HIStalk Interviews Anna Turman, CIO/COO, Chadron Community Hospital

Anna Turman is CIO/COO of Chadron Community Hospital of Chadron, NE.

Tell me about yourself and the hospital.

I’m the CIO as well as the COO of Chadron Community Hospital. We’re a small, critical access 25-bed hospital. Not for profit, of course.

As the CIO and the COO, a good explanation is having to do more with less. I am the more with less. I do have to run both roles. I find that very complicated a lot of the time. I don’t have enough time in the day for it.

We do trauma, we do babies, we do lab, we do surgeries. We have just about everything. I think we are exceptional for a critical access hospital. The next closest hospital to us, which is another critical access hospital, is 53 miles. The next what we call hub hospital or larger hospital is 100 miles north or 100 miles south. The one north is in South Dakota and that’s where we ship a lot of our patients. We usually stabilize and ship, so like hearts or other big traumas, we stabilize and ship.

You were a graphic designer, which is probably the least likely background to get into either CIO or COO roles, much less both. How did you transition into what you’re doing today?

I used to live in the city, got married, and my husband wanted to move back to this town of 500 people that he was from. There’s not a lot of graphic design necessary here, and so I had to reinvent myself and go back and get some education. I’m a highly motivated Type A personality, so it is what it is.

How is your job different from those of other CIOs, especially those from larger facilities?

On the governance level, it’s quite a bit different. We have our strategic plans and run our IT strategic plans off the business strategic plans, but we’re so much smaller that our communication seems a lot easier than having to deal with the complicated governance that you can see in some larger facilities. Our governance is much more simplified in communicating. I think that’s huge.

I took on the COO role and wasn’t able to give up the CIO role because I guess I did well enough at it that he didn’t really feel that it was necessary for me to give it up. I do balance that. It is difficult to balance. The responsibilities are just the same as any other hospital. I’m in charge of the business office and medical records.

What makes it nice is that I can see every aspect of the business. I can help from the IT perspective as well enable those parts of that business to get somewhere, be more efficient, or find the goals that they need to. I think that helps. It ties in. It’s a beautiful tie-in, actually. It helps me communicate better. I don’t have that “one more person” that I need to communicate with to find out what we need to do to enable other goals because I already know everybody’s goals.

What systems do you run?

I run NTT, complete NTT. We did a full-blown, big bang, six-month complete implementation everywhere from HR to financials to clinicals to pharmacy to radiology. Everything is NTT.

Are you doing OK with Meaningful Use, ICD-10, and everything else that’s coming down road?

Yes. I think we’re an exceptional facility. We have an exceptional group of people who are hardworking, pioneer-type people. We are a small facility, small area, small community, so they’re pioneers, they are hard workers. They do more with less. It’s just natural ability.

Because of that we, have been very blessed to have the capability of meeting Meaningful Use Stage 1. We are going to attest to Stage 1 year one and we are working on Stage 2 right now.

We won “Most Wired.” For a small-town, 25-bed critical access hospital, we really are exceptional. That is me patting them on the back, not myself.

How is your IT team structured?

I have one clinical informaticist. He’s a pharmacist. I have a data manager. He runs data, can help us with any reporting, helps us get everybody’s reports out for our data mining and all that stuff. It’s all one database, so that helps tremendously. We have the network manager and he runs all the networks. I have the clinical manager, who runs the clinical informaticist and updates all the systems. He’s also the applications manager.

What IT accomplishments are you most proud of?

It was probably “Most Wired.” That is pretty hard for anybody, let alone a small facility.

How are the IT needs of critical access hospitals different from the average 300- to 400-bed community hospital?

They aren’t. It simply comes down to, we just have to figure out how to do more with less. We have the HIPAA security laws. We have to encrypt all of our emails going in and out. We have to encrypt this, we have to encrypt that. We have to do all the same security. We have single sign-on. We have thin clients at the bedside, med administration at the bedside. Technically, to keep up with everybody else to have Meaningful Use, meet Meaningful Use, and to get Most Wired, we have to have the same needs.

For a while there, our biggest issue was Internet and speed and fiber. Rural Nebraska Healthcare Network is made up of eight or nine hospitals. Eight of them are critical access hospitals. One of them is Regional West Medical Center, which is the one that is 100 miles south of us. We have through grants been able to put redundant fiber into those smaller hospitals. We’re able to coordinate and collaborate backups to each other. Three of them have the same electronic health record, Healthland. They back up to each other’s offsite location and we use the fiber for that. There is a lot of business continuity we can work out through that fiber.

That was probably the biggest thing that was different in the bigger facilities. We didn’t have that access to high speed broadband or anything like that. Now that we do, it’s been a lot better. I can transfer my radiology results to and from. We can do our radiology here. We send them to our radiologists, who are actually in Denver, and we can use our fiber for that. We get quicker response for that because mammograms, for example, take a lot of bandwidth. We couldn’t do it with the T1s we were using originally, so then I had to buy 10 megs of fiber. That still wasn’t enough for the mammograms. When we got this grant that we can have redundant fiber, it’s a gig throughout all of our hospitals. We were capable of doing the mammograms and now we can do digital mammograms. It has to do with me being so much more rural more so than the technology that’s different.

