Q&A with KSB Hospital CIO Ray Sharp: “As a Small Organization, You Can’t Afford to Make Blunders.”

It’s no secret that community hospitals face more than their share of challenges, whether it’s recruiting IT talent (and competing with larger organizations to retain them), securing data on a tight budget, or contending with a much smaller pool of vendors than their larger counterparts. Katherine Shaw Bethea Hospital, an 80-bed acute care facility located in rural Illinois, has dealt with all of these obstacles, and then some.

“When hospitals our size go for bids on certain projects, some vendors won’t even bid,” said Ray Sharpe, who has held the CIO role at KSB since 2018.

It’s not for the faint of heart, but as Sharp said during a recent interview with Kate Gamble, Managing Editor of healthsystemCIO, being with a community organization also comes with plenty of upside. “Every day you go to work, you feel like you’re doing something great for your community. We serve our family, our neighbors, and our friends.” And KSB has been doing so for 127 years, all while remaining staunchly independent, which is no easy feat.

During the interview, Sharp talked about what his team has done in the past few years to ensure the doors are kept open, and how they’re working to safeguard patient data while enhancing the digital experience. He also discussed KSB’s approach to rounding, his long and winding career path (and what he learned from his time away from healthcare), the value of networking and collaborating with other organizations, and the advice he would offer to new CIOs.

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Bold Statements

We don’t have to be passing information back and forth to those records. It’s just one record. Things like meds reconciliation are much easier; because we have all the notes from physician visits or from inpatient, you get the holistic view.

We send a couple of messages each month to every employee and try to make sure that we’re educating them on phishing tactics and what that might look like. We identify people who click on the most links, and we do one-on-one education with that person.

You still need to have boots on the ground in IT. You have to go to the clinics. You have to get out on the floors. You have to get to the users. You can’t resolve everything remotely.

It was a hard decision. But you have to go with what your gut tells you. For me, it was going back to healthcare and having that innate feeling that every day you’re doing something great for your community.

It was important coming in that people knew that I wasn’t going to be the reason it was successful; it was going to be because of all the resources we put together from the organization. That’s what was going to make us successful.

As a small organization, you can’t afford to make blunders. And so, you’re looking around and asking who has done this. It’s developing relationships with people who are ahead of you with some of the technologies and being able to reach out and say, ‘this product has been great’ or ‘this hasn’t worked as advertised.’ That’s been really beneficial.

 

Q&A with Ray Sharp, CIO, Katherine Shaw Bethea Hospital

Gamble:  Hi Ray, thanks so much for putting aside some time to speak. Do you want to just start by telling me a bit about the organization?

Sharp:  Sure. Katherine Shaw Bethea Hospital is a 127-year-old community hospital in Dixon, Illinois. We’re about 100 miles straight west of Chicago, probably 45 miles from the Iowa border, in a rural community. Our service area includes about 50,000 patients, mainly Lee and Ogle Counties of Illinois. We’re a small 80-bed facility, and we have med-surg, ICU, OB, and behavioral health. We have several clinics in Dixon and in small towns around us.

We try to maintain that service area, especially with OB being a problem in some service areas. A few hospitals south of us have closed; we’re in something of an OB desert, which means people are driving an hour to get those services. And so, we think that’s very important for us to maintain that service in our area.

 

Gamble:  That’s something that we’ve started to hear about. Really scary. Now, is Katherine Shaw Bethea completely independent or do you have some affiliations?

Sharp:  No, we’re a completely independent hospital. Our board has been steadfast to try to remain independent. We do our best to make sure we’re trying to survive another 127 years as an independent hospital. We just feel that a lot of times when you lose that independence, you lose community control, and some of the jobs leave the community. Our goal is to stay independent. We’ll continue to strive toward that.

