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Today on Town Hall

So we offloaded a tremendous amount of responsibility and burden over to somebody who is very good at this. This is their space, right?

They are a cloud host vendor. So we gave that to them so that we can do the things that we're great at and let them do the things that they're great at.

My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week Health.

Where we are dedicated to transforming healthcare, one connection at a time. Our town hall show is designed to bring insights from practitioners and leaders. on the front lines of healthcare.

Alright, let's jump right into today's episode.

 Greetings, I'm Reid Steffen, CIO at St. Luke's Health System in Boise, Idaho, and I'm joined today by Jonathan Hatfield, who is the CEO of Klickitat Valley Health, KVH, located in the southwest part of Washington, right near the Oregon border. Jonathan, welcome. Good to talk with you.

Thanks so much for having me on. I'm excited for the conversation today.

It's going to be fun. So we're going to talk about the journey you've been on at KVH to move from multiple EHRs to a single cloud based EHR and the lessons and value that you've learned and gained along the way. But first a little bit about you.

So you've been at KVH for a number of years. And listeners may not know, but you started as the janitor, and you now have ascended to the role of CEO, which is incredible. So just take a couple of minutes and cliff notes, like tell us about that journey.

Yeah, I'll try to be brief. My story is a little bit extreme, think, but it's not uncommon.

There's a number of folks even in our organization at KVH, and you hear these stories in Rural Health Care about folks who, you know, we've got a Director of Quality who was a CNA at the facility. She's been down here 22 years, and she's now our Director of Quality and Risk. And so, I think, when folks come into the organization, we're doing new hire orientations.

One of the things I always tell them is that rural healthcare is a place of opportunity. And again, I'm an extreme example of that. My first role here was to be a night janitor. I used to show up at three o'clock in the morning and I'd sweep, mop, and buff the floors. And then because rural healthcare is a place of opportunity, I found myself very quickly into the IT space.

to a facility that had a mandate to implement electronic medical record technologies, which meant we had to expand our network services, expand our computer access expand our email access. And so I got to be on the really at the foundational level of building the technology for our organization.

And then getting to implement electronic medical record systems, I really got a good understanding from an industry perspective of healthcare operations. Because I was involved in every, medical record implementation, every training. I went to the trainings and I'd come back and train our nurses and providers on how to utilize the EMR software, because again, rural healthcare is a place of opportunity.

We all wear multiple hats. And so nobody has, just a really clearly defined siloed position. We're all. Kind of stretched. And so I embrace that. I thrive on that kind of energy. And so, getting into the EMR system meant that I got into HIPAA, and so I became the HIPAA Privacy Officer and HIPAA Security Officer.

Because now I'm in a compliance space, I had the opportunity to train for and become the Compliance Officer. So within, I'm going to say 10 years or so, I'd gone from a housekeeper, from the janitor into the Director of IT and Compliance. From the director position, I had the opportunity to oversee the HIM department, eventually diagnostic imaging and some revenue generating departments.

And then I joined the senior leadership team and had the opportunity overseeing multiple departments to have a seat at that table, again, expanding my education. And I had the opportunity from there to begin a succession plan with my CEO that knew she wouldn't be here forever. And we had a five year plan for my succession plan at one point.

Two years into that. She said, Jonathan, I've got an opportunity I can't refuse, and she ended up leaving the organization early, and I was thrown in last year into the CEO position, and, we have a great board of directors here, I've got a very solid administrative team, and so everyone supported, you know, kind of accelerating that plan, and gave me the resources and gave me the patience so I'm actually finishing up one year right now.

As a CEO here at KVH and I think we're doing some really exciting things and I'm excited to share our journey along this electronic medical record. We became very quickly a site visit facility for Meditech, recognizing this is one of our most important relationships and so we wanted to be great partners with them and demonstrate proficiency and as much as possible quality and excellence in the use of that system.

And so now, I take every opportunity I can to talk about our journey.

That's awesome. That's, just what a great career story, and we don't have to dive into this because I'm just saying this semi seriously, but if you somehow met your wife along the way here as well, like, this is a lifetime holiday movie just waiting to be written and produced, but, you know, offline.

