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.
- Leadership representation from clinical & IT
- IT’s role in disaster recovery
- Understanding clinician frustrations: “I was wary of the expensive, shiny technology.”
- “Owning” the business case behind IT initiatives
- Rounding with clinicians – “That’s where the breakthrough happens.”
- Long-term vs. static strategic plans
- Changing the culture
- “Moving to a more technologically advanced future is going to take time.”
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We’re in an area that can be impacted by extreme inclement weather — how do we make the best decisions to quickly move those workloads, to have a more robust virtual desktop environment, and to have the ability to cut costs and provide a more mobile workforce? That’s something we talk about a lot, but how do we get there?
I was generally wary of all the expensive, shiny technology that I would see being promoted by administration or IT to solve a problem that my colleagues and I didn’t think existed. We would get so frustrated and wonder, ‘Why don’t they just fix the things that are wrong with what we already have and stop adding this complexity to our day and to our workflow?’
You can do all the workflow mapping in the world and still miss something, and so it’s important to be connected and to realize that they have jobs. They’re taking care of patients. They’re stressed out. Their goal isn’t to reach out to you when the technology is failing — you have to do that. You need to go to them and see what they’re experiencing
We have such a diverse group of people at our organization, with some that aren’t very familiar with technology with people who are fantastic with technology. And so, moving all of us as a group to a more technologically advanced future is going to take time.
Gamble: It seems like a really important part of gaining buy-in is setting and managing realistic expectations, which can’t be easy.
Thomas: It’s not. I don’t know if I’m there yet, but after a year, I can say that we’re better off than we were. It’s a team effort, and I think having a diverse team is really key. I’ve leaned on my leadership team because they have such different experiences. They’re like a microcosm of the expectations of leadership and the operational leads because they come from such different perspectives.
I think going through all of the objections people might have is really helpful, along with having clinical people on your IT leadership team and good technical folks who really understand technology at a really deep level. By using this approach, when we meet with leadership, we can really understand where they’re coming from.
Gamble: In terms of the EHR, you have Meditech in the hospital?
Thomas: We do. And in our outpatient practices and our clinics, we have athenahealth, which was implemented in May of 2017.
Gamble: What version of Meditech are you using?
Thomas: We are on 6.08.
Gamble: You talked about some of the work being done with data and storage; in an area like that, I imagine it really helps having people on the team who have pretty deep knowledge. Is that something you’ve relied on?
Thomas: Absolutely. I think one of the keys to being a good leader is admitting what you don’t know, and knowing where you need help. That’s something I’ve been very open and honest about. I cut my teeth in a clinical environment, and even when I got into the IT department, I was more focused on the application side, as most CMIOs are, because they focus their energy on Meaningful Use and everything relating to the EMR. When you’re a CMIO, you get to know the applications team very well, but you don’t really get that much exposure to operations or security or network issues.
My biggest learning curve as a CIO was to surround myself with people who were passionate about operations, about the network, about design, and about the organization’s mission. And so we made the choice to bring people here from larger organizations who had the perspective of what can happen, but then also understood the limitations of being in a small community hospital with limited financial resources. It’s being able to ask, ‘What are the decisions we can make in year 1, year 2, year 3, and year 4?’ And help us to break that out. So they were key in explaining things like, ‘if we invest in this first, we can do this in year 3,’ and helping me to understand that and communicate it to executive management.
There are so many benefits in doing it that way and helping leadership understand that, by moving to a different design of how we think the organization should have its backend with the defined data center, we’re able to quickly move workloads when required — for example, if the hospital is impacted by extreme weather. That’s very important to us. When we were hit by Hurricane Sandy in 2012, we had to move patients out. At that time, we weren’t fully live on our EHR. We were live on the administrative portion, but we weren’t live with physician documentation or computerized physician order entry. If we had been, considering where our infrastructure was at that point, we would’ve been completely unable to do anything. The fact that we were on paper saved us.
And so that’s something that’s always been a part of our thought process. We’re in an area that can be impacted by extreme inclement weather — how do we make the best decisions to quickly move those workloads, to have a more robust virtual desktop environment, and to have the ability to cut costs and provide a more mobile workforce? That’s something we talk about a lot, but how do we get there? You don’t just hand out a bunch of iPads and iPhones to everyone and say, ‘go use these’ without understanding the security risks and the need for a secure infrastructure. Those individuals were instrumental in helping me understand the steps we needed to take with mobile device management to secure access and enable multifactor authentication. They helped me to understand what we can do in year 1, and what we can do in year 3. It was key to surround myself with people who really get it and are passionate.
Gamble: When it comes to workflow and usability, I’m sure you’re able to draw from your experience on the clinical side.
