Jake Dorst, CIO, Tahoe Forest District Hospital, Chapter 1

One of the most important characteristics for a strong leader is being able to stay calm when the organization hits rough waters. For Jake Dorst — who has survived tumultuous times during his career, including acquisitions and difficult go-lives — the ultimate test came less than a year into his tenure at Tahoe Forest Hospital District, when he was asked to serve as interim CEO. And although he learned quite a bit from the experience, he’s happy to be back in the CIO shoes that seem to fit him so well.

In this interview, Dorst talks about how his team is preparing for an Epic go-live (and why they chose to partner with Mercy Health’s IT services arm), why they’re focusing on “Population Wellness” rather than population health, the challenges of being located in a resort area, and why it’s essential to have a strong project manager. He also discusses why Tahoe Forest appealed to him, his “servant leadership” philosophy, and what it was like to move across the country with young children.

Chapter 1

• About Tahoe Forest – “We’re more than just a critical access hospital.”
• Seasonal patient volumes
• Partnering with Mercy Technology Services to deploy Epic
• Going big-bang on 11/1 – “It’s going to be a big game changer for us.”
• Support before, during & after go-live
• 3 key components of IT service contracts
• Tahoe’s “very robust project plan”

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Bold Statements

We try to offer as much as we fiscally can in our town so our patients don’t have to leave. When it’s snowy in a mountain town and you have basically one main road in and out, being able to keep the doors open is our goal.

We’re really pulling out everything and putting in one system, and trying to make everything work. This is going to be a big game changer for us.

We always felt that the other hosted models weren’t really in the business of hosting. It was more like a side business. We wanted to make sure that we got with the company that had that passion to do it right, and that’s what Mercy had.

Once we got the price worked out and we’re working on the actual terms, it’s not too far off from everything else that I’ve used in the past. It really comes down to service level, uptime agreements, who owns what data. 

Gamble:  Thank you so much for taking some time to speak with us, I appreciate it.

Dorst:  My pleasure, thanks for having me and I appreciate another opportunity to talk to healthsystemCIO.com.

Gamble:  I think the best place to start is by providing some information about Tahoe Forest. And it’s Tahoe Forest Health System, correct?

Dorst:  The official name is Tahoe Forest Hospital District. We’re actually a hospital district in the state of California. So technically, we’re part of the California governmental system.

Gamble:  Can you provide a background about the organization — size, where you’re located, things like that?

Dorst:  Sure. We’re in Truckee, California. It’s in the Tahoe-Truckee region near Lake Tahoe. The major cities are Reno, which is about 30 minutes to the east, and Sacramento, which is about 90 minutes to the west. Further down the road is San Francisco. So we’re kind of a resort town. We have a lot of skiing here, and there’s the lake, which is obviously a big draw. There’s a lot of camping, and there’s a national park. We see a lot of folks coming from our surrounding areas: San Francisco, Sacramento, and the eastern portions, which is largely Nevada.

We are a 25-bed critical access hospital. We have a total of 62 staffed beds, but as a critical access hospital, we have the 25-bed limit on certain beds. But we’re a lot more than just a critical access hospital. We have emergency services and orthopedic services; as you might expect, we do a lot of orthopedic work with the proximity to the ski hills.

Gamble:  Right.

Dorst:  But we also have an ICU. We have a skilled nursing unit with swing beds. We have surgery, obstetrics, and home health, and then we have a multispecialty clinic as well that does pulmonology, internal medicine, and family medicine. We treat sleep disorders, noninvasive cardiology, ENT, GI, pediatrics, those types of things. And we also have a hospital in Incline Village, which is in Nevada, right near where California and Nevada meet near Lake Tahoe. And that’s a critical access hospital. It has only four beds, but it sees more work around the ER. We have a clinic there as well.

In total, we’re doing about $200 million a year in gross patient revenue. And so although we say critical access, we’re in a lot of specialties. One of our biggest is the cancer treatment center here named after Gene Upshaw. He was the executive director of the NFL Players’ Association who used to live up in the Tahoe-Truckee area, and really was the driving force behind this state-of-the-art cancer treatment center, which has now become a model for rural cancer treatment in America through our partnerships with UC Davis and the California Cancer Treatment Network.

Gamble:  It definitely is deceiving when you look at the numbers. The 25-bed hospital is just one aspect of it. It really it sounds like you guys run the full gamut.

Dorst:  Yeah, as far as the larger acute care hospitals with open heart surgery or cardiac cath, we don’t offer those services. But we try to offer as much as we fiscally can in our town so our patients don’t have to leave. When it’s snowy in a mountain town and you have basically one main road in and out, being able to keep the doors open is our goal.

Gamble:  Right. Being a resort area, are you dealing with fluctuations in volume throughout the year?

Dorst:  Yes, there’s a seasonality to what we do. In the summer, we see a lot in the summer. There’s a lot of mountain biking and those types of things that draw people up to the mountains, but our busiest time is still ski season.

I know Northstar California Resort can see up to 14,000 people on the mountain in a day, so it’s a big draw. We’re here to help when folks turn the gravity up on the mountain there towards the end of the day, and we see those folks come into our… But we’re good at it, so we’re happy to provide the service and we get a lot of practice.