Well, I'll give you this, and that is, I moved here because of my then girlfriend because she wanted to get out of Oklahoma. She hated tornadoes. She moved back to her hometown. I followed her and now 18 years of marriage and three kids later the Hallmark movie is complete.

Oh, I love it. It's beautiful.

Well, thank you for sharing that. So let's dive into this topic. I'm really excited to learn from you and what you've experienced on this journey. Let's just start with What led you to, I mean, it seems obvious, but would still want to get your contacts. So you multiple EHRs, you want to move to a single platform.

What kind of led to that recognition? What were the key factors, then, that you used to kind of guide your ultimate choice of Meditech?

Yeah, so when the HITECH So, we were already with a system that was for our billing system. And so we were billing patients, we just didn't have any clinical modules. And so this accelerated our adoption of clinical modules.

Now we had to do, computerized, Physician Order Entry. We had to do point of care for nurses. So we began to add these clinical modules that were provided to us by that billing system. And we were successful with those implementations. We met meaningful use. But at the time that, vendor didn't have an ambulatory system.

They didn't have an ED module. And so we went ahead and went out and we purchased a specific ambulatory module and we purchased a specific ED module. So very quickly we went from zero EMR systems to three EMR systems. And then as that adoption, you know, as we got through those different implementations and optimizations, we added on a hospice and home health module.

How are we doing with the interfaces? How are we doing with the integration? How are, what's your satisfaction with your EMR systems? And we got a lot of responses, but the theme seemed to be, we want one EMR system. We want one patient, one record. And at that time, there were only a couple of folks doing that.

I mean, I say a couple where we, we interviewed Epic. Now we can't go directly to Epic. We would go through the Providence Health System or through MultiCare. So we had conversations with both of them. We looked at all scripts. We looked at CPSI, which was our billing system, and had some of our clinical modules, and they had now come out with an ambulatory system, and they had come out with an ED system and then we also looked at Cerner.

Cerner had a lot of momentum in the industry at the time, and so, we cast kind of that net and we began some conversations. And what's funny was that in our first meetings Meditech wasn't actually at the table. And so when we were looking at our systems, we recognized there's some quality issues with our systems.

And part of that's just from having multiple systems. They have different requirements for documentation. And it turned out the easier it was for a provider to document, They'll lower the quality of that documentation. If you're just clicking boxes and circling things for affirmative and slashing things that aren't present, you just get this bullet point list and there's no narrative, there's no patient story.

And so the next clinician to read that information did not appreciate it, right? They had to search through. So we didn't like the quality of the documentation that we had. But even bigger than that were the safety issues. When you're integrating and you've got interfaces between your ambulatory system and your lab information system, and the orders go across, the results come back, Well, if the orders go across and the results don't come back, that's problematic.

And we had we had some near misses. We had some close calls. We had some pretty critical values that didn't go back and thankfully we caught it. But that causes some safety issues that you know, that, that bothered us. And then the other thing was efficiency. If somebody came to our ambulatory clinic and they registered, And we said, hey, you need to go over and get some labs at the hospital.

They would walk across our campus and we'd ask them all the same questions, right? We need your name, is your address up to date, is your insurance up to date, is your all these questions that they just answered in the other facility. So there's all these efficiency questions. And then you have information that's disconnected and sometimes contradictory.

And so determining what was accurate was problematic. So we came to the table for safety, quality, and quality. and efficiency reasons. And we cast this net, we looked at these different systems that were available at the time, and our steering committee, we formed a steering committee, and the steering committee had our medical directors, had our CEO, had our business office director and CFO and more about some of the inclusion, but we had a pretty robust team that came together.

for the selection committee. And our ED medical director came and he said, if you're going to look at systems, you really should look at Meditech. And I said, we had a little bit of a conversation about that. And he said, they're coming out with this new module at another facility I was at.

It just wasn't ready yet. They're moving to this Expanse software. And so you really should, we should really consider them. And so as an afterthought, we pulled Meditech into the conversation. And so our process was we would do executive level introductions, and so we met with folks that hosted Epic, we met with Cerner, we met with Meditech, and we met with CPSI for those executive level conversations.