Thomas: I am, and I have two great nurses on my team who I actually worked with in clinical practice when I was a resident here. It’s interesting how things evolve, and how we all became interested in informatics and IT. As a physician, and eventually the CMIO, I was generally wary of all the expensive, shiny technology that I would see being promoted by administration or IT to solve a problem that my colleagues and I didn’t think existed. We would get so frustrated and wonder, ‘Why don’t they just fix the things that are wrong with what we already have and stop adding this complexity to our day and to our workflow?’ It just made things worse. There was a collective groan among the medical staff and residents that occurred every time a new piece of technology that was introduced. And that’s what really propelled my interest in informatics and helped me start thinking about how to address this huge gap in creating technology that positively affects day-to-day workflow without augmenting the patient experience? Thinking like that allowed me to develop critical thinking with my team around how the IT department should challenge every piece of technology — every purchase of technology — as to whether it’s going to really advance strategic priorities.
And so we’ve created tools to address that. I’m sure many organizations have these tools, but we weren’t doing it here. We didn’t have a good RFP process. We weren’t doing vendor evaluation forms, or forcing people to talk to us about the business case, or doing post monitoring as to whether the technology actually did what we said it was going to do. We own that now. We started a committee to own the business case of that product and determine whether post-monitoring was actually giving us the return on investment that everybody thought it was going to give.
As a physician, I believe the experience of critically thinking and asking, ‘does this really matter to the person who’s using the product?’ has been constructive to our team. The nurses on our team have also been adding to that. The IT folks we have on our leadership team, our Director and Manager of Operations and our Director of Security really haven’t worked in that capacity with clinical leaders at the IT leadership level. They tell us how helpful it is to hear those clinical critics and be able to come back and say, ‘what about this? Why don’t we do it this way?’ I think that’s the most impactful way in which my experience has helped this department.
Gamble: It’s an issue that comes up a lot when we speak with CIOs — the need to understand what clinicians need from IT systems. So you would say communication is key in helping to bridge that gap.
Thomas: Absolutely. In terms of my own role, I don’t know many CIOs who wear the dual hat of CMIO. It’s very difficult, and I’d be lying if I said, ‘Yes, I can do both and do a great job.’ I believe there is a separate role for a CMIO, because of the amount of time and the conversations required to really understand the evolving challenges that physicians have in our current healthcare landscape. It takes time to listen to people and understand them and really look at their workflow.
Most clinicians have trouble articulating their challenges because there’s so much technology and so many things happening — they know things aren’t working, but they aren’t sure how to communicate that. Sometimes just getting on the phone with them and hearing them talk isn’t enough. Standing with them and watching them go through the screen and looking at the way they use the mobile technology we think is so fantastic — that’s really where the breakthrough happens, because you can see that the technology isn’t working the way it should be. It takes time and energy and investment, and sometimes as a CIO, your priorities are slightly different.
I’m definitely happy that I have a clinical background, but I recognize that the role of being engaged with physicians and hearing them out — that takes a lot of time and a lot of investment. I know that because I have those connections, and I happened to work in the same hospital where I worked as a resident. I have those relationships, and so thankfully, physicians will call me. They’ll let me know what’s happening because they know who I am.
Gamble: Right. Before something is implemented, you don’t know how it’s going to affect users.
Thomas: Absolutely. You can do all the workflow mapping in the world and still miss something, and so it’s important to be connected and to realize that they have jobs. They’re taking care of patients. They’re stressed out. Their goal isn’t to reach out to you when the technology is failing — you have to do that. You need to go to them and see what they’re experiencing, rather than having expectations that they’re going to be vocal in telling you. I think it’s really important for us to be out there and to hear from them.
Gamble: Going back to the long-term strategy you touched on earlier, is there a 5 or 10-year plan, or is it more static?
Thomas: It’s funny. When I first started, maybe a naïve part of me thought, ‘We can get this done in a year, right?’ Then I realized that wasn’t going to happen. And it comes down to culture change, and understanding how long it takes to change the culture — not just of the IT organization, but the organization as a whole. We have such a diverse group of people at our organization, with some that aren’t very familiar with technology with people who are fantastic with technology. And so, moving all of us as a group to a more technologically advanced future is going to take time. You can’t leave people behind because it isn’t working.
We did have a one-year strategic plan that we presented. We said, ‘here are the initiatives we’d like to accomplish this year.’ A lot of it was around the services we provide — making sure the helpdesk was responsive and doing the things a great helpdesk does with service-level agreements and making sure people understood that. We also focused on regulatory projects. That’s what drove the first-year strategic plan. We wanted to get the nurse communication system and the new EKG systems up, and we wanted to update our OB environment and give them a more updated application. To that end, we had some strategic goals with our infrastructure, and we’re in the middle of that now.
We have some plans for year 2 and year 3, but we’ve learned that we need to reassess, because the healthcare landscape — especially in terms of community hospitals and how they’re funded — is changing so rapidly. Sometimes even planning for three years isn’t adequate; you need to plan almost year by year and talk about what we can afford now. And when you look at what you decided to do a year ago, is it still relevant? That’s where we are.
I think we successfully implemented and embarked on the year 1 priorities and we’re closing on them. With year 2 and year 3, we’re renegotiating with leadership and saying, ‘these are our priorities based on the strategic plan, but are these still those things you wanted to accomplish?’
Gamble: It seems like it’s necessary to do it that way. Well, I think that about covers what I wanted to talk about. Thanks so much for your time, and I’d like to catch up with you down the road.
Thomas: Thank you very much, Kate. I really appreciate it.