Anncy Thomas, MD, CIO, Episcopal Health Services, Chapter 1

A pattern was becoming clear.

Every time a new piece of technology was implemented at Episcopal Health Services, there was a collective groan among the medical staff. Not because physicians and nurses were averse to change, but because, much of the time, they didn’t understand why it was necessary. It’s the same dilemma facing organizations across the country, and it’s the reason Anncy Thomas decided to pursue a career in informatics.

Four years later, she’s spearheading the transformation from an IT department that often lagged with basic maintenance, to an ‘information technology and services’ team focused on putting customer needs first. In this interview, Dr. Thomas reflects on her first year as CIO, which involved creating (and reassessing) a strategic plan, and finding quick wins to gain buy-in. She also discusses the need to connect with users, what it takes to “own” the business case behind IT initiatives, why it’s critical to “admit what you don’t know,” and how EHS is adapting to the changing healthcare landscape.

Chapter 1

• About EHS
• Investing in the future – “The organization is going to be stronger.”
• From family medicine resident to CMIO to CIO
• Taking over a department that was “lagging with basic maintenance.”
• Transparent communication between IT and clinical
• Change from IT to ‘information technology & services”
• The “uphill battle” of gaining executive buy-in
• Going for “quick wins” with individual departments

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Bold Statements

We made strategic decisions to move folks into positions where their skills would be better leveraged. That was one of the keys to enhancing our services very quickly and developing a scope of services and a catalog.

It was about changing our team’s mindset. They were used to me being the CMIO or physician informaticist; but now being the lead of the entire IT team, they had to put a lot of trust in me.

Most leadership teams get fascinated or fixated on certain tools and technologies that are being implemented today in other hospitals and other organizations. And so we were very aware that executive management may jump to a solution before they’ve even defined the problems they were trying to solve.

We kept saying, ‘start with workflow.’ I think they may have gotten annoyed with it, but that was our mantra. Start with what workflow you’re looking to change and what outcomes you’re looking for, rather than starting with what technology is available.

Gamble:  Hi Anncy, thanks so much for taking the time to speak with us. I think the best place to start is with an overview of the organization.

Thomas:  Episcopal Health Services is based in Far Rockaway, N.Y., and St. John’s Episcopal Hospital is the main hub. It’s a full service, 257-bed community hospital. The Episcopal Health Services Branch also has about 10 physician practices. We have residency and fellowship programs here, and we’re the only hospital currently serving the Rockaway Peninsula in Queens, with about 2,000-plus medical and administration staff. It has evolved, and we now have a growing ambulatory presence in the Rockaway Peninsula in Queens.

 

Gamble:  In terms of the patient population, I imagine it’s quite diverse.

Thomas:  We have a very diverse patient population. We have a mix of different payers, but we’re heavily Medicaid and Medicare. There’s also a large nursing home and an adult home here, so geriatrics is also a big focus.

One of our biggest initiatives is Delivery System Reform Incentive Payment (DSRIP), which is part of the Medicaid redesign program in New York designed to address some of the healthcare disparities that are associated with our type of community. We are one of the last standing hospitals in this area, and so we have a lot of challenges, but we also have a unique pathology and a lot opportunities from a clinical perspective.

 

Gamble:  It seems like it’s a core part of the organization’s philosophy to make sure everyone who needs care is able to receive it.

Thomas:  Absolutely. It’s interesting; we’ve had a change in leadership in the last three years at the executive level. The Episcopal Diocese, which is the overarching branch of the organization, had made some efforts to shift the strategic focus. When you’re dealing with a tough financial situation, sometimes a health system makes what are perceived to be avoidable investments. It can make it difficult to address patient care, because you haven’t seen how those decisions can affect care 10 years down the line. We’ve made a lot of the investments recently around changing management and making different decisions around technology and patient care services that I believe are really helping us to be in a better place, both immediately as well as 10 years from now. The organization is going to be a stronger one, for sure.

 

Gamble:  I’m sure it’s a really interesting time to be part of the organization.

Thomas:  Definitely. It’s been about a year since I took the role as CIO. I worked here as a family medicine resident and graduated as chief resident, and then was recruited into the IT department to fill one of my informatics electives. I eventually became chief medical information officer, and then most recently, CIO. I have a lot of history here at the hospital, and that has really helped me create a passion for what the organization is trying to do with limited resources, and with the challenges we’ve had for a long time.

When I took the role of CIO, the organization was lagging with basic maintenance and avoiding necessary upgrades of applications and infrastructure because of the perception of the financial implications and the interruption of services. I also think our approach to asset management and security patches was rudimentary. And so we made some immediate budget-neutral decisions regarding monthly patching and rebooting.

We also couldn’t afford the staff ratios that larger organizations have. So we made strategic decisions to move folks into positions where their skills would be better leveraged. That was one of the keys to enhancing our services very quickly and developing a scope of services and a catalog — basic things to help clarify expectations with not only new executive management, but also other departments, so they could understand that we intend to grow and improve. But we need some time to get there. That was key in helping people understand that technology was trying to be a part of the solution and advance them to a different stage in this new, patient-driven environment we’re trying to create.

I’ve been fortunate to have a very diverse mix of directors and managers on my leadership team. Some of them had worked at complex, large organizations and recently migrated to us. I also have nurses and other clinical staff who worked in our organization for many years and really understand the end-user frustration. That balance of having both of types of experiences on our team was really key for us to all sit together and gain a proper understanding of how the current technology at St. John’s was working, how those tools would or wouldn’t affect the clinical workflows, and what to insource versus outsource.