Very quickly, we were able to narrow it down, and we had a really, just a really positive experience through the conversations with Meditech. And we had some other positive conversations, but the Meditech ones really stood out. From there, we moved into demonstrations, and so we were able to schedule Cerner demonstrations and Meditech demonstrations in back to back weeks.

So our key stakeholders, our subject matter experts, could just really in a short time frame be able to see both systems and give us feedback. And so as we continued narrowing this down, it very quickly became really for us a two horse race. We were talking to Cerner and we were talking to Meditech. Then we began our site visits and we also looked at class reports.

So when we formed our Steering Committee, it wasn't just about clinician satisfaction and it wasn't just about one patient, one record because that was fairly common now, right? I mean, we were able to achieve that through multiple vendors, but it was also really important that the, that we took into account revenue cycle because we had heard from some of our neighboring facilities in the area about EMR implementations that really, negatively impacted them in a financial way.

They weren't able to drop claims very quickly. They weren't able to get money in the door and their AR days, their accounts receivable days were spiking to, 120 days in some instances. And so we were sensitive to that. We don't have a lot of cash. We weren't going to be able to sustain a really high spike in AR days.

So we made sure that we had, our business office director, we had our HIM director, and some of those different revenue cycle folks at the table so they could review because we were looking for a clinical system, but also something we could bill out of very quickly and efficiently. So, as a result of reviewing class reports, as a result of going out and doing site visits and then our own demonstrations.

We did some surveys of staff and we unanimously, really we had unanimous consent in the selection of Meditech Expanse as the next EHR vendor for Calicut Valley Health.

I love that. And I, it sounds like a very robust, effective process of a wide range of stakeholders and a holistic view of the EHR, not just as a care system or a claim system, but like the operating system, so to speak, of KVH.

And I think that's Clearly, you're happy with the way that process played out. Maybe kind of share with us now that you're on that single platform, that unified patient record, those disparity HRs into one, what has been some of the most impactful key benefits that you've realized?

Well, there's a number of them.

I go back to the three main drivers that brought us to the table, and I can say unashamedly we have improved the safety of our EMR systems by having a single vendor, and this might have been the case with other vendors. I can only speak to our experience, and that is Microsoft By having a single vendor the safety of our systems, the safety of our processes has been drastically improved.

Like, we trust our system. And so, we wouldn't have said that before, and it was one of the main drivers that brought us to the table. Also, the quality of the documentation. We have the autonomy and the flexibility to incorporate some third parties and that was also important to us, and we can talk about that, but really the quality of the documentation we've seen an improvement because we're on a consistent platform, and so, the user interface is very similar regardless of where you are, and we have some providers that might work in our express care one day, and then they'll work as a hospitalist, and, And so the consistency of the system allows for really solid end user training, accelerated and simplified end user training, and so that's helped as well.

So we appreciate the safety, we like the quality of the system and of our documentation, and then going back to that efficiency, having a single system without interfaces throughout for these key areas, at least, means that when we register a patient, it's across the board, and that sounds simple, but it wasn't something we had, even five years ago, and so the efficiency of the system we've been able to see some good enhancements for.

I think other benefits, I think, are along our, with our community. You know, If you go back to having three EMR systems, that means we had two different patient portals. And so when our community would come and say, hey, I'm looking for my lab results. They're not in my patient portal.

We say, well, they're not in that patient portal. They're in this other patient portal. So now they have to register for that. They have multiple usernames and passwords. And so that was problematic. And so we've improved our community relationship. Also, when you've got three different systems or multiple systems communicating, , the bills that we're submitting to patients can be very complex and complicated and unclear.

And so there was a lot of confusion around our billing at the time. And so that was one of the other reasons that we came to market and we wanted a single record was to improve, consolidate, and clarify our billing statements to our patients. And so we've improved our community relationships through those patient portals, by offering virtual visits, by having a consolidated concise billing statement, that can be, as detailed and granular as the patient would like.

And then also I'll point out clinician satisfaction. When you talk about EMR systems, you don't normally talk about clinician satisfaction. A lot of times we think of EMR systems as a necessary evil, but by having one single system with an intuitive modern user interface, we are seeing improved clinician satisfaction.

They're forced to document electronically, but they're in a system that they don't hate. They're in a system that they don't have to learn multiple systems. They don't have to log into a different EMR to find that ED, that emergency department documentation. It's all in one place, and so we're continuing to see improvement in clinician satisfaction as a result of the migration.

