The CIO of a rural hospital system explains how, as health care goes digital, it has become imperative for IT leaders to join the conversation on patient care.
Tyler Fisher is the CIO for Gordon Memorial Healthcare Services (GMHS), a public hospital district consisting of a 25-bed Critical Access Hospital, two rural health clinics and a long-term care facility. He has revolutionized the way GMHS approaches health care IT by successfully converting the organization from an entirely physical environment with only a single server to one that is 95 percent virtualized.
As a member of GMHS' top executive leadership and administration team, Fisher oversees all IT (including electronic health records) implementations, maintenance issues, concerns and projects throughout the entire organization.
Fisher took time to discuss with CIO Insight how he helped the hospital transition from a primarily paper system to a digital one, how technology allows patients to more actively engage in their own care and how IT produces savings that ultimately can be put toward more patient care.
If there’s an IT outage in, say, the retail sector, it can cost a lot of people a lot of money. What are the stakes when there’s a tech outage in health care?
As you might expect, a tech outage in the health care sector can have many, much more severe consequences. An outage that affects any part of the revenue cycle process can indeed cost a lot of money, but that’s far less troubling than one that affects the clinical systems. More and more, modern health care has become reliant on health care information systems to provide the best quality care to our patients. If our clinical systems go down, our ability to provide care can become significantly compromised. This is one of the main reasons that Gordon Memorial Health Services (GMHS) has invested in converged infrastructure—to get the kind of reliability and performance we need without breaking the proverbial bank.
Would you consider health care IT an important part of patient care, or is it more focused on record keeping, keeping the lights on and (hopefully) reducing costs?
While record keeping, keeping the lights on and reducing costs are all very important aspects of health care IT, they certainly aren’t the only ones. As health care is becoming more electronic and more systems are being developed in this space, it has become critical for IT to be a part of the conversation. At GMHS I serve as a member of our top executive team so that I have visibility of the strategy and where the organization is headed. I and other members of my team also attend weekly and monthly meetings that other departments hold as semi-silent observers. The reason we do this is to better understand the challenges and desires of our fellow employees, which I feel is a critical piece of information for IT to have. We take this information, and we use it to inform our strategy moving forward, and adapt our technology and systems to meet everyone’s needs. By listening to our clinicians and working to acquire and customize our systems based on their needs and desires, IT becomes an important part of not just patient care, but the patient experience as well.
For cyber-criminals, patients’ health care data has more value than credit card data. Is security a major concern, and how do you go about protecting patient data?
Security is definitely a major concern of ours, especially in this day and age. It seems like almost daily I am reading about some huge hospital breach that has occurred, and I have even had my own records compromised in a breach as well (in another healthcare system, not ours thankfully!) At GMHS we use several methods to protect patient data including endpoint encryption, data encryption in transit, multifactor authentication, physical safeguards, and audit logs just to name a few. We have outside parties conduct regular security audits for us, as well as audits we conduct ourselves. Even in just the past couple of years the whole security landscape has evolved greatly, and healthcare has become a more common target. Thankfully VCE and some of our other vendors have provided us with the documentation and tools necessary to harden our infrastructure, and continuously send us notifications as new threats and vulnerabilities are identified. This kind of partnership with vendors is key to keeping the data in and the bad guys out.
As the CIO of a rural health care provider, has it taken longer for the digital boom to reach the open plains of Nebraska?
We were incredibly fortunate to have a series of events all fall into place at the right time to facilitate the infrastructure upgrade here at GMHS. Being a small rural healthcare provider, it can be very difficult to find money in the budget for major initiatives. Prior to American Recovery and Reinvestment Act (ARRA) and Meaningful Use, GMHS was primarily paper, which meant the demands on the IT infrastructure were not nearly as high. Around the time I took over as CIO in mid-2011, we had already been involved in an electronic health record (EHR) selection process for over a year, and it was readily apparent that we were going to need a major overhaul to accommodate all the changes that were about to take place. Thankfully the Meaningful Use incentive dollars helped offset a significant portion of the investment, although we did still have to make a pretty major investment ourselves for the pieces that weren’t covered. The end result though has been an infrastructure that has exceeded expectations and that continues to grow with us.
How has IT improved the lives of patients in rural Nebraska?
By investing in IT, we are now able to offer patients a level of engagement and involvement in their own care that just wasn’t possible before. Whether it’s orders and results flowing seamlessly between our clinics and hospital, or their entire patient health summary being viewable to them in near real-time on our new patient portal, one of our biggest goals has been to make it easy and intuitive for our patients to be involved in, and informed about, their own care. We don’t just make it easy for the patients to get their own information, though, we also make it easy for that information to get to other outside providers who need it for that patient’s care as well. When you’re dealing with the kinds of geographic distances between facilities that we have to, the ability to get potentially life-saving information to another provider at the click of a button is a real game changer.
