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Ed Gaudet:
Welcome to Risk Never Sleeps, where we meet and get to know the people delivering patient care and protecting patient safety. I'm your host, Ed Gaudet.
Ed Gaudet:
Welcome to the Risk Never Sleeps podcast, in which we discuss the people that are protecting patient care. I'm Ed Gaudet, the host of our program, and I'm pleased to be joined today by Michael Archuleta, chief information officer at Mt. San Rafael Hospital and Clinics. Michael, welcome.
Michael Archuleta:
Hey, thank you very much. It's definitely a pleasure to be here.
Ed Gaudet:
So you've been there 16 years? A long time.
Michael Archuleta:
I definitely have been here quite a while.
Ed Gaudet:
For someone in our profession, it's good to see that. Tell us about the hospital.
Michael Archuleta:
Yeah, absolutely. So we're a healthcare organization here in southern Colorado. I've done so much with this organization, and the thing is, I've been here for such a long time, too. So when I came on board, this was really during, when the Affordable Care Act really came out, and it started mandating a lot of these healthcare organizations to basically implement an electronic medical record system. So when I came in, it was a complete disaster. I really had to determine, do I stay in this organization or do I move on, because honestly, if I don't make something of this group, I could possibly just tarnish my overall reputation. Because you figure, when I came in, there was a 59% uptime on some of the critical systems that we basically had here in this organization. There were servers in housekeeping closets, there was switches in housekeeping closets. There was a small home-grade wireless access point. There was no disaster recovery, no data center, no standardization, no centralization. And honestly, so what I did is, when I first came in, I did a before and after of what it looked like. It was just so phenomenal, on some of those pictures, and I'll share those pictures with you, too. I don't know if you could post some of those or not. So then when I came in, I really started focusing on, you know, transformation, knowing that the importance of technology, of where we stand, healthcare was really starting to start moving forward with technology initiatives because you figure, this is the unfortunate that I always say is that the healthcare industry is one of the most antiquated industries out there, and it's such a disservice because you figured we're doing the most important thing out there, and that's taking care of people's lives, that's saving lives, that's enhancing individuals lives, but we're behind the curve when it comes to technology advancements. You think to, you know, look at the oil and gas, look at the finance industry, look at all these other groups that are many, many more years advanced when it comes to technology, and that's a major disservice, because we should be leading the pack when it comes to digital transformation. We should, honestly, but, like I stated, I came into this overall healthcare environment with so many critical issues in place, there was no focus with the Electronic Medical Record System initiative because they told me, well, you coming on board, your first initiative is implementing an EHR. And I said, okay, well, what do we need to do? Where are we at? I don't have any of that information. What, how is the staff trained on? Have we looked at moving? Have we looked at different specific vendors? I mean, it was a massive mess. And I had a consultant group come out here and do an overall analysis of the organization to really determine, hey, we need to go live by this specific date to avoid these penalties that these, this organization was going to receive because they were so late adopters and implementing an electronic medical record system. We had a 20% chance of successfully going live the date that we basically needed to. That was a scary time because honestly, the penalties were getting really high up there if this organization wasn't going to move forward. So definitely rewind from there, we implemented, built the team, we started developing some strong initiatives, and I've really transformed this organization from paper to digitalization. We went from that 59% uptime to that 99% uptime. You know, we went from all physical servers to 99% server virtualization within this environment, and we went from 90% virtualized on a desktop standpoint of things. And we started utilizing and building the first advanced data center for this organization to house all the data depository initiatives needed. We implemented next-generation firewalls, we implemented enterprise wireless systems in place, redundant power management, full automation backups onsite and offsite. Cable management was a huge thing because when I send you those pictures, you're going to see how it was a disaster, the data rooms looked like in this organization. It was like honestly, like a like when you're eating a lot of spaghetti, which I love, and you're seeing all of that just come together, and there's no indications or documentations on what specific area is going. And you figure, this was really, many years behind. Look at where healthcare is now. If we as an organization did not focus on building some of those foundational items and those backbone initiatives needed, we would not be successful with any of the new initiatives coming into place because you figure, healthcare isn't getting easier, it's getting harder, it's getting more complex. We're going from a fetus service, to now more of a value-based care initiative. Look at the cybersecurity landscape in place. This organization during that time had no focus towards it. But look at it now, the healthcare industry is the, one of the top most attacked industries out there. We went from the top ten to the top six most attacked industries. And the thing is, too, is I, as a leader of this organization and trying to stay off the OCR list, mostly every single hospital in southern Colorado has been recently