Rachel
Hello and welcome to the Spark, a view of innovation in healthcare. I’m Rachel Schreiber, your co-host, and in this episode we’re talking with Michael Archuleta, Chief Information Officer at Mount San Raphael Hospital and clinics in Trinidad in southeast Colorado. Mount San Raphael Hospital and Clinics is a 25 bed critical access hospital with specialty clinics serving a rural community. And we’re really excited to speak with a leader of this type of organization doing important work in healthcare, both in his community and in the state of Colorado. I’m joined by Stuart Hanson, CEO of Avaneer Health.

Stuart
Thanks, Rachel. Really appreciate you joining us today, Mike, and welcome again to the Spark. As Rachel said, I’m always impressed with folks that are doing really transformational stuff in any setting, but the fact that you’re so involved in a critical access facility serving your community and also really, and doing so much work at the state level, it’s great to have you on because you’re obviously a fantastic example of the people that we like to talk to in this discussion thread. One of the things we’ve talked to all of our guests about so far is really why are you doing this in healthcare, right? It’s so hard, as you well know, probably better than most of our guests, how difficult it is to really move the needle in healthcare. And usually what we’re finding is that there’s some unique spark, whether it’s a personal story, a family medical experience, something they accomplished or stumbled into earlier in their career, really gave them the passion for making an impact in such a complex industry as healthcare. So before we get into our normal questions, I’d love to hear about your spark and what motivates you to do all the great work that you’re doing.

Michael
Absolutely. Well, thank you very much. First of all, it’s a pleasure to definitely be here, and I’m really excited to be on this podcast. The spark really came in on, I’ve always had a passion of how can I really play a pivotal role in making an actual difference in someone’s life. Healthcare is one of those areas that honestly, even though I don’t have direct patient care, the specific services, the technology initiatives that we incorporate that are really focused on patient-centric initiatives really boost the overall efficiencies for better patient care. How are we using technology to have better patient outcomes? How are we using technology to identify specific items that the human eye can’t catch? How are we using technologies to really just have more of that patient-centric technology initiative that really increase better patient care outcomes? Because at the end of the day, this is what I always say, is as an organization, if we do not continue to build asynchronous tools that benefit our patients both inside and outside of our organization, we are not going to be successful moving forward and having a big passion for patient care because my number one thing is patient care is number one, and having that passion to really make a difference really basically allowed me to really do very well in healthcare, enjoy healthcare because there is a really big reward, and that’s basically having better patient outcomes, seeing individuals get better, which is such an amazing thing because this industry, we’re doing the most important thing out there, and that’s taking care of people’s lives, that’s improving lives.

How do we as an organization, basically do that? And the beauty about working in a smaller rural area too is it’s really community based as well. Having that community perspective of having an amazing organization like Mount San Rafael here in Trinidad, Colorado, is such an awesome thing because we could provide the best patient care, the best patient service initiatives for our community, and truly make a difference because when you look at some of these smaller served or these smaller served communities at times, they really have issues with getting the proper care they need to continue to basically have a better patient care outcome. But again, when you have that good organization, when you have that passion, it’s just been an amazing thing to really do.

Stuart
Yeah, I mean, I think it’s obviously a personal industry, and I think you’re absolutely right. I think it’s hard to, especially in a CIO role or a senior leadership role where you’re not actually providing care, you don’t see patients on a recurring basis, it’s probably really difficult in a lot of large systems to actually see the personal level of connectivity with that care outcome and impact that they’re able to create. I think doing what you’re doing in a smaller community access setting probably provides you a really direct exposure to the impact that the organization can help.

That’s really cool. So let’s talk about a few of the top ways that you and your team are challenging the status quo. I know it’s hard. I know we talked a little bit in our prep session about covid and that really being a driver for what the industry can achieve when there’s an impetus and a strong incentive and a requirement to really do things differently. But you guys are doing that at Mount St. Rafael all the time. Tell us about a couple of the top two or three initiatives where you guys are really driving some change.

Michael
One of the big changes is the acceleration of digital transformation. I mean, that’s such a critical component there too, because when we looked at COVID-19, we saw that there was a lot of issues with some of these healthcare organizations in incorporating that remote workforce, incorporating strong cybersecurity practices. Because the issue has been is that not incorporating technology as that core component to the overall organizational strategy was basically not a good point for them, which created some failure options, which they had issues sending people home, they had security issues, they had issues in regards to determining if they had the proper infrastructure to basically build strong telehealth clinics. And that’s why really reprioritizing the importance of technology because the thing is, is we have to really go away from what I like to call the brick and mortar theology of healthcare. I did a presentation in discussion with Columbia University and we were talking about the brick and mortar theology of healthcare, how that’s, it’s been built because when you look at this industry as a whole, unfortunately this industry is one of the most antiquated industries out there.

