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How Tahoe Forest Health System is Simplifying Patient Access with Scheduling Autonomy

Featuring Jake Dorst, Chief Information & Innovation Officer at Tahoe Forest Health System

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On The Agenda:

Jake Dorst, Chief Information and Innovation Officer of Tahoe Forest Health System shares his "whys" and 'hows" behind simplifying patient access as a whole. The stride to efficiency, however, comes with its own challenges, especially when it comes to caregivers giving up layers of their scheduling autonomy and handing it off to patient-centric technologies. Jake places his digital bets on emerging technologies in healthcare and names his go-to sources of knowledge and events for healthcare IT.


00:00 - 02:08

Tahoe Forest Health’s recent digital initiatives

02:08 - 03:35

Defining KPIs for digital transformation Projects

03:35 - 08:54

CIOs' challenges & pushbacks

08:54 - 17:35

Bullish or Bearish? Jake places his digital bets on emerging technologies in healthcare

17:35 - 21:06

What can healthcare learn from other industries when it comes to digital innovation?

21:06 - 26:38

Let’s get personal: Advice from a CIO and Jake’s go-to sources of knowledge


00:00 - 02:08

Tahoe Forest Health’s recent digital initiatives

02:08 - 03:35

Defining KPIs for digital transformation Projects

03:35 - 08:54

CIOs' challenges & pushbacks

08:54 - 17:35

Bullish or Bearish? Jake places his digital bets on emerging technologies in healthcare

17:35 - 21:06

What can healthcare learn from other industries when it comes to digital innovation?

21:06 - 26:38

Let’s get personal: Advice from a CIO and Jake’s go-to sources of knowledge

<div class="tagline">Full transcript</div>

Full Transcript

[00:00:00] Liat: And today we have a very special guest, Jake Dorst, Chief Information and Innovation Officer at Tahoe Forest Health System. Jake, It's great to have you!

[00:00:07] Jake: It's great to be here. Thank you for having me. 

[00:00:10] Liat: Thank you. We shared some fun times at the recent Becker's Annual Meeting in Chicago. We ate at the best sushi restaurant in town with our folks at Kyruus. So we have some shared memories there. So Jake, thanks for taking your time and let's jump right into it. What is it that you're working on today, when it comes to the digital patient experience? 

[00:00:29] Jake: You name it. So everybody kinda went into hibernation there during COVID. So now everybody's coming out of hibernation. So we've got massive projects. So we moved to EPIC. So I was able to get us onto a community connect platform, moving off of evident, which is the old CPSI and several like six other EHRs. Into a unified integrated epic environment. So we did that six years ago, seven years ago. And we've been building on that.

What we've called the digital front door forever. We've been building on that since that time. So MyChart and we created a centralized access center for scheduling, helping our patients try to find the open slot. So access to care is top of our priority list right now.

[00:01:18] Jake: So that's one of the reasons I'm talking to Hyro and Kyruus and looking at, is there a way for me to simplify my user experience, my patient experience when finding the right care at the right time and not six months out. And those types of things, what doctors are actually seeing new patients who have open panels, those types of things.

[00:01:41] Jake: We're still good, but we could be better as far as opening up our schedules and getting people in faster companies out there like lean toss and other companies that are using. AI to really to look at your data in a mathematical way and look at your scheduling and find out, are you utilizing these slots to the best of your ability and really, making it as efficient as you can using lean methodology.

[00:02:08] Liat: What is your process usually for defining KPIs when you're trying to guarantee a successful outcome from all these digital transformation projects. And if you can maybe use an example to explain from the past. 

[00:02:18] Jake: Sure. So we do a lot of patient surveys, through presi and our own type, our own survey tools.

[00:02:24] Jake: We, we we survey our employees a lot. We get a lot of surveys every year. So I think that's our main tool is how it, when we're talking about satisfaction And that's what we're looking to aim, right now with increasing slots and access to care, we wanna be able to see, we can look at the data are you, is this physician or this provider clinician, is there, are they working at the top of their schedule?

[00:02:48] Jake: Are there, or are we missing? Opportunities for cancellations and filling them with people that want 'em want those slots. So those are all performance based metrics, which we have now, and those are the types of things we're gonna be looking for in the future. If we put something like like your product and Kyon, are we going, can I pull them?