We spent a lot of time sitting down together and talking to understand each of our perspectives. I believe that if we had tried to address all of the liabilities, deficiencies, and everything that was wrong at one time, it would have undermined our whole effort.

And so, a little more than a year ago, we started to address what we needed to do at the organization. We realized we needed to change the mindset of our team — both IT leadership and the staff. We have staff that have been here for almost 30 years. Sitting down and changing their mindset, educating our leadership team, and then making the financial investments — that was how we got on this road to change.

 

Gamble:  With something like that which is really a long-term vision, were you looking for quick wins? What did you focus on first?

Thomas:  Coming from a clinical background, one of the biggest things for me was recognizing that IT needed to adopt a different mindset than what it has traditionally been. We even changed our name from ‘information technology’ to ‘information technology and services.’ It may seem like a small thing, but it was important to emphasize that it’s not just about giving you tools — it’s showing you how the tools work, and that we do provide a service.

For us, it was about changing our team’s mindset. They were used to me being the CMIO or physician informaticist; but now being the lead of the entire IT team, they had to put a lot of trust in me. My formal background is not in information technology, but I needed to help us get on the same page so we could consistently engage ourselves as a team — as a leadership team — in workflow mapping and in collaboration with operational teams like nursing, medical staff, the residents through graduate medical education, HR, and the learning development team, even in the planning stages of ‘backend technology.’ That’s not something they’re used to. They didn’t ever have to worry about people’s opinion about storage or backups or networking because they normally wouldn’t be engaging those teams, but we made it a point to educate and engage. And sometimes it was an uphill battle, because they just want to walk into the hospital and see things run, but we knew that if we wanted to really get people on board with our strategy, we needed to spend some time helping them to understand why the backend and frontend is so important in making a lot of the new strategic decisions.

So, after our teams got that ‘full picture,’ we then made decisions around which applications to update. We made decisions around updating our storage, our network, our backup systems, and we made decisions to leverage cloud technology. We were looking at it from the perspective that not every hospital — not even every community hospital in our payer mix — can do the exact same things. We needed to see where our operational leaders are the strongest, and where can we make quick wins with certain departments.

Another thing we brought up was educating the leadership team. In this post-EHR implementation era with pay-for-performance and value-based care initiatives, there’s this intense demand — especially for the new leadership team that came in about three years ago — for hospitals to harness data and to help them have insights into population health and quality. I think most leadership teams get fascinated or fixated on certain tools and technologies that are being implemented today in other hospitals and other organizations. And so we were very aware that executive management may jump to a solution before they’ve even defined the problems they were trying to solve.

One of my roles as CIO is to help executive leadership shape the vision of what they wanted to see in technology, let them consider what problems they were looking to address, and then point them to the right technical solution. We kept saying, ‘start with workflow.’ I think they may have gotten annoyed with it, but that was our mantra. Start with what workflow you’re looking to change and what outcomes you’re looking for, rather than starting with what technology is available. We had to establish that right in the beginning, because people will come in and say, ‘the vendor says the technology is going to do this.’ I’d say, ‘but what are you trying to do? Do you have the operational lines to even support what that outcome is supposed to do first?’ Because you’re going to purchase a piece of technology that’s going to sit on the shelf. And I guarantee you that in three years, you’re going to say ‘why wasn’t this deployed?’ That was really a big one.

We also needed to assist our management around choosing that data and analytics infrastructure. We needed it to be tightly aligned with the objectives of their strategic plan when we made decisions like moving our data to the cloud for enhanced security. We wanted to educate them about privacy management and computing tools that were available in that environment, but also basic things like, maybe this is not the right time to do this because we’re not trying to be a larger organization. We’re making smaller decisions — maybe this infrastructure is better for the one- to two-year frame, and then three or four years from now, we can leverage some of the bigger solutions to improve our medical outcomes with different tools.

It was important for them to understand what we can invest in. And ultimately, after those steps — getting our team to change their mindset, changing the operational leader mindset, and then educating our executive team mindset — we then made those decisions. And we were able to get buy-in from executive management and our board, because they understood where we were coming from, and that we were on the same page. After that, we focused on upgrading our network and telephony, infrastructure, storage and compute investments for business continuity and disaster recovery objectives.

We’re currently engaged with a vendor to stand up a software-defined data center in upstate New York, and also here at our primary site for better uptime and security, and to take advantage of some of the mobile technology we need to invest in. Ultimately, that’s what people see. They’ll say, ‘wow, you got the organization to invest money that they never did in the past 10 to 15 years.’ But that’s a result of all the other things I talked about, because if we had started by saying, ‘our infrastructure is 10 to 15 years old and you guys haven’t been doing this,’ I don’t think they would have invested if they would have understood all of that ahead of time.

I think that’s where being a clinician ultimately helped. I had to first understand it from my team’s perspective to say, ‘why do we need to upgrade our network and telephony infrastructure? Why do we need to make storage and compute investments right now? Why do we need to worry about backups — why can’t we just update to the next application?’ That was a learning curve for me to understand that we can’t just jump to a new application because it has all the bells and whistles, because our backend is sorely lacking. You’re not going to see any actual improvement in connectivity. It’s not going to move any faster because you’ve really lacked the investment in the backend. As I started to understand it, I started to educate my management team. Those are the few steps I took, and it was really important in getting those investments by the board and by our executive management.

Chapter 2