Yeah, as you were describing that, initially I was thinking about just you and the team at KVH, but that idea of satisfaction, efficiency, quality, that extends to your community and patients as well, because they're going to benefit from that same experience you described, and all of those components, like in my perspective, they drive that safety, which is that preeminent kind of focus, so I, I love how that, is really kind of harmonizing together.

Maybe share, like, how important was the MetaTek as a service cloud capability in this decision?

The MetaTek as a service, once we honed in on MetaTek and we reduced it to really two systems , then we started the financial conversation. What is this going to look like? And again, we didn't have a lot of cash.

There was a lot of uncertainty around that, and so when we were thinking financially, we thought we don't have, millions of dollars. We're going to go and get financing if we have to purchase this. So Meditech as a service, subscribing to this cloud hosted solution really enabled us to have meaningful conversations with Meditech.

If we were going to have a large capital outlay, it would have prohibited us from moving forward in any kind of quick fashion. It really would have made us come back to the table with some of the other cloud vendors that had a subscription model. So Meditech as a Service gave us all, gave us the financial and mechanism to be able to get in with MetaTek fairly quickly.

But then also there were tremendous benefits, especially coming from the IT space. There were tremendous benefits to going with a cloud hosted vendor. We were hesitant at first. We're a rural community. We're dependent on one fiber backbone over to Portland, so 100 miles, and there's no other pathways in.

And so we don't have the most reliable internet connections. And so we were a little bit nervous about that. But the benefits outweighed those concerns. We have meaningful downtime procedures. And so we w we would be able to endure a brief internet outage, even up to hours.

One of the primary goals for us though, was around cybersecurity. We have partners in the area. If you haven't been hit by some type of a cyber attack, it's just a matter of time. And so being able to take our most sensitive, valuable information give it to a trusted. Cloud host vendor who then is worried about cybersecurity.

It's not just a hat that somebody in the IT department wears, right? They have a whole team dedicated to cybersecurity and protecting that data. And so they're thinking about disaster recovery. They're also thinking about not just the security of the system, but the accessibility of the system. So they're worried about business continuity.

They provide remote access. They make sure you're set up with multi factor authentication. And then they're doing the software updates. They're doing the software testing. So we offloaded a tremendous amount of responsibility and burden over to somebody who is very good at this. This is their space, right?

They are a cloud host vendor. So we gave that to them so that we can do the things that we're great at and let them do the things that they're great at. And that's all in that monthly subscription fee. And so there has to be some way. And so my CEO, CFO, and I sat down and we tried to come up with, okay, How much is this?

What dollar value is being brought to the table? And when we looked at five year and 10 year ROI estimates and those things, we felt like it was a very reasonable subscription cost, considering all of the benefits, not just the EMR system, but the cybersecurity and accessibility that came along with it.

Yeah, I think that's a great comprehensive way to view the total cost of ownership. You've alluded to the importance of independence and autonomy in your consideration. Maybe just elaborate more on that and why that was so important to you and the team.

We have had friends and partners in the, neighboring communities who have been EMR systems.

But one of the things we hear, there are limitations sometimes when A, you're hosted by another healthcare provider, not by the EMR vendor, or you're hosted in a pod with other facilities. And there's some limitations around your autonomy and your independence. We had direct relationships with our previous, in fact, we purchased the software from our previous vendors.

So we own that software, we still have it. And so we recognize the value of independence and autonomy. And so by working directly with MetaTek and not having anybody in between us, we knew that would mean that we could look at third party applications, we could look at other tools for efficiencies and other vendors to partner with us, and we would have fewer restrictions and limitations.

We weren't working from somebody else's playbook. When new modules would come out, we could immediately adopt them. We didn't have to go through somebody else. We didn't have to get approval from someone else. We didn't have to wait for somebody else to vet and test it. And so we knew we wanted autonomy.

And that has proven itself to be true. There's some utilities that we're able to utilize from a productivity perspective, from a revenue cycle perspective, from clinical documentation perspective, that we've been able to directly contract with and go straight to. And we've either integrated them through Meditech, And so that autonomy was very important.