[00:03:09] Jake: And I'm sure there's tools. In your software to pull them after their experience, like how was your rate, your experience or give us some feedback, those types of KPIs. So we do that now with a lot of of our programs and we will probably do the same with going forward with whatever we end up with doing for, intelligent chat bots and intelligent scheduling, et cetera, 

[00:03:33] Liat: as a CIO.

[00:03:35] Liat: What do you expect as far as any pushback? How would it impact clinical and operational leaders when you're pushing these projects through? 

[00:03:44] Jake: Sure. Yes. Just moving, taking the so traditionally doctor's offices or provider's offices, clinic clinics, et cetera, were own. Independently. So that's shifted over the last several years into and California just PA allowed critical access hospitals to hire providers directly.

[00:04:04] Jake: Whereas we used to have to contract with them as independent contract. So now they actually work for the organization. and now we're, like before they had a complete autonomy over their schedules, so that's always an issue regardless of what you're doing and has always been an issue is when you take over a practice that was previously run the CEO with somebody in there, we usually the physician, the elder physician there's there can be pushback. They had autonomy on. On their scheduling. Now you're shining a light on that and saying, Hey I like to go swimming or paddle boarding or whatever on Tuesdays cause there's a lot of recreational out and it's a big reason why people live here.

[00:04:46] Jake: So you have to find that balance of, okay you're living here for a reason it's expensive to live here. So you wanna, you don't wanna spend all your time in the office like I do, but you wanna find, okay that's fine. You can still go on Tuesdays, the Thursdays, we gotta have you, you gotta work clinic.

[00:05:02] Jake: Those types of conversations are never easy. Luckily, I don't really have to have those conversations, admin, my other, my, my other admin, the other members of my admin team are. Are on board with this notion that we should really try to increase our efficiencies as much as possible and get our patients in sooner.

[00:05:27] Jake: Get them. We have very good care. We have high quality, mostly four or five star care. That we've been known for. We have a very, once you get into the system, it's a very pleasant experience. It's just getting into the system. So that's another KPI that we can track that we've tracked in the past is what's called out migration.

[00:05:43] Jake: So you can find there's companies now that sell it data from. The private payers like blue cross hand Anthem, et cetera. And then I can say, show me everybody with a billing or home address of 9 61 XX, which is this area that are getting services at eight five, whatever, which is. Nevada. And then I can really start to see what services are they getting?

[00:06:09] Jake: Are those services I should be providing? Or is that a service I provide that they're choosing to go elsewhere? And if that's the case that they're choosing to go elsewhere, why is that? Is that because we told 'em it was gonna be a three month wait before they got in. Probably, I would, tell me it's gonna be September before I'm seeing anybody I'm gonna get arena or Zach, or somewhere else. So there's definitely by SA mean Sacramento, I'm sorry. Using colloquialisms. So those are things that we can also measure, but yeah, there's pushback, right? So there's, you're taking away layers of autonomy that they've never had to do before.

[00:06:43] Jake: And there's been a lot of change. I feel for the providers, cuz it's not how it used to be. Yes. That they, it's really become a very. Intense, there's all kinds of work to be done that there wasn't in the past. It wasn't totally put on the provider was done, but it wasn't done by the providers.

[00:07:01] Jake: For the most part, it was doing a lot of the paperwork and charting and all the things they have to do now. And then really looking at it from. I don't wanna say corporate medicine, but I worked in corporate medicine and that's how they looked at it as like slots are money. And if you're not filling those slots, then you're losing money and they were beholden the shareholders.

[00:07:20] Jake: So we're not necessarily beholden the shareholders, but we would note what the old famous saying of no, no margin, no mission. So we gotta make enough money to keep the lights on and allow people to afford the lifestyle that they have in this. A resort to, 

[00:07:35] Liat: are there other challenges that healthcare executives in charge of patient journeys face that isn't being talked about enough 

[00:07:41] Jake: in your opinion?

[00:07:43] Jake: I think they're talking about it enough, but I think what we are anyway just the lack of the hiring process, finding primary care physicians is pulling a rabbit out of a hat nowadays. And especially up here when houses. The housing market here is insanely spent expensive. We have the benefit of being close to the bay area.

[00:08:04] Jake: And we also have the drawbacks of that is, is those a lot of the houses up here, second homes and people are making all cash offers 10, 15% above asking which is good for my property value, but it's not good for, if I need a PC tech that's making 20, 25 an hour, they can't afford to live here.