There are only about four of us in our area. There’s a band from western Illinois toward the east, to the Rochelle/DeKalb area, between Rockford and the Quad Cities. Rockford is about 50 minutes away from us, and Quad City is about an hour away. In this band, there are three or four independent hospitals that are not 25-bed or less. Critical access hospitals have done very well in recent times, but of the ones that fall into the 80 to 100-bed hospital range, like us, three have been able to stay independent in that section of the state. Just having that geographic isolation being an hour away from the larger tertiary hospitals has allowed us to do that.

 

Gamble:  Are you in touch with the other independent hospitals? Is there communication?

Sharp:  Yes. We try to partner with independent hospitals on some things. And other times, it’s the tertiary hospitals we work with. Interestingly, some of the tertiary hospitals would like to buy us — we get calls on probably a quarterly basis — to try to get us to affiliate. But we’ve been able to remain independent.

 

Job diversity

Gamble:  What are some of the benefits of remaining independent? I would imagine having less red tape is one of them.

Sharp:  Yes. We’re a very nimble organization when it comes to making decisions. One of the things for me is that, from a CIO perspective, I get to do more than just be a CIO and do IT. As a vice president of a small organization, I have other departments, including lab, radiology, dietary, housekeeping, client operations, materials management, PT, OT, and speech. All of those areas report up to me. The diversity of my job is very enjoyable.

 

Gamble:  In terms of an EHR, what do you have in place?

Sharp:  We have Cerner’s CommunityWorks version, where we share a multi-tenant implementation that’s hosted by Cerner. We went live with that in September of 2019, so a little more than four years. We have that not only in our inpatient area, but also ambulatory, patient accounting, etc. It’s the full suite of Cerner Millennium. We still have other third-party products for PACS and things like that.

 

Providing a “holistic view” of patients

Gamble:  What about the clinics and physician groups?

Sharp:  All of that is Cerner as well. It’s one system. We think that from a medication reconciliation standpoint, it’s important to have that integrated system throughout your clinics and hospitals. It’s one record. We don’t have to be passing information back and forth to those records. It’s just one record. Things like meds reconciliation are much easier; because we have all the notes from physician visits or from inpatient, you get the holistic view.

 

Gamble:  Right. What are some of your core objectives at point?

Sharp:  We’re focused on the digital front door and getting more digitally engaged with our patients. Cerner has a strong patient portal, and we’ve been adding to that. Some of the big projects we did in the past year involved HealtheIntent and Cerner EDW.

The HealtheIntent is a population health management platform that allows us to manage population health better. This past year, we installed Artera for bidirectional communication and Kyruus Health for provider search and online scheduling. Now with HealtheIntent, we can run a list of patients who are overdue for things like mammograms. We can then use Artera to communicate; take that list and run a text campaign for mammograms.

During the pandemic, people got out of the habit of routine and screening visits. They didn’t want to go to the doctor because of masks or because of the fear of Covid. They waited until they got really sick and then went to the ER, skipping the physician’s office completely. We’re trying to re-establish those habits and increase wellness visits, as well as mammography and colonoscopy screenings. We want to catch things early and give the patient a better chance of survival.

 

Gamble:  That speaks to patient satisfaction and creating an easier channel to schedule appointments, which has been a sticking point for a while.

Sharp:  It definitely is. That bidirectional communication — where you text the patient about their visit, and they can confirm or cancel — has reduced our no-shows. They can also ask a question and we can respond. I think making that digital connection helps us connect with patients and get them into further visits.

 

Gamble:  What about on the staff side — what are you doing with digital tools?

Sharp:  After we implemented Cerner in 2019, we went through a stabilization period and then started working on optimizing each area. We’ve been doing a lot of work in the revenue cycle area to get it to where it needs to be.

With CommunityWorks, we get quarterly updates. They update it no matter what so that we stay current. We get new stuff from Cerner and get it implemented. That’s been the main thing from our staff — just optimizing what we have and staying current. I used to work at a hospital that was client-hosted. Sometimes you get behind models and versions, and it’s really hard to make that upgrade. With CommunityWorks, we know we’re staying right on model.

 

Covid’s impact on optimization

Gamble:  That definitely seems to be a plus. You said you went live in 2019, so I’m guessing you had time to do some optimization or stabilization before everything stopped with Covid.

