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Building a Modern Emergency Department Information System

Michael Archuleta, Chief Information Officer and Director of Information Technology Services at Mt. San Rafael Hospital, modernized his organization’s Emergency Department Information System to reduce errors, cut costs, and save lives. He took a chaotic all-paper system and transformed it with digital solutions - substituting paper charts and charging methods for quick-use touch screens and easily transferred data.

Health IT on the Record, presented by MEDHOST, explores how innovations in health information technology impact every aspect of a health system, from multi-hospital networks down to individual patients.

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Michael Archuleta: Healthcare individuals live in silos at times. Get out of those silos ladies and gentlemen, we are in the digital age of healthcare. It is extremely critical that we collaborate, that we improve, that we create innovative processes that allow us to be successful and help our patients improve their overall care.

Host: You're hearing from Michael Archuleta. He's the chief information officer and director of information technology services at Mt. San Rafael Hospital. In this episode, he talks about modernizing emergency department information systems to keep up in the most fast paced EDs to reduce errors, cut costs, and most importantly, save more lives.

Michael: We are doing this, at the end of the day, to improve patient care. 

Host: This is Health IT on the Record presented by MEDHOST, a show that dives into how health information technology innovation impacts every aspect of a health system from multi-hospital networks down to individual patients.

In just a moment, you're going to hear Archuleta explain how he took a chaotic, all-paper system and transformed it with digital solutions like substituting paper charts and charging methods for quick-use touch screens and easily transferred data. We'll also hear how this technology has helped the champions of Mt. San Rafael collaborate on faster, safer, and more consistent patient care while also improving hospital efficiency and increasing overall revenue. Enjoy the conversation. 

Michael: Hello, my name is Michael Archuleta, I'm the chief information officer with Mt. San Rafael Hospital. I am in charge of all technology initiatives here at our facility.

Host: Michael, welcome back. I'm really looking forward to talking with you today. So the topic, it's looking at your emergency department. We're going to be talking about EDIS, Emergency Department Information Systems, and your experience with before and after, and also getting your unique insights as a leader in the industry.

I mean, last time we were talking about how you were able to successfully lead a digital transformation, and I still have this funny image in my head when you were describing, it was like this spaghetti wire monster of sorts, and I think you were saying janitor's closet. Really, it was a pretty rough situation when they brought you in just a couple years ago. And you were sharing stats like there's a 59% up time. It was pretty rough.

But you took that and you turned it into a dream scenario with a steady 99% up time. You've won a bunch of awards. So you know what you're doing. You know how to really do this stuff. But I'm looking forward to this. So first, just to start off, thank you for your time. I'm looking forward to this.

Michael: Hey, same here. Definitely always honored to be here, so thank you very much for having me.

Host: So rewind it back before you began implementing MEDHOST's Emergency Department Information System, tell me about your emergency department. What was happening when it came to just the flow, your patient records? Kind of paint us a picture of where things were.

Michael: So just paint a picture of emergency departments are definitely very chaotic at times. I mean, that is literally life-saving individuals in that area. Full respect for them. But of course, when you're doing that and when you're trying to chart everything on paper, that becomes an issue.

So when we basically started, the before, was really fully paper-based. There was really no electronic initiative in place until we basically started looking for a system that was going to be sufficient for the ED departments. Because at the end of the day, like I always stated, is I'm looking for an actual business partner and not a vendor. And the thing is is we were looking for an ED system that can really help deliver fewer medical errors, more revenue for the hospital, faster patient throughput, and higher patient satisfaction scores, which was extremely critical.

And another critical point was we wanted something that was really designed by physicians and nurses to basically understand the system. Because at times, if you don't have that clinical aspect built into the applications that you are implementing in your organization, you will have some fail points. Because at the end of the day, we do have different mindsets. I mean, you have the engineering, technical mindset, which is completely different from a clinical mindset. So it was really critical that the specific systems that we were looking for were really going to be helped – would help our physicians and our nursing staff moving forward.