[00:08:22] Jake: So the city and the hospitals other. We're considered a hospital district. So we're actually part of the government. So we are working in a we created a joint powers authority with some other districts in town, like the power and people that also have they're good paying jobs anywhere else, but here they're mediocre.

[00:08:42] Jake: So we're trying to find, is there a way that we can build housing or lease housing or find a way to lower the barrier of entry? Into this area. 

[00:08:54] Liat: We'll go from challenges to a little game. It's time to play a game where you place your digital BES, Jake. So I'm gonna be naming an emerging technology in healthcare.

[00:09:03] Liat: And then you tell me if it's bull meaning believe it's here to stay or meaning belief. Are you ready? Yeah. Number one, telehealth. 

[00:09:13] Jake: Here to stay bullish. I think telemedicine's been here. I don't think it's gone anywhere. I think that with the pandemic, it really, when the government lifted a lot of the barriers to using that, it shot like crazy like zoom and all those Amwell, tele, med tele all those companies really made out because all of a, I turned on zoom and I was doing telemedicine that same day.

[00:09:40] Jake: So it really shows if the government can get out of the way of certain things and work on the reimbursement, like the old school CEOs, which I agree with is if I can get just arbitrary numbers, if I get a $200 for a patient visit, but I only get a hundred for in person patient visit, but I only get a hundred dollars for a telemedicine.

[00:10:00] Jake: Is it worth it to me to invest the marketing, convincing my physicians to work half a day or a day only doing telemedicine there's physicians that probably don't wanna do telemedicine. Just because it's not their, they don't like it. It's not for every provider and right. But I think if I think the government and everybody else saw when they got out of the way, how quickly innovation happened with just about every.

[00:10:27] Jake: Wearables. Again, this, I don't know if it's emerging. We were doing wearables eight years ago with homegrown software, from another luxury, we have a lot of young retired programming, geniuses that live in my neighborhood who have all startups. So there, I met a guy that had a startup.

[00:10:45] Jake: We worked with getting at the time it was misfit and Fitbit and Garin, just the steps tracking and his idea was he's still in business. He's it's called one And He does a lot of the tracking for large university systems and hospitals now for glucose. So diabetics pre-diabetics and helping people control that better.

[00:11:12] Jake: The idea behind it is a lot of these, a lot of organizations. Self-insured right. So if you can't manage your own self-insured population, which I have, all of my insurance claims, I have 10 years of health data that we've been like screening data that we've been doing, cuz we incentivize it and the government allows for those in incentivizations.

[00:11:34] Jake: So we were able to really bring all that together. However, I think there's limited. Limit like everybody in the world doesn't need to go home with a word, right? Like you're gonna have data overload, like blood pressure cuffs. The widens products are all have open APIs where you can integrate with scales, even spirometer gluers.

[00:11:56] Jake: You name it like you can integrate with it. And blood pressure cuffs are the big one that everybody wants now, but I'm like, who's gonna monitor it. Like it's really, you have to put the program together. One of the good advice I've gotten in the past was what's the, I always ask people now I was like, what's your business case?

[00:12:10] Jake: What's the business problem you're trying to solve. And if it's not a business problem, is it a patient satisfaction of care or safety, which is you, which is really top of the list, right? So you ideally you'll have both, you're solving a patient satisfaction or a patient safety issue that also is gonna be cost you less money or have a return on the investment.

[00:12:29] Jake: So I am, I would say bullish, not because I think it's necessarily the best thing in the world, but I think people think it is, if that makes sense, you're being very, I think you're gonna do it. Yeah. . I think people are gonna do it just because I've had people come and ask me. I said, we tried this eight years ago and you didn't like it.

[00:12:51] Jake: That what's the difference now. And you can now push back with with epic and Cerner and the others. They have these open APIs now with the, HHL seven and fire standards and you can push data back into your EHR, which is handy. But again, who am I gonna ask? Okay doc, now Jake's got high blood pressure.

[00:13:11] Jake: We want you to monitor his 50 home readings every month. He's gonna be like, what? No. Or she's gonna be like, no, I don't wanna do all that. And that'll get pushed down to an ma, but I don't know. But what's the benefit of that. All they really need to know is what's the macro, is it going up steady or is it going down?