Gamble:  Right. I imagine that’s something you’re able to anticipate from a staffing perspective when that influx is coming.

Dorst:  We use a lot of travel nurses, and we are able to flex up and flex down for those types of situations.

Gamble:  Okay. So, in terms of the EHR environment, I read about the initiative where Tahoe is partnering with Mercy Health System’s IT arm to deploy Epic. Where does that project stand right now?

Dorst:  We’re less than 100 days to go-live — we’re looking at November 1. We are currently training our trainers and our super users, poring over order sets, and working closely with Mercy to really hone what our Epic installation is going to look like. We’re very excited to partner with them because they’ve done so many of these. They’ve actually done it for critical access hospitals before. So we’re excited to unify our record up here in Truckee.

Gamble:  And for that November 1st, which facility or facilities is going to go-live at that point?

Dorst:  Everything. It’s big bang. We’re currently using a different EHR on the acute care side of things. We have a different EHR in our labs. We have a different EHR in our emergency department. We’re really pulling out everything and putting in one system, and trying to make everything work. This is going to be a big game changer for us.

One of the things we also liked about Epic is that a lot of the folks that come here for vacation are coming from places that are pretty predominantly Epic healthcare providers. And so we’ll be able to share those records a lot easier with the Connect model. We’re definitely looking forward to that, and our physicians are as well.

Gamble:  Right, with all the tourists that have injuries.

Dorst:  Yeah. If someone shows up unconscious and you’re not sure what the background is, you can get at it a lot easier than it’s been in the past. We’re currently on Epic right now on the ambulatory side, and that’s through a hosted model. Unfortunately, the company that’s hosting it for us didn’t offer an acute care model so we had to look elsewhere. Luckily, I already have some Epic champions in the system, so it helped when we were doing our RFP that there were some folks that really understood how Epic worked and didn’t really want to move off of that. That was a good driver to unify it onto the Epic platform.

Gamble:  How did it come about as far as working with Mercy? Did you approach them? You said they have some experience with critical access, so I’m sure that that was a selling point.

Dorst:  It was. I use a company called VPS – Virtual Procurement Services – which I’ve used before, to help with purchasing. I called them and told them I’m in the market, and so we looked at UC Davis and Renown Health, which is down the hill from us, as possible partners to host with. Those were the two I could find that were local to us. So I called VPS and they said, ‘We work with this other company and there’s a couple of models that we can help you with.’

One of them was Mercy. That was a really good find for us, because we always felt that the other hosted models weren’t really in the business of hosting. It was more like a side business. We wanted to make sure that we got with the company that had that passion to do it right, and that’s what Mercy had. It’s basically a spin-off of their technology services, and it’s all they do. Plus they have to eat their own dogfood, if you will, because when they’re done with the install, they also provide support. So it’s not like a third-party company coming in to do the install, and then they’re gone and you’re hosted by a university system or a system like Renown.

It was a very comforting feeling for us. To be honest, we really felt that Renown was going to be a partnership because of the locality. But my team absolutely fell in love with their process and their ability to get things done, and their experience with it. So it actually turned out to be a better deal for us both financially, and with the quality of service we’ve seen from them.

Gamble:  How is it structured in terms of support? Are there people who come there and visit, or is that done remotely?

Dorst:  We are basically paying for two full-time employees that are based out at St. Louis. When we go live and have the big bang, we’ll have elbow-to-elbow support, we’ll have the trainers, we’ll have the super users — we’ll have all of that here for the initial couple of weeks of go-live. After that, it rolls into their support model, which is dedicated to us, at the Mercy site. It’s 24/7, which is good. We worked out some good service level agreements in our contract with them as far as what we’re expecting for supporting our implementation.

And actually, we were their first California hospital, so we had to work it into the contract. Being a critical access hospital and part of the hospital district’s program, there’s a lot of special reporting that we have to do that is unique to California, so we had to work that out as well.

Gamble:  In terms of structuring that agreement, I know you’ve worked with several companies before, but I imagine was a different experience because of the nature of the agreement.

Dorst:  We used Drinker Biddle out of Chicago. One of the guys that was doing it said he had did about 30 or 40 Epic contracts last year. So he was well-versed in Epic, and actually came up with a lot of things that we would have missed, and after the fact would’ve really been kicking ourselves over. I was very glad that we were able to find someone with that experience. But when you get down to the IT contracting, once we got the price worked out and we’re working on the actual terms, it’s not too far off from everything else that I’ve used in the past. It really comes down to service level, uptime agreements, who owns what data. 

There was language in this contract about HIPAA violations on both sides and what those means. It’s new thing to put into contractual language that you can get a breach of contract and those types of things. Those types of things were a little newer to me, but those are becoming more standard in the terms and conditions coming out nowadays.

Gamble:  Right. And at this point, you said you’re in the training phase as far as Epic?

Dorst:  We’re in the training and build phase. We have a very robust project plan, and very dedicated employees on both sides working diligently to hit those goals. We’re mostly green-lit right now. I don’t anything is lagging too much. We’re entering into the hardware phase where we’re going out and putting up the new infrastructure and things like that, so that’s always fun. That’ll be starting up soon. So hopefully we’ll be able to stay green-lit and look forward to as good a go-live as possible.

Chapter 2