Jason Bray, CIO, McAlester Regional Health Center, Chapter 2

It’s hard to find three organizations as different as those in which Jason Bray has served as CIO. He went from a teaching facility that was on the ground floor of the Meaningful Use movement (Oklahoma State University Medical Center) to a multi-hospital health system that embarked on a massive EHR implementation (Methodist Health System), to a rural hospital that is piecing together an integration strategy (McAlester Regional Health Center). In this interview, Bray opens up about how he has benefited from his experiences at both OSU and Methodist (as well as IBM), and talks about the key priorities on his plate at McAlester, from migrating to a Web-based Meditech platform to expanding telemedicine.

He also talks about the many hats he must wear as CIO of a rural facility, what he learned from Pam McNutt about vendor management, the “incredible ride” it was being an early ACO at OSU, and the enormous potential he believes Watson holds.

Chapter 1

Chapter 2

• Staff education on a budget
• VAR & the “One throat to choke” philosophy
• Learning from “CIO rock star” Pam McNutt
• Early success with HIE Beacon Grant: “We proved MU could work”
• Groundbreaking data warehousing & analytics at OSU
• Centralized data: “It’s going to be vital for reporting purposes.”
• IBM Watson & the physician shortage

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Bold Statements

My criteria here is that if there’s somebody in McAlester that can do it, great. If not, we see if there’s somebody in Oklahoma who can do it, and if not, then we go to the region.

She’s probably one of the most intelligent people you’ll ever meet. She can take on multiple things at a time and still be able to delineate proper direction, and that’s a skill that a lot of people don’t have. And then on top of that, there’s her understanding of the financial and the political side of the equation.

You’ve got hundreds of systems at your fingertips with valuable data that you’re losing out on because you don’t capture it in a centralized manner.

There’s a lot of discussion around artificial intelligence, but nobody’s even come close to anything like Watson. I still don’t think there’s anything like Watson.

Gamble:  Being a rural organization, one of the things you identified earlier as a challenge is the budget. But is there anything you’re doing to try to educate the staff or promote growth?

Bray:  In my head, yes. When I was trying to get my travel approved for the CHIME-HIMSS conference in March, my CEO asked me, ‘are you just going to this to take a vacation to Vegas?’ And I said, no, this is important from two standpoints. First, I don’t go to CHIME by itself anymore, I go to the combined HIMSS/CHIME conference to save costs. Second, I take Tracy, my second in command, with me, and we split up. He takes certain classes, I take certain classes, and then we talk every night, and come back and report all of that. So my CEO said, ‘I need you to take what you just said in your head and put it down on paper so I know that I’m not just paying $6,000 for you to go to Vegas.’ And I was like, point taken. So I now I make sure to get all of that down.

Gamble:  Sure. I also want to talk about your strategy in terms of vendor management. What are you doing to make sure you’re getting the most out of the contracts you have and that you’re able to really stretch those dollars?

Bray:  One thing I learned thing I learned from my time at Methodist in Dallas working under [CIO] Pam McNutt was about VARs — value-added resources. We had certain criteria in Dallas where they had either be minority owned or they had to be part of our GPO. My criteria here is that if there’s somebody in McAlester that can do it, great. If not, we see if there’s somebody in Oklahoma who can do it, and if not, then we go to the region.

I actually have two VARs. I have Pinnacle Business Systems. They’re based out of Oklahoma City, Oklahoma. They are my main VAR. My philosophy is one throat to choke. So if a VAR can handle security quotes, infrastructure quotes, network quotes, storage, software, services, etc., that’s ideal. I would prefer to go to Pinnacle. It’s that one throat to choke philosophy — plus they’re in Oklahoma, so it’s a win-win.

My other VAR is Sirius Computer Solutions. They’ve been working with us for a while, and I’ve made it very clear to them since they are not headquartered in Oklahoma, they will be the secondary VAR, which means that they’ll have a little bit. If at some point Pinnacle isn’t giving me good pricing anymore or tries to take advantage of me, then they’ll get more, and Pinnacle will get less. All of that I learned from Pam McNutt; she may not take credit for it and she may not want credit for it, but that’s what she taught me.

Gamble:  It’s a good lesson. I guess it’s really about trying to establish a certain rapport right out of the gate with vendors in being transparent, and expecting the same in return.

Bray:  Right.

Gamble:  Okay, so the last area I want to touch on is your career path. You said you’ve been at McAlester for about 20 months?

Bray:  Yes.

Gamble:  And before that, you were at Methodist, where you were deputy CIO working with Pam?

Bray:  Yes. She hired me in 2013 to take her place when she retired in 3 to 5 years. And so after 3 years, I asked her where she was at, and she said, ‘I’ve probably got another 7 to 10 years.’ Around that same time, my father had some health issues and I needed to get back to be closer to him. McAlester was available, and so here I am.

