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Going Hosted and Increasing Efficiency with Angie Costakis

With a small team of three on-call 24/7 responsible for basically “anything plugged into the wall,” the Claiborne Memorial Medical Center IT team could easily get stretched to the limit. This included managing an on-premise EHR system, backups, and disaster recovery.

We sat down with their Chief Information Officer, Angie Costakis, to discuss how an implementation of MEDHOST’s hosted EHR solution, MEDHOST Direct, has helped her staff overcome some of the challenges that come with managing healthcare IT in a rural setting. In addition, she also touches on how a thorough implementation made for minimal interruption to the hospital’s current workflow.

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Show Full Transcript

Angie Costakis: When you have all these people doing things on paper manually, you allow for the introduction of human error. And the employees hate it when we tell them, "You know you're going to have to be on paper for 10 hours tomorrow." It's like all of a sudden everybody's sick and nobody wants to work that shift.

Host: That's the voice of Angie Costakis, the chief information officer at Claiborne Memorial Medical Center. Claiborne is a rural hospital that recently adopted MEDHOST as their hosting platform. In this episode, Angie discusses the impact MEDHOST has made not only on the day-to-day operations of the hospital, but also on Claiborne's small IT team.

Angie: It was really in our best interest financially, time wise, manpower wise to go to a hosted solution because we've got the assurance that MEDHOST, who hosts our EHR, they are handling the disaster recovery and the backups on what they are hosting, so that's not on us anymore.

Host: This is Health IT on the Record presented by MEDHOST, a show that explores how innovation in health information technology impact every aspect of a health system from multi-hospital networks down to individual patients. In a moment, Angie will share her experience in taking on a hosting overhaul as a CIO and offers advice for those in a similar situation. Enjoy the conversation.

Angie: Hey, my name is Angie Costakis. I'm the chief information officer at Claiborne Memorial Medical Center. We are a hospital in Claiborne Parish, Louisiana, which is in the north central part of the state of Louisiana.

Host: Wonderful. Thank you so much for taking the time to kind of give us an inside look into what it's like being a CIO and talk about some of the trends that you're seeing, some of the challenges that you're facing. And most importantly, we'll talk a little about how you and your team are overcoming those challenges. We'd love to learn from you and hear from someone on the front lines who's dealing with the kinds of things you are every day.

So, I would love to start off with giving us an overview. Day in the life, big picture, high level, how do you describe some of the things that you're having to deal with as CIO?

Angie: What's kind of crazy about being at a rural hospital setting is we pretty much deal with anything that plugs into the wall. So, the scope is a lot broader than it is in probably a larger industry. We are a 60 bed hospital with a geri-psych unit, an ICU, ER and we have a clinic that's offsite.

We handle our nurse call system, our telemetry system. They both sit on our network as do a lot of our radiology equipment. We have to be very adaptive and flexible in learning new technologies as they're thrown at us. Myself and my staff, we rotate taking call. Somebody has to be on duty at all times to support the hospital and it never closes. We've all got to be a little bit cross-trained so that we can handle different technologies as there are issues that arise.

Host: How would you say, just generally speaking, how is it that your team can juggle and handle both in the moment and staying on top of everything 24/7, but also balancing, staying sharp on what is coming down from – what the future looks like with new technologies, new systems, all of the above?

Angie: There's three of us in my department and then we actually use some people from another department that we've trained to step in and help us when we need some additional help. But to the three of us in the IT department, communication is the primary weapon. Being able to reach one another and being able to communicate and go, "Wait, I forgot what I was supposed to do with this," or "Have y'all dealt with this before? Give me a hint. What's the best way for me to handle this?" or "I'm tied up working on this, can somebody else grab that?"

Communication is of utmost importance, and without it we would be crippled. We each specialize in different areas, but luckily we aren't territorial. So, that knowledge sharing is not a problem. It's . more of a necessity that we've got to do. If we want a day off, somebody better be able to do the job too.

Host: Certainly. I like the way you said anything plugged into the wall is something that your team has to deal with.

Angie: We've got the a security system, emergency alarm buttons, access doors, we technically support the system that does security badges. I mean, anywhere there's software in the hospital, anywhere, anything that's adjacent to our network, we've got our fingers on it. In some way, shape or form we touch it.

Host: Right. Now, earlier, I think you were starting to talk about about just that idea of staying not only online and keeping going 24/7, but included in that is security, and the cybersecurity front also connects to the question we were just talking about of, you're staying in the present, but also being proactive towards a future.