You look at the oil and gas, you look at the finance industry, many more years ahead of the healthcare industry when it comes to digital transformation. But the thing is, is we are doing the most important thing out there that is dealing with patients, that is saving patients’ lives, that’s improving patients’ lives. You would think we would be leading the pack when it comes to digital transformation, and that’s what we should be doing. It wasn’t because of your CIO, it wasn’t because of your chief data officer, your chief technology officer. It was because of COVID-19 that really accelerated this industry completely. And the item is though too, is one of my main focuses has been we have to basically incorporate technology as that core component to the overall organizational strategy. We have to, as an organization, have a strong infrastructural backbone, which is basically the heartbeat of the organization, which allows us to, if we need to spin up a telehealth clinic successfully, efficiently, which we were able to send people home efficiently since we were basically able to do that as well too with the incorporation of virtualization of what we’ve done within VMware and also just continue to improve on those cybersecurity strategies and those aspects, making sure that we’re keeping things secure and safe, which was extremely important because when I go back and I talk about the cultural initiatives of what we’ve done, I’ve really shown that when we look at it as a whole, it has always been considered a cost center.

It has always been the ticket taker versus being a value maker. And that’s really how we need to change that aspect. Going from a ticket taker to a value maker, going from a cost center to a strategic revenue contributor to the organization, which is so critical, showing the true value of what technology brings. Having that infrastructure backbone showing the improvements of hospitals, clinics, or digital companies at delivery healthcare services. We have to realize that we’re living in the digital age of healthcare, and I am an active speaker within the field of HIT. And I always state this and sometimes it’s kind of a funny thing, but we have to tell the Flintstones to meet the jet sense because honestly, it’s about time. Come on over. This is the way we’re doing things. This is the way we’re accelerating digital transformation, incorporating better strategies around patient-centric technology initiatives that really improve better patient outcomes.

Because as I stated in my before statement is patient care is number one. And at the end of the day, I don’t care what position you have in healthcare, you have a new CEO and your new CEO is the patient. And that’s basically the bottom line because your patients, they’re the ones that’s striving the revenue to your organizations. They’re the ones that now are taking more control of their overall healthcare, and they now have options of selecting the organizations that they would basically like to go to. So as an organization, if we don’t continue to build those strong asynchronous tools that benefit our patients both inside and outside the organization, we are not going to be successful at anything we do moving forward.

Stuart
Yeah. You talked a lot about infrastructure and data and security. How important is InfoSec to everything that you do and everything you’re looking to do as you continue down this transformational journey?

Michael
Security that is a top priority, I mean a top priority. When you look at the healthcare industry itself, we went from the top 10 now to the top two most attacked industries out there. This is a major issue.

The thing is, is cybersecurity isn’t just about data security. It’s also a matter of life and death. Look at the medical device industry. Well, let’s talk about that for a second. The medical device industry is basically mandated by the FDA. 83% of those specific companies have admitted that they have a cybersecurity problem, and you figure we have a lot of medical devices coming into the facility itself. You have also implantable devices that are going inside human beings too. Look at the pacemaker software. The pacemaker software alone had several thousands of security flaws associated with it. So then we ask ourselves, can the heart be hacked? And the answer is yes, it can be. So the thing is, security has to be a top of mind. That has to be a priority within any organization. We’ve seen organizations not really basically making that a top priority, and we’re seeing them continuously being breached as a group. And the problem is though too, is there was a national poll that went out there that went out and looked at all of these top facilities, these healthcare facilities, and they determined that 43% of those specific organizations did not even incorporate basic cybersecurity awareness training to their employees. That was mind blowing,

Stuart
Shocking.

Michael
Because the thing is though is look at last year’s numbers. 91% of all ransomware attacks that were targeted towards healthcare organizations were coming through a phishing email. So who are they phishing. They’re phishing our employees. They’re phishing the people because at the end of the day, your biggest risk unfortunately, are the people because we’re very curious. We work in healthcare, we’re very fast paced and we don’t have the basic, some organizations aren’t providing that basic security awareness initiatives for employees to basically understand the actual risks of what can happen if a ransomware attack basically occurred, and also some basic training on identifying specific phishing emails. So the thing is, one of my number one priorities too was within this organization was building a strong human firewall that was so critical. Having the awareness and the security training for employees from when they’re getting supported into hr, running through a cybersecurity awareness training program, part of the overall annual competencies that our clinicians basically run through.