[00:13:26] Liat: Okay. Okay. Moving on to the next. Conversational AI, 

[00:13:32] Jake: Bullish. I think the whole world's moved into that. And I like what you guys are doing with contextual kind of thing. We've all experienced good ones and we've all experienced bad ones, more bad than good, probably. But I forget was on, I was on like the chat bot.

[00:13:46] Jake: I was some software I was using and I went to their support page and they were like, would you like to try our chat support? And I was like, all right, I'll try. And it like within four or five interactions, I had the problem solved, which would've, if I had to pick up the phone, call somebody or what's your name?

[00:14:01] Jake: What's your account? Like all that stuff was already in there. So it was simple. So I'm very bullet that autofill type of thing. Yeah. Yeah. Everything was there. They knew who I was. They knew what version of the software I had a license for. And. I was asking, you have to know how to, maybe it's different because I've been doing this for 20 plus years, but you have to know you're talking to a bot and you have to know how to, sometimes you have to know how to really sculpt your question to help the bot, not get confused with extemporaneous words like extemporaneous, 

[00:14:35] Liat: remote patient monitoring.

[00:14:38] Jake: Again, I think it's a niche. Niche, however you wanna call that, but it's only, I think that's useful. We've worked on one of the cool things we had here was the Tahoe forest Institute for new tech research, things like that rural health. And we went out instead of trying to find, trying to create software and then find a problem.

[00:14:56] Jake: We were trying to find a problem and create a solution for it. One of the things is. White blood portable CBC machine basically. Cause we have a large cancer center. Which is a great cancer center by if you want to get treated in one of the prettiest places on her. So we were having folks come in for chemotherapy or whatever, and they would get here, we'd take their blood and run the test, a complete blood count.

[00:15:21] Jake: Their white cell blood count was too low or there, whatever it was, the metric wasn't allowing them to get. So they drove an hour, whatever. So one of the oncologists, Dr. Larry Heitz was like, we need to come up with a way to send a CBC machine home with somebody, which if you've ever seen a culture counter it's size of a table, they've gotten smaller, they're hard to calibrate. They're super expensive. So the old way, and that, that runs blood cells through an aperture. And every time it clicks through, after counts, it. The old way of doing it. You had a human look through a microscope and they would physically count the blood cells with the in advances in smart software and video capture technology.

[00:16:05] Jake: They were able to create a machine that basically, and there's one in Israeli is Israeli company is doing this as well, but they created a machine that could, the trick was getting the layer down to one cell. So you'd take a pin. It was elizabeth Smart's company where, it's just one little.

[00:16:19] Jake: Drop of blood and it takes it and it gets it down to one layer and then takes this image of it. And then the software counts through it and gives you back the, and before they have to leave the house, so you, they can say, Hey, I did my I'm coming in. I got my appointment. Reminder heroes sent me the text or whatever, and now I'm, or Hiro sent me the text.

[00:16:41] Jake: And now I'm gonna say, yes, I did. And here's my account. And as long as it's good, they can. But that saves them a trip. So that was some of the Tahoe Institute for rural health research. The T R HRS is what it was. So we were doing all kinds of stuff around that wearable heart for using radar, which was crazy.

[00:16:59] Jake: It was like a low dose radar that shoots radar in your heart that detects AFib and a bunch of other stuff. Cardiac motion is what that's called. We were some cool projects, but I think yes, home I'm bullish again, because I think there's big companies behind that think they can make a bunch of money on it, which they will.

[00:17:16] Jake: But I, again, it's, to me, it's really I don't think everybody has to go home with blood pressure machine. I don't think everybody has to go home with a Glu. If you don't have these diseases, you don't need to know you don't need to track those, but if you're a cancer patient and there's a tool out there that can.

[00:17:29] Jake: Prevent you from wasting two hours in a car when you're sick and on chemo and everything else. I think that's a good thing for sure. But what are some 

[00:17:35] Liat: insights as a CIO today that you've gathered from other industries that can be applied to improve patients 

[00:17:41] Jake: experiences? So Maryland was interesting.

[00:17:44] Jake: They have a, they have what's called a weight, the Medicare waiver. So they have basically. The state sets the rates and collections and all that stuff. So they offered a program called TPR, total patient revenue, looking up if you're interested and it's basically capitated funding. So they went into these hospitals and they were like, we will offer you this.

