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.
- Different technology mindset in rural areas
- “When rural folks need care, they’re more interested in just visiting a provider.”
- Coming out of retirement – “I wasn’t ready to hang it up.”
- Policy work to educate lawmakers
- “We’ve had to take caregivers out of the environment where can provide patient care.”
- Representing community hospitals – “I’ve tried to be as vocal as I can be.”
- CHIME-HIMSS CIO of the Year – “It is such a huge honor.”
When rural folks get the point where they need care, they’re more interested in just visiting a provider and getting it taken care of. I don’t think they’re as interested in advancing their knowledge of how to get through to a patient portal.
They don’t realize that how difficult it is for a patient who lives 30-40 miles from a hospital to make that trek, especially if they’re in their 70s. It’s an all-day thing for them, whereas in an urban environment, it’s a couple of hours out of a day. I feel like people in Washington need to hear that.
It’s something that we as an industry need to push forward, because the rural community hospital environment is still huge in this country. Even though a lot of the smaller hospitals and rural hospitals are becoming part of larger organizations, they’re still there.
We’re taking caregivers out of the environment where they can provide patient care, and having them gathering data to meet regulatory requirements. In the long run, I know we have to do that, but it’s getting to be such a burden
Gamble: One of the challenges we often hear about in the rural health setting is in patient engagement, which can vary so much depending on the location, patient demographics, and other factors. What have you found in your experience?
McCleese: It’s interesting. We’ve had some discussions about this in some of the meetings I’ve been to — particularly the CHIME meetings. My career has been in rural medicine, and what I’ve seen is that, for the most part, is that folks are nowhere near as tech-reliant as those in more urban areas. And I don’t mean to generalize, but we tend to be more outdoorsy folks who do a lot of farming and a lot of work outside, and don’t necessarily have time to use technology in the same way that others might. It’s a different lifestyle.
When rural folks get the point where they need care, they’re more interested in just visiting a provider and getting it taken care of. And again, I’m generalizing, because we’re talking about a population, but I don’t think they’re as interested in advancing their knowledge of how to get through to a patient portal and do the things they need to do to take care of themselves that way. And so it’s a little more difficult in that type of environment.
This is just my take on it. From what I see, the patients in the Henderson area aren’t much different from the ones I saw in the Morehead area when I was with St. Claire, because it’s the same rural type environment, and the folks tend to work the same way. They don’t get up every morning and go to a factory or an office to work; they’re office is going out on the tractor or taking care of cows, things like that. It’s different.
Gamble: They’re not checking an iPhone every few minutes.
McCleese: Right. It’s hard to use an iPhone while you’re driving a tractor or milking a cow. But things are changing. It’s getting to the point that a lot of the farmers do utilize technology, but I don’t think it’s being adopted as quickly as it is in urban environments.
Gamble: That’s a really good point. Now, as far as your career, you mentioned earlier that retirement didn’t agree with you. Did you realize that pretty quickly?
McCleese: Yes. I thought I’d like retirement, but I just wasn’t ready to hang it up. I felt like I needed to keep working, and it was the right decision. I feel like I still have a lot to do in the healthcare information technology area.
Gamble: And policy issues continue to be of interest to you. Why do you think that’s been so important to you throughout your career?
McCleese: Part of it goes back to the description I gave of the rural versus urban environment. As I’ve worked with legislators in Frankfurt, Kentucky, I’ve found that they seem to be more in tune with it than the folks I’ve met in Washington through CHIME — both the agencies, as well as some of the senator and representative offices. There’s a lack of understanding from the staff on what really goes on in healthcare, and especially in rural healthcare. They don’t realize that how difficult it is for a patient who lives 30-40 miles from a hospital to make that trek, especially if they’re in their 70s. It’s an all-day thing for them, whereas in an urban environment, it’s a couple of hours out of a day. I feel like people in Washington and other areas need to hear that.
