At the end of 2016, Randy McCleese retired from the position of CIO after spending 21 years at St. Claire Regional Medical Center, thinking it was time to slow down. As it turns out, it wasn’t. A few months later, after realizing he still had “a lot to do in health IT,” he started a new CIO role at Methodist Hospital in Henderson, Kentucky. Both the organization and the industry are better for it. At Methodist, he stepped into an environment that had been through a tumultuous time, and provided the stabilization that was needed. Meanwhile, he continues to serve the industry through his advocacy work, which helped him earn the honor of CHIME-HIMSS John E. Gall Jr. CIO of the Year.
In this interview, we speak with McCleese about how he approached his new role by emphasizing stability over change, what his team is doing to increase buy-in among physicians, and the many challenges that face rural hospitals. He also talks about why he prefers the community hospital setting, why advocacy is so important to him, the steps he believes need to be taken to lessen the burden on caregivers, and how it felt to receive such a prestigious award.
- About Methodist
- Stabilization, not change as the new CIO
- “We need to make sure caregivers are getting what they need to care for patients”
- Meditech C/S in acute, Meditech Practice Management in clinics
- “It’s not total integration, but it’s the same vendor.”
- Adding more layers of security
- Communicating with physician groups – “We brought them together and asked for feedback.”
- Geography challenges in rural health
I didn’t come in with the attitude that a lot of things had to change, but with the attitude that a lot of things had to be stabilized, and that we need to make sure the caregivers are getting what they need in order to take care of patients.
The layers of security are like slices of Swiss cheese; if you have one layer of security in place, it’s easy to get through it, as it would be with one layer of cheese. When the ransomware incident happened almost two years ago, there was one layer of security; now there are four layers.
We’re encouraging the physician group management to get more heavily involved in making some of those decisions about how the templates need to be set up and how we flow patients through the physical environment.
After the install, we brought the pediatric providers together and talked to them about how things are set up within the system. We made sure it was convenient for them by having the sessions after hours. We brought them together and asked for their feedback, and we’re now making some changes.
Kate Gamble: Hi Randy, thank you so much for taking some time to speak with us. I look forward to hearing about everything you’re doing.
Randy McCleese: You’re welcome, I appreciate the opportunity.
Gamble: Can you start by providing a high-level view of Methodist Hospital?
McCleese: Sure. Methodist actually is two hospitals. There’s the flagship hospital, which has 192 beds and is in Henderson, Kentucky, and then we also have a 25-bed critical access hospital in Morganfield. We’re a community hospital serving patients in northwestern Kentucky. We refer patients to Evansville, Indiana, as well as Owensboro Health, which is about 30 miles west.
Gamble: And then you have a physician network as well?
McCleese: We have the Methodist Physician Group. It has 19 clinics that provide a range of services; most of the physicians that work in those clinics are employed, and some are independent.
Gamble: And you’ve been with Methodist since April after having spent quite a bit of time at St. Claire. What was it that appealed to you about this organization? I can imagine part of the draw was being able to stay in Kentucky.
McCleese: I actually retired from St. Claire, but I found out rather quickly that I did not like retirement. One of the main draws was that this was in Kentucky. Another was it’s a community hospital, which is the type of environment which I really like to work in. That made a big difference in what I was looking for. As I looked at Methodist and talked to some folks, I really saw a need for my skills here, and frankly, I have fit in very well.
Gamble: How did you approach the new role?
McCleese: It was very interesting coming into the organization, because there had been some issues over the past few years, especially in 2016. The organization suffered a ransomware attack that took the system down for a while. And so we’ve been going through the process of remediating that with all the security parameters that needed to be repaired.
Also, from an organization standpoint, there had been significant turnover in the higher level, especially the CEO role, where there were three in two years. The long-term CEO left the organization in 2016, and then there was a CEO that came in for about 11 months. He’s been gone for almost a year now. So it’s been a change in the direction for the organization, while of course dealing with the security issue. And of course there are other things we’re working on that are specifically relevant to the network itself and making sure that we can provide everything that the caregivers need.
Gamble: I would imagine the presence of so much turnover affected the way you approached the role. With so much turnover, I’m sure you were focusing bringing some level of stability.
McCleese: I think I’ve been able to do that. I’ve gotten some positive feedback within the organization that there’s more stability here now. One of the comments I got was that I hit the ground running. There are so many similarities between Methodist and St. Claire’s, where I was for 21 years. Having learned all that I did there, it didn’t take me long to understand what I needed to do to get things stabilized. I didn’t come in with the attitude that a lot of things had to change, but with the attitude that a lot of things had to be stabilized, and that we need to make sure the caregivers are getting what they need in order to take care of the patients.
