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.
- Getting practice by implementing Paragon
- M&A trends — “Independents are going to be a thing of the past.”
- Tapping into Ohio Health’s buying power
- Wearing multiple IT hats
- Positioning for innovation
- CliniSync HIE
- Ohio’s Paragon user group — “We bounce ideas off each other.”
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Making that jump in two years to Epic is going to be so much easier because they’ve been through a build process. They understand how an EHR functions, so they’ll be ready at that time. They’ll understand the impact on the workflows.
We’re tapping into their buying power for all of our supplies — both IT and non-IT related. We’re able to tap into their specialties so they can rotate specialists through our organizations.
Turnover just kills the small organization. I’m single-threaded in some areas, and losing one of those positions really hurts.
We have to get past this project so we can do real IT. Because to me, IT begins when you’ve got a system in place and you find ways to really innovate, to expand, and to gain efficiencies. We’re just not there yet.
I’m a firm believer in reaching out. There are times when you don’t want to be bleeding edge or leading edge — you just want to copy what somebody else has already done.
Gamble: You’re going to be going live on Paragon, and then, as you said, in the next couple of years, you’re going to be looking at Epic. I’m sure that that has to be tough, but I guess the focus just has to be, ‘let’s look at this next step — let’s focus on Paragon.’ Are you trying to convey the message of let’s not even worry about Epic right now?
Mash: That’s what we’ve told folks. We’ve also told them that this process is actually good for everybody. Making that jump in two years to Epic is going to be so much easier because they’ve been through a build process. They understand how an EHR functions, so they’ll be ready at that time. They’ll understand the impact on the workflows. The transition from Paragon to Epic is going to be nothing more than learning the new screens and the clicks — not how to integrate that into their current workflow. So it’s going to pay dividends.
Gamble: That’s true. There’s a huge difference between going from paper to electronic as opposed to going from electronic to electronic.
Mash: Right. There definitely is.
Gamble: Being a smaller organization, it makes sense wanting to have some kind of association or a merger with Ohio Health. Is that something you’re doing for the survival of your organization?
Mash: Yeah, that’s the trend in the industry. Because of changes to reimbursement and requirements and just trying to keep up, small independents are really going to be a thing of the past. From the O’Bleness standpoint, in terms of the relationship of Ohio Health, we’re tapping into their buying power for all of our supplies — both IT and non-IT related. We’re able to tap into their specialties so they can rotate specialists through our organizations. Of course on their end, for OhioHealth corporate, the referrals for certain specialties that won’t rotate through here, we can refer up to one of the larger Ohio Health Hospitals in Columbus — Grant Medical Center, Doctors Hospital, Riverside Methodist. So it’s really beneficial for both organizations.
Gamble: What you’re saying is absolutely true. It’s a definite trend. It’s not like five or ten year ago where it was a rare thing to see community hospitals go into these new relationships. Now it’s become the norm.
Mash: It really has. For something as simple as negotiating your payer contracts, when you’ve got the power of OhioHealth, their payer contracts alone are much better than ours. So just for that one single fact, we’ll be in a much better position.
Gamble: You talked before about how being a small organization means you have to rely more on vendor relationships and consultants. Maybe that’s something that will change, but I guess you have to see how things start to pan out in the new environment.
Mash: Ohio Health has a very large IT organization, which of course allows for specialization within a certain technology, and we’ve been able to tap into that. We were a managed entity before we became a member, so we had that relationship with them. And being able to tap into a Citrix specialist or a VMware specialist has been invaluable to us.
In the smaller organization, I really like the idea of specialization. When you have one server administrator and one network administrator, they don’t really get to specialize in, let’s say, firewall security. They’ve got to do the firewall security switches and every piece of the technology, from our internet pipe coming in right down to the desktop. So we all just kind of jump in wherever we’re needed.
Gamble: That’s the really nice part about working for a smaller organization, that you do get experience in a lot of different areas. But like you said, maybe not enough so that you become specialized.
Mash: And turnover just kills the small organization. I’m single-threaded in some areas, and losing one of those positions really hurts.
Gamble: Does the organization have any relationship with the university, or is the university doing any education to try to build the IT workforce?
Mash: We’ve had a couple of interns from Ohio University. Ohio University has a medical school and we act as a teaching hospital for them as well. I worked at Ohio University for 13 years before coming over to healthcare, so I know a few folks over there and have tapped in to those resources a time or two. If we’re having a problem we can’t solve, I know the folks over there that we can call and ask a question to. I try not to abuse that relationship, but we definitely have some contacts over there that we rely on.