So, as a CIO, as you're starting to think about trends and challenges around cybersecurity, what comes to mind? What are some of the things that you're facing just at a high level, just to sort of paint a picture of today's climate?

Angie: There's so many options. I'll tell you what intimidates me is, as I educate myself as I go to conferences or do online training, it seems like there's different layers of security and you've got to get your bang for your buck.

Especially at a hospital like ours, which is funded by the taxpayers of this parish, we can't just go out and frivolously buy the coolest thing. Who's got the best salesman? What's the snazziest package out there? We really have to be diligent in how we spend money and we've really got to do our research and there's so many different options and layers and security as a service or you know, different security sim tools and we can't get it all. We don't have the fortune of being able to just buy it all. So, we've got to really weed through, "What is it that's necessary, what would we like to have and what is just not going to happen?"

We're in the process of doing that right now as we budget for next year and we kind of figure out, "What is necessary, what is the bare minimum we've got to have to secure this hospital virtually going forward?" Then what would we like to have were we to get the funding approved that would make us more comfortable with how secure it is versus this is not going to happen. That's intimidating to me because there are so many companies that do this. There are so many good products and there's a lot of different companies that are really trying to sell you something that I question the value they bring.

Host: I bet. You're probably getting all of that all the time. Everyone wants to talk to you. Everyone wants to talk to the CIO. It sounds like you're trying to look past all of that and trying to get to what actually matters most and what's going to help your hospital.

Angie: Yeah. In a nut nutshell, you're really trying to quickly filter out the crap versus what's substantial and what we really need versus what the frills are.

Host: On that theme of trying to analyze what is important, what isn't important, strategically thinking about what the future is going to look like and how you need to be ready, I would love to walk through the idea of hosted. Where you're hosted, your hosting environment: onsite, in the cloud, whatever. Where have you been? Where are you going, where is your priority, where is your thought process? I would love to get an inside look to a CIO and to how your team is approaching this.

Angie: One of the challenges with having an I series on premises is backing it up and having a disaster recovery plan for it. It's extremely expensive to be able to do the backup and to have a disaster recovery plan for an I series, so that it's one of the things we took into account when we were weighing whether or not to go to a hosted EHR solution.

We had virtualized every other server in our server room. Everything is virtualized, a hundred percent of it, except for that I series. When we looked at pricing, we looked at having to renew the IBM entitlement to do the OS upgrade. We were going to have to buy a new I series in 2019. All of that money plus adding a disaster recovery and backup option, it was really in our best interest financially, time wise, manpower wise to go to a hosted solution because we've got the assurance that MEDHOST who hosts our EHR, they are handling the disaster recovery and the backups on what they are hosting. So, that's not on us anymore.

Now, we do have a full backup of everything within our hospital. We've got a disaster recovery plan. That was a two for one deal for us, getting it hosted offsite so we aren't maintaining the server or the software anymore. MEDHOST is doing that, but also they're handling the disaster recovery and the backups, and that's a bonus. That really freed us up to focus on other things within the hospital.

We're pleased with our decision and what worked out even better is that transition has been pretty transparent to our clinical people and to our financial people, so a lot of them don't even realize it's not hosted on premise anymore. They just opened the same link and the same software pops up and they don't know any different.

Host: I would love to dive a little deeper into this, especially if you can think of any examples or any stories, when you say time wise and how much time you are spending, that has a cost, right? Not only on just the other things you could be doing, but also on you because you're being pulled in a lot of directions and just like you said earlier, there's someone always on calls, that smaller team, it's a rural hospital setting.

So, when we look at it like a before and after, let's focus on the before first, looking at time, looking at that cost and pain that you were experiencing, do you have any ways to quantify that and give us a look into what your life was like and then maybe we'll fast forward to where it's going and where it is today?

Angie: For me it translates into staying up here at night. A lot of evenings doing the updates on the I series, the various updates we have to run on for MEDHOST. We would try to do those in the evenings, which meant somebody had to stay up here to do those that are not something you could remote in and do. You've got to be onsite with the machine to be able to do them.

I live an hour away, so a lot of times it would be long hours at night. I'd either have to camp out here at the hospital or drive home super late and drive back in super early. It doesn't allow for much of a life when you're really babysitting the technology in a hospital like that.

What's happened now is, it's so much less time consuming. It doesn't need to be babysat as much. I actually get to leave work at five or six o'clock most days and I'm pretty grateful for that. I know my staff is pretty grateful for that and their families are grateful for that. Just in the ability to not have to be cranky and just completely dedicate your whole life to the equipment in a hospital, that's not ideal for anybody,

Host: Certainly. It can be unsafe, those late nights driving and that's not a good idea.

