Eric Jimenez, CIO, Artesia General Hospital
In this interview, Eric Jimenez, CIO of Artesia General Hospital, a 25-bed hospital with 16 clinics in southeastern New Mexico, discusses the hospital’s initiatives and challenges as a rural healthcare provider. Jimenez talks about going from many EMRs to standardizing on TruBridge; a recently completed on-premise data center; and how they are integrating AI to improve operations, reduce physician burnout, and enhance efficiency with Microsoft Dax Copilot.
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Anthony: Welcome to healthsystemsCIO’s Interview with Eric Jimenez, CIO at Artesia General Hospital. I’m Anthony Guerra, Founder and Editor-in-Chief. Eric, thanks for joining me.
Eric: Thank you for having me.
Anthony: Very good, Eric. You want to start off by telling me a little bit about your organization and your role.
Eric: Artesia General Hospital is a 25-bed rural acute care hospital with 16 clinics located in southeastern New Mexico. We have a main campus and clinics in Artesia, New Mexico and we also have remote clinics in a town about 30 miles south of us in Carlsbad. We provide a large range of services from family practice, behavioral health, endocrinology, cardio, ortho, pain management, podiatry, urology, room care hyperbaric services and of course, we have the traditional inpatient, ER, radiology, lab, all those different services that a regular health system would have.
Anthony: Very good. You’re a rural small health system. You’re facing some of the challenges that that group of healthcare providers is facing and we’ll get into that. Why don’t you start off by telling me about some of the main projects or things that you’ve been working on in the last year or so and then we’ll go from there.
Eric: We just completed build-out of our new data center at the beginning of the year. We were in a full hyper converge environment and we are running out of space and size in storage, in cooling. We’re facing constant issues with our data center and our executive team decided we had to make big decisions, one of them was if we’re going to move to the cloud or stay on premise. The executive teams believe that staying on prem is still the best road map for us. Being in a rural area, we do have limited internet connections sometimes and that can hinder patient care. We decided to double down and build a new data center that allows us to be prepared for the future.
Another major project is our CEO tasked the executive team to focus on how artificial intelligence is going to help us in the future and to figure out how to best make that work for our organization. We always have to look at it from a different manner as far as the triple aim mentality, and that’s where I want to focus. We look at that triple aim of care and try to figure out how to mix that into our IT strategy.
Anthony: They assume you’re the AI guy and you’re going to know it like Elon Musk, right. In your situation, in every healthcare system, you’re trying to do the best you can with what you have. Everybody says it’s tight in healthcare all over the place in terms of margins and costs. You have to watch your expenses. In IT, you’re expected to bring in solutions that are going to save money even though they cost money to bring them in.
AI is one of those things that people hope, or assume, or think, might be what saves them. How do you go about figuring out where AI might help the health system? This is a classic dynamic in IT leadership – how much do you lead and bring ideas to users and how much do you let ideas and request bubble up from users. It’s got to go both ways, right?
Eric: Correct. That’s a good statement. I think one of the big things that our CEO brought to me was a video of a health system in Florida. The health system, they’re talking about pajama time. They’re focusing on how can we improve physician burnout, how can we improve that pajama time. He shared that with the executive team. I saw what he wants, I know what he needs and of course, the program that was being highlighted in that was Microsoft Dax Copilot. How can we bring that environment here?
We went to Microsoft to try to figure out how to partner with them and how to get them in our environment. There’s a cost associated with it and once we vetted them, looked at different models, different vendors, we went down the proven track. Because Dax Copilot has been the leader in the industry. If we went with a start-up, those start-ups can cause problems down the road, that’s why we went with Dax Copilot.
When we implemented it, everyone wanted the tool right away. But we wanted to make sure we implemented in a pilot program – take 10 physicians and walk them through the year and see how that improves their workflow. We had a new provider start recently with us at the hospital and he was struggling with our technology and we said “okay, hey, I know it’s one more piece of technology but let’s add it into your workflow. Let’s see how it improves your day to day.”
He went from seeing about 5 to 6 patients to seeing back to a full workload that he was doing at his previous place because he didn’t have to sit there and remember the workflow. He said now that he’s got the flow of how the electronic health record works and Dax on top of it, he’s seen a great improvement in his day to day. He’s not staying late. He’s not using pajama time to do that stuff. That’s kind of what we try to tackle in our environment, find use cases for artificial intelligence.
Anthony: Very good. I want to go back to what you were talking about with the CEO and how your CEO said this is a concern of mine, burnout, clinician satisfaction, clinician happiness, go do stuff that makes this better. It seems to me like that’s critical to get that kind of messaging from your CEO. Hopefully you wouldn’t get someone like this, but you might have someone who says ‘I want you to spend less on IT,’ right?
Eric: Correct. I mean, we’re blessed because our CEO is also a practicing physician. He understands the pains, the struggles and everything that a physician has to go through. Our strategy over our future plans for our hospital is A., how do we improve the patient journey and how do we improve the employee journey on top of that. Those are the main goals that we’re trying to figure out.
