In today’s complex healthcare environment, pushing any initiative forward isn’t merely complex. In fact, it’s like “hitting a moving target with a bow and arrow from 1,000 yards away — while blindfolded,” says Patrick Yount. But no matter how big (or small) the task, the key is to ask the right questions and talk to the right people. And for the past year and a half, that’s precisely what he’s been doing as CIO at Lincoln Community Hospital, where his goals are to move to a single EHR platform, improve the patient experience, and shore up the revenue cycle process.
In this interview, Yount talks about how his plans to tackle these lofty goals, all while dealing with the challenges that come with being a rural health facility. He’ll discuss his strategy in selecting a vendor, the “fantastic opportunity” Lincoln has to become a leader in behavioral health, the approach he took as the organization’s first CIO, and why, despite its faults, he’s still a champion of Meaningful Use.
- About Lincoln: serving Colorado’s rural population
- Goal to remain 100% independent
- His approach as new CIO: “There was a lot of 1-on-1 dialogue and an open line of communication.”
- Addressing “rudimentary” disaster recovery plan
- Moving to SOC 2 data centers – “That was a big win for us.”
- Challenges recruiting IT talent
- Selecting an EHR & planning the rollout: “There are a lot of components”
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It’s always a strategy of mine to try to align the IT initiatives as closely as I can with the overall initiatives of the business. But without really understanding what the end users were dealing with, I was just making a lot of assumptions which don’t usually go across all that well.
We don’t have any patient data living in our data centers. I feel like that was a big win for us. Regardless of what we choose moving forward, we’re going to be better off in terms of having one patient chart and having a more robust system.
The end user experience is one of the most heavily-weighted factors, but you can’t necessarily make the decision solely based on how the end users are going to use the system. You need to ask, is it going to work for us? Are we going to be able to implement it?
We want to make sure we do it right — not just fast. That being said, there are always those regulatory issues forcing your hand. You have to have certain functionality in place in order to meet those and avoid the subsequent penalties in future years.
Gamble: Hi Patrick, thank you for taking some time to speak with us. I look forward to hearing about what you and your team are doing.
Yount: Absolutely, thank you for having me. I can’t begin to tell you how nice it is to be recognized, and to speak with organizations that are putting a spotlight on rural healthcare. We tend to be the red-headed stepchild in the healthcare space.
Gamble: To get started, can you give an overview of Lincoln Community Hospital and Care Center — what you have in terms of hospital beds, long-term care, things like that?
Yount: Absolutely. Lincoln Community Hospital is a critical access hospital located about an hour and a half east of Denver along the I-70 corridor. We have a 15-bed critical access inpatient unit with a 40-bed long-term care unit attached to the facility. We started practicing medicine in 1959 and received the critical access designation in the early 1990s. In terms of demographics, our patient population is about 10,000, but we actually service an area that’s larger than the State of Connecticut. We have patients coming to us from far and wide, and I feel like we’re a crucial care provider for our patient population. There is only one other hospital between the Kansas State line and Denver, so if we weren’t here, people would have quite a bit more issues getting care than they do now.
We have four primary care clinics that are located also along the I-70 corridor in three other small communities. Most of those are staffed by mid-level providers, but they operate under one supervising physician. We have a very robust rehabilitation center. We offer rehab services along with primary care in all of our clinic locations, and we have a pretty renowned behavioral health service line offering. It’s one of the things we’re known for.
Gamble: Is the organization independent or do you have any affiliations?
Yount: No, we are 100 percent independent. We have a board of directors that are appointed by the community, and our independence is one of the things that we’re very proud of. In the last couple of years, 86 critical access hospitals have closed. We’re proud to say that we’re not one of them, and we would like to maintain our independence as long as we can. It is the vision of our board, it is the desire of our community members, and it’s something that we’re going to do everything we can to maintain.
Gamble: Okay. And we’re going to get into some of the things your team is working on, but first, you’ve been with the organization for a little bit over a year, right?
Gamble: Talk about your approach in starting with a new organization. How did you get to know the team and the organization itself?
Yount: I actually had the opportunity to work with the organization prior to coming here. In my last role, I was director of IT for the State Office of Rural Health, where I provided consulting services across a wide spectrum of IT type activities for up to 18 hospitals. So when I came onboard at Lincoln, I already had the pleasure of knowing most of the staff members by name — I had been working with them for about a year and a half. But when I came onboard fulltime, I approached the role the same way I do with pretty much anything, with the mindset that every person I meet can teach me something. It doesn’t matter if they’re the CEO of the organization or a housekeeper. I feel like I can always come in and learn something from somebody else.
Within my first two weeks, I did nothing but sit down and have one-on-one interviews with all of the department heads to talk to them about their perceived challenges related to IT, and how any of those challenges may inhibit them from moving on with their day-to-day workflows. It’s always a strategy of mine to try to align the IT initiatives as closely as I can with the overall initiatives of the business. But without really understanding what the end users were dealing with, I was just making an awful lot of assumptions which don’t usually go across all that well. So there was a lot of one-on-one dialogue and an open line of communication moving forward. That’s key, regardless of who you’re speaking with.
