, and that change they want may impact the rest of the organization. So we have a very structured, disciplined approach to change management, and we’re very communicative around that.

Right now the HIEs aren’t all talking to each other the way they probably should be, but we found that if we can at least get connected to all three, we’re going to share in the data that the providers around the city need.

Gamble:  Hi Brian, thank you so much for taking some time to speak with healthsystemCIO.com.

Thomas:  Hi Kate, thank you. I really appreciate the time.

Gamble:  To give our readers and listeners a little bit of background, can you give an overview of Swope Health Services — the type of care you provide, where you’re located, things like that?

Thomas:  Absolutely. Swope Health Services was established about 47 years ago in the basement of a community church. Since then, Swope has grown into the largest community healthcare center in the region, which serves the Greater Kansas City area on both sides of the state line, including seven counties.

We offer many specialties, including behavioral health, women’s health, radiology, optometry, dental, pediatrics, and several others. We’re a safety net health organization; we serve many of the inner city uninsured and underinsured patients in these communities. As our mission states, we improve the health and wellness of the community by delivering accessible quality and comprehensive patient care.

Gamble:  Approximately how many practices do you have at this point?

Thomas:  In addition to those specialties, we have our main location which is east of mid-town, and we have nine other clinic locations around the Greater Kansas City area, which include both Missouri and Kansas in several different counties. It’s about a 100-mile square radius. We also have some behavioral health residential facilities that we manage.

Gamble:  Are you affiliated with any hospital systems?

Thomas:  We are not. Many of our training partners across the Greater Kansas City area, many of the hospitals that we have here, we work with but we are independent. We   I do or I might add that we are an FQHC or a Federally Qualified Health Center, so some of our funding does come from the federal government.

Gamble:  Okay. Can you give a brief overview of your primary responsibilities in your role?

Thomas:  Sure. As CIO and vice president of Support Services, I’m responsible for technology, the program management office, facilities management, call center, purchasing, security, and our environmental services, so far to date.

Gamble:  So a lot on your plate.

Thomas:  Absolutely.

Gamble:  One of the concepts that, obviously, we hear a lot more now but used to be big for some people is the patient-centered medical home. Can you talk a little bit about what that concept means and why it’s become more important?

Thomas:  Absolutely. Several years ago here at Swope, we decided to begin the process of becoming truly a patient-centered medical home and, subsequently, certified so we could improve the quality around patient care. From my perspective, PCMH means care is truly patient-centered. It’s comprehensive, coordinated, and accessible for our patients here in the community. It’s a partnership between the providers and the patients, and it really helps patients ensure the decisions they make are in their best interest, and that education is provided to them so they can make those informed decisions and actually participate in their health care, which is a total move away from the way health care used to be managed.

And so, while I’m not a clinician and don’t have purview over those clinical departments, my team simply provides the support to our behavioral and medical providers and their programs to ensure their success.

Gamble:  Okay, and now, in terms of IT systems, what type of EHR system or systems are being used?

Thomas:  Our electronic health record is eClinicalWorks. It’s a fairly robust system and it’s done well for us here. We implemented it about six and a half years ago. We came from a completely paper environment and now, we’re a paperless environment. So, we’re pretty excited about that. Obviously there are other systems that connect into it — we have ERP system for financials, and then we’ve got our radiology system and some of the other reporting systems that come along with that connect into it. So again, we’re just continually improving the system — adding new capabilities, integrating other data connections, and assisting with improving the clinical workflow from an EHR standpoint.

Gamble:  When it comes to improving that workflow, what type of process do you have in place? How do you usually get that feedback from clinicians and incorporate changes?

Thomas:  Since I’ve been here, we’ve built just a phenomenal team here. As part of a strategic plan, we’ve built a medical informatics department that works hand in hand with our technology department and our medical providers. The definition of insanity is to keep doing the same thing over and over expecting different results. I’m all about the customer experience, and when you start hearing the same issues surface over and over, you can’t just address those one at a time. You have to start looking at integrating other technologies or connecting to other trading partners within the system, to give not only a better customer experience for the patient, but also for providers, who need things to be done more efficiently and more accurately so they can provide better care quality and more time with the patient.

Gamble:  Right. So are there certain physician leaders in the medical informatics department who provide that feedback?

Thomas:  Yeah. When I first arrived at Swope, just like any organization, you get into the trenches and really understand and hear what the customers are saying. And so we developed a medical informatics team to help integrate their clinical workflows into the way you chart within the electronic health record. That team has been instrumental. Initially we didn’t have that; integrating that team has made huge leaps for us in improving patient care from a provider’s perspective, and also reducing the number of tickets we get in IT, for example.

Gamble:  Right. There seems to be a fine line as far as wanting to increase satisfaction, improve workflow but not making too many changes.  How is that something that you and your team were able to balance?

Thomas:  I learned early on in my career that if it’s not broke, don’t fix it, right?

Kate:  Sure.

Gamble:  Essentially, we have a very robust and structured change management process, because you may have a squeaky wheel or provider that wants something, and that change they want may impact the rest of the organization. So we have a very structured, disciplined approach to change management, and we’re very communicative around that. When we do put a change in place, it’s tested, and we communicate to the organization what this means to you as a provider. It’s worked fairly well and it’s a well-documented system. I attribute that to a lot of my experience in my previous careers. It’s been very helpful.

Gamble:  Right, and that’s something I definitely want to get into in a little bit. But first, you mentioned that you do work with hospital systems. Is that through an HIE? How does that go as far as the data exchange?

Thomas:  Sure, we currently are connected to a health information organization. We initially connected to the State of Kansas because their platform was free to all FQHCs and they’d already set up that hub or that HISP, so to speak. Since then, because we sit on really the border of two states and there are three HIOs in the area, we are now connected to all three of them, because our various partners throughout the city, whether it’s a specialist or a hospital, may be on different HIEs. Right now the HIEs aren’t all talking to each other the way they probably should be, but we found that if we can at least get connected to all three, we’re going to share in the data that the providers around the city need to take care of the patient. That’s one part of it.

The second part of that is various vendors in the industry just don’t talk to each other very well when it comes to sharing data. So we’re working with Cerner right now and eClinicalWorks on a referral process and appointment scheduling. That’s been very helpful, but again, when you’re on two different platforms and each vendor thinks that theirs is, obviously, the system of choice. It’s hard to get systems to talk to each other, but we are making progress. I have to say this has been one of the biggest struggles in our industry, is interoperability. We’re just not there yet. I know we’re putting a lot of pressure on it, but we’ve just got to continue to work on that as an industry.

Gamble:  It must be incredibly frustrating for CIOs.

Thomas:  Absolutely, it is. I hear it every day from the medical providers that say, ‘I need records, I can’t this,’ and they can’t get to it. Now they are starting to get to it, I but it’s still in its infancy stages where the data is pretty rough and it’s not everything that they can use. So we’re getting there slowly but surely, but it’s going to take the whole village to get this thing to where it needs to be.

Chapter 2