Angie: Yeah. I've totaled two cars trying to drive home at three or four in the morning from the hospital, and I think the state police are pretty glad that I'm not running the roads at all hours anymore.

Host: Yeah, I'm glad you're safe and you're here today.

Angie: At some point I bought a couch that folds out in my office to sleep on because I was spending so much time. I think the hard part was when it was on premise, you've got to do a full backup before you do one of the major updates and our full backup took eight to ten hours. We would usually start it in the late afternoon and run it all night, and then we'd do the big update. We'd start it the following morning and it would take eight to ten hours usually. It was time consuming.

Then by the time that gets done and you're bringing everything up and if there's problems, you can't go to sleep. Everything has to be tackled and handled before you're done and off duty and you can actually go take a nap. For that to happen, every couple of months, it's a lot on a person. It doesn't make you want to run in and do the job. As a CIO, I feel like I need to set the example and I needed to take that on and not just require it of my employees to do that. I tackled it for the most part. It was on me.

Host: So, during that backup, all of those backups, all those updates, what does that translate to for the hospital? How did that interrupt your normal workflow? Or did it interrupt? Can you help me understand that?

Angie: When the system's down, we do what's called "going to paper," which means all the charting is on paper. What I appreciate is that our project manager we worked with really kind of held our hand. The team we worked with, we had a weekly calls, so we really always knew where we were, what we were responsible for or what action items anybody on the team was responsible for and when they were due. We stayed ahead pretty ahead of schedule.

We're pretty proactive as far as our project timeline and we weren't on our own. They've done it before and they're experienced in troubleshooting. They had people come onsite when we were going live. They had people onsite to not only work with IT, but to work with the other employees. There's enough work that it does interrupt work for several hours, but we did get everybody up. We got all of our interfaces, had VPNs between us and somebody, the VPNs had to shift to that entity and MEDHOST. We got those up and running pretty quickly. It was a pretty seamless process.

Naturally, we hit some snags, as anybody is going to do. The difference is they didn't just stay issues. They were addressed immediately. They were handled pretty quickly and we were up and working, things were functioning. Ever since then, when MEDHOST Direct does the same updates we would stay up all night to do, they do those in just a couple of hours and sometimes there'll be an hour or two of downtime, but for the most part, there's not anything significant. I actually track our downtime and our downtime just has dropped significantly since we've gone hosted.

Host: That's a good point. At the end of the day, you're CIO, you have a different perspective and thankfully now things have changed. I really appreciate the context of what it was like. A lot of great examples both from you personally, your team, the weight that that added, the burden that that added.

Now let's look at the after. What were the steps you had to take to get where you're at today? How have you seen improvement? What advice do you have to maybe other CIO's and if you could go back and tell yourself something when you first started this process, what would you tell yourself? I would love to kind of shift the conversation there now.

Angie: I guess it would be to have your team on board. Everybody on your team needs to participate in the project planning and the calls, but you also need to extend that to the other leadership in your hospital so they know what to expect, so they're on board. When we were planning this process, we actually made sure that our physicians were on board, our other leadership in our other departments, we wanted everybody to feel like they had a say, that this wasn't being forced on them. That was one key thing.

The second is to do your homework as far as your ROI and is this the best solution for you? Is this the most economic solution for you? I know as far as me and our board of directors, I had to demonstrate that the ROI was in our best interest and I couldn't imagine anybody proceeding on a significant investment without doing that research and that homework. Those are two of the key things that any CIO probably needs to do in deciding whether or not to pursue a project of this size. Those are two steps that we had to go through.

Host: Well, Angie, thank you so much for taking the time. I know how busy you are already, and so that we could get you here for a few minutes to share your story, the before, the after, your insights into the trends and challenges right now, how you've come through on the other side, really valuable stuff. So, any final things on your mind or on your heart before we wrap?

Angie: No, I just appreciate y'all letting me rattle on.

Host: It's been helpful, it's not just rattling on. This is someone who's in the trenches and on the front line. It's been really good.

Angie: Well it's been a good experience for us and our team has a lot more free time and like I said, we've got other work to do and other projects that were freed up to pursue and to work on. That's been a bonus. We're not having to contract additional IT help because we're shorthanded anymore. We are actually able to get our arms around our other projects and back to kind of an equilibrium where we can balance work and life and we're not sacrificing one for the other, so I'm pleased. I'm pleased with the way everything had worked out.

Host: Wonderful. Thank you so much and we look forward to continuing the conversation in the future.

Angie: Well good. Thank you for your time.

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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