We wanted flexibility. To us, autonomy also means flexibility. And so you can very quickly pivot as you need to meet the different needs. So we have a number of staff that have cross trained into multiple departments. And so if they're going to go from, a CNA on the floor to an ED tech at night later in the week, We're able to pivot very quickly.

We're able to make those security changes without going through another organization. It also meant that we could customize our clinical documentation to meet our specific provider's needs. We've tried to be careful with that, but we do have that flexibility so we can build templates, we can build order sets, and we're not putting in tickets and waiting for somebody else to do that work.

And so there's a certain amount of agility that also comes with that autonomy.

Yeah, so what I'm hearing is you don't have to be a large health system with deep financial resources to be able to acquire a robust EHR solution that helps to drive safety, quality, efficiency, but still maintain a healthy degree of autonomy and flexibility.

That's awesome.

That's been our experience.

So, we're getting short on time. One kind of last question, maybe to wrap it all up, and within the context of this, and maybe even a bit beyond, as you look ahead, how do you see technology like this really shaping rural health care in America?

I used to say that question would be above my pay grade, but I guess it is my pay grade now, right?

You know, uh, I, I have gone over the last several years, and I can't credit MetaTek with all of this, but I've gone from somewhat jaded because the industry, the EMR tools, the EMR vendors I feel like have consistently over promised and under delivered, right? Hey, we've got this functionality coming.

We've got this improvement coming. We've got these tools coming. And we have adopted, we've been, I don't want to say bleeding edge, but we've tried to be on the forefront of some of the adoption to improve clinician satisfaction, to improve efficiencies in our operations. And I can say now that I'm almost naively optimistic.

So when you say about the next 5 to 10 years, we're starting to see, I feel like, the meaningful integration of these technological tools to the EMR space and rural healthcare spaces. I'll give you a couple of examples. One of them is around the natural language processing and ambient voice technology, right?

And so, we've been subscribers for probably three or four years now to some of these technologies, ambient voice technologies. And again, this is a space that has over promised and under delivered. And right now, I can confidently say, we are really seeing the first steps. These are the fruits of those efforts and the maturity of those products.

And so if in the last 2 to 3 years we've seen these products mature to actually be a benefit, and a help to our clinicians, I'm looking forward to what they're going to be looking like in 5 years, right? The other thing that we've been adopting is robotic process automation. And so it's very, it's very, It's a little bit clunky right now, it's a little bit primitive right now, but it's operational.

We've got six different revenue cycle processes that we've currently, automated through these bots. Now, right now we're bolting on these systems or we're, we're copying and pasting still in somewhat a primitive way. So, when I look at the future, when we start to , technologies, that they can become native to the application or have better integration with the application.

I feel like we're going to start, especially in rural health care, we're going to start seeing not just clinician satisfaction, but across the spectrum of revenue cycle, there is tremendous opportunity in every rural health care facility. I don't mean to overgeneralize, but we all struggle with this, right?

We need money in the door. We need every dollar that we're due. And so, we're using the RPA, the Robotic Process Automation, but once the machine learning comes together, once these tools can be embedded in the Electronic Medical Record System, I feel like we're going to see improved accuracy, improved efficiency, and we're going to see better performance on our financial metrics and on an RPA.

a tangible, meaningful way. So I don't want to be overly optimistic. Again, I'm naively optimistic, but we're starting to see where it can go. We're starting to feel the benefits of it, and it's really still, I feel like, in a primitive state. So, five years from now, I'm excited to see where these technologies have gone and how they're integrated with the electronic medical record systems.

Well, I'm an eternal optimist, so you are speaking directly to me, and amen to everything you just said. This has been fantastic, Jonathan. Thank you. Thank you for all that you're doing in your community to improve health outcomes. Thank you for making the time today to share with our broader healthcare community.

I think this makes us better. Really appreciate your insights and congratulations on just the great outcomes of your EHR consolidation that you've shared with us today.

I appreciate it. It was a heavy lift and I don't deserve credit for it. was a part of a tremendous team here at KVH and I appreciate all of our staff and our community that have just bought into this transition and this evolution.

And we haven't arrived yet. There's plenty of room for growth, but we're pursuing it aggressively. So I appreciate you having me on today.

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