Sharp:  We had about six months of stabilization before Covid hit. Honestly, I don’t think our optimization happened as fluidly as we would have liked. For the next two and a half years, we weren’t doing a lot of optimizing. We were just trying to deal with the pandemic. Now we’re back in that optimization mode trying to make sure we have best practices in place across our clinics and making sure we’re doing things optimally.

 

Gamble:  You can have every intention of doing optimization but then you have to find ways to get people tested and do everything else that had to be done.

Sharp:  Right. And in fact, we were one of the earliest hospitals in the country to do drive-through Covid testing. Being a small, nimble organization, we were able to get that set up quickly. Our CNO did a great job with that initiative.

 

Gamble:  That is really impressive. And I’m sure it was a big lift.

Sharp:  Actually, we had been doing a drive-through flu clinic every October, and so we already had a process in place. Only in this case, instead of giving the flu vaccine, we were administrating Covid tests. That really helped us having that experience. The process had already been set up for many years, we just adopted it for Covid testing.

 

Gamble:  Interesting. So, I want to talk about cybersecurity. I would imagine you don’t have a dedicated CISO.

Sharp:  We don’t. It goes back to the diversity of work with an organization like ours. Just as with our IT staff, different people have different responsibilities with cybersecurity. My job, and IT leadership’s job is to identify the risks for the organization, what it would cost, and what we would do to mitigate that risk. We then bring that to the executive leadership team and the board and let them make the decision as to whether we can afford to mitigate that risk or we can afford to live with that risk. We’ve been doing pretty well with that.

We use a lot of Microsoft products. We’re a Microsoft 365 shop, so we use Microsoft Defender ATA (Advanced Threat Analytics) and ATP (Advanced Threat Protection). We’ve also implemented CrowdStrike. We use KnowBe4 for phishing education and testing where we send a couple of messages each month to every employee and try to make sure that we’re educating them on phishing tactics and what that might look like. We identify people who click on the most links, and we do one-on-one education with that person. Those are some of the things we’ve done in the cybersecurity space.

Some of the risks tend to be with our partners — medical systems that have to go through FDA approval. They have a hard time staying current with the operating systems and databases because of having to go through FDA approval all the time. And so, sometimes, they might not have an offering to where you can get to the most current OS level of Microsoft. Those are sometimes a risk for us as well, and so we’re working with those vendors all the time to get the most current versions and make sure we have all the patches.

 

Rural cybersecurity

Gamble:  One of the positives we’ve been seeing is that there are more resources than in the past for rural organizations when it comes to cybersecurity. Have you found that to be the case?

Sharp:  We’ve been fortunate to be involved with some of the AHA offerings from the federal government; particularly the 405D resources for managing threats. I’m trying to stay involved with those organizations and use those resources.

The AHA has been great about sending out security alerts; that helps us make sure we’ve been alerted of a patch. We appreciate that. And 405D has some good information and is helping us with educating our staff and making sure we’re staying current on some of the threats.

 

Vendor challenges – “Some vendors won’t bid on us.”

Gamble:  Now, as far as some of the other challenges of being a rural organization, I know there are quite a few. But one I want to focus on in particular is vendor partnerships. Has that been difficult? What has your approach been?

Sharp:  One thing is that when hospitals our size go for bids on certain projects, some vendors won’t bid. They only want to bid on the larger organizations. Before Cerner had the CommunityWorks model, you could host it yourself, but that took a lot more resources—not only staffing-wise, but from a financial standpoint as well. We’re fortunate that Cerner offers the CommunityWorks module. We use a multi-tenant model, which has reduced our cost and helps us stay current. You need to find vendors who are looking to operate in this space, and partner with them.

“Boots on the ground”

Attracting quality staff has also been tough. You still need to have boots on the ground in IT. You have to go to the clinics. You have to get out on the floors. You have to get to the users. You can’t resolve everything remotely. When Covid happened and we had the whole trend with remote work, it was hard to keep staff when they could work anywhere in the nation from their home.

