Latest / Becker’s Healthcare - Clinical Leadership Podcast / John Gaede, Director of Information Services at Sky Lakes Medical Center

Transcript

John Gaede, Director of Information Services at Sky Lakes Medical Center · Becker’s Healthcare - Clinical Leadership Podcast

• 0:00
  Would you like to exchange best practices and ideas to improve care,
• 0:04
  enhance operational efficiency,
• 0:06
  and address financial challenges with your peers?
• 0:09
  Becker's Healthcare is facilitating these conversations at their eighth annual
• 0:13
  health, IT digital health and R C M meeting.
• 0:16
  You can check your eligibility for complimentary attendance at the link in the
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  description. We are excited to welcome you in October.
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  This is Laura Dedo with the Becker's Healthcare Podcast.
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  I'm thrilled today to be joined by John Gatey,
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  who is the director of Information Services at Sky Lakes Medical Center in South
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  central Oregon. John, it's a pleasure to have you on the podcast today.
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  Thank you so much. Thank you for the privilege to be here.
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  Now, I know we have a lot to talk about.
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  There's so much happening in the healthcare space and technology is really
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  driving a lot of changes. But before we dive into my questions,
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  can you tell me a little bit more about yourself and your background?
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  Sure. Happy to. So I've had the privilege of working in, um,
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  healthcare for my entire, uh,
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  working life outside of those jobs you have in high school and college and
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  things like that.
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  And started as a medical technologist working in a small critical access
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  hospital and doing rural medicine in Kansas. And, uh,
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  that is how my IT career started. Uh,
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  we were pretty much on paper, this is the early nineties,
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  and I went to my boss and said, you know,
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  there's ways we can automate our workflows rather than handwriting. And, uh,
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  so we ended up installing a laboratory information system in that hospital and
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  started printing our results. You remember back in the nineties,
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  we had cumulative results on, uh, you know, printed, uh, paper records.
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  Uh, so that's where the IT career started and working, um,
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  in the laboratory and building out laboratory, um, systems.
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  And then had the opportunity to, uh,
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  move down to Southern California where I worked as a clinical systems analyst
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  and helped implement, uh, electronic medical record there at a standalone, um,
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  hospital that was, um, part of the city. And then from there,
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  eventually became, uh, the director. And I've been doing that now for over, uh,
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  20 years. And so it's just a, one of those things where I,
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  I always tell my staff, you know, um,
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  we have a mission statement here within our IT department at Sky Lakes,
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  and it's, uh, and we save lives and we innovate and in that order.
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  So when we get out of bed in the morning, we know we're coming to do healthcare.
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  It, we get the joy and the privilege of making a difference in people's lives.
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  It's not about bits and bytes and computers, but about, you know, people,
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  process and technology bringing those together. So we, um,
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  enable our caregivers, providers, physician nurses, respiratory therapists,
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  medical technologists, rad techs, you name it across the organization,
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  tools that they can take better care of patients.
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  And that really drives what we're doing. It's driven me personally as well,
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  and being passionate about healthcare IT and knowing that we can make such a
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  difference in patients' lives. And then I get to do that in a setting. Um,
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  clam Falls, Oregon, 4,300 feet. It's, it's dry.
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  We get four seasons, lakes, trees, sunshine,
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  absolutely, absolutely beautiful, uh, wonderful community and, and people.
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  And we are a standalone not-for-profit hospital. Uh, we're, uh,
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  licensed at 176 beds.
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  We staff about at 101 beds like everyone else.
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  Through the whole COVID crisis,
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  we experienced those higher censuses and challenges, uh, that, that brought.
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  Uh, but I, when I look at our,
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  our organization and the people and just to see the resiliency of,
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  of the team here at Sky Lakes, it's been a wonderful place to,
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  to work in and to live in and to make a difference in our community.
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  Fantastic. I love that. And, and certainly, you know,
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  what you do is so important to, uh,
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  making sure that you provide healthcare services to the community, um,
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  and are really doing that in a way they can relate to efficiently, effectively.
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  Um, I know technology touches so many aspects of healthcare right now.
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  So given your perspective,
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  what are the opportunities that you're most excited about as well as the
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  headwinds you have your eye on right now?