Michael: When we started this process, we did a lot of studying, a lot of verification, a lot of workflow processes, workflow analysis to kind of determine what is going to be the best system for our organization. So we started even doing site visits.

I remember going to three different states and looking at their ED system because at the time we were looking at MEDHOST's EDIS, and then we were looking at two other ED EMR systems. And as I stated, we really wanted to bring that aspect on how ease of use was it for our physicians? For our nursing staff? And then, of course, what were the outcomes and the improvements that it basically brought to the organization and to the patients that we basically serve?

So really, I mean, we had a lot of investment involved in getting a system for the ED department from site visits to verifications to demonstrations to hospital resources that were using the system. We even reached out to patients that were involved with the systems too and how their input was in utilizing, say, the patient portal, or did it seem like it was a good experience for the patient moving forward. So we started doing our verification in really kind of determining the best of breeds, and that's what I like looking at it. MEDHOST EDIS was one of the top systems out there at the time, and it still is.

Michael: And as I stated, at the endpoint we wanted something that, since we already had the inpatient EHR system, we had the enterprise applications, we wanted to make sure that the system that we did also get was going to be interoperable with all the other additional items that we did have with MEDHOST because it is extremely critical when information can basically flow smoothly.

Because at the end of the day, if you have smooth data, you also have a smoother patient, better patient care, better continuity of care, better ways of traveling that data to the appropriate groups or organizations needed to move forward and improve the care of that patient. Some of the additional EDIS features that we really like made life so much easier for the clinicians to basically go down that path.

And then, of course, to help boost up some of the revenue for the organization, they had automatic capture charges, going in, selecting a specific item with it during the documentation, charge by documentation. So it really smoothed out that overall process moving forward. And MEDHOST has really, as I stated, has really focused a lot on patient improvement, patient experience because I always tell you, at the end of the day, we all have a new CEO, and that's the patient.

Host: I love that line.

Michael: Absolutely.

Host: I love that mindset.

Michael: It is so critical because at the end of the day, if we're not providing the proper tools, we will not be a successful organization. So you figure a lot of these applications and these designs are really focused towards the patients, which was extremely critical of improving the overall aspect of care.

And having MEDHOST as an actual business partner versus an actual vendor was so critical because at the end of the day they saw our success, and our success became their success, and also, their success really became our success. So that's always my overall motto in creating a good structured business relationship with good groups of individuals that you are going to invest a lot of capital against to really improve your overall organization.

Host: Right. Well, you're very relationship-driven. And I know you just said that one mindset that you are really trying to drive home to your entire team about it's the patient, they become your CEO. Now, when you were talking just a moment ago, you were painting the picture of these are – I mean, of course in the ED these are, you were saying, life-saving individuals. And you were talking about how it's chaotic, it's high stress, there's a lot on the line.

And when we look at some of the challenges from the old paper-based system, and that's just the way it was. But when you're working with the people, I know that's really important to you, whether it's the end patient or the actual team, your physicians, nurses, what were the staff attitudes in changing to an EHR from the paper system? And not only that, but how is it, perhaps, varying between departments? And how did you, as the leader on that, how did you manage that? Keep the relationships going with everybody to make sure you could actually get to where you were wanting to go?

Michael: Absolutely. So as I always say, it really takes that overall good story behind it. The reason why you're doing this, the outcomes, the preparation, and having the support from top down is extremely critical.

So as I stated, the ED system was fully paper-based system. Imagine this, I mean, you figure you have a trauma coming into your facility, and everything is paper, and you're trying to pull out the supplies that you basically need. You're really not mattering what you're taking here or there or what you're removing to save that patient's life. It is a quick, high-paced environment.

And at the times, we were losing revenue because all of the actual physical items that were basically utilized on the patients contained yellow stickers, and those yellow stickers had to be unpeeled, and then attached to the actual paper chart of the patient because then that would allow the individuals to go in and charge that patient properly. But if you forgot to run through processes or you forgot to pull a sticker off, you figure if that happens constantly, that really loses a lot of revenue to the organization.