We’ve had a little bit of that. We recently lost a staff member to a health system that offered a fully remote role. We can’t really offer that. If things go down, we’ve got to have that person on the ground. We can be flexible; some work can be done remotely, but for the most part, we want local employees who can be on the ground when needed.

 

Rounding is “a big part of what we do”

Gamble:  What about rounding — do you do a fair amount of that?

Sharp:  Yes. Again, Covid shut us down a little bit in terms of rounding, but our goal is for clinical analysts and technicians to round together; to go to clinics together. Usually, you find a lot more problems than are reported, and a lot of the time, you can resolve them right there. Rounding is a big part of what we do — not only from a leadership perspective, but from an IT perspective, from a plant and operations perspective, and from a housekeeping perspective. It’s really important to get to every one of those clinics, be face-to-face with those users, and develop relationships. Rounding helps you succeed in so many ways. People are more apt to tell you exactly what’s going on when you develop that relationship with them. A lot of times, you have to have eyes on them.

There’s a lean manufacturing term called ‘go to the Gemba’ which means go to where the work is done. I talk about that a lot with our IT department. We have to make sure we’re going to the Gemba, where the work is done. When you lay eyes on it, you usually resolve it faster and with a better solution.

 

Gamble:  It makes sense. When people get to know someone, they’re going to be more open. But also, as you said, being there in person makes people more likely to tell you things that might not seem like a big deal but could become one in the long run.

Sharp:  It’s those nuisances that you might solve in 30 seconds. Or you see that they’re doing something that could be done better. With a lot of applications there are three different ways to do something. They might be taking what we perceive to be the long way, and we could say, ‘you can do that quicker by just doing this.’ Instead of five clicks, it’s two clicks. That’s part of it too — watching their workflow and giving them tips to improve efficiency.

 

Gamble:  And it helps IT as well by getting a better understanding of how people work.

Sharp:  It helps us understand what they’re doing, and it gives us a better appreciation for what they’re going through on a daily basis.

 

From banking to manufacturing to healthcare

Gamble:  Looking at your career path, you’ve been with the organization for about 5 years. And before that, you had some roles outside of healthcare. I imagine that gave you a unique perspective.

Sharp:  The good thing is that IT travels from industry to industry, but obviously, healthcare is different. I started my career in banking with Citibank right out of college. I was a computer science major as an undergrad. I was doing programming and writing first mortgage loan origination systems on PCs and Novell Networks back in 1985. I started out in programming, and then moved back to the area where I grew up and went into national manufacturing with a company where I had interned in college. Someone had retired, and they recruited me for a job. I worked with them for about 11 years, mostly in a programming role, then in a project management role. I was fortunate enough to go back to school at the University of Chicago and did my MBA during my tenure there.

At that time, I was doing a lot of volunteer work in the community. During a volunteer meeting, I met the CEO of CGH Medical Center, who told me they were going to be posting for a CIO position and it would be in the paper the next week. I applied, and he hired me to be the first CIO at CGH Medical Center. I was there for 16 years.

Then, I made the switch to go back to manufacturing as global CIO for Wahl Clipper Corporation and had some great experiences there. We put a new plant in Vietnam, and I was able to go there and put in all the IT. I also traveled to China, Germany, and some of other places where we had plants.

At the end of 2017, KSB had made the decision to commit to Cerner Millenium CommunityWorks. I’m Chairman of the Board for Sterling Federal Bank and the CEO at KSB [David Schreiner] is vice chair. He was the VP here while I was VP at CGH; whenever we went to hospital events, we always did things together. We’ve known each other a long time, and so, he convinced me to come back and implement Millennium, which I had implemented at CGH in 2001. He convinced me to come back to healthcare.

Community health – “It’s a different feeling.”

