Scott Mash, CIO, O’Bleness Health System, Chapter 1

It’s not the easiest situation to walk into, knowing you’re the third CIO who’s been charged with leading a transformation from paper to electronic. But Scott Mash was up to the task, and in just over a year, O’Bleness went from lacking a wireless network to going live on Paragon. And as the challenges continue — the organization enters into a membership agreement with Ohio Health, which most likely means making the switch to Epic down the road — Mash is poised to lead his team. In this interview, he talks about the advantages of merging with a large system and why he’s not stressing about making another major change in a few years. He also discusses the CIO’s role as road block remover, what he’s doing to lay the foundation to do “real IT work,” and why he hates cell phones.

Chapter 1

• About O’Bleness
• Merging with Ohio Health
• Implementing McKesson Paragon, but eyeing Epic down the road
• Accelerated tracks for MU 1&2
• Third CIO to lead the EHR initiative — “I was looking for a challenge.”
• Leaning on vendors
• Playing catchup — “We didn’t have a wireless network.”

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Bold Statements

Some of the previous leadership didn’t invest heavily enough in the infrastructure prior to making the decision to implement the McKesson Paragon EHR, so we’re building our infrastructure as we’re implementing the product.

That’s part of the challenge once you implement a system — trying to implement improvements or identify areas for business process reevaluation while you’re also trying to keep up with all of the regulatory updates.

I knew in looking at the position and talking with the senior leadership that there was just a really good energy. So I really didn’t have any reservations.

Anytime you inject $27 billion dollars into a $2 billion dollar business sector, it’s going to be disruptive. And that’s what Meaningful Use really did. Any consulting group that specialized in healthcare just hired anybody and everybody.

There’s never a question what you’re going to do every day. It’s just going to be how much can you get done in a day’s time.

Gamble:  Hi Scott, thanks so much for joining us today.

Mash:  Thank you.

Gamble:  Why don’t you give us a little bit of background information about your organization to start us off?

Mash:  I’m the CIO with O’Bleness Health System. We’re a regional network of healthcare providers and a one-hospital system located in Athens, Ohio. O’Bleness is about 90 years old. There’s some competition with some other organizations in our area, and we’ve just recently announced that we’re becoming a member of the Ohio Health Organization.

Gamble:  Where in the state are you located?

Mash:  We’re in the southeast corner of the state in Athens, Ohio, which is the home of the Ohio University Bobcats.

Gamble:  Nice. So you have the one hospital. How many beds?

Mash:  We’re staffed for about a hundred beds. Within our system we have an ambulatory practice, which is Athens Medical Associates. We have a lab, we have some home health — we pretty much run across the healthcare spectrum.

Gamble:  Okay. And you just had the announcement you were being acquired by Ohio Health. The ink is just drying on that, right?

Mash:  Actually, a week ago our board voted to move forward with the membership with Ohio Health, which had been approved by the Ohio Health Board a month before. As far as when that merger is going to take place, there’s a 60-day waiting period, so it will be sometime in late January or early February.  I don’t see it happening until they close the books on January.

Gamble:  And that’s obviously a pretty large sized system.

Mash:  Ohio Health is actually the second largest employer in the state, behind only OSU. I believe they have 24,000 employees. They’ve got something like 15 major systems within the organization.

Gamble:  It’s certainly going to mean some changes but I guess right now it’s hard to tell how everything’s going to pan out.

Mash:  Yeah, there’s going to be a lot of work to merge the systems over time. From a technology standpoint, Ohio Health has a very large project — they’re moving all of their sites towards Epic. Here locally at O’Bleness, we’re in the process of implementing McKesson Paragon. Long term, probably within two to three years, we’ll probably migrate over to the Epic platform along with the other Ohio Health sites.

Gamble:  That’s always fun. You said that you are implementing Paragon. What phase are you in?

Mash:  Our go-live is set for January 28 for the McKesson Paragon product. We’ve foregone the first year of the Meaningful Use incentives; we’re a little bit behind some of the other organizations. But with our go-live in January, we’re going to roll right into a 90-day reporting period to get our Meaningful Use Stage 1 funds. Shortly after we go live, we’re rolling into our Meaningful Use Stage 2 project as well.

Gamble:  You have to go fast-track at this point.

Mash:  We do. I’ve been with the organization for about a year. I was the third CIO to have the project. The project was about five months old when I came here. We’ve had a lot of turnover in the organization, and so it’s been a real struggle to keep the project on track. Another challenge we had is that some of the previous leadership didn’t invest heavily enough in the infrastructure prior to making the decision to implement the McKesson Paragon EHR, so we’re building our infrastructure as we’re implementing the product. So it’s been a real challenge for us.

Gamble:  What system was in place previously?

