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