How have you gone about updating the IT infrastructure at GMHS?
It was a highly strategic undertaking because of the challenges involved. It might seem like a minor project because Gordon Memorial Health Services (GMHS) is a small provider in a small town—in fact, the hospital is a 25-bed facility in Gordon, Neb., which has just over 1,600 people. But it’s also the only real hospital within a 50-mile radius, meaning we actually serve 10,000 people across 10,000 square miles. This includes two entire Nebraska counties and a portion of South Dakota, as well as outpatient services at an attached walk-in clinic and an off-site clinic in nearby Rushville. At the same time, we’re proud to have been recognized as one of the top 100 Critical Access Hospitals in the country.
However, we had an aging IT infrastructure that required a great deal of upkeep, and considering our ambitious plans for the future, we needed a major update. But we just didn’t have the flexibility or scale: When I got here in 2009, the entire IT infrastructure ran off a single server (we added two more in 2010). The goal was to replace the infrastructure with a new platform that could support an EHR solution and address other critical IT needs—to provide better care, enhance efficiency and lower IT costs.
After considering different options, we chose MEDITECH for the hospital’s EHR. We worked closely with MEDITECH to add Vblock Systems as an approved platform for its latest release, MEDITECH 6.0. The Vblock System arrived as scheduled in four weeks and was assembled in only a day and a half, and fully configured within a week. We also acquired EMC Data Domain and EMC Networker software with DD Boost to optimize and accelerate the backup and de-duplication process. This enables us to maintain a near-real-time copy of the data at the Rushville clinic 15 miles away.
The new infrastructure enables us to support a mission-critical EHR solution that allows our healthcare professionals to securely access and exchange patient records in real time. This inevitably leads to better patient care and outcomes, and gives us room to grow. And because we don’t fully utilize the available capacity, we generate revenue by providing cloud-based solutions to other medical institutions in the area to improve care across the region.
Can you explain a little about converged infrastructure, and how you’ve implemented it?
GMHS is not immune to the transformation in the entire healthcare industry. With new mandates addressing the use of electronic health records and the growth of digital tools and solutions to assist in care delivery, we increasingly rely on digital services—a big change from pen and paper records that have been in place for so long. This places significant pressure on small and rural facilities like ours that don’t have large IT teams or budgets.
So as we looked into our options for an infrastructure refresh and did an intensive 10-year total cost of ownership (TCO) analysis. The results were a very pleasant surprise, we knew we would save money with a converged infrastructure, but we weren’t expecting the magnitude of the savings we identified. Here’s the bottom line upfront, by deploying a VCE Vblock System we expect to save an estimated $695,000 over a decade for services, support, hardware and staffing. For a hospital of our size, this is business-changing. We can put the savings towards new technologies to help improve patient outcomes, instead of using it on maintenance to keep the hospital systems up and running. It allows us to put our focus squarely where it matters: our patients.
Here’s how it’s happening. Since the implementation, our IT team has been working to input the data and launch the EHR solution—rolling out individual capabilities such as support for the nursing staff as each module becomes available. But that’s not the only activity. From the beginning, we’ve been moving almost all of our other applications to the virtualized environment running on the Vblock System. This includes domain name servers, Microsoft Exchange server, Microsoft SharePoint server, DrFirst e-prescribing, pharmacy med-dispensing server, the 3M coding solution used to translate ICD-9 and 10 codes for billing, Craneware revenue integrity solutions for optimum pricing and reimbursement, and the virtual desktop infrastructure (VDI) just to name a few.
In short, GMHS is currently running almost the entire hospital on 100 virtual servers on a single Vblock System. As one example, the EHR and the exciting hospital-wide VDI solution support approximately 300 clients for the clinic team and administrative staff.
That’s the real value of a converged infrastructure cloud-based computing model: It cuts costs while improving time to market. Most importantly, it allows us to focus on core priorities—specifically, patient care—instead of integrating, validating and managing IT infrastructure. As industries like healthcare feel the effects of digital technologies, smaller players like us will feel the pinch. Converged infrastructures offered us a way to address this transformation head on.
How has your experience been with VCE?
As I mentioned earlier, this was a major project for us. Our IT team is small with a limited budget. It is absolutely crucial that our technology partners—and the solutions we implement—appreciate our challenges and work closely with us to ensure a smooth transition. Healthcare doesn’t have room for trial and error.
We knew VCE has amassed considerable experience working with healthcare providers both large and small, and we saw that experience put to very good use in our environment. Our interaction with the company has been extremely positive, and it certainly helps to have great technology — since the Vblock System began running most of the hospital’s applications in
2013, there have been no major issues or unexpected downtime. Support from VCE has been responsive and proactive—there’s just one number to call (rather than the six different vendors included in some proposals). The customer advocate stays in constant touch and anticipates our needs before they arise.