The great thing about working for a community hospital is that every day you go to work, you feel like you’re doing something great for your community. We serve our family, our neighbors, our friends. It’s just a different feeling. Wahl Clipper is a great corporation and they’re very benevolent in our community. I actually coach high school basketball at the Catholic high school, and they’re very supportive. It’s a great company, and so, it was a hard decision. But you have to go with what your gut tells you. For me, it was going back to healthcare and having that innate feeling that every day you’re doing something great for your community.

 

Gamble:  I’m sure we can do a whole different segment on the difference between doing an EMR in 2001 and 2019. But I would think having that background certainly played a role.

Sharp:  You bet. But for me, it was about connections. I’ve known Pete West for more than 20 years. I had really good relationships with Cerner and the people in leadership there, which helps too. To be able to pick up the phone and call people at different levels if something needs to be escalated is very valuable.

 

Gamble:  It definitely seems like it was the right career move.

Sharp:  You have to live your life looking through the windshield and not the rearview mirror.

 

Organization-wide commitment

Gamble:  That’s a good way to put it. Did you have any hesitancy going into healthcare because of how much had changed in just a few years?

Sharp:  I did because I was out of healthcare for five years. But I maintained my ACHE fellowship and tried to stay current in healthcare. You just never know where your career is going to go. There were some big changes, but some of them were similar to what we were doing. For example, at Wahl, we were changing ERP systems and looking at cloud-based solutions. It’s some of the same things from an IT foundational standpoint that you have in healthcare.

All of these are big projects that need involvement from the whole organization; they’re not IT projects. We need a commitment from the organization. You need to have people from every area working on the project to make it successful. I’m fortunate that our CEO committed the resources to make it a successful implementation.

 

Coming in as the new CIO

Gamble:  What was your approach when you came to KSB? I’m sure you wanted to get to know the organization and the people before making a big change.

Sharp:  When Dave brought me in, some people already knew me. I had been in the community for a long time and was coaching basketball. But it was important coming in that people knew that I wasn’t going to be the reason it was successful; it was going to be because of all the resources we put together from the organization. That’s what was going to make us successful.

I started on July 1, 2018, and we kicked off the project right then. The main focus for me for that first year and a half was the Cerner implementation. After that, I started to take on the other projects from a leadership perspective.

 

Healthcare’s big advantage

Gamble:  So you did have to jump right in. Interesting. Okay, the last thing I want to ask is what advice you might offer to someone who is stepping back into the CIO role after a while, or maybe even a new CIO. Any guidance on how to negotiate what can be a tricky adjustment?

Sharp:  First of all, one of the differences between manufacturing and healthcare is that in manufacturing, if you go to a conference, you don’t share information with anybody because it’s so competitive. You’re competing with everybody. In healthcare, you can go to a conference and the other CIOs are so collaborative. Organizations in general are more collaborative because you don’t necessarily compete with them.

When I first came to CGH, I joined CHIME, and went to a conference that was all healthcare CIOs. You could ask anything, and people would tell you how things work. I think the biggest thing for healthcare CIOs is to develop relationships with other CIOs, because you can ask them anything.

Through CHIME, I’ve developed some great relationships with other CIOs. I feel like I can reach out anytime with a question and they’ll help guide me. I really appreciate the mentorship, which has helped me grow as a CIO in healthcare. Professional organizations like CHIME, ACHE, and HIMSS are really important to help get up to speed on healthcare and learn how you can help your organization.

 

Gamble:  That’s a great point. I can’t picture asking someone at CHIME which EHR system they’re using and having them say, ‘I can’t tell you that.’

Sharp:  Right. As an example, when Citrix first came out, people were asking, ‘who’s implementing this? Is it working?’ That’s so important because as a small organization, you can’t afford to make blunders. And so, you’re looking around and asking who has done this. It’s developing relationships with people who are ahead of you with some of the technologies and being able to reach out and say, ‘this product has been great’ or ‘this hasn’t worked as advertised.’ That’s been really beneficial.

 

Gamble:  All right. Well, I want to thank you so much for your time. It was great to meet you and hear your story.

Sharp:  It was great to meet you, Kate, and I appreciate you taking the time to talk with me.