Jake Dorst, CIO, Meritus Health, Chapter 3

When Jake Dorst started as CIO at Meritus Health in late 2011, he came in with a pocketful of ideas. But he was soon hit with a reality check — a three-year wait for the Meditech upgrade that would hinder the process of attesting to stage 2. That simply wouldn’t do, so he and his team implemented a system that would help integrate ED and inpatient records. In this interview, Dorst talks about his ACO plans, his mobile device strategy, his motto when it comes to vendor management, and why job descriptions are never set in stone. He also discusses hiring a PR pro to help physicians ease into the electronic world, how he hopes completing his MBA will make him a better CIO, and how Meritus has benefited from employing a professional negotiator.

Chapter 1

Chapter 2

Chapter 3

• Learning from the past
• Forced innovation — “We cobbled together products that are now being sold as one”
• Trust but verify
• “I’m in the right spot at the right time.”
• Pursuing an MBA
• Building a CIO network

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Bold Statements

We put a lot of innovative things in at Southside. We had a pretty ingenious way that we kind of cobbled together a couple of products which are now being sold as one.

We had weekly meetings about the progress of it, but a lot of it, as a CIO, is to trust what they’re saying, but actually dig into the system and make sure what they’re saying is really happening.

Part of it was hard work in getting it fixed, and part was putting a very good face and public relations piece on it. By the end of it, I saw physicians giving Connie a hug in the hall, so it was a win, and I credit her completely with that turnaround.

Wal-Mart can find a bag of Lay’s Potato Chips in Beijing, China down to the shelf, and we’ll lose a patient coming out of the ICU going to med-surg for an hour. Where’s the disconnect there?

I think most CIOs are getting into that situation now where as they come to the senior leadership table, they want to be prepared for that business talk that they’ve missed out on.

Gamble:  How long were you at Southside Regional?

Dorst:  About six years.

Gamble:  While you were there, were there pretty drastic changes as far as the clinical application environment? I imagine during that timeframe there probably were many changes.

Dorst:  Yeah, we put in McKesson Horizon Electronic Medical Record in a very short timeframe. We actually built the hospital without the capacity to have paper records, so we were forced to get that running before we left. That was a difficult situation. It took a while to recover from that, but we came back strong. At the end of it, the doctors actually really liked the product, and they liked being able to sign off electronically on their records from their house.

The precursor to PatientTouch was a product called IntelliDot. We put that in five years ago. So that was pretty cutting edge at the time as far as bar code drug medication administration is concerned. We put a lot of innovative things in at Southside. We had a pretty ingenious way that we kind of cobbled together a couple of products which are now being sold as one. We had Ascom phones and Ascom bought GE/Dukane, which was the nurse call system. So we had all those products in there working together — now you can buy them as one product now that Ascom took it over. The nurse call set-up we had there was really cool and innovative for the time that we put it in.

Gamble:  How much time did it take to implement the McKesson EMR?

Dorst:  Eight months.

Gamble:  Okay, so you went from paper in eight months. Wow. As CIO, I’m sure there were a lot of things you learned from doing something like that, especially in a short timeframe. Anything that really stuck with you as far as what you learned from that experience?

Dorst:  Yes — trust but verify. I was in the middle of building the hospital, so I had just about every department figuring out where their PCs and phones and networking closets were and making sure all the fiber was delivered on time and tested and toned and that we had electricity and cooling and everything else in the building, while the whole McKesson conversion was happening. Then when we opened the doors, we noticed that with the census physician’s list, if you came in through the ED — which is obviously the majority of patients — you didn’t get on the list. We probably should have noticed that before we opened up the doors, but of course we had a lot of McKesson consultants in the mix there. We had weekly meetings about the progress of it, but a lot of it, as CIO, is to trust what they’re saying, but actually dig into the system and make sure what they’re saying is really happening.

Gamble:  As far as leading that kind of change, was there a good amount of resistance in going from a paper environment to something that was very different?

Dorst:  Yes, there were at first, especially with the problems we had — I don’t want to call it a botched go-live, but there were definitely some issues with it. We spent about three months having biweekly conference calls with our McKesson vendors, our interface developers, the CFO and myself, and our HIM director. Every week we would go over the punch list. Once we got it down to where we thought it was back to where it should be in terms of true usability, I went out and hired a lady named Connie, who actually was working as an airline attendant at the time. She had a little bit of IT background but she was just the perfect personality for that; she’s very bubbly. You could tell she had a smile on her face every time she answers the phone; she’s super nice and would go out of her way to accommodate the physicians.

