Randy McCleese, CIO, St. Claire Regional Medical Center, Chapter 1

To say that Randy McCleese believes in the power of education is an understatement. He holds four degrees, served as an adjust instructor for 10 years, and holds a CHCIO certification. “If you’re not learning something new, you and your organization have become stagnant,” he said in a recent interview, during which McCleese discussed St. Claire’s journey from best-of-breed to an integrated system, the organization’s three-pronged approach to Meaningful Use, the ACO path it is pursuing with Bon Secours Health System, and its involvement in the Northern Kentucky RHIO and the Kentucky HIE. McCleese also talks about St. Claire’s early telemedicine work with the University of Kentucky, which includes school-based programs, why he carves out time for public policy activities, his involvement in CHIME, and how he went from a field geologist to a CIO.

Chapter 1

• About St. Claire’s
• From best-of-breed to an integrated system
• Meditech 6.0 – going live with CPOE & physician documentation
• Building a base with financials
• Using a multidisciplinary “team approach”
• Selecting a system — “It was the troops that made the choice.”
• Working with Northeast Kentucky RHIO & Kentucky HIE

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We got the base built and then brought nursing on and got that clinical data in the system before we started the physicians on their documentation so that when the physicians did come live, they would have that data to rely upon and to build upon.

We looked at how they viewed what we as an organization were trying to do. Are they specific to their department or their specific area, or are they viewing this as an enterprise‑wide opportunity? We wanted those that viewed this as an enterprise-wide opportunity.

We noticed that most of them were having the same issues that we were. And that is, when you get into a best-of-breed environment, you have to deal with all those interfaces that go on and the issues with making sure that the data is consistent.

I’ll never forget the morning after we had informed our CEO at our leadership meeting that Meditech was the choice. He called the group together that had been looking at the different systems and told us, ‘You all have made the choice,’ indicating that it was essentially the troops that had made this choice. This was not an executive-level decision.

We send HL7 messages to the HIE and we’re able to pull the CCD from that. We have found that to be quite beneficial because we can get to entities that are outside our geographic area and pull those patients’ data if we need to, if that patient happens to show up here.

Gamble:  Hi Randy. Thank you so much for taking the time to join us today.

McCleese:  You’re welcome, thank you.

Gamble:  To start off, why don’t you give us a little bit of information about St. Claire Regional Medical Center, in terms of what you have in the way of bed size and clinics, things like that.

McCleese:  St. Claire Regional Medical Center is a standalone Catholic hospital, licensed for 159 beds in rural Northeastern Kentucky. St. Claire has a family medicine operation for which we operate five clinics in Morehead as well as in surrounding towns. St. Claire also has a medical group, which includes two practices, one of those being surgery and the other one being a multispecialty clinic primarily focused on internal medicine. We normally function with a patient load of about 70- to 75-patient average census.

Gamble:  Just to give us a little bit of an idea about Northeastern Kentucky in terms of geography, what is the nearest city?

McCleese:  Morehead is located about 60 miles from the Huntington, West Virginia and Ashton, Kentucky area, and about 60 miles east of Lexington, Kentucky. We’re right along the interstate 64 — very conveniently located an hour from each of those metropolitan type areas.

Gamble:  Okay. Let’s talk a little bit about the clinical application in the hospital. You’re on Meditech, is that correct?

McCleese:  In the hospital, we have just installed a Meditech 6.0 platform having gone live since January 15 with CPOE and physician documentation, which is the culmination of that project. As a matter of fact, the last group of physicians went live this week, which were the psychiatrists, and we’re now up and running with essentially everything being electronic. We’re still going through some growing pains and some hurdles with that, but we’re getting there.

Gamble:  Okay, that was just January you said?

McCleese:  Yes, January 15 is when the first group of physicians went live, and yesterday was the last group of physicians to go live.

Gamble:  Obviously, you’ve had your hands pretty full recently.

McCleese:  Yes.

Gamble:  The hospital is live on CPOE at this point?

McCleese:  We are live on CPOE and physician documentation. All the nursing documentation went live March 1, 2012. All of our functions within the hospital as far as the clinical systems as well as the finance systems are all now on the Meditech 6.0 platform.

Gamble:  I can imagine that, like with many organizations, this has been a multi‑year initiative. When did you start the journey to go electronic?

McCleese:  We actually signed the contract with Meditech on December 30, 2009, and started that implementation in the summer of 2010. We started building the system, going live with our first group of software applications on March 1, 2011. That was primarily the financial functions, scheduling, ancillaries as in lab, radiology, pharmacy, and then the second group of applications came live March 1, 2012, which included the nursing documentation, surgery, and also surgery scheduling at that time. Bedside medication verification and the eMAR also came up on March 1, 2012. We went live with CPOE and physician documentation in January through February of 2013.

Gamble:  So it’s been kind of spaced out so there’s almost a year to focus on the post-implementation.

McCleese:  Our theory is that we need to build a base in order to add the clinicals to it. So we needed to go in and switch off the older systems that we were on because we were in a best-of-breed environment where we had multiple vendor products in each of the specific areas — QuadraMed at the core for patient registration and also for the financing part, and then various other vendor products in the lab and radiology and pharmacy and surgery. We’ve switched all of those out, but we wanted to build that base and get all the patient data into Meditech. Our nursing had never been electronic, so we got the base built and then brought nursing on and got that clinical data in the system before we started the physicians on their documentation so that when the physicians did come live, they would have that data to rely upon and to build upon. And it’s worked very well for us.