breached except us. And the thing is, I always say that it's not if, but when an attack basically happens, and that's really the thing. But we've implemented a lot of strong initiatives with artificial intelligence, predictive analytics, strong specific outcomes, looking at abnormalities in our environment, starting to focus on some of these next-generation initiatives, and they're like, wow, man, this small hospital is doing some amazing things out there. As I stated, it's been one of those items that you've really developed and built since like birth. It's kind of like, you know, when you have a child, I have two kids, I have a son and a daughter, and you teach them, you grow them, and you have so much investments in them. This is what this hospital has been to myself. And we built a brand new facility, too, we've implemented so many good consumer-based digital tools that really enhance the overall patient experience, which has really been so critical in such an important thing to our overall success. Because in the end, and you probably heard me speak all the time, is that, I always state that our new CEO, I don't care what position you work in this organization or a healthcare organization, but your new CEO is the patient, and that's basically the bottom line. And it's funny, too, because when you come into my office, I have this big poster just like right above the door, and it shows The Flintstones meeting The Jetsons. And that's what I always say is that healthcare has been behind the curve with technology advancements. It is time for the Flintstones to meet The Jetsons, because honestly, we have to really reprioritize and realize that hospitals and clinics are digital companies that deliver healthcare services. We're truly living in a digital age of healthcare initiatives. And I know you asked me a question on, hey, you know, how long, and I really took it to another level, so I do apologize.
Ed Gaudet:
No, this is great.
Michael Archuleta:
Just a lot of passion in regards to that.
Ed Gaudet:
I can tell. What are the charges you put on?
Michael Archuleta:
So the group already had a selected EHR, and of course, I was in charge of implementing it. So the inpatient EHR that we do utilize is a company called Medhost, and then our ambulatory EHR system is Athena Health.
Ed Gaudet:
Oh, good, okay. So how did you get into healthcare? How did you end up getting into the field itself?
Michael Archuleta:
I just started coming into place, and there was an opening in regards to a network engineer for a hospital organization, because, it's funny because, as a child, I was terrified of doctor's offices. I used to hate going to doctor's offices, and that was one of the things, and ironically enough, I basically, work at a healthcare organization. So it was just one of those things that really came into place, everything worked out. I was looking for some change and was looking at really seeing how I could be involved in helping individuals and even like, you know, IT, we don't have direct patient care, but everything that we implement really creates better outcomes for patient efficiencies, patient outcomes. So I really got involved in regards to that and really came into place and just started doing it.
Ed Gaudet:
It's that shared mission too, I love about healthcare that you can't get in any other industry. Because, like you said earlier, we're all patients, we all know patients, we're, families are all patients.
Michael Archuleta:
And that's the thing, though, too, is, and that's what I wanted to change. I've always been one of those individuals that want to make an impact change towards enhancing better initiatives for patient care. I've seen a lot of individuals, especially in these smaller communities, they go to these other hospitals, and these other facilities don't really focus on asynchronous tools that benefit patients both inside and outside the organization, and that's why my motto has always basically been that my new CEO is a patient, and that's basically the bottom line, and as an organization, if we don't continue to really invest in those specific initiatives, we're not going to be successful moving forward. And we have to continue to lead the pack on this, and that's why even during ViVE, I just had a lot of passion in regards to ladies and gentlemen, we had so many start-ups in place, the start-up groups. These innovators, we are disruptors, we need to disrupt our industry moving forward to create better enhancements for us all. And that's really critical because as I stated, it's a disservice that we are behind the curve. We need to be leading the pack towards innovation, towards digital transformation. And it wasn't because of your CIO, and it wasn't because of your CTO that really made a digital transformation happen in this industry. It was more because of COVID-19. And the thing is, the issue is when COVID really hit, a lot of organizations really determined if their home was in order, and that was really a major problem because you figure a lot of these groups were having to really retransmit, re-really focus towards what they're doing with employees, how they're sending employees home, how they're making sure that their information is kept safely, they're spinning up these overall telehealth clinics, and the issue is a lot of them didn't have that foundational backbone that was basically needed to create these efficiencies. COVID-19 hit, we had a very strong virtualization backbone, we had a very strong broadband connectivity because we designed an overall border gateway protocol initiative that basically utilizes multiple ISPs with a standard one public ... IP, which creates more efficiencies and full redundancies for connections. So we were able to spin up specific telehealth clinics effectively, efficiently. We were able to send people home securely, effectively, efficiently. So the thing is, our home was in order because we had a strong foundational backbone that created those specific initiatives and those efficiencies to create better outcomes ...
