Q&A with Kate Pierce, Part 1: “Everything’s Not Going to Be Perfect at Go-live.”

“We’re pretty much on an island.”

For rural health organizations, it’s a harsh reality — especially ones like North Country Hospital, a critical access hospital based in Northeast Vermont where “the community is very dependent” on its facilities. In fact, NCH owns nearly every practice in the area, some of which are operating at a loss, just so patients won’t be left out in the cold.

Being a rural health facility means having to do more with fewer resources, getting creative with growing talent, and for leaders, having to wear many hats. To some it may seem daunting, but Vermont native Kate Pierce, who started with the organization 18 years ago as a systems analyst, wouldn’t have it any other way.

Recently, she spoke with healthsystemCIO about the transformation the organization is undergoing to improve workflow, how they’re working with other facilities to better manage costs, and how they’ve been laying the groundwork for the shift toward value-based care.

Chapter 1



* Being a CAH – “The community is very dependent on us.”

* Working with Vermont’s Green Mountain Care Board to control costs

* Migrating to athenahealth’s cloud-based system

* Diverse representation w/ EHR selection & planning committees

* “It wasn’t IT-driven; it was more organizationally-driven.”

* Gaining clinician buy-in

* Go-live expectations – “It’s the baseline.”

* Optimizing documentation



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Bold Statements

At one point, we did an analysis and it turned out we were supporting 173 different applications in over 300 different interfaces. That’s just not a sustainable model.

That has allowed us to become a lot more predictable in our IT costs, because the cost is a percent of your collections. If we do well, they do well. If we don’t do well, they don’t do well.

The leaders of each department were responsible for making sure the software met their needs. Our informatics team would support each one of those directors, but the build decisions weren’t made by informatics or the IT side. They were made by the clinical side.

Every time you have to manually enter information, there’s an opportunity for error. And so it wasn’t hard to get buy-in from providers.

We set the expectation that everything’s not going to be perfect at go-live. Instead, it’s the baseline from where we we’re going to continue to build.

Gamble:  Let’s start with an overview of North Country Hospital — what you have in terms of care offerings, where you’re located, etc.

Pierce:  North Country Hospital is located in northeastern Vermont. We’re a critical access hospital; we have 25 beds. There’s not another hospital for over 40 miles, so we’re pretty much an island, and the community is very dependent on us. We own about 85 percent of the practices in the community.

We have an emergency department and a surgical department, and we offer maternal child health services. We have two large primary care offices and 14 clinics that offer a variety of specialty services for our community. We recently did a community needs assessment to make sure we’re providing all the services that are needed. There may be a few additional offerings that spring up over the next year or two based on that.

 

Gamble:  Right. And you said North Country owns about 85 percent of the practices in the area?

Pierce:  It may be higher than that; I can only think of two practices in the area that are not hospital-owned at this point. One is a pediatrics practice and one is primary care, and they’re both single provider offices. We became owner of all these practices because it’s very hard as an independent physician in a rural community to meet all the challenges.