Michael Archuleta: If you looked at some of the before and after pictures, the cable management on the before, it was literally a nightmare, man. You come in, you're thinking you're being attacked by a group of spaghetti wires. Coming in and trying to find anything; it was absolutely insane.

Host: That's Michael Archuleta, the chief information officer and director of information technology services at Mt. San Rafael Hospital. He tells us about the profound changes he's made to meet the requirements of Meaningful Use Stage 3 and how those changes created a more positive patient experience.

Michael: Always remember, you are doing it for the patients and that patient could be your mother, your father, your brother, your sister, your grandma, your grandpa, any family member associated.

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

In today's episode, Archuleta shares how he led his team to a successful digital transformation for his entire hospital. He turned an outdated and disorganized system with only 59% uptime into a dream scenario with increased productivity, a reduced operating cost, and a steady 99% uptime. We'll also hear how Archuleta's strategy of treating the patient like the CEO has played a pivotal part in earning this small hospital top industry honors. Enjoy the conversation.

Michael: Hello. My name is Michael Archuleta. I'm the CIO of Mt. San Rafael Hospital here in Southern Colorado. We've honestly have had an amazing couple of years. I mean, going from a full paper system to a fully digital system.

This organization has basically been recognized by HealthCare's Most Wired award. So we've won Most Wired three years in a row. The Most Wired hospitals award is given annually by Hospitals & Health Networks magazine to the top hospitals in the country making the most progress in the adoption of health information technology.

As I stated, from where we started to where we're at now has been truly, truly, a humbling and, I don't know, an amazing experience to see that digital transformation basically blossom into something great.

Host: That is an excellent way to start this off and I know you've been really excited about the entire digital transformation you and your whole team have been doing together and I know it's got to be a team effort. So before we start talking about today's topic, Meaningful Use Stage 3, could you just kind of paint a picture of your team: what's the environment like at your hospital, what are some of the goals and the focuses that you all have in the community? Kind of let us know who all you're working with.

Michael: Yeah, absolutely. So I have an amazing team. The beauty about it too, is I have been able to build my own team here in this organization. When I came on board to Mt. San Rafael Hospital, my first initiative was we need to implement an electronic medical records system.

I said, "Okay. We need one for the hospital. We need one for the clinic." I said, "Excellent." I go, "How far are we along with the progress?" "We're not far at all. We haven't even started to look." I said, "Really?" I said, "Wow. This is going to be interesting." So what I did was, is I actually brought in a consulting group to do an overall evaluation of the organization.

So what happens is, they come in, they look at your current staff, they look at the infrastructure, they look at the applications that you're basically wanting to implement. They look at everything at a 360 view. And of course, the end result was when do you want to install and implement all of these different applications?

I said, "Well, with the electronic medical record system, I'm going to need to start my 90 days April 1." Because if not, the organization was going to be penalized. So they came back to me and they stated, "Okay. So you want to install all of these different MEDHOST applications?" Because we're using MEDHOST as our preferred inpatient EMR and our preferred ED EMR system. So I'm like, "All right. So give me the percentage of how successful I would basically be in moving in this direction?" "You have a 20% chance of successfully going live with everything that you basically want to do." I said, "20%." I said, "Okay. That's crazy."

Michael: And at first, it was kind of funny because when I took over as technology leader of this organization, I was kind of evaluating. I was like, "Man. This is a big risk," because you figure the environment before, there were servers in several housekeeping closets throughout the whole organization. There was no centralization. There was no standardization. There was basically nothing in place.

When I looked at the systems on a systems standpoint, I wanted to see how good their uptime was. So at the time, the uptime was basically set to 59%. That was 59% uptime with the systems that they basically had. Insane. That's crazy. The systems would be up 59% of the times and the remainder, they would be down. They would go in and out, in and out, crash, have problems. So of course, an organization that's say, for example, trying to use an enterprise system for registration: you got outages, you go down, you're back to paper.

So there's no consistency with the specific systems that were in place. And as I stated, before it was a 59% uptime, servers in housekeeping closets, network switches in housekeeping closets. There was legacy hardware and software. We had a legacy firewall system that the company went bankrupt but they were basically still using it which was absolutely crazy. Then they had home-grade wireless access points throughout this whole organization. And absolutely insane. I've never seen anything like it.

They still had tape solution backups. There was no disaster recovery in place. There was no data center. Of course, no standardization or centralization. No redundant power management. No network redundancy. No cable management and of course, no focus towards cybersecurity.

Michael: So when I looked at that 59% uptime, I said, "Okay. You have no network redundancy." So get this, the I would say it was the third day I took over, there was a fiber cut basically 30 miles away from us. That fiber cut was backboned into this organization so all data connections were completely down for 12 hours. 12 hours. You figure. Think about it, man. You and I, we get on the internet; that's our lives.

I mean, we basically do everything digital and if you have nothing you can do, you're going straight back to paper. Straight back to paper, my friend. And that becomes a problem. So coming in, it was really an interesting process of what we basically have done. And looking at the after effects, now we have 99% uptime. We have 99% server virtualization. So all our servers are virtualized. We have 90% desktop virtualization meaning we no longer have physical towers within this environment. We have a full NetApp all-flash fast storage solution.

