Sheri Rawlings, CIO, San Juan Regional Medical Center, Chapter 1

When Sheri Rawlings started as CIO at San Juan Regional more than 4 years ago, the EHR picture in the physician community was dire. Users were giving up and going back to paper, and action needed to be taken. Quickly. But as a longtime veteran of healthcare, Rawlings knew that the situation wasn’t going to right itself unless the clinicians participated in and owned the selection of a new solution. And so IT stood on the sideline and offered support instead of running the show, and it paid off. In this interview, Rawlings provides her honest take on Meaningful Use — and why it’s much more challenging for community hospitals, and the strategy she employs when introducing change. She also talks about business continuity planning versus disaster prevention, why culture plays such a huge role in engagement, and when she got bit by the health IT bug.

Chapter 1

• About SJRMC
• Meditech Magic, Allscripts in ED, GE Centricity in clinics
• Virtualizing servers — “It was time.”
• Disaster recovery vs business continuity planning
• “Community hospitals struggle with laying down the law.”
• Challenging Ed Marx
• Going paperless — “They’re receptive, yet resistant.”

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Bold Statements

We decided it was time. We were just getting to the point where we were a little worried that they were going to come back up the next time we did a reboot.

I hate it when those things happen, but on the other hand, it validates what I’ve said we need to spend effort on.

It was the most frustrating thing I’ve ever done, because this organization doesn’t have that culture. Every meeting you go to, it’s printed out. You’re handed a packet. The only way you’re going to get notes is if you write your notes on the paper and scan it later. It’s a very difficult culture to change.

There was never a push. There was never any marketing. We just went in and showed them what could be, and they accepted it and they love it.

If I had said, ‘I want to buy it and implement it,’ it never would have happened. But because we bought it as we came across their pain points, we were able to say, ‘let’s help you get rid of the paper. Let me show you how you can do this.’

Gamble:  Hi Sheri, thank you so much for taking some time to speak with us today.

Rawlings:  Good morning. Thanks for the opportunity.

Gamble:  To lay the groundwork for our readers and listeners, can you just tell us a little bit about San Juan Regional Medical Center — what you have in terms of bed size, ambulatory care, things like that?

Rawlings:  Sure. We’re a 254-bed licensed hospital located in Farmington, New Mexico, in the Four Corners area. We have the advantage of being the sole provider in the community. The closest acute hospital is in Albuquerque, which is quite a distance from here, and then then there’s a smaller critical access hospital about 50 miles away in Durango, Colorado. We have about 150 practicing physicians in the community, about 75 of which work for the hospital itself. We run Meditech Magic in the main hospital and the GE Centricity EMR in our clinics and AllScripts is in our ED.

Gamble:  In terms of the patient population and geography, is it a fairly rural area?

Rawlings:  It is. Farmington itself is about 47,000 people, but we have over 200,000 covered lives. We have an interesting dynamic here. We have a lot of Indian Health Services patients. Actually, what I’ve read is only about 4 percent of the land is available to live on, or maybe 6 percent. The rest of it is reservation land and oil and gas, so it’s a very large physical area with a lot of covered lives, but only a few right inside the town itself.

Gamble:  And as far as what those patients have for insurance, does that pose a challenge?

Rawlings:  Yes. I’m not sure I can discuss it exactly, but the way in which we get services paid from IHS is an interesting challenge. We’ll just live it at that.

Gamble:  Okay. You said that you have Meditech Magic in the hospital. How long has that been in place?

Rawlings:  They actually installed that in the mid-90s, probably as early as 1993. The EMR in the clinics, however, has only been there since 2012.

Gamble:  That’s Centricity?

Rawlings:  Yes.

Gamble:  With Magic, are there any updates planned?

Rawlings:  We are currently on the newest version. We’re probably behind a few Priority Packs, but at this point there is no formal plan to move forward with any changes, whether it be 6.X or another vendor. We are actually doing a gap analysis and getting recommendations this year, but as of right now, there are no plans to make any changes. In fact, we just moved our physical servers to a virtual environment finally. To me, that’s a longer term investment, and so I don’t think we’re going to do anything for another five years or so.

Gamble:  Can you talk a little about that project just as far as what it entailed?

Rawlings:  We’ve had it since 1993. We’ve made several changes over the years, but the physical server base was about eight years old and ran about 12 segments for the Meditech Magic platform, and so we decided it was time. We were just getting to the point where we were a little worried that they were going to come back up the next time we did a reboot.

We actually partnered with INHS (Inland Northwest Health Service) — their new name is Engage — and they’re now certified for these kinds of things. So we brought them onboard and it was actually pretty much a painless project. It started in July and went live in October. We had very little involvement with it, but so far it’s gone very well.

We’ve also moved them into our disaster recovery plan. Disaster recoveries are really hard to talk about in this community because we don’t have them. There’s no tornados. There’s no ice storms. We don’t have earthquakes. We really have to talk about it in terms of business continuity. We were able to partner with them and they’re actually now providing disaster recovery for the Meditech system. I think we will expand that for our other top systems over the next year or so. It’s much more cost effective than maintaining another physical environment in our town that we have to worry about managing, especially when you’re never going to use it.