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  So I would say some of the, um, opportunities that we're most excited about,
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  um, really center around Sky Lakes, I have to say, unfortunately,
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  we were hit with, uh, a ransomware attack in October of 2020.
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  And having lived through that and gone through that,
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  I'll just say one of the areas that is important to us is
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  security. So we've really, uh, having gone through that security first, right?
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  So everything we're doing, and it's,
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  it's pretty amazing to me to watch what's happening in the landscape.
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  Now we're reading about the ransomware 3.0, right?
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  So the bad actors have gone through 1.0 2.0, they're different flavors now.
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  They're wiping out, um, operating systems other than Windows,
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  very much of a problem. So an opportunity is continuing to grow our,
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  our footprint around security and what we're doing to keep the organization
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  safe and keeping our systems available, highly reliable,
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  uh,
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  so that we can take the best care of our community because we did experience a
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  23 day outage and the impact to patient care. When,
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  when you've been doing healthcare it and you've been running on an EMR for 18
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  years in the hospital, and you shut that all down for 23 days,
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  and every system's offline,
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  you real quickly understand why we make these investments in it
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  and,
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  and the patient safety features of some of the technologies that we implement
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  and the importance of that. So we live that and learn that firsthand. So for us,
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  um, internally, that's an area that we're, we're really focused on and,
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  and growing. Then I'd say another area is the whole patient engagement.
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  Sky Lakes is, we're, we're in south central Oregon,
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  and you have to drive about a hundred miles in any direction north, south,
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  east or west to get healthcare,
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  and we're pretty much a sole provider of healthcare for our community.
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  So it's really important, um, that we're providing systems that, again,
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  are available and really engaging patients in new ways. So I think we're at a,
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  we're seeing, um, especially coming through the pandemic, we're,
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  we're seeing kind of a pivot where the patient engagement side
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  of technologies is becoming more and more important. And I know, you know,
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  just across the country,
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  health health systems are just at a whole spectrum on how they're engaging
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  patients. Uh, the questionnaires before, self check in,
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  all of those kind of things. And for our community, again, it's a, a really a,
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  a, a rural area, farming, ranching, uh, community.
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  Um, these are areas that we're, we're just now diving into and, um,
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  expanding, uh, services around.
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  So it's kind of exciting to see the growth in that area and the, the benefit,
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  um, that we'll receive as an organization. So as an example of that,
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  just the efficiency of a patient having the opportunity to,
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  prior to that appointment, right,
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  fill out that questionnaire and provide information, really allowing,
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  um, efficiency in their visits. So when they see the provider, they've got a,
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  a set of data that's already there coming directly in the words of the patient
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  and the response of the patient. So I see that as pretty exciting and, uh,
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  we're, we're going through that process right now.
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  That's amazing to hear. And you know, from your perspective,
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  and you talked a little bit about what the community looks like.
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  Have they been pretty adaptable to some of these new changes, the new ways to,
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  uh, digitally connect and, um, engaged with the, their healthcare? And,
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  and when you are making some of these updates around patient engagement,
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  how much do you think about, um, the, the demographics and,
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  and where the overall population is headed within the community?
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  Yeah, I would say, again, we're, we're similar to, you know, use cases.
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  You might have some, um,
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  differences between more urban areas versus more rural areas,
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  but the fact of the matter is, uh, you put a cell phone in,
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  in the hand of any, uh, young teenager or child for that matter,
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  and they figure it out very quickly, right? And so it's been interesting to see,
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  I think we've, um, again,
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  through the virtual visits that we did through telehealth, right,
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  during the pandemic, people really grabbed onto it, um,
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  and embraced it. But I would say it, it's use cases, right? So there's,
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  there's some use cases where there's, uh, more of an uptick in uptake of, of,
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  um, technologies where it, um, makes sense and then, you know,
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  there's nothing that can quite replace the, um,
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  that face-to-face conversation with providers as well, right?