Gamble:  Was that part of the strategy to get the nursing on it first, because it made more sense to have them do it so they could offer that support for the physicians?

McCleese:  Yes and it was intentional for us to do it in that sequence, although we’ve tried not to over burden the nurses with trying to support the physicians, but for the nurses to understand so that when the physicians came with questions, at least they would be able to help take care of the physicians whenever that time came.

We actually did a team approach to the implementation throughout the entire process. We developed an internal team in 2010 when we started down this path. That team was a multidisciplinary team. They continued to function part-time in their original position but heavily loaded toward this project itself. We brought in a group of folks — one was both lab and radiology, so we brought in that ancillary area. We had a pharmacist. We had a nurse. We had finance. We had HIM. We had a physician and then a project coordinator, and then I was part of that group too as that executive liaison. And that project team has been dedicated through the entire thing and we’re now at the point that we’re moving that project team from the project itself off into continued operations and maintenance of the system.

Gamble:  In terms of the representatives that you had, were these people who stepped forward and expressed interest in this? How did you put together the team?

McCleese:  That’s exactly what we did. Because as we went through the selection process in 2009, there were people that came forward with real interest in doing what we knew we had to do. They understood the reasoning behind it, and the folks that stepped forward, as we looked at them, we looked at how they viewed what we as an organization were trying to do. Are they specific to their department or their specific area, or are they viewing this as an enterprise‑wide opportunity? We wanted those that viewed this as an enterprise-wide opportunity and knew what needed to happen to set it up so that we could use it across the entire organization. That’s why it’s been so beneficial for us to have that team put together.

Gamble:  When you did kind of start down this path, you said that you had a best-of-breed strategy in place before. Was it something that your organization leaders were thinking about for a while, the idea of, ‘We want to go on one system’ or was it a difficult sell?

McCleese:  It was something that we had thought about quite a bit. To be frank, the main reason that we ended up choosing a new system because of ARRA and HITECH. We knew we were going to end up getting to the point where we would get an electronic medical record system. We had started down that path prior to February of 2009, but we were looking at how we could advance the systems that we already had in‑house, and we were looking at the integration of those. We had done demos and talked to other hospitals and systems about how they were able to handle those things, and we noticed that most of them were having the same issues that we were. And that is when you get into a best-of-breed environment, you have to deal with all those interfaces that go on and the issues with making sure that the data is consistent across all those different interfaces and all the different systems. We realized, both from an executive standpoint and from a management standpoint, that we wanted to go to an integrated system.

As HITECH came into place and became a part of what we were looking at, we broadened that scope a little bit and stepped back and said, ‘What do we really want to do here?’ We went out and looked at several systems, and I won’t say we did demos or anything like that, but we looked at several different systems that have an ‘integrated approach.’ And after our demos and site visits and those things we came down to Meditech. That was the choice of the people here. I’ll never forget the morning after we had informed our CEO at our leadership meeting that Meditech was the choice. He called the group together that had been looking at the different systems and told us, ‘You all have made the choice,’ indicating that it was essentially the troops that had made this choice. This was not an executive-level decision. He said, ‘You’re the ones that are going to be selling it to the other 1,200 people in this organization,’ and that is what’s happened.

Gamble:  I can understand the logic behind taking an approach like that; to give ownership to the users. I can see how that would help buy-in.

McCleese:  And we have implemented this, especially the last two phases of it, as a clinical project. This is not an IS project. It’s a clinical/business project and our CMO is excellent at working that area. He’s done a wonderful job.

Gamble:  That’s one of the things that we’ve always heard is that it’s so key having good people around you; having that strong leadership team.

McCleese:  And fortunately, as a part of that team that I mentioned earlier, that project team with the pharmacist, the nurse, the lab/radiology person — they have been so key in giving that buy-in from the clinical staff.

Gamble:  You need to have that.

McCleese:  Yes.

Gamble:  Okay, let’s talk a little bit about RHIOs. I was going to say HIEs, but it’s the Northeast Kentucky RHIO. Tell us about the work you’re doing with the RHIO — where does it stand now and kind of what are your goals for the immediate future?

McCleese:  There are two things going on as far as health information exchange from a St. Claire standpoint. The Northeast Kentucky RHIO, which is officially incorporated as a 501c3 organization, is doing some data exchange. We went through a test process and exchanged data with some other entities in this area, but frankly, the operations of the Northeast Kentucky RHIO are primarily from the regional extension center standpoint and that has been the biggest function for the last 18 to 24 months for that organization. The Northeast Kentucky RHIO is a subcontractor to HealthBridge in the tri-state regional extension center, and the Northeast Kentucky RHIO has been emphasizing these standalone physicians in Northeastern Kentucky and getting them up and running on electronic medical records and preparing them for health information exchange.

They’ve also helped us here at St. Claire’s hospital and a couple of other smaller hospitals in the area. That’s kind of quick on what the Northeast Kentucky RHIO is doing. St. Clare is also heavily involved in the statewide health information exchange called the Kentucky HIE, and have been, since the beginning of 2012, sending data to the Kentucky Health Information Exchange. And of course that’s a much larger organization in terms of geography and data.

The Kentucky Health Information Exchange has the capability to accept and produce either an HL7 message or CCD, and we send HL7 messages to the health information exchange, and of course we’re able to pull the CCD from that. We have found that to be quite beneficial because we can get to entities that are outside our geographic area and pull those patients’ data if we need to, if that patient happens to show up here.

Chapter 2