California's Santa Rosa Community Health, a federally qualified health center, serves more than 40,000 uninsured and underinsured people in the greater Santa Rosa area.

THE PROBLEM

In 2017, the Tubbs Fire destroyed 6,000 homes and the provider organization's largest health center, which served half of its patients. The devastation traumatized staff, patients and the community. It took months to put out the fire, and Santa Rosa Community Health had to reorganize on a dime.

"We opened three new sites within four months, one permanent and two temporary, and had to create a centralized call center," said Naomi Fuchs, CEO of Santa Rosa Community Health. "We faced internal IT challenges and financial pressures as we redid our phone and computer systems and opened these new clinics."

Add to the scenario citywide infrastructure damage and outages.

"Since we're in a high-risk wildfire zone, our electric company proactively shuts down power with only 24 hours' notice," Fuchs said. "We now have generators readily available at our three largest clinics. In 2018, we evacuated for a week and set up our administrative services somewhere else because of nearby wildfires. Then, in 2019, our newly rebuilt Vista clinic opened. Shortly after, we faced more wildfires in the area, and then a global pandemic in 2020."

For years, the clinics have been plagued with persistent phone problems, bandwidth problems, storage problems and connectivity issues. As a healthcare provider, it of course relies on its electronic health record. When this software continually freezes or doesn't work right, providers and staff can't do their jobs and patients get frustrated.

"Numerous weekly outages and hundreds of active, unresolved IT work tickets posed a potential health hazard to our patients," Fuchs explained. "For too long, we found ourselves patching holes, rather than addressing root causes. We desperately needed an IT service provider to transform our ailing IT environment, all while keeping clinics open for patients."

PROPOSAL

Managed IT services vendor HBNS suggested Santa Rosa Community Health address the root issues of the IT instability so that the provider could create a healthier, more reliable, efficient and economical IT environment that could respond to the community's needs.

HBNS wanted to standardize equipment and system configurations, automate behind-the-scenes processes for quicker repairs and troubleshooting, migrate some off-site servers to the cloud for greater flexibility and disaster recovery, and provide proactive, on-site technicians.

"Knock on wood, it's been pretty quiet for the last several months in terms of IT issues. Now we're looking at ways to use more remote technology and integrate our medical and dental EHRs."

Naomi Fuchs, Santa Rosa Community Health

"We needed a collaborative, problem-solving partner because healthcare IT is complex," Fuchs said. "It requires a breadth of expertise from infrastructure and network architecture to data management and help desk support. We contracted out to HBNS rather than develop an IT department because that isn't our expertise. Our top priority was to be available 24/7 for our patients."

MEETING THE CHALLENGE

First came delivery of IT services. Fuchs said the first six to eight months was a painful time.

"HBNS discovered many hidden issues with our older, misconfigured and under-maintained hardware systems, including a lack of proper documentation and passwords," she recalled. "Our software had bugs and our network was wonky. We'd been growing so fast that we had a hodgepodge, or Winchester House, of IT problems.

"HBNS brought a spirit of collaboration and partnership to their work with our internal staff and external vendors," she continued. "They didn't just fix the latest problem; they examined the whole system and addressed the root cause. They focused on building an infrastructure that was stable and robust."

Second came relevant operational reporting. The EHR had glitches. The provider uses the eClinicalWorks EHR and Relevant Health data-reporting software daily. These systems often failed, or took so long to process that they didn't meet functional needs.

"HBNS, our internal EHR team and clinical quality teams collaborated with vendors to address the issues by optimizing the entire environment," Fuchs said. 

"Before that, the Relevant system struggled to process the critical day-to-day operational reports for the providers and nursing staff. The reports would either take eight to 10 hours to process, would crash, or both, causing the reports to be unavailable to staff the next day."

Now the provider organization generates reports in 18 minutes. This means that clinicians have up-to-date information about healthcare gaps for patients at the time of care, and the organization can track progress toward quality goals at the patient as well as population level in real time.

Third came hardware replacement and an environment rebuild. When HBNS first started, Santa Rosa Community Health was up against a challenge of older hardware that had reached performance capacity and was aging out. The provider also had many issues with the way the systems were originally built and configured, causing operational issues.

"We didn't want to purchase new hardware for our off-site servers, which would have been a large capital expense, but the older servers weren't addressing our data management needs," Fuchs said. 

"HBNS worked with internal teams and external vendors to rebuild and migrate 37 physical servers to an AWS cloud-based environment. Migrating to the cloud allows us to quickly ramp up or down based on our IT resource needs."

Some of the software vendors on the servers include Microsoft Great Plains, eClinicalWorks, Relevant, Microsoft SharePoint and Remote Desktop, as well as Open Dental. 

One of the things that has been a great benefit is that HBNS focuses on minimizing the time provider staff is offline, Fuchs added. HBNS completed the final migration to the cloud over a long holiday weekend. Once the migration to the cloud took place, the operational IT issues improved greatly, she said.

Fourth came COVID-19, remote workers and telehealth. Almost overnight, when COVID-19 struck, the provider needed to transition its care-delivery model to telehealth and create a remote work environment for staff.

"Right before we moved to remote working, HBNS had already tested an alternative remote desktop environment using Microsoft Remote Desktop licensing," Fuchs said. "We expanded that test environment over a couple of days to make this accessible to all of our staff. This transfer could not have happened so quickly or easily if we hadn't made the decision, and initial setup, to work in a cloud environment."

Telehealth has been an amazing shift in the organization's healthcare delivery model, she added.

"Yes, many healthcare issues need an in-person visit. However, a lot can be handled over a phone or video call," she said. "Telehealth is an incredible benefit to our patients, especially for people who are working, have kids at home, are disabled or are struggling financially. It has dramatically improved access to care."

RESULTS

"In addition to all of the aforementioned benefits, on a personal level HBNS has taken a huge headache and burden off my shoulders," CEO Fuchs noted. "Knock on wood, it's been pretty quiet for the last several months in terms of IT issues. Now we're looking at ways to use more remote technology and integrate our medical and dental EHRs."

ADVICE FOR OTHERS

"Access to care anywhere/anytime where providers can work from any location is going to be an essential part of care delivery in the future," Fuchs stated. "The old brick-and-mortar approach to healthcare is no longer effective as the only way to provide high-quality care. As leaders in healthcare, we must be thinking ahead about our business models, our risk mitigation and, above all, health equity."

As a federally qualified health center, Santa Rosa Community Health's mission is to care for people who often experience huge health disparities, including access to care. Technology is one of the tools in a provider's toolbox to overcome those disparities to ensure that everyone has an opportunity for a full and healthy life, Fuchs said.

"There are natural disasters happening every year across the country and the world," she said. "If your phones go down and your IT isn't working, it creates a critical health risk to patients and the community. IT is not just a back-office function – it is one of the most critical elements of the healthcare team."

With the right IT vendor, the power of the cloud and a stable IT environment, a provider organization can have better workflows, the flexibility to add sites and provide telehealth, better access to patient records, and operational reports, she said.

"When you invest in more stable, robust IT, you can quickly shift your focus to address the most pressing needs of your patients and communities, like providing COVID-19 vaccinations and telehealth," she concluded. "Ultimately, creating a more just and equitable healthcare system for all."

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
Healthcare IT News is a HIMSS Media publication.