She actually would go to physician’s houses, help them log in to the VPN, sit with them for two hours at their house, and train them on how to use the EMR. She went to physician clinics and would sit there with the staff and help them log in and show them how to assign their patients and everything else. So part of it was hard work in getting it fixed, and part was putting a very good face and public relations piece on it. By the end of it, I saw physicians giving Connie a hug in the hall, so it was a win, and I credit her completely with that turnaround.

Gamble:  One of the key things in being a leader is finding good people to put in these positions. I’m sure that that was also a very important takeaway — just to make sure you have the right people in place.

Dorst:  Right. It’s a good lesson to not have very strict job descriptions or requirements.

Gamble:  Oh yeah, sure. I’m sure that she didn’t initially plan on doing two-hour house calls, but if that’s what it took, then that’s what it took.

Dorst:  Right, exactly.

Gamble:  Now Southside Regional was your first CIO position, correct?

Dorst:  That is correct. I was an IT director prior to that when was in a 200-bed hospital in Mississippi. CHS owned that hospital. It was my first entry. It was 1999, I think, down in Greenville, Miss. I worked as an IT director there before I moved to the corporate office in Nashville.

Gamble:  You picked a pretty interesting time to have your first CIO role. The last six, seven or eight years, we’ve seen just a huge amount of change.

Dorst:  Right. Are you familiar with Outliers, that book?

Gamble:  Yeah.

Dorst:  Ten thousand hours — the idea that you have to spend 10,000 hours to get good at anything. Unfortunately, I spent my 10,000 hours in healthcare IT, so I’m locked with it now. But I love it, it’s what I like to do, and I feel very lucky actually where it’s at right now with the focus on big data and population health and all the things that we’ve wanted to do for years but there may have been budgetary constraints.

Five years ago, the big spend was, what’s your latest MRI? How many slices is your CT? That’s where the money went. There’s been a paradigm shift now to, what system are you running? What’s your HIE? What’s your HIS? Those are the questions you’re hearing now, so it’s very good for us. I think the HIT industry is years behind the rest of the world, as far as business is concerned. Wal-Mart can find a bag of Lay’s Potato Chips in Beijing, China down to the shelf, and we’ll lose a patient coming out of the ICU going to med-surg for an hour. Where’s the disconnect there? I’m glad that I’m in the right spot at the right time here to really help make a difference and drive some of this new technology.

Gamble:  There’s certainly never a dull moment in health IT these days. With everything going on right now, a lot of the CIOs we speak to are doing different things to make sure they’re on top of their game and a lot of that is through continuing education. I read that you are currently pursuing your MBA and I just wanted to ask you what drove you to do that.

Dorst:  Actually, I completed it in December. It was just time to learn some more. I was going to more and more meetings where I didn’t understand what a financial statement was, or I was getting confused by what EBITDA meant, so I think it was time. I think most CIOs are getting into that situation now where as they come to the senior leadership table, they want to be prepared for that business talk that they’ve missed out on. I came up through the ranks of IT, and we were never really challenged with those types of situations financial-wise and in terms of strategy and business and understanding what marketing is and how the best way to sell your product.

I think it’s been very helpful for me. Like I said, HIMSS is always great. There are a lot of new products to learn about. I’m actually going to be on a panel Friday actually for Maryland and Virginia HIMSS and we’re going to be talking about the challenges that we’re facing and what big data means — does it mean anything, and cloud technology and those types of buzz words that you’re hearing around now. I like to stay abreast of what’s going on in the industry. I read HISTalk a lot. I’m sure everybody does in this industry. It’s very insightful and has a lot of new up and coming information.

Gamble:  And then as far as just reaching out to other CIOs, is that something you do pretty often?

Dorst:  Yeah, I’ve got a pretty good network just from working with people all across the country. I’ve tried to maintain those relationships. A friend of mine out in Texas is working with Vanguard Health and doing some pretty cool stuff out there with smart card technology. I was talking to him the other day; he actually won an award down at HIMSS, so I had to come back early so I wasn’t able to celebrate with him. They’re doing some pretty cool incentive programs to incent people to get their blood pressure taken and giving them reward points and things like that to spend in hospitals. There are some good ideas that are coming out. I reach out a lot to a lot of colleagues that I’ve met along the way.

Chapter 4