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  And so I would say we'd, we'd be like, most communities,
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  we have kind of a mix of,
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  of all of that where we have higher adoption in some areas and,
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  and not so much adoption in others, but I'll just tell you our, for those,
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  you know, many, many people are running epic MyChart,
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  our uptake in that area has been, um, just skyrocketing and,
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  and growing very rapidly. Again,
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  as we make more information available to the patient in a real matter through,
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  um, MyChart, very, very helpful. I want to, um,
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  piggyback onto a question you asked a little bit earlier, and,
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  and it's around what opportunity, opportunities and headwinds, um,
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  you mentioned. So I want to talk about some of the headwinds now and challenges,
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  uh, that we're facing. And I, I would say coming out of the pandemic,
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  and for us personally as an organization coming out of a ransomware attack,
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  then coming out of where our, um,
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  HR system also had a malware attack, and going through that,
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  coming out of all of those things and then experience something, uh,
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  some growth in the organization,
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  there's been kind of this convergence for it and,
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  and it really centers around staffing. So I, I,
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  I would say that number one challenge that we're facing right now is,
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  is workload and prioritization.
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  So it seems like, um, I was mentioning this to you earlier,
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  it seems like to me that for whatever reason,
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  we've always been busy and healthcare it, but it sure seems like, uh,
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  the workload is higher now than ever.
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  And it seems to have something to do with the fact that as people,
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  process and technology,
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  right in almost every process and everything we're doing in healthcare now
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  involves it.
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  We just opened up in new pharmacy in town to expand services for our community
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  with the drive through. Um, and again, the level of effort, right?
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  To set up all the it and the infrastructure, uh, for those services,
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  you name it. We're, we're, uh,
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  building out a siding here for us at the hospital. Uh,
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  our cafeteria is going through a major uplift. Um,
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  staff in the community will be able to enjoy just a nice refreshed place to get
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  food and relax and,
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  but we're also the technology and the point of sale system and the ability to,
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  you know, order from your phone and have a meal ready to come down and pick up,
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  giving some of those, those features and that technology, again,
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  technology is all entwined.
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  So what it's done is we seem to have more work than we can do in the,
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  the time of day and the number of people and resources.
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  So figuring out ways to balance for our staff and our team is really a focus for
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  us. How do we balance the needs of the organization,
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  family, uh, personal time, all of those kind of things. So I,
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  I would say that for us is the number one headwind in making sure we take
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  care of our people and making sure that our people, um,
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  have the tools they need to be successful in delivering for the organization.
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  And then just balancing that, um,
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  with the number of hours in a day and life, um,
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  outside of our work at the hospital so we can, um, recharge.
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  So really focusing on employee wellbeing is what I'm seeing right now is
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  probably the number one area of focus. And, um,
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  working with the organization to balance prioritization and workloads.
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  That makes a lot of sense. You know, and it's really fascinating to, um,
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  think through how you can troubleshoot and have that right balance and,
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  and leverage technology and automation and all of that to help where possible
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  with some of those, um, staffing and workforce issues and shortages and,
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  and fill some of those holes. I know it's, there's no one real easy answer,
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  but certainly, um, as you mentioned,
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  having that balance and trying to figure out how you can, um, you know,
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  make sure that you are able to offer the healthcare services needed while also
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  not burning out your staff and, and team,
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  and making sure that wellness is top priority is also so important. And,
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  you know, with that in mind as well as the,
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  the cybersecurity areas that you talked about earlier,
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  how are you thinking about growth and adding value to Sky Lakes overall?
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  What does that look like for you? And, and where do you see that headed?
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  Yeah, so for growth and adding value, I,
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  I would say first and foremost is delivering highly
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  reliable and available systems, right?
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  So I feel like we just have this responsibility to our community,
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  to the organization, and doing everything we can. And,
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  and so for the organization to grow,
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  and even with MIT is taking the systems that we've made investments in over
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  the years and making sure that those systems are available and
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  up, right? Minimizing outages and, and downtime. So I think,
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  um, to enable the growth,
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  to enable where we want additional technologies that we wanna come in,
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  paying attention to infrastructure.
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  So this comes back to product lifecycle development, right?
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  As we bring systems in. And,
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  and that's one of the areas where now with the cloud and having software as a
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  service, that's some of those,
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  some of that product lifecycle work can be uplifted, right? And, and,
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  and some of that burden can,
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  can be taken off of the local teams and the on-prem traditional services
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  that we've provided, but,
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  but making sure that those systems are available and functioning, um,
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  I think is critical to enabling the growth, both from an IT perspective,
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  but also from a strategic perspective for the, uh, organization itself.