Gamble: Right. And once you were able to have those discussions, what were your first priorities in the role?
Yount: First, it was putting out those initial fires. Any initiative or problem that directly inhibited patient care rose right to the top. Right off the top, I noticed we have interface problems that were stopping our radiology images from reaching a third-party radiology vendor. We don’t have any on-site radiologist. We’re a Level 4 trauma center — without being able to have those images read within a timely fashion, we were, in essence, sitting dead in the water.
So we started with those patient care-related issues, and then moved into more of the fun stuff. I had an opportunity to interview the onsite IT staff when I came onboard, and our disaster recovery and backup solutions were rudimentary at best. Literally, the disaster recovery plan was if there’s ever a fire — if there’s a tornado — we’re going to drive into the data center. We are going to grab this physical piece of equipment, and we’re going to put it in the back of our car and drive as fast as we can in the opposite direction.
As with anything in healthcare IT, it’s like hitting a moving target with a bow and arrow from a 1,000 yards while blindfolded. The key initiatives change all the time, but I ask myself the same question with every decision that’s made: how is it going to affect the patient? Does it align with the business, and can we afford it? If I can get a ‘yes’ to those three questions, it allows me to put it into my quadrant of responsibility.
Gamble: It certainly seems like a moving target. Now, in terms of the EHR, what type of systems are you using?
Yount: We actually have four electronic health records, and none of them natively speak with one another. One of the big key initiatives we have right now is consolidating all of the EMRs into one enterprise solution. We’re going through the selection process right now. We’ve narrowed it down to two vendors, and we’ll be going live with an enterprise-wide system no later than Q2 of next year.
One good thing we’ve been able to do is that all four of the disparate systems are now hosted in SOC 2 compliant data centers across the country. And so we don’t have any patient data living in our data centers. I feel like that was a big win for us. Regardless of what we choose moving forward, we’re going to be better off in terms of having one patient chart and having a more robust system altogether, trying to get rid of a lot of those workarounds.
Gamble: Was that something you knew was going to be a big priority going into the role?
Yount: Absolutely. That was one of the big reasons they brought me onboard. As with most rural settings, I’m sure you know that talent is always lacking, especially in the IT space. It’s hard enough to get providers and doctors to come out to rural America. There are grant programs and repayment/forgiveness programs that will help attract talent in that regard; but when it comes into IT, the higher paying jobs and better opportunities are generally located in your urban areas. They tend to attract the cream of the crop.
So that was one of the big key factors in bringing me onboard — to consolidate the electronic health record, to improve the patient experience, and to shore up the revenue cycle processes, which is never easy when you have four disparate systems. And I have a history of electronic health record implementation. It seems like everywhere I go, it’s one of the first things I usually have to tackle. A colleague of mine always jokes about it, and when I step into a role and find that an implementation is on the horizon, his words come to mind: ‘The road to hell is paved with conversions.’ They’re not easy, but it’s a necessary evil nowadays. You just hope to make the right decision so that you can prolong the next implementation as long as possible.
Gamble: Right. No matter the size of the organization, it’s never an easy decision, because you have to factor in so many different components. So I’m sure having that experience helps you in leading this process.
Yount: It does. Change is never easy. Change is scary. But doing these implementations has helped me learn what questions to ask to differentiate between something that’s nice to have versus something we absolutely cannot do business without. As with any selection, the end user experience is one of the most heavily-weighted factors, but you can’t necessarily make the decision solely based on how the end users are going to use the system. You need to ask, is it going to work for us? Are we going to be able to implement it? What’s the proven track record of the organization you’re looking at? What’s their long-term viability? Can they help me with the problems I’m dealing with right now, and do they also have the resources to keep an eye on the horizon and tell me the things that I don’t know?
There are a lot of components. It does help, though, to know what questions to ask and to help reassure people, ‘Hey, we’ve done this before. We can do it again, and it will be okay.’
Gamble: I would think that definitely makes a difference. So, once the final decision is made, you’ll have to pretty quickly start ramping up to hit that goal of Q2.
Yount: Correct. We’re going to give ourselves as much time as possible to do the implementation. We want to make sure we do it right — not just fast. That being said, there are always those regulatory issues forcing your hand. You have to have certain functionality in place in order to meet those and avoid the subsequent penalties in future years. But yes, we plan to do an implementation within 12 months of signing a contract, which should give us plenty of time.
Right now, we’re identifying those key components that our super users need; the critical pathways we need to make sure the implementation is done and that we’re able to do the implementation without hiring additional staff. That’s always a worry. There’s a hospital to run. There are patients to be seen. And a lot of implementations — even if the vendor is willing to own a large portion of it — still require an additional 25 to 40 percent of your staff’s time to get the build done. So there’s definitely a tight rope to walk.
Chapter 2 Coming Soon…