Mash:  We were running Affinity by QuadraMed — that was our EHR. We were using SoftLab for our lab system. We had the Picom PACS system. Along with implementing Paragon, we’re also implementing McKesson HPS, McKesson HLAB, Riverside Radiology, and the McKesson Paragon RIS as well. We’re doing a major switch-out of all of our technology. Though we had Affinity QuadraMed, we were very heavily paper based up on the floors. We’re ripping everything out, installing everything new, and we’ll go from a paperless to an electronic system overnight.

Gamble:  So obviously you knew going in that you were walking into a pretty significant undertaking.

Mash:  Yes, I did. I was looking for a challenge, and I found it here. The great thing is that this organization is ready for the change, from our senior leadership down. They want to do away with the old paradigm and go to an electronic fully integrated system, because right now we’re tracking down papers and making sure that your orders get to where they need to be and relying on faxing. Folks are just tired of that. They’ve had experience going to other organizations, even some of our more local competition, and seeing where a fully integrated system can take you, and there’s a desire for that.

We’ve got a lot of support throughout the organization. The doctors are on board. While it’s a huge challenge to do both your infrastructure and a major upgrade, I just can’t say enough about the support we’re getting throughout the organization, including our board.

Gamble:  It sounds like everyone is kind of on board and saying, ‘Okay, we’re going to do this right this time.’

Mash:  Absolutely. We’re coaching folks as we go along that we want to do the best we can, but the product we deliver is not the final product. We can always make improvements. There’s always going to be an upgrade. That’s part of the challenge once you implement a system — trying to implement improvements or identify areas for business process reevaluation while you’re also trying to keep up with all of the regulatory updates that you’ve got to do in the system. For a small health system — a small independent health system, especially — it is a huge financial burden just to implement and keep up with all of the regulatory changes and all the requirements coming out. To me, it’s very difficult. It takes a huge investment.

Gamble:  From your perspective, did you have reservations about going into this situation? Like you said, there had been some turnover and different CIOs who had the role. I know you said you wanted the challenge, but was it something where you said, ‘Okay, am I sure I want to get into this?’

Mash:  You always have second thoughts once you get into it, but really, I didn’t have any reservations. I had some previous experience in healthcare for about six years with another organization. It was a heavily integrated group using best-of-breed applications, with some McKesson Paragon experience as well. I knew in looking at the position and talking with the senior leadership that there was just a really good energy. So I really didn’t have any reservations.

Now that’s not to say the position doesn’t come with challenges. Athens being a small market, when you have turnover, it’s really hard. It’s almost impossible to find somebody that has health IT experience. It’s difficult enough just to find somebody with straight IT experience who’s not already employed at Ohio high university or another organization. It’s just very hard to recruit.

Gamble:  I can imagine. Unfortunately it’s a theme that we’re hearing in all kinds of different areas in the country right now.

Mash:  That’s the fault of Meaningful Use. Anytime you inject $27 billion dollars into a $2 billion dollar business sector, it’s going to be disruptive. And that’s what Meaningful Use really did. Any consulting group that specialized in healthcare just hired anybody and everybody, so when those Meaningful Use dollars run out and everybody slows down on their implementations, in my opinion, there will be a flood of healthcare IT workers. But right now it’s just such a competitive market, which is made even more complex when you’re in a rural part of the state.

Gamble:  You talked a little bit about the size of the organization. What about the IT department — approximately what size group do you have?

Mash:  We’ve got 12 FTE in the department. Three of them are dedicated to just desktop support and helpdesk functions. We’ve got three focused on infrastructure, and the rest are our application analysts focused on just keeping up with the applications and making improvements, doing the necessary builds and upgrades and what not. So we have 12 FTE, including myself, and we’re supporting 700 end users.

Gamble:  That’s a lot for 12 people.

Mash:  It really is. We are stretched very, very thin, and that makes our vendor relationships that much more important, because we have to stay in tune with coming upgrades to our applications or coming expansions. That way, we can make sure that we have a very detailed project schedule. We do rely a lot on supplemental resources from a variety of consultants and we lean heavily on our vendors as well. But it can be a challenge at times, especially with this Paragon implementation — we know when we go live, it’s going to be two weeks of very little sleep.

Gamble:  Are you going to bring some cots into the office?

Mash:  With IT people, you give them a little bit of sugary treats and some coffee and you have an air mattress somewhere and they’re good to go.

Gamble:  Tight. So your go-live is in January. As far as everything that needs to happen from here to there, I imagine that even in the preparation that you’re looking at some pretty long days and just having to be stretched pretty thin.

Mash:  We’ve had to supplement with some temporary resources, especially in our desktop area, because we’re going from a paper shop to an electronic system. In preparation for this upgrade, in the time I’ve been here, we’ve added about a hundred end-user devices. We’ve purchased and rolled out work stations on wheels for a lot of our medical areas. We’ve had to install a wireless network. We didn’t have a wireless network. We didn’t have network drops in all of our rooms. We’ve installed 200 network drops. There’s never a question what you’re going to do every day. It’s just going to be how much can you get done in a day’s time.

Gamble:  You’ve really had your work cut out for you the last year.

Mash:  Yeah.

Chapter 2