We focus on the provider side of things and now there’s more to come with our partnership with TruBridge. What they’re working on in the background with artificial intelligence and how they’re slowly working that through their systems will be important to see how they’re going to come out, how they’re going to help us improve that physician side of thing and from the employee side of thing.
We’re also tackling it from our perspective on the employee burden and how do we lessen that burden and that cost. We’re starting to look at technologies like RPA (Robotic Processing Automation) to help those frontline workers do their day to day job, to make sure they’re able to tackle, focus on the patient, not focus on ‘hey, did I check eligibility, hey, did that patient get the right information from the driver’s license.’ We’re trying to help that part of that burden on those employees.
Anthony: TruBridge is an EMR for the smaller health system. Is that how you would describe it? What’s the best way to describe what niche they’re the best for?
Eric: Of course they can handle multiple size hospitals but I think their niche is that 50-bed and below, sort of like us, critical access, rural hospitals. You get a good product for the cost. You know what I mean. That’s what their good with. Our partnership with them has been great. We migrated from multiple systems, paper processes into one health record. Their net process, our goal was one patient one bill.
TruBridge helped us get there with that one patient, one bill type of format. Now, we have 10 year’s worth of data from the ambulatory side because it’s an encompassing solution from the inpatient site to our ambulatory sites. We do have a lot of clinicians that do surgeries and that’s what our niche is. We provide great quality care for our community. A lot of our patients they have options. There are two hospitals north of us and a hospital to the south of us. They’re a little bit on the bigger side but patients will travel to see our doctors from those towns and so we pride ourselves on that community and that excellency to provide quality care.
Anthony: Let’s talk to your peers out there in comparable size health systems and try and help them out. If you want to describe your search for a new EHR, you said you had multiple EHRs, you had paper processes and you wanted to standardize. I assume you did a formal search and said ‘okay, we want sort of the Epic for the small market. We want inpatient, outpatient. We want a unified health system. We want to get on one system.’ Tell me a little bit about the process of making that selection, involving users, however you did it, with an eye to your peers who maybe in the same position and about to go down that road.
Eric: The best way to put it is it’s not an IT project, it’s an organizational project. Sometimes in our rural areas we have to wear multiple hats. Of course, that’s where that process – don’t tackle it as an IT project, it’s an enterprise project. Everyone has to have buy in from the executive team to the med staff to the directors, everyone has to have the buy in of that solution.
Lessons I’ve learned from the implementation of TruBridge, – if I would give advice to myself 10 years ago, I would say take your time. Don’t rush the process. At the time we needed to replace our electronic health record because we’re banging against meaningful use. Ten years ago, that was the big thing to make sure that we were part of that meaningful use money.
Now, it’s about looking for the efficiencies, looking for how a solution can help you, that patient going through that patient journey, the importance of understanding that from every side of things, that’s the key element of a good implementation. That would be another piece of advice, understand the patient journey and understand the employer journey through your health record.
Anthony: What would have been better by not rushing it? Would it have been more time to sell it, so to speak, internally and the benefits to the users? Is that what more time would have afforded you or you tell me?
Eric: I think we were ambitious and we implemented a single solution big bang type of thing within 90 days. From the time we signed the contract to the time we got it in place and it was a 90-day window. I think the big thing is it’s more than just 90 days. You know what I mean? It’s the understanding your processes, understanding your workflows, understanding – it’s got to be a mirror of technology and process together and sometimes what exists won’t work in the future and you have to augment that and get to a better, cohesive process that will mirror the new way and help improve things.
I think that’s what happened. If I look back, we tried to take the old bad process and put technology in place and that doesn’t work well. We’ve learned. We’ve learned for the past 10 years that if there’s a problem with the technology, then we would go back to our vendor, we would go back to TruBridge and say hey, we need this improved. They would come back several months later and say hey, here’s what we got.
Anthony: Let’s talk about understanding workflows as an IT executive. If you’re going to lead IT, it’s important to really understand clinical workflows and the needs of your users. When you run any type of health system, there’s a whole number of specialties. There’s inpatient, there’s outpatient. There’s many, many users that all have their own specific workflows. It’s critical when you’re leading IT to understand as much of that as possible and make that a continual education journey. Then get out there and see what people are doing and understand to the best of your ability what they’re doing because it will help you be a better IT executive. Does that make sense?
Eric: It makes sense, makes perfect sense. Like I said, I don’t like talking about myself or my journey through being where I’m from. That was kind of my big thing is I’m not a nurse, I’m not a doctor, I’m not a lab tech but I want to know what you do on your day to day basis to best understand how I can deliver technology to you, you know what I mean and how can this piece of technology help you improve your day to day work. That’s kind of where I always start something.
When I look at a piece of technology, I look at it from that workflow, how can we improve that. I like to roll up my sleeves, get in there and go through that patient journey, understand. As a patient, I want to understand hey, what is that person doing on the computer and why is it taking them so long? I look at it from that lens and then I put it in front of the employee lens of how that workflow goes through and how do I tackle this, how can I improve that process. That’s kind of where I get involved. Sometimes, I get stuck in the weeds but I have to wrangle myself out of it and think of that big picture or what we’re trying to do.