Basically, efficiency, speed, quickness, good security practice. We have a new-generation firewall. We have enterprise wireless system throughout the whole organization and campus. You can walk from one facility to another and not drop any type of connections moving forward which has really boosted up our process. We have redundant power management. We have full automated backup systems onsite and offsite.

And of course, I would love to share some of these pictures we have, but if you look at some of the before and after pictures the cable management on the before were –

Host: Oh, oh. I can only imagine.

Michael: I mean, it was literally a nightmare, man. You come in, you're thinking you're being attacked by a group of spaghetti wires. Coming in and trying to find anything; it was absolutely insane. So no management standardization was really my key aspect. We really centralized everything and I built the very first data center that this facility basically had had. And really, adding virtualization efforts helped reduce costs 56% and improved uptime from 59% to 99% with increased business productivity, operating efficiencies, and enhanced services while reducing operating expenses.

Michael: And moving forward from there, we were basically recognized as HealthCare's Most Wired 2015, 2016, 2017, and we're very hopeful on 2018. And we were also basically recently recognized, before end of year of 2017, as HIMSS Analytics Stage 6 which was a huge thing in showing all of the different efforts that basically have happened.

Because honestly, you don't see this type of digital transformation in small organizations. You see this type of digital transformation in your metropolitan wards, in your bigger hospital systems but it was absolutely amazing because honestly, I always tell people too, at these big hospital systems, look what we're doing as well. Do not think just because you're a big health system that you have no idea that it would be ten times easier in basically doing it in a smaller system. To a point, yes. But definitely come into my world and see how many different hats that we basically have to wear and still be up there with those metropolitan organizations and start winning those specific awards to match out towards them.

Host: It's a big deal.

Michael: Absolutely.

Host: I love how you've painted a picture, it was like a nightmare the word you used of the spaghetti monster. Not a good situation. So you took that from a nightmare to a dream situation and so, later on, I'm going to ask you what advice you have for other health care providers who are looking to digitize like that and also to meet Meaningful Use Stage 3 criteria. Because you can't even come close to that if you don't have the basics down. So congrats on the big uptime increase. So we'll definitely kind of hear from you later on in this conversation and future conversations of how other people can learn from you.

But let's jump straight into Meaningful Use Stage 3. Just in your own words: what is it, how do you describe it to other people, what's happening today with this? And then, I'll want to kind of go on a journey of your organization and how you all are now ready to attest this and you're one of the first organizations in the country to be prepared to attest Meaningful Use Stage 3.

Michael: Absolutely and thank you very much. It's really been, as I stated, a humbling experience and honestly, it has really, truly been a full team effort in making this successful.

So Meaningful Use Stage 3 is a third phase of the Meaningful Use EHR incentive program. The centers of Medicare and Medicaid Services and the Office of National Coordinator for Health IT have published some of the final rulings for Meaningful Use Stage 3. So looking at it kind of in a simple – in a format, I mean, there is menu objectives, there is core objectives, there's specific objectives organizations have to meet in order to be utilizing a system in a meaningful way.

With this actual journey, I mean, we've always focused on, how do we, as a smaller organization really try to improve the patient aspect? Because I always say, "Guys, meet your new CEO." Everyone looks at me, "Okay. I thought I had a CEO already." I said, "No, you don't." I go, "You need to meet your new one now; your patient." Every patient is your new CEO. Period.

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 www.medhost.com. Let's jump back in.

Host: You were just talking about how your patient, they're the new CEO. I really like that mindset and why it's so important to treat the patient like that. Now, after that you were talking about why it's a big deal that not only have you gone from the nightmare to the dream, but how you've become an award-winning hospital, an award-winning organization with your digital transformation. So next, I want to hear about the how. How did you do this? What did that implementation process look like?

Michael: Absolutely. So just kind of discuss technology and I'm being a very technology-driven leader. Technology is part of the answer by helping patients manage their health inside and outside of your organization. Health care is really changing and we need to provide opportunities and adventures that will allow our patients to access their information more effectively which would minimize the time between leaving their provider's office to having the patient's health information readily available at their fingertips. This is vital to the overall success of any organization.

And then, of course, you asked me well, how do you do it? Or how'd you do it? This is what I always look at; me as an individual, me as the technology leader of this organization, I am looking for business partners. Business partners that are basically going to look at my mission, which is our success is your success and your success is our success. Those are the specific type of individuals that we basically need.

We did an evaluation of our inpatient systems with different EMR vendors. The one that definitely came up on top was MEDHOST. MEDHOST has honestly been an innovative organization. Has really been invested in our organization and invested as a whole towards my IT team allowing us to beta test, beta install some of their applications that are basically coming out and really looking at our overall best interest.

At the end of the day, MEDHOST talks health care and I look for individuals that know how to speak health care, that know how healthcare works, and that basically are going to bring technology to really help patients manage their health inside and outside of the organization. And that is such a critical thing. I think you need those business partners that have a very solid technology focus which, at the end of the day, they also know that patient care is number one.