[00:18:07] Jake: And based on your numbers from last year, you made 400 or 500 million, so we will guarantee you that money. You're gonna get paid that regardless, but. You have to keep your quality up and all, it was all these, it was a pilot program, which is now I think permanent for some, if you choose to get in it.

[00:18:25] Jake: But what that did for us, which was amazing is that once you change the way that like the money's guaranteed to come in, so it's like a, European model where it's capitated, but it's guaranteed. So we went into this hyper lean. Mindset like any dollar we saved was a dollar we put in the bank, so we started doing all kinds of lean. It's called Kan events and trainings and looking at gemba walks and trying to figure out how can we cut out waste and efficiencies while keeping our. Quality at a certain level, high level. Cuz we were gonna the words of my old CEO from there is were gonna compete on quality, were gonna win and cuz that's what you were competing for there, cuz it was mostly cap.

[00:19:10] Jake: I think there was nine or 10 hospitals that joined that program in the state, which they were in a unique position to do that because they controlled all the money. I think that may be the wave of the future, but in that town, there was the old Mac truck Factory that was bought by Volvo and they were a very lean driven organization.

[00:19:30] Jake: So we went and did field trips with them. Really to understand what a gumbo translate. I think it's like a shop floor, right? So going to the shop floor so you would sit down with, you'd bring everybody in the room that had a ownership in that what's called the value stream, and then you'd map it out first.

[00:19:47] Jake: You'd go to the floor and watch and observe and look for obvious things. And then you'd map out the value stream. And then you put the pinch points in there and then you try to solve for those pinch points. And we shaved off. A couple of 70, 80 minutes out of the discharge process, which there, like the healing started there, the finish the healing wasn't gonna be at your house or wherever you were going.

[00:20:10] Jake: So the idea was like, let's get folks out of these beds. They can go home and I've been like stay in the hospital too long anyway, so right. That was a big deal for us is really understanding that lean. And then we're starting to do that here, but I. If the government moves, like California's talking about a single payer system, if those types of things really everything's driven by the reimbursement model, like we saw with the like we saw with telemedicine, once that was turned loose, everybody did it.

[00:20:41] Jake: Everybody. For various reasons, like you didn't want the doctors there getting COVID right. Or the providers dealing with COVID patients or vice versa the patient that doesn't have COVID coming in and getting COVID from someone that's past COVID. So that was a big, like we had to do it and everybody did it.

[00:20:58] Jake: So I think if you see that if you see like a single payer model, get traction ever. I don't know if it will or not. I'm I'm bearish on that. 

[00:21:06] Liat: What advice would you give to a CIO just joining this ecosystem in 2022 and then 20, 23 and onwards. 

[00:21:15] Jake: I learned a lot, like I said, through the unique position I was in at CHS community health systems.

[00:21:22] Jake: So I traveled around a lot. I, my advice to people just becoming CIOs or even it directors is get. Into the go into the hospital round, meet the providers, meet the nurses, meet the dieticians, the EVs, the everybody that plays a part radiology pharmacy laboratory go let them know who you are and ask.

[00:21:45] Jake: What can I do to help you? Are you, is there tools you need, or is there something that can help improve your job that you know about that you haven't told anybody, kind of thing. That's a big part of it is really having that level of of confidence and not, and familiarity with your processes.

[00:22:02] Jake: That's another thing is really understanding how a hospital operates from how a patient finds. The service, they want to getting that service to how that ancillary, if they get labs, which they almost always do labs or images or drugs, through the pharmacy, however understanding how all of that works and then the bill and how billing works because you gotta get those bills out the door, paid, approved, and brought back in.

[00:22:30] Jake: And I would join a lot of the, I think, chime. Chime is a good one. They're working on becoming more open, I think to, to. Lot of the issues is the, all the folks there, the CIOs and things they've known each other forever. So it's a bit, clickish when you first join. I have a bit of an outgoing personalities off.

[00:22:52] Jake: Yeah. I don't mind walking up to the stranger and introducing myself. There's another one called V now. And there's, Becker's where we met. I think Beckers is always, I've been going to Becker's ever since they started it. And I like it. There's hymns, but hymns is. Hymes is a monster, it's, you get lost in the sauce out there with Becker and Beckers is getting bigger and bigger.