Do you think Meaningful Use set the direction that’s best for patients or would you have done anything differently had that not been the carrot that was in front of you at that moment?

Oh, boy, you’re going to ask for my soapbox, aren’t you? [laughs]

I don’t know. I think there could have been some better ways to go around it. For example, I’ll give you my soapbox.

Everybody is throwing out this patient portal. There is not a lot of collaboration. People are trying, don’t give me wrong, but there are still clinics everywhere like ENT clinics or hospitals who are competitors and things like that. We are trying to communicate and share the data. We do that with our Rural Nebraska Health Network. I have an ENT clinic appointment up in Rapid and they give me a patient portal to access their information and do things there. Now I have their patient portal with a user name and password. I log in and help them meet their Meaningful Use.

When I go to the ER across the state in Lincoln because I was watching the football game and I ended up in the ER by breaking my arm, they get me on the patient portal, give me a user name and password, and now I have that one. Then if I go and visit over here, I have to go to a dermatologist or something, I have their patient portal and their user name and password. Then they come to this hospital where the actual physician is and their clinic here. I have their clinic and the hospital’s patient portal.

How many patient portals does that patient have to have? How many user names and passwords do they have to have? It really does come down to that exchange of information. That is going to be a key player.

What have you done that’s innovative?

I like that we use our televideo for mental health. We really do push because we are so rural. For our home health and hospice, they really do travel a 100-mile radius to reach those patients. We’re trying to push our televideo now to start doing the home health and hospice that way as well. But we do use it for mental health. We use it for dialysis patients so they can see their dialysis nephrologists through the televideo. We used it once when the baby was sent to another facility and they had to stay here because the baby was in danger — we used it so they could see the baby.

We use the televideo quite a bit. That’s a key feature for us rural people. It’s important. Innovative? I don’t know if we’re able to be as innovative and on the brink of things, but we really do try to.

Did you ever look at a big hospital and either wish you there or be glad that you aren’t?

No. I usually try not to see “grass is greener” anywhere else. I usually just try to be happy where I’m at. [laughs]

Communications in bigger facilities is so much more complicated for them. I am very happy that we have the communications that we have here and that we work so well together and work hard to get things done as a team. I think it’s a lot harder to do that in a larger facility. We see each other face to face so much more than anybody else would.

What opportunities and challenges do you see from an IT perspective of keeping up with reimbursement and regulatory changes?

To be honest with you, that is probably one of our biggest sticky points in a small facility. Larger facilities will have a HIPAA privacy officer. Well, I’m the HIPAA privacy officer. A larger facility will have a HIPAA security officer. Well, I’m also the HIPAA security officer. Having to know everything, know it well, and be very successful at it is very hard because so many roles get put under one person. Right when you think you’ve got it down and you could do it well, they change it again.

It does make it very complicated. Right now, I’m just cleaning up the Omnibus. Omnibus came out, changed out the privacy stuff, so I had to go and make sure we got all that taken care of. Every time they make a change, whether it’s technologically or patient privacy, it’s complicated for us because we have to know everything. One person has to know so much more and wear so many hats than a larger facility. It’s hard to keep up. It really is.

Do you think that economy of scale will lead more hospitals to acquire each other because they can’t go it alone?

The survival rate of the critical access hospitals is hard now. As we move more towards the future, it’s going to get harder. I don’t see it getting easier.

That is probably not typical of my perspective. I tried to look at everything from positive perspective, but no, it’s not getting any easier. The sequester makes it harder. Things like that just make it harder to survive as a small hospital. Even in Nebraska, governmentally they are looking at how to get rid of some of those critical access hospitals.

For a CIO who wants to do as you have in becoming a COO, what would surprise them most about what it’s like?

It makes being CIO a little bit easier except for the “more work” part. [laughs] You get a glance at the business goals and you can align the strategic plan so much easier. But that’s because I play dual roles, so I don’t know. That is kind of difficult.

For me, it was easier because I can see everybody else’s plans and I can coordinate with them and collaborate a lot better. I’m trying to think what the biggest surprise is. To be honest with you, CIOs are less just technology and more business structured anyway, so it was a fitting role to move into the COO position. I think CIOs have been moving away from just technology for some time. They have to understand the business strategy. They have to be a business person.

Most CIOs see it differently, but other people may see CIOs as just a technologically knowledge base. In reality, we are also a business knowledge base. It’s a good transition to go from CIO to COO.

Any final thoughts?

I should say a little bit about ICD-10. As small as we are, we only have a few coders, so the training is a little easier. But then again when ICD-10 does switch around, the bulk of the problems are going to come down on just a couple of people. If it all is smooth, great, but we have to have expectations for the worst. We don’t have that many people, so resources, when it comes down to going live, will be a little different for us.