And we need to continue to develop a synchronous focus towards patients. And I say asynchronous tools focus towards patients that help them meet their needs and solve their problems to improve their quality of life.

Host: I love how it all comes back to the patient experience with you. That's just a recurring theme that I continue to hear. Now, I want to continue that conversation on the patient, specifically looking at an individual. And so I'm going to kind of frame this up, and kind of what I'm thinking through and I'll see if it makes sense but as we're keeping in mind all of the traditional methods for patient access and engagement, why is the criteria for Meaningful Use Stage 3, why is that helpful for the patient through your eyes?

And when you're thinking about how meeting this criteria is changing the patient experience could you kind of, with your patient focus that you have, could you kind of walk us through an example. I mean, we can just call her Leanne. But just what her journey looks like coming to your hospital with a problem. How all of this is now changing her overall experience. So does that make sense?

Michael: Yeah. Absolutely. So I want to read a statement about our digital transformation that basically incorporates Meaningful Use Stage 3. And this is what I said:

The state of digital transformation of Mt. San Rafael Hospital over the past few years has been truly humbling and amazing. Mt. San Rafael has worked hard to ready to attest in January 2018 for Meaningful Use Stage 3 and I'm very proud of our continued commitment in meeting regulatory requirements early. Meeting Meaningful Use is challenging and takes overwhelming commitment from the entire organization. Workflow redesign, clinical documentation improvement, and training are just the beginning.

Using the system in a meaningful way throughout the organization is the key to success in providing exceptional quality and safety of patient care. Commitment from the Mt. San Rafael board of directors and administrators, combined with the strong collaboration with physicians, nurses, clinical staff, IT, and our business partnership with MEDHOST, have made Mt. San Rafael Hospital a leader in utilizing technology to improve care in our community and we're very proud to have met all Meaningful Use Stage 3 requirements.

And as we know, MEDHOST was one of the first to certify their products for 2015 edition for the use with Meaningful Use Stage 3. And MEDHOST customers, as a customer we know that they have always dedicated their focus towards improvement of technology and improvement of patient care. Because as I stated, we needed to provide those tools to our patients, which we have, which will basically allow them to take care of themselves within the organization; within the walls of the hospital and outside the walls of this hospital.

And at the end of the day, I know a lot of physicians hate Meaningful Use because, at the end of the day, we need to let physicians be physicians. But I look at Meaningful Use as an actual tool that has really improved the aspects of patient safety. Improved some efficiencies of what we're basically doing. Is a program perfect? Absolutely not. It is not.

But the key aspect is, is I'm a disrupter. I'm a healthcare IT leader. I'm a collaborator. I come together with all these amazing colleagues that I have to really try to improve the aspects of technology and improve the aspects of meaningful use. MACRA, MIPS, and any new incentives or items that we have to face as an organization come to play. Collaboration is such a key element and I think – and it's always critical that we can collaborate with other colleagues out there because we do not want to reinvent the wheel but we also want that teamwork aspect because, as we always hear this, is team is definitely about everyone achieving more. And that is always a key aspect. We need to come together to improve these aspects.

And going back to Leanne coming into our facility. Going from before, she would come in and she would just get a piece of paper and wouldn't understand what is going on. Now, she comes into an advanced system. Basically, gets registered, has the ability to view her information through an advanced patient portal. Now has the ability to track wearables through the patient portal. Now has the ability to basically just take more control of themselves to improve their overall aspect of better patient care.

And the beauty about technology too is, we now try focusing on the continuity of care. I have a patient coming to this facility getting lab results, getting radiology results, doing those specific tests, and then getting results, and then needing to go to a more specialized group. You don't want that patient to be exposed to another needle. To be exposed to more radiation. The advancements of technology have allowed us to improve that continuity, have allowed us to transfer information more effectively, smoothly because the overall continuity of care documentation process with the incorporation of the Health Information Exchange program has been a critical element as well, too.

We have honestly seen a 360 view of our digital transformation journey and, I always say, it really takes that vision and that teamwork and always remember you are doing it for the patients and that patient could be your mother, your father, your brother, your sister, your grandma, your grandpa, any family member associated. Take it. It is such a serious topic for me. I'm so passionate about really trying to utilize technology to the best possible way in improving those outcomes of those individuals.

Host: Michael, that was well said. I think that's such a great way to wrap up our conversation. Earlier, I was saying I was hoping I could hear some of your advice to other health care providers who are looking to meet Meaningful Use Stage 3 criteria among other bits of advice you have and I think that just achieved it.

So I know you are a busy person. I know you're starting to get some phone calls coming in. You've got a big operation you've got to run over there so how about we wrap things up here? And I know we will be continuing our conversation in the future. So do you have any final words you want to share before we wrap up?

Michael: No, sir. I think we hit them all. Thank you, very much.

Host: You got it. Thank you, so much. I really appreciate your time.

Michael: Hey. Same here. Have a wonderful day.

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