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  And then I would say also enabling growth happens
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  when we have a culture, a leadership principles,
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  and a culture within it of where,
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  where our teams understand the why. And I, I alluded to this earlier,
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  but understanding that when,
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  when we're providing IT services to the organization, um,
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  it's not just about standing up a computer or a server or an offering of
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  software, but every one of those becomes tools to the patient.
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  Every one of those becomes a direct path to patient care.
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  So really sustaining growth and sustaining our workforce
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  through having a culture where we say we value people and we value what the work
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  we're doing because it's focused on patient care.
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  And then I would say finally around, uh, growth and adding value, I,
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  I think data is an area, uh, we, we could have a whole conversation about,
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  um, ai, but from my perspective, um,
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  and where we're at in our maturity level as an organization,
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  it's really now, um, getting to the point where we're taking our, you know,
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  core systems, our E R P, so finance, supply chain, um, your, um,
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  HR systems, people management, taking those pieces,
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  taking your electronic medical record and all the data on
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  the clinical side,
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  and be able to bring some of that together in terms of how we're gonna manage
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  people, how we're gonna manage workforce, um, what we're doing, uh, around,
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  um, our, our care and the value of that care,
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  and having access to real time data. So in our journey at Sky Lakes,
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  we're at a point where that's really at, at, for us,
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  that's where we're focused on, I'd say in the near term and,
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  and for around growth is around data and analytics,
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  and then not just data and analytics and silos,
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  but data and analytics across the multiple systems
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  that we have within our hospital environment.
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  I love that. That makes a lot of sense. You know, and it's really, um,
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  an important aspect of any healthcare today,
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  looking at what the data can tell you how to leverage and use the data,
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  getting it in front of the right person, um,
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  so that they can make good decisions for the organization as well as healthcare
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  delivery with their patients. And so I think, you know,
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  really that kind of data management AI is, is very, um,
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  front and center in the conversation on healthcare today, but also, you know,
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  very new. And so when you, you know, look through, um,
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  an organization like Sky Lakes, uh,
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  what does it take in order to acquire some of the data platforms and
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  technologies and make sure you're doing it in a way that is helpful for the
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  organization, but at the same time, um, you know,
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  getting the information to the right person and, uh,
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  understanding some of the resource limitations that you might have as a smaller
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  hospital.
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  Yeah, so it's interesting you asked that question.
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  I think everything you said is completely relevant because we're right there.
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  We're literally in that process of recognizing that we have tools
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  within our subset of applications,
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  but we are at a point where we need a tool that spans across the applications,
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  right? So we're in the market right now investigating,
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  looking at the tools that are available. And key here is efficiency,
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  having the ability to have systems that help us build out data models
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  that bring value that we can, um,
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  query against and pull up analytics that, that, um,
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  bring value to so we can make good decisions.
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  But behind that is the whole world of the data governance process, right?
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  So that's another area we're investing in and focused on,
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  is putting in a solid data governance process. Because as we know, um,
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  bad data in is bad data out, right? And good data in is good data out.
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  So there's a whole lot of work,
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  very robust work that has to go around looking at our workflows and making sure
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  that we're capturing the data that we need to capture, that it's available,
• 18:51
  right? That it's mineable, that we can, um,
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  pull it together and then make it a available to the right people at the right
• 18:58
  time. So we're actually in that process right now.
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  And then you have to, as you alluded to there,
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  you have to balance that within your human capital, your resourcing,
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  the people side of it, and then budgets, right? Um, what kind of investment,
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  because when you start talking about a data lake and analytics systems, um,
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  there's right there in itself, right? That could be multiple, um,
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  people, uh, a whole bunch of money spent around, um,
• 19:29
  the technologies to make that work. So we're in that process right now,
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  and we're evaluating all those things, right? The, the, the, what kind of, uh,
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  people, resources is it gonna take to stand up this platform,
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  to use this platform to get the data available?
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  What kind of resourcing is it gonna take around the data governance process?
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  Making sure that we're capturing what we need to capture when it comes to the
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  input of data within the electronic medical record or our HR
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  system or supply chain system.
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  So we're in that stage right now of, of building it out and doing that,
• 20:07
  doing that work.