Gamble:  Right. And so you view that as a good experience and learn what you can while in that role from someone who has been at this for a long time.

Bray:  I call her a healthcare CIO rock star, because she’s been at Methodist for over 25 years. That’s unheard of. I think our average lifespan is around three years.

Gamble:  That sounds about right. Why do you think she’s been able to last that long?

Bray:  She’s good. She’s probably one of the most intelligent people you’ll ever meet. She can take on multiple things at a time and still be able to delineate proper direction, and that’s a skill that a lot of people don’t have. And then on top of that, there’s her understanding of the financial and the political side of the equation — she’s good at budgets, and she loves looking at contracts and dealing with government on changing legislation.

What she doesn’t like, I was good at, so we made a good team. She didn’t want to deal with vendors, but my view was that they’re a partner, and they can either help you or hurt you. So we made a really good team.

Gamble:  It sounds like it was a great learning experience.

Bray:  It was.

Gamble:  And before that, you were CIO at Oklahoma State University Medical Center?

Bray:  Yes. I was there for about 7 years.

Gamble:  Based on the time period (2007 to 2013), it seems like you were there during the time when EHR adoption really started to accelerate.

Bray:  Oh yes. I could tell you some great stories. In 2007 when I got there, the government had a great opportunity to try and show how a health information exchange in an ACO might work. We qualified for that grant and implemented HMS, Cerner, and Meditech at three smaller hospitals, then implemented Meditech at our place. We put in an HIE called Covisint to exchange patient data back and forth through different systems and proved that meaningful use could work. Then we took that successful project and moved it into The Beacon Grant with ONC, where we got $19.2 million to connect over 700 different health care organizations in the Tulsa area together through a health information exchange. We started a company called MyHealth which is still in existence — they are the HIE for the state of Oklahoma. That was a lot of fun at OSU, having grant money and capabilities and working with government on some pre-mandated projects that are now mandated.

Gamble:  I’m sure that was quite a ride.

Bray:  It was an incredible ride.

Gamble:  Is there anything that really sticks out to you from that time, when it was starting to become evident that these things were going to be mandated?

Bray:  Just that it was going to be a fun ride. There was a lot of technology that was going to have to be invested in by folks. When they put out the Meaningful Use incentive program, that was really good for a lot of folks. The groups that actually took those moneys and applied it toward a new EMR are benefiting the most. The groups like McAlester that didn’t use those moneys for a new EMR and are just now deciding to do a fully integrated solution wish we would have used it for an EMR, but instead we had other things going on.

Gamble:  Right. It’s interesting when you think back to that time, and then look at where the industry is now. It’s been such an amazing decade.

Bray:  It has. One of the things we implemented for reporting purposes at OSU Medical Center was a data warehouse and data analytics component so we can report to the government on data sources for all of those entities. When I went to Methodist, obviously for reporting purposes, like ACO and CMS, a lot of that is within the EMRs, but a lot of it isn’t. You’ve got hundreds of systems at your fingertips with valuable data that you’re losing out on because you don’t capture it in a centralized manner.

Methodist has one now and we’re looking to do that here as well, and I think that is going to be vital for future reporting purposes. I think you’ll see audit agencies like Joint Commission and DMV want real-time access to your data instead of coming out on a surprise visit. I think they’ll develop dashboards around your data. And if you want to keep them out of your EMR, if you have an analytics or a warehouse tool, you could segregate the data that they need to see only for them and keep them out the rest of your business. It’s going to save them more money on travel expenses and it’s a lot more efficient. I think we’ll see that in the next 10 years.

Gamble:  Interesting. It would make more sense, it’s just a matter of getting to that point.

Bray:  Yes. There’s a lot of discussion around artificial intelligence, but nobody’s even come close to anything like Watson. I still don’t think there’s anything like Watson; of course I used to work for IBM, but I think that’s where we’re going to end up. Because of the physician shortages, you’re going to see a different level of telemedicine, and I think you’re going to see it in the hospital setting — very similar to eICU with intensivists but I think instead of having as many hospitals as we do, I think you’ll have a computer at everybody’s bedside that is plugged in to Watson. And then Watson will have your EMR, your biomed data, all of your information. So it can produce reports and analysis to physicians remotely, and hospitalists won’t have to spend as much time with the patient.

Gamble:  And they’ll have access to information that isn’t always that accessible.

Bray:  Exactly, and be able to process it that quickly. But that’s probably out there quite a ways.

Gamble:  Really interesting. Well, we’ve definitely covered a lot of ground. I think that’s all I have. If there’s anything else that comes up, I’ll follow up with you, but it’s been really interesting. Thank you.

Bray:  Absolutely. It was good to reconnect with you. I think it’s been a few years.

Gamble:  It has.

Bray:  Well, let me know if there’s any other questions or things that I can help you with, and I look forward to talking to you soon.

Gamble:  Great. Thank you so much, Jason.

Bray:  Thank you.