And as I said, please note, the number one thing is patient care and I could care less what is being pulled out here and there as long as that patient's living. But on an organizational standpoint, that really affected the revenue coming in because they would see quite a bit of a loss going out to the actual supplies that were provided to that specific department.

And when you look at the electronic medication administration record, really software that's there to replace your current paper MARs, which is extremely critical, it's such a night and day difference because you now have this electronic documentation, verification, more efficient, better patient safety, a quicker way of capturing charges. So it all works out in the end because the number one thing is it improves the way we're documenting or running a patient through the actual organization.

It allows us to capture everything needed that was associated with that patient. It allows us to keep the patient safe. And it allows the communication between nurses, physicians, and clinicians very, very comparable as a 360. I always say a 360, why? Because we always want to know the overall 360 of the organization, of our environment, of our department, and that really brings a lot of benefit is with proper communication, proper verification, proper documentation of that patient, which eventually allows if that patient has to be transferred out, which allows you to send more of an advanced continuity of care, which at the end benefits that patient and the overall care that patient receives moving forward.

So really a night and day difference. And it has been, honestly, as I stated, has really been a privilege working with MEDHOST and their team because they are absolutely an amazing organization. 

Host: Health IT on the Record is brought to you by MEDHOST. With over 30 years of experience partnering with providers nationwide, MEDHOST is helping evolve better solutions for healthcare management through innovative workflows and technologies. For more information, visit Let's jump back in. 

Host: I just want to kind of take it back really quick because you were talking about the focus, of course, it's about the care, it's about saving their life when you're in the emergency department. So there's a lot of unknown and you want to make sure that they're being helped. You were also talking about the organizational bottom line, and of course, to continue helping people you have to continue to make sure it's a healthy, thriving organization where you're not bleeding from missed revenue and all of that.

So what I'm trying to get to is when you're introducing a new tool like this there's a funding process, and I just want to talk about that. What was the funding process like for implementing the new system? And how were you, ultimately, able to get that money needed?

Michael: Absolutely. So at the end of the day we all come down to what is the return of investment back to the organization? What does this specific product that you're looking at implement, how does it improve the aspect of what you're doing? What is the current strength, weakness? What are the assessments you have done with the organization and with the application through basically putting together?

These are all really a very, very important aspect. We started utilizing, and I'm not sure if you're familiar with this, but we do a lot of SBARs here at our organization. So the SBAR basically stands for situation, background, assessment, recommendation. So it really improves the communication towards what is happening, what is the current situation as we speak right now.

We are a fully paper-based system, the efficiency isn't there, patient safety is compromised, etc. What is the background? How did we get here? What are we doing moving forward? And then, looking at the assessment. What have you done to see any improvements moving forward with your search? And what are you recommending to the overall finance committee? Is it an application that's going to be beneficial to the org? What type of return of investment are we looking at? What type of total cost of ownership are we looking at? Have we done evaluations on other organizations utilizing this product? What are the intakes from the physician's standpoint? How ease-of-use is it for the physician?

I mean, it was really an extensive verification of what we had to do in order to be successful to basically sell this. And once the SBAR was basically approved, we came out and we did a presentation to the board of directors on this is where we're at now, and this is where we want to be. This is the reason why we're moving in this direction, and this is the total cost that it will cost this organization moving forward. But at the end, this is the return on investment and the improvement of revenue that would basically be brought out if we did implement this system.

So really, with all of those specific aspects in place, really helped us improve and basically sell that specific story and that specific project to our organization, which was extremely critical.

Host: Next, I want to ask you about the goals that you were thinking about, the goals for implement the EDIS. And as you're going through coming up with the concepts, the benefits to create the overall story so it makes sense so you can communicate that from the top down, I know you've talked about how important it is from the top down, can you walk me through what the goals were? And on top of that, what advice you would give to other CIOs, other people who are in a similar path right now as they're walking through this?