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  And one of the ways we're attacking this is we're doing it across the
• 20:13
  organization. So we're, we're, we're, we pulled together multidisciplinary team,
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  um, from the operations side, IT leadership,
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  working together to formulate that solution and, uh, move us forward.
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  Unfortunately, us at Sky Lakes, we,
• 20:29
  we recently had a change in our senior leadership, and we've,
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  uh,
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  brought in some vice presidents that really have a passion for this area and
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  get the value of it. So having that support from the senior team to say,
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  Hey, we,
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  this is a priority for the organization and we're gonna support this process
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  that makes all the difference in the world as well.
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  Absolutely critical. And, and I can imagine, you know,
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  it makes you really feel like, uh, you're in a,
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  a space where you can have the resources that you need in order to do something
• 21:02
  that's truly impactful. And, um, you know, along those lines, I,
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  I think when you look at resource allocation,
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  what do you think is one area where it's still important to make investments or
• 21:14
  a risk that's worth taking this year,
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  given the limited resources that most organizations have?
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  Yeah, so I, I'm sorry, I'm gonna, I'm gonna, um, go back to something we,
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  we've said earlier, but, uh, um, investing in people.
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  So I would say it's our, it's our people,
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  because if we don't have that, we're not gonna get any, anything else. And so,
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  uh, going back to, uh, in fact,
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  I had this conversation with my boss yesterday around resourcing,
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  so looking at the number of applications we have in the hospital. Um, so,
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  so the risk I think that we need to take as an organization is saying,
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  let's make sure we're right sizing, um, the resources around, um,
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  it so we can be successful.
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  It's one thing to implement a product, uh,
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  a software, bring it into the health system, and it's another to maintain it,
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  keep it upgraded, keep all the security patches, uh,
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  all of that work that happens around it. So I would say that,
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  uh, it,
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  it's making sure that we have the right set of resources so we can be
• 22:27
  successful. We have some very good systems within the hospital.
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  We have some wonderful vendor partnerships, um,
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  at the hospital that we experienced through the ransomware attack that just
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  incredible people stepping up and, and so,
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  but now how do we grow and mature these systems? And, and the risk,
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  and the reason I say it's a risk is we're trying to balance that right at a time
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  when the hospital is having some coming out of covid and coming
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  out of a time where the,
• 22:57
  the funding that was supporting healthcare systems through,
• 23:01
  through covid is, is really coming to an end.
• 23:05
  So making sure our travel agency costs, right, and,
• 23:09
  and expenses, uh, compare with the revenue that's,
• 23:13
  that's coming in and, and balancing that. So,
• 23:17
  so the risk I think that we need to take as an organization is making some
• 23:22
  investments in the right people so that we have the resources so that we
• 23:27
  can sustain the technologies that we have in the hospital.
• 23:32
  That's such a great point. And definitely, you know, uh,
• 23:34
  it seems like finance 1 0 1, but easier said than done in terms of, um,
• 23:38
  you know, keeping your costs low and, um,
• 23:41
  bringing in revenue as much as possible today. I know, um,
• 23:45
  there's just so many challenges in, in so many, um, you know,
• 23:48
  areas where inflation or, or other things that are, are really, uh,
• 23:53
  make it challenging to,
• 23:54
  to get that equation to work for hospital and health systems right now.
• 23:57
  So I appreciate you kind of talking through that and, and definitely, um,
• 24:01
  you know, that that culture, uh, within the hospital and health system,
• 24:06
  um, is just so needed these days. So before we wrap up our conversation,
• 24:10
  I was wondering if you could talk a little bit about where you see the best
• 24:13
  opportunities for yourself and in growing in the future and the teams that you
• 24:17
  work with?
• 24:18
  That's a, that's a great question. Um, I would say,
• 24:24
  again, I, for, for us in our organization and, um, my,
• 24:29
  my colleagues and staff that I have the privilege of working with here,
• 24:32
  I'd say there, there's two areas. Uh,
• 24:36
  one is we've talked about is around analytics and data,
• 24:39
  I think is gonna be critical for our hospital going forward. And,
• 24:44
  and secondly, uh, is, um,
• 24:47
  our infrastructure making investments in our, our infrastructure.
• 24:52
  So growth for us internally as a team,
• 24:54
  we're building out a secondary data center, our size hospital,
• 24:57
  that's not something we've had. We've had, um,
• 25:00
  a data center where we have things in pairs, right?