Ed Gaudet:
And some IT groups were actually brought into the clinical side to help out with clinical operations. I don't know if your team had gone through that process or not.
Michael Archuleta:
Yeah, absolutely. I mean, the thing is, we were all in this together, no doubt about that, and we were really trying to make sure that we all, any way we could help, we were there. We were honestly there. Like I was part of some of the initiatives of really looking at obtaining specific PPE, obtaining additional masks, because the inventory on the materials management standpoint, it was really hard to get a lot of those protective equipment that was basically needed for our clinicians. So it really just going out there, being part of all these groups advocating for our organization to obtain some more information. So we really stepped up, we stood out from our current roles, and we just all teamed together to really create some better initiatives and better efficiency. But the thing is, we've learned a lot, especially from this unique situation of what COVID-19 is. And as I stated, we've seen the importance of what digital transformation and technology is, because the problem is that when we look at healthcare, and especially we look at healthcare organizations and smaller and smaller communities, we always categorize IT as a cost center, right? That's a major issue. And this is what I always say is, we need to move away from that cost center initiative and really be focused as more of a strategic revenue contributor to the organization.
Ed Gaudet:
It's an enabler, it's an enabler, if you don't have it.
Michael Archuleta:
That's really the thing, and you figure, IT has always been, what, a ticket taker versus a true value maker. That's what's really important too, is, and that's why I tell a lot of these CIOs that we're behind. Sometimes, unfortunately, we see this trend of CIOs living behind a desk, creating these specific outcomes and these initiatives. That's not my personality, and that's not how I roll. I've developed an overall no-nonsense framework initiative, which basically I'm part of the GSD groups, and I'm like, ladies and gentlemen, you have to be part of this GSD group in order to continue to build successful outcomes for your organization. They're like, Mike, what's a GSD group? I said, let me tell you something. There's talkers, there's individuals that talk, and they have these amazing discussions, but they've really never said that, what we've done, and they haven't created these outcomes. They don't go outside of their overall office. IT has always been siloed, and that is a problem. We have to come out of this shell and really expose all the benefits and the initiatives that this department basically does. And the thing is, and I'm like, come on, guys, we have to build that GSD mentality, right? What's that GSD mentality like? That's like Getting Shit Done mentality, and that's basically the bottom line. I walk it, and I talk it, and I get it done, and that's why I've developed that no-nonsense framework initiative, that's why I've been really established towards GSD. We have to GSD, and we have to really create these outcomes and stop being so stagnant because the thing is technology and IT has always been siloed, and they've always been seen as that cost center versus that true value maker, that true strategic revenue contributor. And I did a discussion with Columbia University, and we are talking about the brick-and-mortar theology of healthcare. And you figure the brick-and-mortar theology of healthcare has always been established in this overall mentality. We have to move away from that mentality. We have to look at healthcare as a digital company that delivers healthcare services. We can no longer really think of that brick-and-mortar theology of what this organ, of this industry has been built on. We have to innovate. We have to digitalize. We have to refocus where technology sits, and that's really a critical component moving forward. And we've even seen the evolution of the chief information officer in the healthcare industry itself from really being more of just an advisor role to really driving and leading the organization moving forward.
Ed Gaudet:
Yeah, driving transformation, like you said, being the chief digital officer versus the information officer.
Michael Archuleta:
100%, and that's really a critical component moving forward. But like I said, it's funny because always quote that as, because it is honestly time that The Flintstones meet The Jetsons of that, and that is really critical.