Anthony: That’s all really good. When you’re trying to ask questions and learn workflows and you’re asking about your issues, about your problems, is that always well received or is there a way to do that and screw it up? I’m thinking probably not initially but I’m thinking if you do that, if you do get in there and ask questions and the clinicians give you their time and explain things to you and nothing happens, the next time you go back, they’re going to say “no, I gave you an hour of my time. I told you everything and nothing changed.” If you’re going to ask for their time so you can learn their workflows, you have to show results. Does that make sense?
Eric: It makes sense. It makes perfect sense. That’s what we’re looking at right now. We’re still at the very infancy of gathering the data and so we’re asking them to walk us through this process, tell us how you go through the electronic health record and make sure we knew and have a good understanding of how you check the boxes.
What we try to do at the beginning, always start with that why. Why are we doing what we’re doing? Get them to understand hey, we’re going to tackle this, this is why we’re doing it because we’re trying to help you during your day to day burden and get there. When we’re doing that with the RPA process, that was kind of the understanding that hey, this is why we’re doing this so you could focus on patients. That’s ultimately what the end result is. With the providers that we implemented Dax, they saw the return on investment, improving his day-to-day workflow has been great.
Anthony: Excellent. Very good. The why helped you get their time, right. Because these are very, very busy people and sometimes they may not be that receptive to “hey, I need you to join this committee or I need you to sit down. I don’t have time, I have to see a zillion patients today. By the way, your tools are slowing me down and I got to do all this documentation and I want more pajama time” and you’re like “but I can’t help you unless you give me a few minutes.” Tell me about that and you said you start with the why. I’m guessing that’s part of what will get them to agree to sit down with you.
Eric: I think getting them to start with the why but just like you said earlier, that return on investment, you’re selling them on a dream, kind of a possibility that could happen if we partner together. That partnership is key. I give them the why, but also understand that there’s a partnership that has to be associated or is the little give and take that has to happen and it’s not always going to be perfect.
I can tell you that partnership with TruBridge has never been perfect but there’s always that give and take, “hey we need you to improve this.” That’s kind of where we try to do, try to get that partnership in place.
Anthony: Excellent. I want to shift gears in the few minutes we have left, talk a little bit about cybersecurity. It’s constantly discussed as sort of a pain point for rural health systems that just having the expertise in-house, having the resources and the money to combat what could be nation state actors is just not a winning proposition and the government needs to do something to help out small health systems.
I thought of it when we were having our earlier discussion about your CEO saying clinician burnout, pajama time, I want this to improve. Cybersecurity is an area that it has to be good. It’s not even like it’s got to be mentioned, right. Well, I guess you could have a CEO that emphasizes it but we assume everyone is saying that’s like stakes to play. That’s got to be solid. How do you handle it? How does a small rural health system handle cybersecurity as well as possible?
Eric: It goes back again to technology. Again, I’m blessed because our leadership has always given me the ability to purchase the right technology and make sure that technology gets implemented. There are also great partners, your VARs that you partner with, I think those play a key factor into it. But again, it truly falls back on the individual. Even though I’m going to say “hey, I got to put my cybersecurity hat on or my CISO hat on this week and I have to focus on making sure that we’re protected. As a CIO, you have to be ahead of the curve. You can’t always be reactive. You have to be proactive. You got to find those tools and grants and projects that are out there that allow you to learn something from, out of the whole process.
I think Microsoft and Google have given us the ability to help rural hospitals out but also being able to have that uncomfortable talk with your CEO or your CFO to say “hey, we need to invest in this technology because it’s either that or we’re going to have to invest in people.” I think one of the big things is for the longest time, I focused on putting the right tech in place and now I’m focusing on making sure “hey, I’m able to man that tech to the best ability with the right people.”
Finding those right people in rural America is very hard. You got to sell them on a dream. You got to sell them on a challenge. There’s always going to be people out there that don’t care about the environment around them, they just want to be challenged and work.
Anthony: That’s awesome, Eric. We’re just about out of time. I’ll just ask you one final question and I’ll frame it up, asking you to give your best advice to someone in your position at a comparably sized health system.
Eric: Always be a student, never let your ego get in front of you. Always be ready to learn something new. Like I said, without that ability to understand, the ability to constantly be learning, your ideas will never always be the right ideas. They might get you from point A to point B but always be open to other people’s ideas. Because they might be able to spark something that will lead you down another path.
When I go to conferences and I meet different people from different health systems and we all talk, from large health systems to small health systems, we all had the exact same problems, it’s how we handle and how we do things internally. I think if I would give anyone advice is be a student. Always be ready to learn from that.
Anthony: That’s wonderful, Eric. That was great. I want to thank you so much for your time today. I think our listeners are really going to enjoy it.
Eric: Well, thank you.
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