[00:23:13] Jake: When I went, the first one I went to, I think there was like 800 people or something. I think there's six or so thousand there, the vendors there are strong and the education is put on by people that are actually doing the work, which is nice. It's not sales folks for the most part.

[00:23:27] Jake: Not that I have anything against sales folks, but there's people that I want to. Talk to that have actually implemented it. And I always have those types of questions. 

[00:23:35] Liat: And what are you reading nowadays? Where do you get most of your information? How do you stay up to date? 

[00:23:40] Jake: I just, I have so many lists.

[00:23:42] Jake: Like I have a news aggregate from tons hardware has actually been doing some cool stuff recently. They've of moved out of that niche world of Of hardware, high end hardware to really just a lot of things, but Beckers have great, they're like a news aggregator themselves. And they give you the water down version of not water down, but synopsized, I guess like through the open AI Software.

[00:24:06] Jake: We, we had looked at, which is cool. Like security's a big thing. That's the thing I have every day. I check, I have a feed coming in of anything from ISAC or any new threats. Palo Alto is who we use basically for our firewall. So we, I try to keep up on any kind of patches or anything that my guys may have missed.

[00:24:24] Jake: They probably get sick of my FYIs, but yeah, no, but it's good. Cuz they're like, oh yeah, we know about this. We got it. Patched, because of the patch. Staying on top of patching is a big part of any it position, constellation research. If anybody follows them, they're also very good Ray Wong and his crew put on good events and they're, I always come away from they're like, They're in all kinds of other industries.

[00:24:51] Jake: And I come away from those events really inspired, oh, this is what real world folks are doing. Cause you know, it and healthcare is a bit stymied from the years of neglect. Yeah, so it's good to see other how other organizations are really leveraging AI and chat bots and smart automations.

[00:25:10] Jake: Those things are really good. So constellation research look them. 

[00:25:14] Liat: To end this off, Jake. I wanna know who you view as a trailblazer in the healthcare it industry that you'd perhaps like to nominate as a future guest on our 

[00:25:23] Jake: podcast. There's a lot. Aaron Mary comes to mind immediately. He's out at Baptist recently moved to Baptist CCI out there.

[00:25:30] Jake: Very his energy level was amazing. And he's brilliant. And he's also got a seat at the table with the federal government on a lot of the goings on of decision making at that level. So I'm sure he would bring a unique perspective to these types of questions. Dr. Zhar Childry he is at Seattle.

[00:25:48] Jake: Children's super smart. I always looked at him for he's a super honest person too, which I like, he's it would be sitting in the middle of a vendor thing. I say, what do you think you gonna put this in? He was like, I sat through three of these presentations. And the more I hear about it, the more I don't think I want 

[00:26:03] Liat: We need that honesty on this show.

[00:26:07] Jake: He's honest and and brilliant again. Who else? Oh, Chuck Podesta. Super nice guy. He's he used to be the, he's been a use. He's been a I CIO for a long time. Very smart, seasoned. I lean on him a lot for questions. Luckily, he used to be this. He's been in Boston. He's a Boston guy, but he was at UC Irvine for a while.

[00:26:28] Jake: And now I'm lucky enough that he took the open CIO job at renowned in Reno. 

[00:26:33] Liat: Thank you, Jake so much for joining us and sharing your unique perspective. 

[00:26:38] Jake: My pleasure. Thanks for having me.

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About the host
Liat Kozuch
Liat Kozuch
Podcast Host, Hyro

Part production junkie, part people lover, Liat's passionate about making genuine connections and amplifying peoples’ life stories. With exposure to Hyro’s champions at leading health systems, she started Patient Journey Pioneers to expose strategies from healthcare’s most influential digital leaders and C-suite executives, who share insights that are inspiring the industry to move further and faster than ever. Join the journey as Liat continues to seek the next-best-disruptor in healthcare.

About the speaker
Jake Dorst
Jake Dorst
Chief Information & Innovation Officer, Tahoe Forest Health System

Jake spent the last 25 years working in Healthcare IT, and joined Tahoe Forest Hospital District in September 2014 as the CIO and served as interim CEO in 2015. He returned to his current role as Chief Information and Innovation Officer. Prior to that, Jake was the Vice President and CIO of Hagerstown, Maryland -based Meritus Health, the CIO of Petersburg, Virginia as well as other IT-related positions with Community Health Systems in Tennessee.

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