Mastering the Challenges Facing CIOs in Smaller Hospitals: One CIO’s Perspective

Far from the nation’s largest cities, the CIOs of smaller, standalone hospitals in smaller cities and towns face budgetary and staffing challenges not faced by their big-city, multi-hospital-system counterparts. How do they manage to master the challenges in their environment? Recently, Tom Kurz, the CIO of Memorial Healthcare, a 162-bed hospital in Owosso, Michigan, spoke with Healthcare Innovation Editor-in-Chief Mark Hagland regarding his IT team and how he and his team members are mastering the moment in their environment. Owosso is a town of 15,194 people located in east-central Michigan, 26 miles northeast of that state’s capital, Lansing, 40 miles south of the city of Saginaw, 25 miles southeast of the city of Flint, and 94 miles northwest of Detroit. Below are excerpts from their interview.

Tell me about your background? How long have you been in your position?

I’ve been here for five years, as CIO. I handle not only the IT areas, but also business development and public safety—all three areas. I came to this organization following a previous career in higher education; it’s been a wonderful journey.

Tell me about your organization?

Yes, we have a 162-bed, independent community hospital. We also have 30 medical practices represented on our medical staff, with about 100 providers. We cover family practice all the way through all the specialties. One big service line for us is neurology; we have 11 neurologists in our organization, which is unheard of in a community hospital.

How big is your IT staff?

22 FTEs on our IT staff; that includes helpdesk, desktop support, networking and systems engineering, as well as clinical analysts. We’re on Meditech Expanse. Half are clinical informaticists. Two nurses, a couple of folks from radiology.

Do you have a CMIO at your organization?

We have a CMO, who operates our provider advisory committee, where all medical staff meet around the EHR [electronic health record] sit on that committee, chaired by him.

What are some of the key challenges you face in your organization, especially given the small size of your team?

We occupy an interesting space, kind of that middle-market type of hospital. Crain’s Business Detroit ranked us as something like fourteenth in revenue among Michigan hospitals. Spectrum, Ascension, DMC, are the big ones. But we as an organization operate more like the larger hospital systems than a critical-access hospital. We have the same level of complexity when it comes to service lines, services we offer, specialty practices. So we operate similar to a larger hospital system, but at a smaller scale.

What does that mean in terms of having to stretch your capabilities?

We have to make all of our resources go that extra mile. We have to operate “lean and mean.” And where some organizations might have a team of people working on a situation, we might have one. We can’t afford to add layers of complexity around any type of challenge we’re trying to address. We’ve established a clinical directors’ program to help all the clinical directors establish all the priorities. That relationship between the directors on the clinical teams and the IT teams, is very important. We have to make sure to address the most important issues.

Are there areas in which you wish you could move faster?

Yes, there are; some involve the most complex projects. EHR optimization, we have great team members who help us identify issues to operationalize and improve. Some of the larger projects, I wish I could put a dedicated team on. And sometimes, timelines are added to projects or potentially not allow us to address them.

Are there perhaps two or three specific areas where that’s true?

Data and analytics would be one where I wish I had a full team around; another would be the development of new toolkits within the scope of EHR optimization.

What are some areas in which you find that you’ve been able to move forward the most fully?

We’ve been live on Meditech Expanse for a year and a half. We had been on separate instances or systems for inpatient, clinic, and home health; we have to converge those systems onto one system. Expanse is not only an EHR system but also ERP, and handles finance, supply chain, billing, and other areas. By converging on a single system, it allowed us to focus, to get it to be successful.

How has the pandemic affected your operations?

I think with all healthcare organizations, we’ve seen a shift, and it’s made us be a bit more agile, especially when addressing the changing needs of the pandemic from the initial focus on keeping our patients safe, to developing a separate COVID floor and COVID ICU, to an alternative care site, where we kept potentially exposed patients out of our ER and regular screening areas. We were one of the first to stand up one of those alternative care sites; we were number four in MI to create in-house COVID testing. We were among the first … Michigan is a certificate-of-need state; we actually added acute-care beds to the hospital for COVID care, both in the ICU and med/surg areas. We added specific beds, with all the appropriate protocols. And established drive-through testing centers. And throughout the entirety of the COVID pandemic, we’ve been addressing new issues constantly. If anything’s been constant, it’s been change.

What have been some of the key learnings for you as a CIO, in the past year?

We are an organization that has spent a significant amount of time on emergency preparedness. So one of the key learnings has been around—we’ve used the NIMS preparedness model. That’s allowed us to have the right people around the table, including the operational and clinical people, including our CMO, to address incident response. It involved using the tools and capabilities we had, to adapt to the pandemic, and making constant adjustments. That’s probably been the biggest set of lessons learned—navigating continual changes in federal and state regulations, and adapting in terms of operations.

What do the next two years look like for you and your team?

It will involve adapting to a new normal. Does that include a bigger reliance on telemedicine? Integrating clinical practice visits, urgent care, into telemedicine? Before COVID, we had no telemedicine; now it’s in urgent care, primary care, and even some specialty care. Advanced ICU is a company we work with. So the next two years looks to us like settling into a new normal, and meeting the care needs of patients. Most of our patients now feel much more comfortable coming to the practices. But we now have a zero-waiting-room process. We limit as much as we can, anyone waiting in any one spot. So defining the new normal will be huge for us.

Are you getting the resources you need from the c-suite of your organization?

Sitting on the executive team has been very helpful. And if we have needs, everyone is going to work as much as we can, to appropriate the correct resources. It might sound a bit cliched, but we really do have an executive team that works well together to identify and address needs. We’ve built the relationships we’ve needed at the c-suite level.

What’s your advice for CIOs at smaller organizations like yours?

My advice would be, collaborate, don’t compete. And work with your peers. We have a wonderful group of CIOs at the Michigan Hospital Association, where we have great discussions. Find a peer group, see what other organizations are doing, and work collaboratively, not competitively, to make sure you’re taking care of your patients.

And in terms of what’s staying remote and is now onsite—that was a problem that we had to solve early on, particularly where we had executive orders from our governor around where work must be remote if it doesn’t need to be onsite, so we followed that. Our facility for IT was largely cubicled, and didn’t meet certain standards, so pretty much everyone on our IT site was pushed to remote; our helpdesk folks and desktop folks stayed onsite, but everyone else went remote. About 20 percent ended up staying onsite.