“We’re pretty much on an island.”
For rural health organizations, it’s a harsh reality — especially ones like North Country Hospital, a critical access hospital based in Northeast Vermont where “the community is very dependent” on its facilities. In fact, NCH owns nearly every practice in the area, some of which are operating at a loss, just so patients won’t be left out in the cold.
Being a rural health facility means having to do more with fewer resources, getting creative with growing talent, and for leaders, having to wear many hats. To some it may seem daunting, but Vermont native Kate Pierce, who started with the organization 18 years ago as a systems analyst, wouldn’t have it any other way.
Recently, she spoke with healthsystemCIO about the transformation the organization is undergoing to improve workflow, how they’re working with other facilities to better manage costs, and how they’ve been laying the groundwork for the shift toward value-based care.
- The “opportunity” NCH offered
- Learning respect & discipline with the Army – “It was a lot more than I ever expected.”
- NCH’s evolution – “I feel privileged to have been part of the change.”
- The many hats worn at small organizations
- Controlling costs with approval system
- Eliminating waste – “That goes a long way in keeping us financially viable.”
- Rural health challenges: “Our community needs us.”
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A large organization might have a whole team to address security needs; but for us, it’s part of my job. It’s part of my tech supervisor’s job. It’s part of a lot of all of our jobs — it’s a team effort.
You have to understand what is happening across the organization. You don’t have to be an expert at everything, but you have to know how to find the answers you need. It’s a great job; that’s why I’ve been here so long
If we need to replace a system that’s outdated, we look first to cloud-based vendors to see if there’s something viable that we can use, versus having to put something else in our data center. These types of things have really helped control costs.
We have to figure out how to do more with less. That’s what IT is about; making things more efficient; starting to fully utilize the tools you have at your disposal versus doing it the same way we always did it.
Rural facilities just can’t survive. And so one of my goals — and our organization’s goals — is to make sure we’re as efficient as possible, because our community needs us.
Gamble: Are you from Vermont originally?
Pierce: I am; I was born and raised here. I joined the Army after high school, so I was gone for about 10 years. During that time, I got married and had two children. For me, coming home to North Country Hospital was an opportunity to help the facility grow, and make sure that if my mom, uncle, aunt, or cousin needs to go to the emergency department, they’ve got a great place to go. I have a large family, and I’m probably about two degrees of separation from everybody in this community.
Gamble: I’m sure it has its ups and downs, but it really does instill that sense of community.
Pierce: It’s funny, people might think that since I work at the hospital, I must know that Uncle Joe, for example, was there the other day. It’s really not like that. If I hear about it in the community, it’s usually the first time I’ve heard about it. And the way HIPAA is structured, I wouldn’t talk about. I can’t talk about it.
Gamble: Right. Let’s talk a little bit about your experience with the Army. I can imagine it really changed your perspective and helped you grow as a person.
Pierce: It was a great experience. Being in the military teaches you respect. It teaches you discipline. It teaches you some of those basic skills you need in life. It teaches you work ethic. And while I may not have another opportunity to use the exact skills gained during my training in the Army, the skills I gained by being part of a team are certainly transferrable.
When I was high school, I wanted to get an education, and I saw Army as a way to do that. But I quickly learned that it’s so much more than that. It’s about serving our country and being part of something bigger. It was so much more than I expected.
Gamble: That could be a whole other discussion, I’m sure. So, you’ve been with North Country for a while, during which time there have been tremendous changes. What has that been like?
Pierce: We’ve come so far since I came here. I feel privileged to have been part of that change, and now part of leading that change — not just where we are now, but what we need to do ensure that we remain financially stable, and make sure we’re strategically focused on the right things for our community. To me, it’s an honor.
When I speak with other CIOs across the country, whether it’s at the CHIME conference or another event, I think people often don’t realize some of the struggles we face, especially as a 25-bed critical access hospital. What they don’t understand is that I wear so many hats, as does my staff. We cover all the areas that larger organizations do, with fewer resources. But those staff members are so versatile; they know a lot about so many different areas. Whereas a large organization might have five people dedicated solely to implementing Dragon, that’s a small part of one or two peoples’ jobs at a small organization.
It’s the same with security. A large organization might have a whole team to address security needs; but for us, it’s part of my job. It’s part of my tech supervisor’s job. It’s part of a lot of all of our jobs — it’s a team effort. In a smaller organization, being in IT or informatics helps develop people with broad perspectives who understand what it takes for an organization to be successful.