We also incorporate a mandated cybersecurity training initiative for those individuals. And then also we have a simulated phishing test initiative within the group that basically sends out simulated phishing emails. And basically we’ve developed a program called Clickers Anonymous. So basically we have individuals being considered clickers and they’re having to basically be part of this overall mandatory training moving forward, which really kind of opens their eyes on, well, what did I click on? How could I, sounds like a self-help approach. Yeah, that’s cool. So again, we’ve really done a lot of focus around that. We’ve incorporated smart technology initiatives of looking at our complete environment itself, looking at IOT initiatives, looking at network of vulnerabilities, looking at any type of abnormalities, utilizing artificial intelligence to try to predict an attack before it happens. We’ve also incorporate what we call user identification management initiative. So what that is, is this specific AI algorithm basically learns patterns from user behaviors.

So mean, Mike Archuleta, if I come in to work Monday through Friday from seven to 6:00 PM and I’m going to, I come in on Saturday and I’m trying to access something different, it’s going to automatically basically show in an abnormality, create immediate shutdown access for that specific user because it’s learning the patterns of what we’re doing. So that’s why it’s so important to incorporate these strong tools and making sure that we have the strong cybersecurity posture to really keep our overall organization safe, our patients safe, are employees safe and moving forward and trying to really avoid being one of those organizations that gets completely breached.

Stuart
Yeah, there’s one in the news in Chicago where I am right now, where they’re still in a system shutdown for the past six days. So I couldn’t agree with you more in terms of how seriously people need to take cybersec and InfoSec. Let me move on. I’m going to ask one, I don’t know if this will be a tough question or not. It might be tough for you to take a pick out of all of the things that you have planned for your organization, is there one initiative that you’re the most excited about what the potential is? Or if you want to answer it a different way, one thing that you wish the industry would do as a whole to really help advance digital transformation in healthcare? You can answer both if you want. You don’t have to pick. Yeah,

Michael
Absolutely. So the industry, as I stated before, this was a very antiquated industry and we’re starting to see a lot more progression towards interoperability, towards connecting systems from one organization to another. The thing is is we’ve always had that very old antiquated HL seven a DT standard of sharing information. But what really came out of the HL seven group was fire the fast healthcare interoperability resource initiative. That was really a big thing that a lot of these specific electronic medical records vendors, all of these different specific vendors really jumped on board on saying, Hey, we need a standard way of communicating our overall process and easy ways of getting connected to one facility to the other. Because the thing is, when you look at all of the EHRs, I mean the evolution of the EHRs, everything is so proprietary that it’s been one of those items that it created a lot of conflict of saying, how can I send my continuity of care from one system to another system successfully, efficiently?

That wasn’t a case before fire, in my opinion. We’re starting to see more focus towards interoperability because in my opinion, interoperability has been one of those buzzwords that we’ve always seen. I agree more companies trying to kind of make this happen, but we’re starting to see more progressions with the incorporation of fire API integrations, which is such a huge thing. I think though too, is a lot of these EHR vendors are also realizing the importance of jumping on that fire bandwagon to making sure that their product is as interop as possible moving forward. Because as an industry itself, we have to create better ways of how are we doing better continuity initiatives for our overall patients. If a patient is requiring a higher level of care, how are we successfully being able to transmit all of that continuity of care information that would be beneficial to send over electronically to another system to incorporate into their actual system and have that overall 365 view of the patient’s overall history of what’s been happening.

So again, really excited to continue to see those interoperable focus initiatives, which is so important. We’re starting to see this industry really, especially the healthcare industry, go away from the on-prem going into more of a fully cloud-based initiative, which I think is extremely important there too, trying to get out of the data center business, going into more of those cloud-based strategies, which is really important. I mean, we’ve incorporated a lot of processes with Nutanix from a hyperconverge infrastructure with VMware to fully virtualizing our complete environment to having some partnerships with AWS on some of the cloud-based initiatives and strategies that we basically do, and then really incorporating those strong cybersecurity focuses. So again, there’s a lot of good passion, a lot of good things really happening. And also too, when you look at the complete payment model of healthcare, we’re going from a fee for service to now more of a value-based care initiative. So the thing is making sure that we’re really incorporating having that patient-centric technology strategies in place that really allow us to show what we’re planning on doing with the value-based care initiatives for the organization itself. So again, there’s a lot of focus around here, a lot of ways that we’re continuing to improve a lot of digital strategies that really show a strong return of investment back to the organization and just show a really good enhancements towards better patient care outcomes and better patient care as well too.