Fortunately, through my involvement with CHIME, I’ve been able to raise awareness, and I want to continue that as much as I can. It’s something that we as an industry need to push forward, because the rural community hospital environment is still huge in this country. Even though a lot of the smaller hospitals and rural hospitals are becoming part of larger organizations, they’re still there. They still have to provide that front line of care for patients. They just may be part of a larger organization as they do that.
We have to have folks out there that are talking about this. Fortunately, we have a few others in CHIME that are starting to do that as well. I’ve had the opportunity now for about 15 years to be involved, and I’ve really enjoyed it.
Gamble: It’s pretty clear that you really enjoy being in the community hospital environment. I’m sure it’s valuable for those who are in different settings to hear that perspective from someone who lives it every day.
McCleese: I’ve been there, done that. I want others to know that these are the issues we have — some of them are unique to the rural environment, but then there are a lot of similarities to bigger organizations as well.
One thing I’ve always liked is that in the community environment, I think we’re much more in tune with the patients. Both at St. Claire and here at Methodist, we’re very close-knit. When a patient shows up, a lot of times they have someone working here who is part of their extended family. I know in the urban environments that probably doesn’t happen anywhere near as much.
That also raises issues about patient confidentiality. That’s something we have to pay a lot of attention to because you can’t go talking about your third cousin who is in the hospital, because that’s a breach of confidentiality. But it’s something we have watch for in smaller communities.
Gamble: Right. Certainly a different viewpoint than with large health systems. Now, I wanted to congratulate you on being named CHIME-HIMSS John E. Gall Jr. CIO of the year. I’m sure it was a tremendous honor to receive it.
McCleese: I can’t explain how I felt when I learned that I had received the award, because it’s such an honor to be included with others that have received this. As I went through the list of past winners, which was sent to me by Buddy Hickman, I thought, ‘how in the world did I do something like this?’ It is such a huge honor to be included in that company.
Gamble: I think a lot of people were happy to see the award go to not just someone who has worked so hard to push the industry forward in terms of health IT adoption, but who comes from the rural health community, which isn’t always represented as much.
McCleese: I certainly appreciate the opportunity I’ve had to have represent rural and community hospitals over the years. I’ve tried to be as vocal as I could be, and yet be prudent and make sure that the folks that need to know what’s going on — whether it be through CHIME or HIMSS, through the regulatory agencies, or on Capitol Hill — are aware of the issues we have to work through.
I keep saying this, and I’ve been saying it a lot over the past few months: these things that we’re doing and pushing forward — how are they helping us do a better job of taking care of the patients? We had an opportunity recently at Methodist to have some input on some of the quality measures that CMS is working on (this was through CHIME). I told the person we spoke with who was representing CMS, ‘I have six people sitting around this table. Five of them are caregivers, with four of those five being nurses, and what they’re doing is gathering data. But the data they’re gathering has nothing to do with what allows them to take care of a patient any better.’ We’re taking caregivers out of the environment where they can provide patient care, and having them gathering data to meet regulatory requirements. In the long run, I know we have to do some of that, but it’s getting to be such a burden, especially in a rural environment, because this hospital is about 75 percent Medicare/Medicaid and those reimbursements are on a decline. So we have fewer people to take care of patients. We want to keep as many of those caregivers taking care of patients as we can, but it’s difficult with the increased burden that we’re seeing.
Gamble: Absolutely. It goes back to what you said in the beginning about making sure caregivers get what they need to care for patients, which should be at the core of all of this.
McCleese: Right. We want to provide evidence that we’ve taken good care of the patients, that’s where quality comes in. And yet, the systems are not being able to keep up with it as fast as the folks in Washington want to be able to see it. So, unfortunately, we have to throw more people at it, which makes it more difficult to take care of the patient.
Gamble: It’s not easy stuff. But your organization is doing some great work to help move things in the right direction. I want to congratulate you on the honor, and thank you for taking the time to speak with us.
McCleese: Thank you, Kate. I appreciate it.