With Its New Hospital, Rural Utah Gets A Fancy EMR (And A Sacred Hogan)

On Google Earth, one can spiral quickly into the geologic wonderland of Blanding, Utah—a part of the old frontier canyonlands—where scenes for John Wayne westerns, Thelma and Louise, and the TV classic Maverick were filmed.

With only 3,100–5,000 people, the town is about as rural as it gets. It sits in the corner of large and expansive San Juan County, which boasts only 1.8 people per square mile, about as sparse as can be in the contiguous U.S.

It is, frankly, a surprising spot for the development of one of the newest, most modern, technologically savvy small hospitals in the U.S.

Yet 78 days ago, the 11-bed critical access facility, Blue Mountain Hospital, opened its doors, the dream of the late Jim Redd, MD, a local family practice physician, and Donna Singer, CEO of the Utah Navajo Health Systems, a network of community clinics.

Sadly, Redd took his own life a few weeks before the hospital was set to open.

With a price tag of $18 million, the 45,000-square foot facility has a completely digital phone and instrument system with electronic medical record access in every room, two enormous surgical suites, and "one of the largest, most spacious emergency rooms of any hospital I've ever seen," says Blue Mountain's new CEO, Lorin MacKay.

The hospital's seven emergency bays act like a trauma center for the region because of the large numbers of car accidents along the region's winding two-lane roads.

"Even though our volumes aren't yet very large, the type of patients who come through the door are usually very critical, with fairly heavy trauma from a lot of auto accidents in the area," MacKay says.

"In the state of Utah, 85% of human fatalities are caused by collision of a car with wildlife," says Cherrie Evans, director of the hospital's clinical services.

Each patient room is private and large, with sleep chairs to accommodate visiting family members. "The culture in the area is to have large families, and we've accommodated them if they wish to spend the night," Evans says.

MacKay adds: "I'll tell you, I've been in this field for 28 years, and this is the nicest small rural hospital in the entire U.S., and I'm not bragging."

It has an eight-station dialysis center to care for the large numbers of patients with diabetes (Native Americans are said to be 13 times as likely to have diabetes than Caucasians). "Because of that, we have a high incidence of end stage renal disease and are providing dialysis to about 30 patients," MacKay says.

Here the population is 60% Native American Indian, mainly Navajo and Ute. And health needs are real. According to the Association for Utah Community Health,

  • 85% of the population served "has no running water, electricity, telephone or central source of heat
  • 56% are unemployed
  • Per capita income is $4,106
  • 57% of the population is below the Federal Poverty Level

Prior to July 15 when the facility opened, patients had to drive as far as two hours in each direction for dialysis, for a four-hour treatment three times a week.

Out of respect for Native American cultural beliefs, the hospital also has a traditional medicine healing building called a hogan, a 40-foot-diameter circular just outside the front door.

"It is representative of the Navajos, with doors facing to the east, windows for light to come in, a dirt floor and a ventilation system so Native Americans can have their fires. The open beam roof built of poles of teepees, and patients and their families can bring traditional medicine men to perform their faith healing rituals," MacKay says.

The hospital also has brought together historical enemies, the Utes and the Navajos, who sit on the hospital's board. "This is very unique situation to bring the Utes and Navajos together on a common cause," MacKay says. "They used to fight all the time, and did not trust each other. Now they are friendly."

But what is perhaps its biggest pride is a brand new electronic medical record system, an adaptation of a free "open source" program developed by the U.S. Department of Veterans Affairs . The system was installed and expanded with billing templates and other interfaces to meet Blue Mountain's needs by Medsphere, a Carlsbad-based company, at a cost of about $300,000 to $400,000, says MacKay.

Even in the first two months as staff are getting used to the new system, Evans says EMR is already saving a lot of time.

"There was one day when we had a high census, and we were kind of short-staffed," she says. "We didn't have time to log on to every computer and every room. Instead, I could enter everything on one computer."

Charting the old way would have taken at least 30 minutes. Instead, she did it in less than 10.

MacKay hopes that some of the cost of the system will be defrayed by federal stimulus funds. But whether the hospital will receive it is still unclear.

The rest of the $18 million project funds come from a combination of financing through the Department of Housing and Urban Development, the U.S. Department of Agriculture, and the Ute Mountain Tribe and Utah Navaho Health System.

The hospital has made it much more convenient for people in Blanding and surrounding areas to get hospital care. Before July 15, residents had to drive 25 miles north on winding, two-lane roads to Monticello's San Juan Hospital, a 50-year old facility. The road is also closed during many parts of winter, prohibiting even emergency access, MacKay says.

Staffing has been an issue, but MacKay has been able to hire adequately trained professionals from area clinics. There are about six or seven physicians on staff.

"Staffing has not been the easiest thing to deal with. But now, I'd say we have enough providers, although we're still looking for a general surgeon and an internist, and another good nurse or two," MacKay says.

MacKay acknowledges that most of San Juan Hospital's patients are now coming to Blue Mountain. "We're getting about one new admission each day," he says. And the average daily census after 78 days is about three patients.