Ed Gaudet:
So what keeps you up at night? You got a lot on your plate. What keeps you up at night?
Michael Archuleta:
There's a lot of things that keep me up at night, unfortunately, and one of the things, of course, is some of the security outcomes. I mean, the, cybersecurity is no longer just about data security. Cybersecurity is a matter of life and death, if you really think about it, because look at the medical device industry right now. The medical device industry is mandated by the FDA, right? 83% of those specific companies have admitted that they have a cybersecurity problem. Look at the pacemaker software alone. The pacemaker software alone had 5000 security flaws associated with it, 5000. That is an implantable device that's going inside a human being. So you figure, can the heart be hacked? The answer is yes. And this is becoming a serious issue. And that is why security has to be a core component to the overall organizational strategy in order to create success, because it isn't just about data security, it's also a matter of life and death. And as an organization, if we don't really focus and reprioritize ourselves on some of these initiatives, we're not going to be successful. Because when I go to my board of directors, I focus on three things, especially when it comes to cybersecurity. I focus on financial, operational, and reputational. What would happen on a financial standpoint if a breach happened? What would happen on an operational standpoint if a breach happened? And worst of all, what would happen on a reputational standpoint if a breach happened? We have to really reprioritize this and really continue to invest in some of these technology initiatives and these technology tools that enhance our cybersecurity outcomes because we need visibility. Because as I stated, it's not if, but when a cybersecurity attack happens, and we have to think like that too.
Ed Gaudet:
Continuity is so much more important, resiliency is so much more important. You have to have the ability to recover and keep the business available.
Michael Archuleta:
And that's 100% thing. Making sure the business is fully up, making sure that the disaster recovery initiatives are fully enabled, that are backup options are fully enabled, that we have a plan in place. We've always seen a lot of healthcare organizations, you know, really focusing on a hospital emergency response team, but what about a cybersecurity emergency response team initiative, doing specific tabletop exercises to really, truly evaluate and say, yes, my plan works. Yes, I have a full disaster recovery plan, a strategic plan in place via an electronic document. But does it truly work? And that's where tabletop exercises really come into play. So security outcomes are really definitely an item, that is something that I do worry about a lot because as I stated, that, there is a lot of issues that could really happen with security. We went from the top ten now to the top six most attacked industries out there. Electronic medical records contain an extensive amount of data, that's why they're very valuable on the dark net, and we have to really reprioritize our overall focus too. And sometimes it's kind of like, well, why are we continuing to invest in these specific tools? This is where we really have to drive home a strong initiative so individuals truly understand that, and I think that's what's really critical as well.
Ed Gaudet:
Great, great. Let's switch gears a little bit. Let's talk more about you, what you've gone through over the last couple of years post the pandemic. What are you most proud of over the last year, personally and professionally?
Michael Archuleta:
I'm just proud of this organization as a whole. I'm proud of this team because during COVID, it was actually phenomenal to see every single department in sync working together just for a efficient process for our patients. I'm extremely proud of the digitalization efforts that we've made with this organization. We've honestly went from nothing to something. We are a seven-time Most Wired winner, which is a top nationally recognized healthcare IT award given to the top facilities, making the most progress of health IT or HIMSS analytics stage six facility, which is a feat that only 30% of the US hospitals hit. We've built a very strong, robust team focusing on digitalization, focusing on cybersecurity outcomes. I've really partnered up with strong business partners. I fired all the vendors because honestly, there's a big difference between a business partner and a vendor, and I brought in some strong partners that really state, my success is your success and your success is ours. And then really focusing a lot on the consumer experience too, building specific digital tools, asynchronous tools that benefit our patients both inside and outside the organization has been such a critical component too, and has been a really big thing that I'm extremely happy with, and it's just been one of those amazing opportunities to be here and just do all these amazing things. And that's why I've been here for so long is because it's hard to let go of your child that's just growing and just doing some amazing things, and then, but eventually, you know, there is times to let go, too, but we'll determine where that future holds moving forward from there.
Ed Gaudet:
Yeah, so outside of healthcare, what would you be doing? What are you most passionate about outside of healthcare?
Michael Archuleta:
What do I do for hobbies?
Ed Gaudet:
Yeah, what do you like to do? Where would you spend your time?