Rachel
That’s a really important focus, and I know that you and your organizations have been recognized by industry organizations like you’re a finalist for the CIO of the year award hosted by the Colorado Technology Association at this year’s Tech Summit Apex Awards. What other recognition have you received?

Michael
So we’ve gotten recognitions from, and thank you again. It’s been such an honor to first of all, be a finalist at this year’s Colorado Technology Association Tech Summit. I mean, that’s such a huge thing because so much, yeah, congrat has really come into making this really happen and they’ve seen the passion that we’ve had as an organization itself, but I really give a lot of kudos to my entire team because I wouldn’t be anything if it wasn’t for my team moving forward. But some of the additional recognitions has, we’ve been most wired facilities for many years, which is a top nationally recognized healthcare IT award given to the top facilities making the most progress of health it. I’ve also been a high tech 100 awardee as well, which basically just recognizes the top influential Hispanics in the technology industry, just really making an impact in this overall industry, especially with a lot of initiatives that I’ve done with stem, with initiatives with different, these are more volunteer bases of helping schools basically try to develop a STEM program, getting our individuals to basically learn more about the technology industry.

The Colorado Technology Association also held their program called Sheet Tech, which was pretty phenomenal because it really got all of these women executives all together in the technology industry, and it allowed all of these girls from schools to really participate in this initiative to really learn on coming outside of the box and really thinking outside of the box and saying, these are the potentials that can really happen moving forward. So not only do I incorporate initiatives for the organization, but I also do a lot of volunteer based items as well too. And also part of the overall state of Colorado initiatives. Also part of the school districts that I do help on in regards to some of those, because I have such a passion for trying to promote technology, especially to underserved communities and underserved schools as well too, that don’t have that type of exposure that they would basically need to learn and to be exposed to possibly gain some of these experiences and knowledge and say, Hey, I could be the next CIO of this organization. Hey, I could be the next CEO of this organization. Really having those aspirations and those dreams to really make a big difference has really been a good passion of mine as well too.

Rachel
That’s really important work. It’s really having a vision for what’s possible, I think is the first step to achieving a person’s potential.

Michael
And see, the thing is though too, and I appreciate that and I speak from the heart because as a kid, just that my mother raised me, so I just had the mother in the household. I also, we lived in the projects. I was a first individual to basically go to college and do something that I have that personal direct experience and connection to speak with some of these underserved schools to show the benefits and the potential that could really come out if you really just continue to move forward in a positive direction and having the proper mentors in place to really boost you up is so important there too. So it’s one of those things that I’m speaking from the heart and speaking personally because I’ve been in those overall kids positions moving forward and I’m really trying to change that aspect as well too.

Rachel
That’s exciting to hear.

Stuart
Love that passion.

Michael
I appreciate that.

Rachel
So switching gears a little bit, I know on the hospital side the technology can be viewed as a cost center, but as you made a really good point that it is also a revenue generating organization, but there are so many ways, and we know in healthcare that there’s so many ways that tech can be used to better serve patients. But when you’re looking at doing your planning for the year, how do you decide which initiatives make the cut and which are the priority? What are you looking at when you’re making those decisions?

Michael
Yeah, absolutely. So anything that we have is there has to be a patient-centric technology initiative associated with it. How does this improve on patient care? Number one, what is the patient care initiative? Then we basically look at is there a return in investment back to the organization? What ROI is associated an ROI just doesn’t mean return of investment back, but it also means return of enhanced patient care back to the organization. Can we basically see that moving forward and then really looking at top priorities from some of our continuing digital transformational initiatives that really improve on better efficiencies, especially on the revenue capture standpoint of things from our professional financial services initiative. How do we improve on the billing aspect of things? How do we improve on the collections aspects of things? How do we incorporate technology to really improve on that, create more automation points Because in the end too, we have to realize how can we use the tools, the technology to do since we’re doing more with less. So then when you’re doing more with less, you really have to have those automation points really incorporated into any new project that basically gets incorporated into the organization itself. And then looking again, what is the return back to the group and showing the benefits. But my number one thing is when we look at specific projects again, is looking at the patient-centric technology needs, continuing to build those asynchronous tools that benefit our patients both inside and outside of our organization.

