Randy McCleese, CIO, St. Claire Regional Medical Center, Chapter 2

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 telemedicine work, 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

Chapter 2

• Kentucky HIE — “They’re doing a good job matching patient data”
• Working with UK to connect schools with primary care clinics
• Why telehealth is “sputtering”
• Dividing & conquering MU
• Meditech in the hospital & medical group
• Partnering with Bon Secours on an ACO – “We’re just starting down that path.”

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From the provider and the participant standpoint, we have not yet been paying anything to become part of this. We realize at some point that’s going to happen; we just don’t know yet when or how much that will be.

They know about the telehealth capabilities, so if one of the students comes in and needs a telehealth consult, they know they can get to it rather quickly.

There are certain services that we can provide just as well across video as we can in person. But we have not yet gotten to the point that the payers are paying for those visits. And until that happens, it’s going to be sputtering.

In the hospital, because we’re installing Meditech, we had to get to the point that we were able to do some of those functions, especially from the clinical quality measures of being able to meet the Meaningful Use criteria.

The state HIE coordinator kept telling me I need to come to the meeting and I told her, ‘I’m trying to get through stage 1, and I’m getting so confused on the requirements for stage 1 versus stage 2. If I come and listen to you, I’m going to get more confused.’

Gamble:  So just looking at the HIE landscape, there is one primary HIE in the state, correct?

McCleese:  Yes, the Kentucky Health Information Exchange. The Kentucky HIE is one that was funded through the grant funding that came three years ago. That group sends regular communications via email as to what’s happening with the health information exchange and then they also have an annual meeting, which is in September of every year where they bring everybody together in one location. But the health information exchange personnel also participate in numerous state presentations. For example, on February 12, HIMSS, Kentucky AHIME, and CHIME all sponsored a Health Information Technology Advocacy Day in Frankfort, our state capital. And the Kentucky Health Information Exchange folks were there letting folks know what was going on with the HIE. They do that at various meetings around the state and make sure that everybody’s aware that the HIE is there and available, and the amount of work that’s going on.

Gamble:  The issues that you hear with the HIEs most often I would say are interoperability or funding. In terms of that, does the Kentucky HIE seem like fairly strong? Has it been able to stand up?

McCleese:  From the information exchange standpoint, they’ve done a very good job of being able to match the patient’s data coming from the various entities. As we’ve gone in to look at patient data, we can see what has been put out there by other providers. For the part that I’ve seen when I’m watching clinicians access this, it’s thorough. They’re doing a good job of being able to match the patient’s data. I do know they’ve hired some staff from some of the organizations around the state that are good at that kind of work. I know one of the HIM folks that they’ve hired and put on staff there. She’s very good at matching patient data. She’s got a lot of experience at that.

On the funding side, so far they’ve operated only on grant funding that has been made available to them. They have done a lot of work to determine how they can sustain it. From the provider and the participant standpoint, we have not yet been paying anything to become part of this. We realize at some point that’s going to happen; we just don’t know yet when or how much that will be. So I think they’ve got some work to do there.

Gamble:  So being in an area that’s pretty rural, is St. Claire fairly active in the telehealth area?

McCleese:  St. Claire has been active in telehealth. We actually started participating — if you can believe this — 20 years ago through the University of Kentucky.

Gamble:  Oh really.

McCleese:  We started participating in some of the UK grants that were available. And I think this is still true, St. Claire was the largest telehealth site on the University of Kentucky telehealth network outside Lexington, which of course is where UK is located. We are a hub for roughly 40 telehealth participants in Northeastern Kentucky, and of course when it comes through here, it can be fed back to Lexington and distributed out anywhere else in the state or the country. But we have telehealth sites in several of the schools and school districts around as well as connections to other hospitals around Northeastern Kentucky.

Gamble:  That’s pretty interesting. I hadn’t heard much about it in schools but it makes sense.

McCleese:  Yeah, we have done that for five or six years now in the schools. From a St. Claire standpoint, we have contracts with some of the local school districts to provide nurses in some of those schools. That makes it kind of nice. They know about the telehealth capabilities, so if one of the students comes in and needs a telehealth consult, they know they can get to it rather quickly — whether that’s at one of our primary care clinics, whether it’s here at the hospital, or whether it has to go on at UK.

Gamble:  That’s great that you’ve been doing it that long. It’s really impressive.  Across the industry, it seems like telehealth is something that sputters a little bit. We know that the barrier, a lot of the time, has come down to money, but what do you think we’re going to see as far as trends with telehealth? Do you think that it is something that will finally start to take off a little bit more in other areas?

McCleese:  I think it’s going to take off for selected services. That’s what we’ve seen here. But you’re right, when it comes to the money part it’s the funding or the payment for medical care to be provided in that manner. It’s not traditional, because it’s a physician seeing somebody across video. So it’s different for the payers, and that’s the biggest issue that we’ve seen. From the provider standpoint, there are certain services that we can provide just as well across video as we can in person. But we have not yet gotten to the point that the payers are paying for those visits. And until that happens, it’s going to be sputtering, and we’re kind of sputtering along right now trying to get payment for a lot of those things that we’re doing.