I had two big tasks. One was that the organization was in the process of installing a new ambulatory EMR, and the second was to get the final phases of the security program in place and get them stabilized. Both of those projects were nearing the end — of course, neither are the things that you ever finish, but we’re nearing the end of the install project and getting into the maintenance and operation phases.
Gamble: What ambulatory EHR system are you using now?
McCleese: We switched to the Meditech Practice Management. The main reason was because Meditech is the acute care system we use. The idea is that we want all of our providers on the same vendor product. It’s not a total integration, however, because we’re using Meditech Client Server, but at least it’s the same vendor with the same medical record. It’s much easier for us to get those two different components working together than it is to be working with different vendors. That was the reasoning behind the decision, which was made several months before I got here.
Gamble: You mentioned that the EHR implementation is complete — or at least nearing completion. What’s the next phase as far as ambulatory?
McCleese: We’re moving into the operational phase. There are still a few things that we’re doing from an install standpoint. But for the most part, we’re at the point where physicians are making the requests that you usually see a few months after go-live. They want some changes made, and they wanted it optimized for their use.
Gamble: And in terms of security, is the organization at a better point in terms of keeping data safe?
McCleese: Yes. The way I see it, the layers of security are like slices of Swiss cheese; if you have one layer of security in place, it’s easy to get through it, as it would be with one layer of cheese. When the ransomware incident happened almost two years ago, there was one layer of security; now there are four layers. This way, if you get through that first layer of Swiss cheese, you might get through the second one, but then the third or fourth one may stop you. That’s where we are today.
The next level we’re looking at it is to have someone monitoring that 24/7. We are doing the best we can, but we have a limited staff. So we’re in the process of looking outside the organization. We’ve already spoken with some solution providers who we feel can do a better job of keeping up with the latest ransomware and any kind of malware that’s out there, because it changes by the minute. I can’t afford to have someone here monitoring that 24/7, so we’ll look outside. That’s the last part of that phase, but it doesn’t mean we’re done. We’re going into optimization mode, and we’ll have to constantly monitor it. And of course, as with any organization, we have continual projects.
Gamble: Right. You mentioned that a core focus is to make sure caregivers are getting what they need to be able to provide care, and of course there are so many different components to it that go beyond just having systems in place.
McCleese: There are. We’re trying to get to the point where caregivers are comfortable asking IT folks to make the changes that they feel they need. And I hesitate to use the term ‘standardize,’ because I know a lot of providers don’t like it, but what we’re doing from a systems standpoint is putting forth a concerted effort that they practice medicine similarly within the discipline.
For example, if it’s orthopedics, let’s have them practice orthopedic medicine in a similar fashion — or as close to as they can. As we move forward in the HIT industry and get more familiar with the way providers practice in the different disciplines, we’re learning how we can start to do this. From an IT standpoint, we’re encouraging the physician group management to get more heavily involved in making some of those decisions about how the templates need to be set up and how we flow patients through the physical environment to make sure we don’t burden the patients with anything. It’s constant change, but change to the standpoint that we’re trying to make it better for the patients.
If I’m working on these types of things, I try to picture myself as the patient and see what makes it easy for me and what makes sense. And I can’t do that in every scenario, but at least I can put my 2 cents in there on how the data should flow, and what changes we can make to the physical environment to make sure patient flow is better than it was.
Gamble: And of course you don’t want physicians and clinicians to feel this is being done to them, but to get their buy-in. How do communicate with those physician groups?
McCleese: Yes. I mentioned the groups of physicians because after the install, we brought the pediatric providers together and talked to them about how things are set up within the system. We made sure it was convenient for them by having the sessions after hours. We brought them together and asked for their feedback, and we’re now making some changes.
And we’ll be doing the same types of things with different groups of providers over the next several weeks. About every two weeks, we’re getting one group of them together after normal business hours and just talking through how we’re doing things and what they see that needs to change, and then we’ll make modifications to remedy that. It’s being spearheaded by IT, but we’re bringing in the physician group management, as well as the clinic management folks, and making sure they’re all involved.
Gamble: Going back to what you said about putting yourself in the patient’s shoes, I’m sure a big consideration in improving that experience is in making sure patients don’t always have to travel far to receive care. As a rural organization, is that a key priority?
McCleese: It is. We’ve have some clinics in some of the smaller towns. Most of them have at least two providers, but when I say ‘smaller towns,’ I’m talking about 2,000 to 3,000 people, some even fewer. We’re trying to provide care as conveniently as we can to these patients. The challenge is that some of them have difficulty traveling, and if we can’t provide them care close to home, they’re going to get sicker and sicker until they show up in the ER, which of course adds to the overall cost of taking care of patients.
And so by having these clinics, we’re trying to provide care to them as close as we can to their home. In our service area, we have two hospitals where we can provide care at another level, and then we’re not that far away from even higher levels of care in Evansville, Indiana.
Chapter 2 Coming Soon…