Michael Archuleta:
Yeah, so most of my time is, so I'm at the gym every day for two hours. That is such a mental thing for myself. I also do triathlons as well. I did a quadrathlon last year, so it was a four-event item, and then I do a lot of cycling, which I really enjoy too. So I'm really active in a lot of those exercise, fitness, hey, let's get a little crazy adrenaline-rushing kind of sports.
Ed Gaudet:
How about the Ironman? You ever look at the Ironman?
Michael Archuleta:
I haven't. I've looked at the Ironman and that's definitely on my bucket list too to do, and I'm super excited for it. I think that'll be an amazing event because as I stated, I did quadrathlon it was called the The Purgatory Four, so it was basically rowing, biking, running, and then it ended off with a shoot as well.
Ed Gaudet:
Oh, cool.
Michael Archuleta:
So it was absolutely amazing.
Ed Gaudet:
That's pretty.
Michael Archuleta:
And then, but, and then of course this year I'm looking at some additional events as well, so it's going to be pretty exciting.
Ed Gaudet:
So you've been through a lot. What would you, if you could go back and tell your 20-year-old self something, what would it be?
Michael Archuleta:
You know, to, honestly, is just, believe in yourself, remember where you come from, and I think that's really important, and just truly know that you could really make a difference moving forward. I think at times, especially like myself being the first to graduate college, growing up in the projects, and becoming something was really a huge initiative. And sometimes a lot of the individuals that I know just didn't have that mindset that, you could really, truly make a difference in yourself if you truly believe in yourself. And I think that's what's really critical is that a lot of individuals just stop believing in themselves, and if you can believe in yourself, you could truly accomplish anything you want moving forward, so, absolutely.
Ed Gaudet:
Yeah, so I'd be remiss if I didn't ask you this question. What's the riskiest thing you've ever done?
Michael Archuleta:
What's the riskiest thing I've ever done? Now this is a rated G show, so.
Ed Gaudet:
Like, yeah, what's the risk? I've had some people tell me some risky things, we had to cut it out of it.
Michael Archuleta:
Well, I think the risk is thing is, that I've done has been, of course, you know, skydiving, and then, of course, going down some extreme rapids, like to the raft as well.
Ed Gaudet:
Where did you do that?
Michael Archuleta:
So we did that in Canon City, Colorado. Are you familiar with?
Ed Gaudet:
I'm not, no, no.
Michael Archuleta:
Definitely look that up. It's a beautiful area. So we have a place called the Royal Gorge. It's, I think, the second-largest expanded bridge in the United States, and then they have the Arkansas River, which is really extreme. And the scary part about it is there's a lot of because there's a railroad track that goes around that canyon. So there's a lot of spikes in the actual water itself. So a lot of individuals, of course, when they're rafting the raffle hit a spike and then of course, that raffle blow, and then everyone is just, it's a scary thing, but the thing is, it's absolutely phenomenal. I've also done some rock climbing over there. I did the Via Ferrata, which was a pretty phenomenal event too. I mean, that was pretty risky. I regretted it when I was bringing my kids with me too, because I'm like, hey, I'm crazy as I can, you know, if I go solo, that's it, but then my kids, of course, are there wanting to start getting that those adrenaline initiatives in place. They wanted to join and it's amazing, but definitely look that up.
Ed Gaudet:
I'll check it out.
Michael Archuleta:
Great thing.
Ed Gaudet:
Yeah, how old are your children?
Michael Archuleta:
So my son is 13 and my daughter is 16.
Ed Gaudet:
Oh, those great ages, yeah.
Michael Archuleta:
Yeah, I mean, I got a little bit of gray hair because that's the story.
Ed Gaudet:
Keep working out, like you look great.
Michael Archuleta:
I appreciate that.
Ed Gaudet:
All right, thanks very much. Thanks for joining us today. This is Ed Gaudet, and for those of you on the front lines protecting patient safety, stay vigilant.
Ed Gaudet:
Thanks for listening to Risk Never Sleeps. For the show notes, resources, and more information on how to transform the protection of patient safety, visit us at Censinet.com. That's C E N S I N E T.com. I'm your host, Ed Gaudet, and until next time, stay vigilant because Risk Never Sleeps.
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