Gamble:  Anybody can see the benefits of it, especially when you’re talking about elderly patients or chronic care patients, but that funding is a huge barrier.

McCleese:  And we’ve got a lot of those patients because of our patient population. From a St. Claire system standpoint, we’re about 70 percent Medicare and Medicaid so we have a heavy patient load of a lot of folks that are not readily mobile.

Gamble:  It will be interesting to see how that shakes out in the next couple of years. In terms of Meaningful Use, where does St. Claire stand?

McCleese:  From a Meaningful Use standpoint, we have divided our organization into three different areas. One is our family medicine operation; family medicine has been live on electronic medical record since 2007, and they are Medicaid providers. In that area, we were able to take advantage of Meaningful Use very early. We’ve already done the first two years of Meaningful Use for our family medicine operations. And in that case, we employ all those physicians, so either from a hospital standpoint or a higher-level organization standpoint, we took care of doing all of the Meaningful Use attestation and working through the paperwork and everything for all those providers. So that part we’ve gone through year 1 and 2 and they’re all Medicaid.

In the hospital, because we’re installing Meditech, we had to get to the point that we were able to do some of those functions, especially from the clinical quality measures of being able to meet the Meaningful Use criteria. Right now, we were intending to start our 90-day attestation period for year 1 coming up Friday, but we’ve got a few little issues and it’s going to be delayed several days. So we intend to do our 90-day attestation between now and June 30. That’s for year 1. And then of course stage 2 starts in 2014 so we’re working on stage 1, year 1 right now and we’re moving to year 1, stage 2 within 2014.

In our medical group, we’re installing the Meditech LSS Ambulatory system, and again, that’s two different groups of practices that are going on; one is surgery, and one is the multispecialty clinic. The surgery group is Medicare, and we’re working to get that system up and running so that we can do our 90-day by the end of calendar year 2013. The multispecialty clinic is Medicaid, so we’ll be waiting until 2014 to do that. We’re kind of on the late end on getting our Meaningful Use stage 1, year 1 in the hospital and within our medical group practices. Right now, we’re looking at being able to get there. We know in surgery that we’ve missed year 1 Medicare, but we want to get year 2.

Gamble:  So that sounds like that can get a little bit sticky with the three components. Do you have a committee that’s looking at that? How does that work?

McCleese:  We do have a committee that is looking at it. Frankly, it’s three different groups that look at it, and I’m involved with all three. Because when it comes to the family medicine group, I’ve got three people there that I work with. When it comes to our medical group, there’s another three people there that I work with and then in the hospital there are five of us that are working. And I’m trying to keep it straight in my brain as to which one am I talking to today. It gets confusing at times.

Gamble:  I bet.

McCleese:  Especially the differences between the hospital and the providers. We employ all these providers. We have very few physicians or providers that practice here within the organization that are not employed.

Gamble:  So really more for you than anyone else, it has to get a little bit tough separating the three.

McCleese:  Yeah. As a matter of fact, there was a meeting in which the state HIE coordinator was on the panel and she was talking about stage 2. She kept telling me I need to come to that meeting and I told her, ‘I’m trying to get through stage 1, and I’m getting so confused on the requirements for stage 1 versus stage 2. If I come and listen to you, I’m going to get more confused. I understand and I’d like to hear you, but I’m going to get more confused. I’m going to take a rain check on that.’

Gamble:  Yeah, you don’t need to throw too much more into the mix right now.

McCleese:  Right. Let me get through stage 1 here first.

Gamble:  Obviously, there’s a lot going on there. Anything else in your organization that you’d say is a top priority for the next six months or the next year or so?

McCleese:  We have just become involved with the Bon Secours Health System in the accountable care organization world. There was an announcement back in January that there were 106 new ACOs approved, and ours was one of those. We’re just starting down that path with ACO, and like I said, that is with the Bon Secours System. They have done an ACO in some of their other operations in the Virginia-Maryland area. But this is the first in Kentucky for them, and we’ve become part of that ACO here in the state. That hospital is in Ashland, Kentucky, which is about 60 miles east of us. That’s going to be a big emphasis for us. We’re just now getting into that, and we’ve had two or three meetings on it so far. As a matter of fact, I’m working through the patient list that we’ve gotten from CMS and trying to get through those things.

Gamble:  That’s going to start up the discussion and planning phases of that.

McCleese:  Yes.

Gamble:  Is there a specific time table set up for that at this point or is it kind of just preliminary?

McCleese:  It’s preliminary at this point. We haven’t set any dates yet. We have not gotten far enough along in our discussions to say what date we’re going to be doing what.

Gamble:  Bon Secours is pretty spread out as an organization, right?

McCleese:  They are. I don’t know remember exactly what they have but it’s about 10 to 12 hospitals in the Maryland-Virginia area and then over into Kentucky. They may have some more on the northeast, but there are several hospitals that are part of it, and again they’re Catholic, so that’s a good fit for us.

Gamble:  All right. That will be good to be able to move toward ACOs. That’s something more and more people we talk to have on their list. I’m sure at least there’s some satisfaction that you’ve taken the initial steps toward that.

McCleese:  Right.

Chapter 3 Coming Soon…