Gamble:  It makes a lot of sense focusing more on business continuity, because I think that’s the case in a lot of areas — it won’t necessarily be a natural disaster that happens, but something else that affects the ability to get to the data.

Rawlings:  Right. In my prior role, I was in a hospital in Emporia, Kansas. That’s tornado alley, so you did end up with a redundant data center and you were worried about those things. Our biggest fear here is the fuel trucks that comes around the corner too fast right next to the server room, or the helicopter that crashes into the server room and it’s gone. But it’s highly unlikely that’s ever going to happen.

Still, we’ve had issues this past year or so — not with the Meditech system, but with other things that have happened, maybe it’s a virus or other things occurring within the environment itself — that we really have to focus on business continuity. I hate it when those things happen, but on the other hand it validates what I’ve said we need to spend effort on. I don’t ever look forward to those kinds of events, but I’m always glad at the end when they’ve occurred.

Gamble:  Definitely. Now, with Meditech having been in place a while, can you talk about the transformation the organization has gone through with having Meditech but then also just getting to that paperless point and some of the challenges faced there.

Rawlings:  I really want a paperless environment. I have been in hospitals where they were paperless and I loved it. I honestly think that changing a community hospital to a paperless environment is one of the biggest challenges CIOs face. In fact, what happens is we just create more and more paper every day. I think community hospitals struggle also with laying down the law — ‘you’re going to do this, we’re going to get rid of that, you’re all going to be CPOE,’ etc. Until those challenges are dealt with, we’ll never be truly paperless, and I think that’s our biggest challenge.

It’s funny, I read Ed Marx’s article one time where he said he didn’t trust anybody who uses paper anymore. If they don’t go completely electronic, he doesn’t trust them as a CIO, or something to that effect. I tried that for six months, and it was the most frustrating thing I’ve ever done, because this organization doesn’t have that culture. Every meeting you go to, it’s printed out. You’re handed a packet. The only way you’re going to get notes is if you write your notes on the paper and scan it later. It’s a very difficult culture to change.

We’re starting with as many of the forms as possible and as many of the processes as we can within the clinical systems. Registrations are still printed out and signed by the patient. So we’re moving as many of those processes as possible into the virtual environment. We’ve also, since I’ve been here, started working through removing faxes and setting up virtual inbound faxing. Not only has that been a culture change, but they’ve seen the benefit in that. We’ve been able to take HIM to almost a paperless environment in terms of how they send information to other places. They’re receptive, yet resistant. Does that make sense?

Gamble:  It does make sense, because if you’re showing them specific ways where you can help move this task along, that makes sense, but having that blanket approach of ‘none of you will use paper’ — I can’t see that going over well.

Rawlings:  No, it doesn’t. We haven’t even advertised things like virtual fax. When I got here, we had licenses for Forward Advantage inbound and outbound virtual faxing but only two people were using the virtual fax. I take that back, one. Outbound faxes to blast fax physician offices for updates. That was it.

And so we began basically going undercover meeting with different departments and saying, what are your pain points? When they would bring something like that, the team was told, you offer virtual faxing. You set it up. You show them the advantages. Just do it. And we’ve managed to convert a large number of departments to virtual inbound and outbound faxing. There was never a push. There was never any marketing. We just went in and showed them what could be, and they accepted it and they love it.

Gamble:  That seems like a smart strategy when you’re talking about change management because that’s something that we always hear CIOs say can be such a challenge. I guess it really is in the approach and knowing the people you’re dealing with.

Rawlings:  We’ve done that a couple of times. There’s a couple of tools I’ve invested in where I knew that if I went out and said, let’s do this, I would have gotten a lot of pushback. One of our products is a visual smart board. It’s an overlay to Meditech and basically it takes a written report and changes it into an electronic work list. For departments who are work list heavy but work from paper, that paper is only as good as the moment that you print it off. And then you do work and now that paper’s outdated. It’s one of those things where I just said, you know what? It’s not that expensive. Let’s buy it. It’s going to take a long time to get it implemented, but now we’ve got those smart boards going in our patient billing area, in lab, and in several other places, and we continue to add people to it.

Again, it’s a tool that if I had said, ‘I want to buy it and implement it,’ it never would have happened. But because we bought it as we came across their pain points, we were able to say, ‘let’s help you get rid of the paper. Let me show you how you can do this.’

Let’s say it’s a report that has a bunch of outstanding accounts and I’ve made contact with an insurance company and I want to update that record. So if I click on that record in that work list, it will take me into Meditech, allow me to update my notes, save it, and then go back to my board, and it’s updated and I can go on to the next one. We were able to show them the benefit in that workflow, get rid of other products maybe that weren’t being helpful, and get rid of their paper. Those are the kinds of things we really covertly try to get done, and it’s made a difference in this organization.

Chapter 2