Michael: Yeah. Absolutely. So it's always very critical to kind of determine what type of situations you have right now. What type of governance does the organization have to approve new implementations, new projects? And really trying to get buy-in from your clinicians is really critical. I mean, having a physician champion, a nurse champion really associated with the sell of the project is really, really a key element. I think that really brings in the concepts which allows the physician champion to sell to his colleagues, which allows a nursing champion to sell to his or her colleagues.

So it's extremely critical that you have that type of collaboration within your organization. And having that is going to be kind of a really good success point towards you because it allows you to kind of bring in more individuals of understanding why are we doing this. We're not doing this to basically ruin anyone's life. We're not doing this to change your overall process. I mean, there's absolute many different improvement reasons on why we're doing this. We are doing this, at the end of the day, to improve patient care. Period.

And that's what I always look at is the improvement of patient care is an extremely critical element that we always try focusing on moving forward. So it is something that collaboration, proper communication, and understanding of what it is is really an important aspect. Like I always say, man, you gotta change that culture and you gotta change it big time. And I always like saying too, at the end of the day, healthcare, we're so behind the curve when it comes to technology, but we got to let everyone know, and we gotta say, "Hey, Flintstones, come meet the Jetsons. Let's all work together and make a collaboration of one."

Host: Man, you've got the best visuals. I really like that. Okay, so I know you've got a little bit of time left and now what I'd really like to do is just zoom in about implementing an EDIS change and how that change affects the patient. I know you just said it's all about the patient experience.

So let's kind of zoom in here, maybe just come up with a name, like Evan, perhaps. So Evan comes into your hospital with – really, into your emergency department. Now, recapping what we've been talking about so far, what are the biggest changes from how it was, paper only, and how it is now with a solution that you've successfully deployed? What are the big changes that really stand out to you?

Michael: Yeah, absolutely. So I mean, there's basically more improvements of patient safety. That's a critical element. I mean, when it comes to having an electronic system which allows you to improve your overall order entry, your results, better communication workflow is really critical. So I think, at the end of the day, you've really seen a night and day difference of a patient coming into our ED now versus before, really focused towards that patient's safety. The improvement of the continuity of care towards that patient. Really making the care as efficient as possible.

And on a materials management and revenue standpoint, you really improve the aspects of capturing charges a lot more efficient and more accurately, which as been really a key element, I think, for the improvement of the finance groups within the organization.

Host: Good deal. Well, one of the final questions I have, what advice do you have for other healthcare providers who are looking to make the leap from a totally all paper system to an EHR?

Michael: Man, at the end of the day, do your research. That's extremely critical. And also, too, this is what I always say, and some people may not like this, but healthcare individuals live in silos at times. We need to get out of these silos. We need to start collaborating together and start basically improving healthcare as a team element. Don't come up with the scenarios, and I've heard this over and over again, "Well, I'm not a metropolitan hospital," or, "I'm not technology-focused," or, "What is technology?" or, "Why do we need technology?"

Get out of those silos, ladies and gentlemen. Start learning that we are in the digital age of healthcare. It is extremely critical that we collaborate, that we improve, that we create innovative processes that allow us to be successful and help our patients improve their overall care. Collaboration, my friends, is key to everything.

Host: Excellent, Michael. It sounds like you just dropped the mic. I hope that was what you did because that was a great place to stop.

Michael: That's exactly what I did, man.

Host: Well, great. Well, thank you so much. I'm really looking forward to getting you back here soon. But in the meantime, best wishes to you, and looking forward to talking and keeping the conversation going in the future.

Michael: Hey, same here. Always an honor to be here. Thank you very much. 

Host: Thanks for listening to Health IT on the Record presented by MEDHOST. For more stories and content like this, be sure to visit Thanks.

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