Gamble: It’s interesting because in some ways it’s a competitor for jobs, but then in another way it can be almost like a feeder program.
Mash: Yeah, you’re correct. It’s both. When we have an open position, I send those job postings over to a few folks I know over there so they can reach out to their contacts. But with Ohio University, it’s hard to pull somebody away — especially somebody that’s been at the university for a number of years, because they’re invested into the state retirement program and whatnot. From an IT standpoint, they’re a competitor for good staff.
Gamble: I bet it’s tough competition because there are all kinds of nice benefits in working for a large university.
Gamble: Okay, so you talked before about the Athens Medical Associates group. Are they owned by the system?
Mash: Yes. Athens Medical Associates is an entity within the O’Bleness Health System. That’s where our employed physicians and our ambulatory physicians have their practice.
Gamble: What type of system are they using?
Mash: They’re actually using the athenaNet application, the hosted application from Athena Health. It works out pretty well. From a small IT shop perspective, I love it because it’s one system we don’t have to support. We do have a few interfaces with the application, but since its Cloud based, it really has a small footprint.
Gamble: Do you have physicians who are affiliated with the system but not owned?
Mash: Yes, we do. I don’t know the exact number, but we have quite a few physicians that are on staff but not employed. Currently they do have access to get into our Affinity system, and we are working on a training plan for those physicians to get them into McKesson Paragon. Actually, they’ll use work stations, but we’re setting up their access, and we’re going to be providing training to them soon.
Gamble: Being in a rural area, are you involved in any telemedicine initiatives, or is that something that you’re looking at in the future?
Mash: That’s something we’re definitely going to be moving toward in the future. We do participate in Ohio Health Stroke Network, and once we get past this project, we’re going to be in a good place to pursue some telehealth.
Gamble: I would imagine that with the current set up it’s a little bit tough.
Mash: Yeah, we’re running at a 100 percent now. We have to get past this project so we can do real IT. Because to me, IT begins when you’ve got a system in place and you find ways to really innovate, to expand, and to gain efficiencies. We’re just not there yet. We’ve got to get this system in place so we can do some real IT work.
Gamble: Right, you have to do all the not-so-glamorous stuff first.
Mash: That’s right. We are setting a great foundation though. We’re going to be well positioned to finally be innovative.
Gamble: What about health information exchanje? Is that something you’re involved with?
Mash: Ohio actually has a statewide HIE which is called CliniSync, and we signed up for that. It’s going to be part of our Stage 2 plan. There’s over 100 institutions across the state that are signed up with the HIE. It’s something that I’ve been very interested in from when the HIE was established. I’m really looking forward to getting on with that project. Again, it’s going to be after our go-live, but the statewide HIE here in Ohio is growing very quickly.
Gamble: Yeah, that’s one of the bigger ones in the country. I’m not sure how exactly they all rank, but that’s one we’ve certainly heard a lot about. They’re doing something right. They’re gaining traction.
Mash: Yes, they are. They definitely are. They’ve got a large presence in Cleveland and Cincinnati. They’re just breaking into the Columbus market, and here in Southeastern Ohio actually, there are two or three smaller health systems that are on board. So for us, it’s going to be pretty exciting.
Gamble: Are you in contact with other local CIOs? Do you have any meetings or things like that?
Mash: There is an Ohio Paragon users group, which is an ad hoc group of CIOs and leaders from nine different organizations across the state. We try to have a monthly call just to bounce ideas off each other or to share challenges with the Paragon system. I’m also a board member on the Central and Southern Ohio HIMSS group, and I use that as a means to make contacts with other organizations across the state. But I do whatever I can, because contacts are invaluable.
Gamble: Yeah, especially if you’re going through a big project or even just a change within the organization. I can imagine it’s really beneficial to be able to reach out to a couple of your colleagues and talk to them about experiences they’ve had.
Mash: Absolutely. I’m a firm believer in reaching out. There are times when you don’t want to be bleeding edge or leading edge — you just want to copy what somebody else has already done. I will say that the contacts I’ve made are more than willing to share information on anything from policies to challenges with different projects or contacts within vendor organizations. We’re all in the same boat; smaller organizations are very thin-staffed, and if we can get and give help, we do it.
Gamble: It does seem to be a pretty unique thing where among health system and hospital CIOs, there is a lot of willingness to share stories, and there’s the mentality that you don’t have to reinvent the wheel. People are willing to help each other out, it seems.
Mash: You have to do that to survive.