For many critical access hospitals, the future looks bleak. They have the same list of priorities as health systems, but with a fraction of the resources. But Mt. San Rafael is not your typical rural hospital, and Michael Archuleta is not your typical leader. Since taking on the IT Director role four years ago, Archuleta has led the transformation from a paper-based system to a Most Wired hospital. In this interview, he discusses the enormous challenges faced by CAHs, how he’s changing the perception of IT from one of “cost center” to “business partner,” and what it took to implement the organization’s first IT strategic plan. Archuleta also talks about the value of young leaders, how he “sold” cybersecurity to the board, what he hopes to accomplish next, and why he won’t apologize for being an over-communicator.
- About Mt. San Rafael
- Rolling out MedHost as a bare-bones IT shop — “We had nothing.”
- Overhauling infrastructure, data center & equipment
- IT as a business partner
- His handpicked team — “They go above and beyond.”
- Value of young leaders
- “I’m an over-communicator.”
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It was absolutely amazing to see the individuals finally understanding the need to go to an electronic medical record system and improve documentation, because overall it did improve patient care.
Moving forward with HIT and this new wave of digital health, if you are not leveraging technology to the fullest, and if you are not putting technology as the main backbone of an organization, you will not be successful. Period.
We are challenged to the max. And it’s hard because we’re underfunded, we’re understaffed, and there’s a lack of knowledge of what HIT is doing and why it’s so important to leverage technology — that’s what we need to instill in our individuals, because digital transformation is not stopping.
When I started, we were at barebones. We had different servers in different laundry room locations and different switches in clean linen rooms. There was nothing standardized. There was no advanced technology in place. I was even saying, ‘can we really do this, especially with what we have?’
It’s been stated at times that maybe I’m an over-communicator. Well, I am an over-communicator; communication is my number one key aspect. Without communication, we have nothing.
Gamble: Hi Michael, thanks so much for taking some time to speak with healthsystemCIO.com.
Archuleta: Thank you, Kate, for having me today.
Gamble: To give our readers and listeners some background, can you give an overview of Mt. San Rafael Hospital, what you have in terms of bed size, ambulatory, where you’re located, things like that?
Archuleta: Mt. San Rafael Hospital is a 25-bed critical access facility serving the medical and surgical needs of residents Trinidad and surrounding areas. We are located in Southern Colorado, about three and a half hours from Denver. We currently have our hospital and we have two clinic facilities.
Gamble: As far as other hospitals, what do you have nearby — is there anything that close to you?
Archuleta: The next biggest hospital is 90 miles away from us, which is Parkview Medical Center.
Gamble: So it’s a pretty rural population that you’re serving?
Archuleta: Absolutely. We are in a rural community; the population right now is around 9,000 individuals. So of course, we’re really trying to boost our services here at Mt. San Rafael and really try to get some more surrounding individuals to basically come to our facility. When you live in a rural community you really need to provide the best services to the surrounding individuals, because at times it is very hard for our elderly population to go 90 miles away to get care.
Gamble: How long have you been with the organization?
Archuleta: I’ve been with the organization for eight years now, and have been director of Mt. San Rafael for four. It’s definitely been a huge jump. When I started here at Mt. San Rafael I came in as a network tech, moved my way up, and basically became director. The issue was though when I became director, I was in charge of doing full implementations of the electronic medical record system, for both our clinics and our hospital. It was myself, a staff of one, and my main task was we need to create an electronic process for the organization. I said, ‘wow, this is a big, big challenge.’
Unfortunately, the overall resources in rural America is one of our main problems we have; it’s really hard to obtain good individuals and basically, individuals that understand technology and HIT itself. So when I came in to this role, we had nothing. The overall server infrastructure was scattered within the whole facility. There were machines — nothing was standardized. Switching equipment was all thrown out.
So when we actually did an overall organizational analysis with our EMR vendor, they came down, they looked at our resources that we currently had, they looked at our current hardware, and looked at the current configuration of our process — because we needed to go live April 1 to start our 90 days. If not, because we were such late adopters, we were looking at getting penalized with Meaningful Use. They came back to us and they said, ‘Well, when do you need to go live?’ I told them the actual date, and they came back and they said, ‘you have an actual 20 percent chance of successfully going live, so take it or not.’
It was literally days and nights I spent in this facility redoing the overall infrastructure, adding in the first data center, and replacing all the equipment needed, and we went live that specific date. It was a huge accomplishment because not only did I have to build my team from a clinical side and add more individuals into IT, but the resources that we had and the equipment that we had were all out of par. Going with the EMR company that we did — we’re utilizing MedHost on the inpatient side and the ED side —was a very big constraint on us, because we didn’t have the actual servers in place to make this process happen. So it was an amazing accomplishment.
Over time, we’ve digitalized this organization. We added a lot of interoperability and full access within full facility. I was actually a little bit afraid going down to the floor at times. And I make a joke of this, but the nurses would kind of gather up and they would say, ‘There he is; there’s that guy that digitalized everything. Let’s get them!’ And I’d thing, ‘wow, this is a little intense.’ But it was absolutely amazing to see the individuals finally understanding the need to go to an electronic medical record system and improve documentation, because overall it did improve patient care.
We’ve digitalized our patient care unit, our ED department, and our rehab services. There are some items that we’re still working on, but we’ve made a massive change. We went from having nothing to the very first data center here at Mt. San Rafael. We virtualized all our servers, so we’re 99% virtualized.