Gamble: I remember speaking with a CIO from Nebraska a few years ago. When I asked if she had a CISO, she said, ‘You’re looking at her.’ I think that’s something a lot of people don’t understand, and I believe the additional pressures rural healthcare leaders face are often underestimated.
Pierce: We always get that. People will ask, ‘Who deals with your infrastructure?’ I do. ‘Who deals with informatics?’ I do. ‘Who deals with security, and recruiting?’ I do, and the list goes on. I remember being in the CHIME Boot Camp a while ago, and there was a question that had to do with budgets and finance. I was able to answer by talking about how our budgeting process works and what constraints we have. You have to understand what is happening across the organization. You don’t have to be an expert at everything, but you have to know how to find the answers you need. It’s a great job; that’s why I’ve been here so long.
Gamble: And it’s not the faint of heart, it seems like.
Pierce: It’s not. You have to be willing to roll up your sleeves and do the hard work. If no one else can do it, you do it yourself. You have to be able to work alongside your team. I think a lot of CIOs have teams that do the work, but I feel as though I often have to become a part of those teams.
Gamble: I’m sure it’s not the first time.
Pierce: It’s not. It happens a lot. Another thing that’s difficult with rural organizations is controlling costs. Before we made the transition to an integrated system, and before I became director of IT and informatics, each department was left to their devices when it came to selecting software. They would knock on the door and say, ‘Hey, we bought this software. Can you implement it right now? Because we really need it.’
As an organization, that’s not sustainable. We couldn’t continue to grow to the point where we didn’t have enough staff to support all the servers we have on site, or to manage everything that was happening. And so we put in place a governance structure for IT procurement. Now, if you’re purchasing something that touches IT, it has to go through IT approval. We have a committee that prioritizes implementations.
With our governance team, we’ve managed to consolidate our data center and drive down IT costs. We’ve strategically chosen to move systems to the cloud. That way, if we need to replace a system that’s outdated, we look first to cloud-based vendors to see if there’s something viable that we can use, versus having to put something else in our data center. These types of things have really helped control costs.
We’ve moved a lot of the costs from capital expenditures to subscription-based items that are operational costs, which has helped in being able to predict costs. I had a staff of 18 between the two departments (IT and Informatics); I now have 13. When you think about it, that’s 12 people managing 14 clinics, along with the entire hospital, the nursing home, and all of the informatics and IT support required. That’s pretty efficient.
Gamble: Right. You need that ability and willingness to say, ‘Okay, we don’t have a big pile of resources, so what can we do?’ That’s something that can serve people well.
Pierce: It can. We’ve adopted Lean principles across the organization; we have projects going on all the time to help improve processes. We’re constantly asking, ‘how can we eliminate waste in this process?’ It’s all about getting rid of waste, which will go a long way in keeping us financially viable. There are a lot of regulatory requirements that could easily increase costs, and we have to figure out how to do more with less. That’s what IT is about; making things more efficient; starting to fully utilize the tools you have at your disposal versus doing it the same way we always did it. Because of that Lean initiative, people are more open to that concept. It’s actually been good for everyone to think differently; that’s what we have to do to stay viable.
Gamble: That seems like a good mindset to have.
Pierce: I read a piece from the National Rural Health Association that said 69 percent of rural hospitals have a negative operating margin. To me that’s scary. They’re predicting that 25 percent of rural hospitals are going to close within the decade, and you see it happening. Rural facilities just can’t survive. And so one of my goals — and our organization’s goals — is to make sure we’re as efficient as possible, because our community needs us. We have to help each other. I can’t imagine having to drive 45 minutes to deliver a baby.
Gamble: It ties back to what you said before that it really is all about patient care. It’s challenging, but it also seems to be very rewarding to be in that type of environment.
Pierce: There are hospitals that are looking to do whatever they can to survive. They’re looking to see if they can affiliate, or merge—whatever they can do to keep their doors open. It’s hard. And we know healthcare is costly, but being a rural facility, we have upwards of 50 percent Medicaid patients. When you have that type of revenue stream, it’s really difficult to be able to sustain your organization, and it’s important to cut out waste.
Gamble: Right. Hopefully by talking about what your organization is doing and the challenges you’re dealing with, it will help others. We really appreciate you taking some time to speak with us. It’s been great to hear about what you’re doing, and I’d definitely like to speak with you again in the future.
Pierce: That sounds great, Kate. Thank you for taking the time to chat.