As the industry grows at a rapid pace, the demand for IT talent is increasing, creating a competitive market in which CIOs are scrambling to recruit top staff members — and prevent them from being poached. But in Nashville, Tenn., one of the many markets affected by the shortage, a group of leaders came up with a different solution: a multifaceted program focused on identifying untapped resources and working with universities to develop HIT curricula and create internships. In this interview, Mark Gilliam talks about the framework being developed by Tennessee HIMSS Workforce Initiative to help enhance the IT talent pool. He also discusses Ardent’s unique operating model, the massive effort to standardize IT, and how he leverages his past experience as both a consultant and small business owner.
- Ardent’s unique operating model
- “We have a piece of every part of the health care continuum.”
- Standardizing IT with McKesson clinicals and Lawson financials
- Racking up frequent flyer miles
- Offering access to non-employed docs, but not a hosted EMR
- “We haven’t determined there’s a driving need in the markets we serve.”
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We try to emphasize getting out of the office and get in the field. I spend a lot of time interacting with our business unit leaders and monitoring what’s going on and visiting with their staff in the office; but we do rack up the frequent flyer miles quite a bit.
Our goal is to try to create as much standardization and consistency as possible where it makes sense. Most of our core strategic platforms are standard. Our general financial system is one of the first things we installed, and it’s consistent across the organization.
When you get out into the imaging area and PACS we’re not as standard, because there are varying flavors of those and we just integrate those in. But when it comes time for an upgrade or replacement, we look to try to get efficiencies and economies by using what we already have.
We have a pretty large non-employed physician network and at this time, we’ve investigated it, we’ve looked at it, and we’ve talked about it. And while we offer some capability for them to access, we have not gotten into offering a hosted EMR capability at this time.
It really comes back to what’s your market situation and the ownership that comes there. If they’re clamoring for it and we believe we can provide that to help address a need, we would look at it, but we just haven’t determined that there’s a driving need in the markets we serve right now for that.
Gamble: Hi Mark, thanks so much for taking the time to speak with me today. I appreciate it.
Gilliam: You’re very welcome. It’s good to have you.
Gamble: Why don’t you start by telling the readers and listeners a little bit about Ardent Health Services? It’s a unique operating model that you have.
Gilliam: I think it can be unique, while it’s fairly typical probably here in the Nashville, Tennessee area. We’re a corporation based here in Nashville. The interesting thing is we don’t operate or own any organizations in Tennessee. Most of our operations, hospitals, and physicians are out in the West. We have today 11 hospitals that are part of our organization in Oklahoma and New Mexico. So we operate and manage hospitals and other health care organizations. We also have around 210,000 member health plan in the state of New Mexico.
With our latest acquisition, we have a multispecialty physician group in New Mexico with about 40 providers. And then in Oklahoma, we have a number of hospitals and we have two multispecialty physician practices with around 200 clinicians. We also have a retail pharmacy that we operate, a rehab hospital, and we just announced a pending acquisition to close on another operating system in Amarillo, Texas at the first of this year, which will bring us another hospital and multiple physician practices, a cancer center, and other types of surgical organizations. So we’re very diverse in that we seem to have a piece of every part of the health care continuum that we own and operate.
Gamble: In terms of your history, have you been onboard at Ardent since the different health systems were acquired?
Gilliam: As we exist today, I have. I joined Ardent in early 2002, so I’m in my 11th year with the organization. At that time, Ardent was primarily a behavioral hospital organization. The predecessor was known as Behavioral Healthcare, and in 2000 the organization’s name was changed to Ardent Health Services with the focus of really venturing into the medical-surgical side of the business. We had acquired two independent facilities at that time — one in Baton Rouge and one in Lexington, Ky.
In late 2002, we acquired the Lovelace Health System in Albuquerque, and then followed that up in 2004 with the acquisition of the Hillcrest Health System in Tulsa, Okla. Concurrently in 2004, or early 2005, we divested our behavioral operations too. At that time it was Psychiatric Solutions. So we’ve gone through a number of gyrations of growth and divestiture to get to where we stand today.
Gamble: In terms of the leadership structure, how does that work? Do these hospitals or health systems have separate CIOs who report up to you?