We’ve centralized all our networking equipment to one single point location. We’ve doubled the overall efficiency that this facility has seen. Because the problem was that the overall concept of IT was that these are just individuals focusing in a room and just fixing computers and printers all day. That concept was ongoing, and at times it’s still ongoing here in rural America. But the thing is, I’ve been part of the strategic plan and the business development plan. Because in moving forward with HIT and this new wave of digital health, if you are not leveraging technology to the fullest, and if you are not putting technology as the main backbone of an organization, you will not be successful. Period.
The issues we face here, though, in rural America is really trying to get the concepts toward and letting them understand what HIT is — what is technology? How is technology improving the overall lives of our patients? There are so many different educational processes that need to take place for people to really understand these objectives, because if you look at the actual current process with critical access hospitals in rural America, they’re closing down, dramatically because they never leverage their technology. They never leverage their EMR system. I went to an actual critical access hospital that they didn’t even have a firewall in place. And now we’re so focused on cybersecurity — it’s such a huge threat to healthcare because 2016 is definitely in the year of ransomware and the year of attacks. And if you’re not onboard with the overall vision of technology and leveraging technology to the fullest, how are you going to sell cybersecurity to your board if you’re not even putting the basics in place?
My thing is, it’s been very difficult because you go and look at a metropolitan organization and they have different specific departments, server networking, programming, clinical informatics, etc. You come to a critical access hospital and you’re doing everything that all these different groups are basically doing. So we are challenged to the max. And it’s hard because we’re very underfunded, we’re understaffed, and there’s a lack of knowledge of what HIT is doing and why it’s so important to leverage technology — that’s what we need to instill in our individuals, because as you know, digital transformation is not stopping. And it’s not going to get easier. It’s going to get harder. It’s going to get more complex. Moving forward with technology, it’s going to get more advanced. You need those resources and understanding of HL7, programming, clinical informatics, EMR systems etc. If you’re not really focusing on those different areas, how are you successful even in accomplishing Meaningful Use?
And in talking about Meaningful Use 2, a lot of the facilities took the hardship exception. My goal was we will never take that because we will always meet all of our objectives for it. We were one of the first critical access hospitals in the state of Colorado to connect to the Health Information Exchange program. We were one of the few small critical access hospitals that were 99 percent virtualized. We started adopting virtual desktop infrastructure in our facility. We started adopting single sign-on.
We’ve been really putting our standards to the max, because that is what I want to see. We’ve really shown what we have been capable of doing, and we’ve done it where we’ve met Meaningful Use Stage 1. We’ve met Meaningful Use Stage 2. And we continue to improve and we continue to try to be one of the best critical access hospitals out there, because we understand that technology is the backbone of any organization, and you really need to get out of that concept that the IT department is a cost center. No, ladies and gentlemen, the IT department is a business partner to your organization that you need to utilize to be part of that strategic plan in improving the efficiencies of our patients in this community.
Gamble: That’s really good point. You talked about the critical access hospitals shutting down — we’re seeing that so much, and you can’t help but think there’s a lack of willingness to invest in IT. Even for your organization, I can imagine that it was a tough sell just to be able to build your team. What does your team look like at this point?
Archuleta: Right now we are a total of five individuals. I have two clinical informaticists, and I have two individuals focusing on the technical realm of our departments. I’m on both sides, technical and clinical, so I understand the overall functions there. We’ve really established a strong IT team. And last year, 2015, we were named Most Wired. That was such a huge accomplishment for Mt. San Rafael Hospital. It was so heartwarming to myself because, honestly, when I started, we were basically at barebones. We had different servers in different laundry room locations and different switches in clean linen rooms. There was nothing standardized. There was no advanced technology in place. I was even saying, ‘can we really do this, especially with what we have?’
I am never an individual that gives up. I’m an individual that always wants to excel and excel to the fullest, and that’s what we did. We moved forward. We did the overall analysis and did the hiring of my team. I handpicked each individual in this department, and we’ve done amazing things. My team has been a great inspiration to myself too because those individuals really do a lot for this organization — they go above and beyond. So big kudos to them.
It’s really been a good thing, because when you go from nothing to something and then when you get recognition for doing some amazing things like Most Wired, it’s amazing. I recently was named to Becker’s 100 Hospital and Health System CIOs to Know, and that was such a huge accomplishment. The thing is, I’m a young, innovative individual. At that time when I took over, I was only 28 years old, so basically I’ve accomplished all of this by the age of 30. And so I really want to let everyone know that age, at times, is just a number. If you have an individual that’s really focused on trying to improve and create that overall leadership aspect in the organization, that individual would be just such a great asset to have. I think that’s what I’ve been trying to develop with my team. Of course, all my team members are a lot older, but the thing is, they’ve seen what I’ve been able to accomplish, do with the organization and they really try learning and leveraging some of my thoughts towards them too.
It’s really been great in trying to develop these individuals because developing leaders is a number one thing, I think, especially moving in this more advanced digital technology space that we have. You really need to show that kind of leverage, and you really need to develop a strong team. I’ve built a team from nothing to something where everyone is synced together. It’s been stated at times that maybe I’m an over-communicator. Well, I am an over-communicator; communication is my number one key aspect. Without communication, we have nothing.
It’s honestly been very humbling, especially to be recognized by Becker’s Top 100 CIOs to Know. It was a huge accomplishment for the overall team too to be named Most Wired 2015. Honestly, we’ve been leveraging technology to the fullest and we continue to move forward with doing some amazing things. So watch out, you’ll start hearing some more about Mt. San Rafael here soon.