Rachel
Makes a ton of sense. So then related, how are you, what kind of outcomes have you seen from the digital transformation initiatives that you’ve invested in or other tech investments?

Michael
We’ve seen some phenomenal initiatives. We’ve seen some increase of revenue from different initiatives. We’ve seen some increase of better patient care outcomes with the utilization of artificial intelligence algorithms into our overall radiology practices. So we’ve seen a lot of good benefits in regards to that. We were able to spin up very successful telehealth clinics that allowed us to basically continue to provide patient care even during the pandemic, and we’re still utilizing those additional services as well too. Since we’re in rural area, we also incorporate a lot of units from a telestroke initiative in our ER department that connects directly to uc Health in Denver, Colorado to provide that higher level of care. We have a patient coming in showing stroke symptoms. The immediately the telestroke robot comes into place, directly connects into a specific physician. That physician has direct access into our PAC system, looking at those images, diagnosing that person then and there with a patient here in Trinidad, Colorado with a physician in Denver, Colorado. So continuing to see those enhanced better patient care outcomes has been a good successful point for our organization, which we’re going to continue to basically do as well.

Rachel
That’s so interesting. So then the next thing I was curious about is there are a lot of startups and other innovators work with larger organizations to pilot or to try to make those innovation initiatives happen and work with these larger organizations. And what I was curious is how do you suggest that the tech industry look differently and think about organizations like yours that are rural health focused?

Michael
So first of all, startups. I love startups. I mean, I really do. I have a passion for startups because the thing is figured you might. That’s great though. So these startups in my opinion are disruptors. We need disruptors in this field. We really do. We need disruptors in this field so they could basically make a difference. There hasn’t been enough disruptors, but I think now with all of these startups really coming into place, it has really seen a good impact because we’ve even incorporated a lot of startups in our organizations. Hey, let’s run through a proof of concept initiative with your group. Let’s determine if this is going to create a better outcome for our organization. But I think though too is a lot of these startups really need to learn on, especially some of the smaller organizations, how am I using my technology to create less manual processes and create more automation processes, create better enhancements for better patient care and try to reduce readmissions into the organization, better enhancements towards collection captures, and of course just continuing to improve on different revenue initiatives.

So again, there has to be a focus because the smaller organizations are definitely a lot different than your bigger organizations. But the thing is though is you figure we have the exact same mandates as these bigger organizations and we are doing, again, we’re doing more with less. So trying to have that process, that understanding that how can I as a startup come in and really create value for the organization, really create that more automation point, which I think is really important. I think if they had those good focuses, I think that would be a good fit for our organization moving forward.

Rachel
Yeah, perhaps the path to automating is shorter with a smaller organization.

So as a wrap up, what are a few words that you would use to describe the vision of what you’re creating in your organization, maybe in the state of Colorado, wherever you’d like to focus?

Michael
There’s a lot of key phrases I like using. We’re small but we’re mighty. That’s how I really see it. We continue to focus on innovation, good collaboration, good patient-centric initiative, which is extremely important. There’s also a Spanish word that I like using, which is so I believe in this industry. I believe in what we’re doing and I really want to make sure that we’re continuing to move forward, move which Lanta means forward and really forward in a collaborative way that we learn from other organizations, that we learn from different startups, that we continue to incorporate strong technology initiatives that enhance better patient care outcomes for us, which is extremely critical and important.

Rachel
That seems to capture the heart and vision of what you’re doing really well.

Michael
I appreciate that. Yeah,

Rachel
So thank you. We do need more leaders like you who are driving change in the local community and in the state, and we really enjoyed this time talking to you. If people want to learn or to follow you on LinkedIn or X, they can find you by looking for Michael Archuleta. Is there any other tips for connecting with you?

Michael
I’m very active on LinkedIn, very active on X as well. So my X is @Michael81082, and you can find me on LinkedIn at: https://www.linkedin.com/in/michaelarchuleta1

Rachel
Great. Awesome. Well, thank you for joining us today, Mike.

Stuart
I really appreciate your insights. Yeah, keep up the good work, small and mighty is what this industry needs more of.

Michael
I appreciate you too as well. So thank you again. It was a pleasure.