Gilliam: We’ve centralized most of the IT organization from a management and a strategy point of view. Most of the IT leadership and executive management are based here in the corporate office. Our primary physician presence to support our employed physicians is based out of Oklahoma and reports in to me, and then our health plan side, I have a CIO that reports to me, but they’re positioned out there. For the rest of the hospital and the business units, while we have division IT resources on the ground to provide support and assist with some project work, the majority of the strategy and support runs out of Nashville. This is where our Enterprise Data Center is. It’s where our customer support function is, and most of our strategic projects are run out of here.
Gamble: That makes sense. Do you still have to do a good bit of traveling?
Gilliam: I do travel. I think it’s important. We try to emphasize getting out of the office and get in the field. I spend a lot of time interacting with our business unit leaders and monitoring what’s going on and visiting with their staff in the office; but we do rack up the frequent flyer miles quite a bit.
Gamble: I bet. It’s not like you’re not getting into the car driving an hour.
Gilliam: No, there’s nothing you can get to in less than five hours. It makes for a familiarity with various airports around the United States.
Gamble: Sure. Okay, let’s talk a little bit about the clinical application environment at Lovelace and Hillcrest. Is it different from when Ardent acquired them?
Gilliam: It is, in some aspects, a little bit more different in one division, and in the other it’s drastically different. When we acquired Lovelace, that was actually accomplished in two different acquisitions. We purchased St. Joseph’s Health System, and then followed it up with the acquisition of Lovelace. There were two health systems in the city of Albuquerque and the surrounding areas, and we merged them into one. Both of them ironically were running a very antiquated, old IDX system prior to GE purchasing them — two different versions, two different instances, because they were two different systems.
When we purchased Hillcrest, they were running the McKesson product, and it was an older version. They had not kept it up to date and actually had customized it a little bit. Our strategy has always been to try to standardize and create consistency with what we run, so we selected McKesson to be our standard platform. Over the last eight years, we’ve gone through a number of iterations, from bringing the Hillcrest division more current and optimizing what they’ve had, to creating a standard core system, which is a revenue cycle-based clinical and ancillary solution that’s somewhat standard across both of our divisions. And then we added that to our latest project we just completed earlier this year, which was implementing all the advanced clinical capabilities across all of those organizations to achieve Meaningful Use. The Hillcrest division was primarily McKesson, but the flavor of McKesson and the features and capabilities they have are much more advanced and different than when we acquired them. And in Albuquerque, it’s a completely different platform now.
Gamble: I would think that in having a pretty large health system or corporation, you can’t really go best-of-breed and you can’t have disparate systems. Like you said, you have to standardize.
Gilliam: We try to look at that appropriately. Our goal is to try to create as much standardization and consistency as possible where it makes sense. Most of our core strategic platforms are standard. Our general financial system is one of the first things we installed, and it’s consistent across the organization. We run Lawson. We have a centralized business office function so most of our patient accounting and revenue cycle applications are next, and then as you start to move out into the perimeter a little bit, the base capabilities — the nursing documentation, the order management, and the CPOE and all those capabilities, we try to make consistent. When you get out into the imaging area and PACS we’re not as standard, because there are varying flavors of those and we just integrate those in. But when it comes time for an upgrade or replacement, we look to try to get efficiencies and economies by using what we already have.
Gamble: What about on the ambulatory side?
Gilliam: On the ambulatory side, we’ve got two flavors. We’re primarily on the patient management side using GE Flowcast — I still call it IDX Flowcast. And then on the EMR, we’re primarily NextGen. In our cardiology group, we use GEMMS. It has a little more specialization around cardiology needs of their service line, but the 90 percent of our employed physicians are NextGen, and that’s kind of our stated standard there.
Gamble: Are there physicians who aren’t employed by the system that refer into the hospitals?
Gilliam: There are. We’ve got a pretty diverse provider network if you look between our credentialed physicians and non-employed credentialed physicians in both divisions, as well as when you get into New Mexico with our health plan out there. Their provider network numbers well over 100,000 across the state, and if they’re in the location of our hospitals, of course, they provide. But we have a pretty large non-employed physician network and at this time, we’ve investigated it, we’ve looked at it, and we’ve talked about it. And while we offer some capability for them to access, we have not gotten into offering a hosted EMR capability at this time.
Gamble: Is that something you think you’ll plan to do? That’s a huge undertaking.
Gilliam: It is. We’ve looked at it, actually, off and on for the last three years, and it really comes back to what’s your market situation and the ownership that comes there. If they’re clamoring for it and we believe we can provide that to help address a need, we would look at it, but we just haven’t determined that there’s a driving need in the markets we serve right now for that.