• 25:03
  But we don't have a true redundant business continuity platform,
• 25:06
  and we're building that out. So building out our infrastructure,
• 25:09
  upgrading our core switches so we can go into this next, uh,
• 25:14
  cycle of, of care. And, and,
• 25:19
  and I'll just mention this,
• 25:20
  really growing the platforms we're using around nursing. And so to do that,
• 25:25
  moving, you know, to handheld devices at the bedside, um,
• 25:29
  epic's got products around that rover, uh, to, but to do that,
• 25:32
  we've gotta have the wireless infrastructure, right?
• 25:35
  And you've gotta have the switching infrastructure, uh,
• 25:39
  not having end of life switches and, and all that infrastructure.
• 25:43
  So for us personally, um, we're focused on, on, on,
• 25:48
  uh, reestablishing our foundation and reestablishing the foundation on our
• 25:52
  infrastructure so that we can take on, uh,
• 25:56
  the additional work and,
• 25:58
  and the next strategic steps in terms of helping a nurse do the work they're
• 26:02
  doing at the bedside better, and giving them tools that help them, um,
• 26:07
  be successful and ease some of that burden that's sitting on them.
• 26:10
  So we're motivated to do that and really driven to do that focus in that area
• 26:14
  right now.
• 26:17
  Absolutely. That's so important, just getting that infrastructure down. Um,
• 26:21
  just fascinating to hear. And, you know, uh,
• 26:25
  for the conversations that you have with your team, is it pretty, um, you know,
• 26:28
  are, are people pretty excited about doing this?
• 26:31
  How do you make sure they're motivated around, uh, some of the,
• 26:34
  the nuts and bolts things that are important in getting the platforms together,
• 26:37
  the infrastructure switches and,
• 26:39
  and really understanding what potential it has for the future?
• 26:44
  Yeah, so right now, um,
• 26:47
  to directly answer that question, it's resourcing, right?
• 26:52
  It's, so I'll just tell you, our, our team is feeling the weight of all this,
• 26:57
  and I mentioned it earlier, product life cycle development,
• 27:01
  having to re reestablish foundation, right?
• 27:04
  Our equipment's coming to the point that it needs to be changed out.
• 27:07
  So that's a another opportunity for us to, um,
• 27:11
  really make a difference. And, and on the other side of the coin,
• 27:15
  there's the excitement around it, right?
• 27:17
  Recognizing the kind of speeds we're gonna get, the kind of, um,
• 27:21
  technology,
• 27:22
  the kind of efficiencies that some of the new switching technologies
• 27:27
  provide.
• 27:28
  So some motivation around it is knowing where we're going and knowing
• 27:33
  the, the value we're gonna bring to the organization.
• 27:36
  The challenge around it is, okay,
• 27:38
  how do we do this work with everything else we're doing?
• 27:40
  And so that goes back to the prioritization conversation and the resourcing
• 27:43
  conversation. So, and in our case,
• 27:47
  it was having a conversation with our CFO saying, look,
• 27:50
  if we really want to do this and we want to do it well, we need to consider,
• 27:54
  we will it take from a resourcing perspective to make this happen.
• 27:57
  So having a very good conversation. And so of course, um,
• 28:01
  part of that process is benchmarking, right?
• 28:03
  Comparing ourselves to other healthcare organizations of our size
• 28:09
  and figuring out what makes sense from, from a resourcing perspective.
• 28:12
  The reason I bring that up is because, um,
• 28:16
  there's hope in that hope knowing that if we can, um, you know,
• 28:21
  add an additional resource that can come alongside us to help us renew
• 28:26
  our infrastructure, uh, there, there's value in that. And,
• 28:29
  and our team is at a point where, um,
• 28:32
  knowing that we're gonna need to,
• 28:35
  and then the organization understanding that and the organization willing to
• 28:38
  make that investment that really helps drive and motivates people,
• 28:43
  uh, to, to do the kind of work that we're doing.
• 28:47
  I love it. John, thank you so much for joining us on the podcast today.
• 28:50
  This has been a really fun conversation and I look forward to connecting with
• 28:52
  you again soon.
• 28:54
  Thank you so much. I appreciate it.
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