Cletis Earle, VP & CIO, St. Luke’s Cornwall Hospital, Chapter 1

When a hospital wants to connect with community providers but runs into resistance, what’s a CIO to do? For Cletis Earle, the answer is a “road show.” By that, Earle is referring to the organization’s efforts to visit physicians, educate them about the local RHIO, and give them to nudge – and support – they need to climb on board. In this interview, Earle talks about St. Luke’s “localized HIE strategy,” his strong focus on security and data loss prevention, and the challenges in planning when possible mergers are looming. He also talks about the range of innovation happening at his organization, from population health alerts to adding bus routes to help transport patients between facilities.

Chapter 1

• About St. Luke’s Cornwall
• Meditech Magic 5.6.6
• Consolidation & mergers in New York
• Community docs — “It became unsustainable trying to connect with the one-offs.”
• RHIO as primary HIE
• IT managed services organization
• The CIO road show — “It helps alleviate some of the anxieties.”

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Bold Statements

You’re talking about doing this for a couple of years and becoming very disruptive just for a very short timeframe, and it doesn’t make the most business sense possible.

We have our own localized HIE strategy where we will connect with some local partners via our own regional HIE so that we wouldn’t have to worry about some of the red tape that you would see going through the state.

Many of these facilities that have these one-off EMRs or EHRs just don’t have the capacity. They don’t have the skillset to be able to facilitate integration, and I’m not only talking about the practices. I’m talking about these smaller EHR vendors. They’re not used to being able to connect to organizations of our size.

We can’t help them make that decision, but we can try to influence it as much as possible so that they make the best business decision in understanding what’s going to happen in the next few years.

Gamble:  Hi Cletis, thank you so much for taking the time to speak with us today.

Earle:  Hello. Thank you so much for having me.

Gamble:  Sure. To give our listeners some background, can you just talk a little bit about St. Luke’s Cornwall Hospital — what you have in the way of hospitals, bed size, ambulatory care, things like that?

Earle:  St. Luke’s Cornwall Hospital is a small to medium-sized community hospital located in the Hudson Valley, New York. It’s a beautiful area, particularly around the fall. It’s a 350-bed multi-site system. We have a few campuses that are peppered throughout the Hudson Valley region. From the ambulatory side, we have multiple sites, again, throughout the region. As the facilities go, it’s actually separated by several miles. So it’s a challenge. It goes into some areas where it’s rural and accessibility can be a challenge, but we’ve worked with our providers to make sure that we have connections and have a robust continuum of care.

Gamble:  What type of systems are you using?

Earle:  In the hospital, we use the Meditech Magic 5.6.6 Priority Pack 8 for our EMR. We use on our ambulatory side Greenway’s PrimeSuite solution. We’ve had Meditech at this facility for approximately 20-plus years. We went live fully with CPOE a few years ago when I first got here. The entire organization is doing it. We use the basic suite for the acute side, including the radiology systems. For PACS we have something separate; we use the DR Systems PACS that integrates with our EMR system.

Gamble:  Are there any plans for either update to different versions or anything like that, as far as Meditech Magic?

Earle:  That’s the question of the day, because the Meditech Magic platform is pretty old. Meditech has not taken a stance when they’re going to end support or stop supporting that particular platform. So as of right now, there are no immediate plans. We’re located in New York State, as I said earlier. New York is catching up with the rest of the states throughout where we’re starting to see consolidation and mergers of facilities throughout the state.

I anticipate once we decide on an actual partner for tertiary/quaternary care, we will most likely have an overall major system implementation as far as that direction. So I don’t anticipate anything for the next several years. When I say several years, I mean we’re four, five or six years out before we move on to something else. Right now, it’s sustainable.

Gamble:  It makes sense to stay with that product.

Earle:  Yeah. It doesn’t make any sense to go ahead and do the upgrade. I know they have the 6.0 and 6.1 platform, but you’re talking about doing this for a couple of years and becoming very disruptive just for a very short timeframe, and it doesn’t make the most business sense possible.

Gamble:  Right. And it won’t go over that well with the users if you had to do one major switch and then another.

Earle:  Exactly. The doctors would not be happy, as well as clinicians as a whole. Those are our number one customers, along with the patients.

Gamble:  As far as the data exchange between the hospitals and the practices, what level of integration do you have there?

Earle:  Our organization has taken a stance. Our physician community is not as integrated as you may see in other facilities. We have a significant amount of community doctors — some in the larger medical groups that are in the region, but for the most part, we have a significant amount of one-off doctor practices or small group practices, and all of them have different systems. Many of them want to connect with us so that they can have their labs and their radiology information interchanged.

And it became unsustainable trying to connect all of these facilities with these one-offs. We’ve adopted a two-pronged strategy approach when it comes to interconnecting our HIE strategy. We’ve decided to move with our RHIO and utilize the RHIO as a primary HIE. Because of the regional aspect, many hospitals in the area have already connected through RHIO and we’re interchanging information and advanced clinicals as well. We’re very excited with our participation with the RHIO.

I’ve become somewhat of a salesman for some of our practice providers as well as your sub-acute care facilities and long-term facilities, pushing them toward the RHIO for the interchange as well, Again, because of the practicality of us connecting with each one of these facilities and having the HL7 interface connection, it’s not something that we would like to maintain because of the shared nature of volume. It would impact us, so we’ll push it out to a statewide strategy.

We also have our own localized HIE strategy where we will connect with some local partners via our own regional HIE so that we wouldn’t have to worry about some of the red tape that you would see going through the state from that perspective. Again, it’s a pronged approach, one RHIO and then when we find fit, actual or a small local HIE which has an EMPI infrastructure so that we could share information with those facilities that have chosen not to partake in our particular regional strategy.

Gamble:  It sounds that can be pretty challenging, especially when you’re talking about smaller physician offices where even if they do want to go to a certain system, they just don’t have the resources. Has that been a challenge getting that physician adoption and engagement?

Earle:  You’ve hit the nail on the head. Many of these facilities that have these one-off EMRs or EHRs just don’t have the capacity. They don’t have the skillset to be able to facilitate integration, and I’m not only talking about the practices. I’m talking about these smaller EHR vendors. They’re not used to being able to connect to organizations of our size in varying capacities.

It’s been a challenge, and what we’ve done is in some cases we have an IT managed service organization, a for-profit arm where we go in and facilitate some of these challenges that they need to connect if they hire us. But for the most part, that’s not our book of business. We would help when needed, but what we would rather do is connect them via the HIE and then work with them. Literally work with them, working with our RHIO and seeing how we can help out in any case possible.

But again — and you hit it on the nose — they just don’t have the capacity to do so, even though they would like to. As HIPAA becomes more challenged, we emphasize that things shouldn’t be printed out or faxed through without having PHI information secured, which is an older method. They understand that they want to have that information in their medical record, and it’s just not something that they find very effective being a one-off.

Gamble:  As far as managing the relationships with the local physicians, how have you done that? Do you have either a team or a person who’s tasked with that? What’s your strategy there?

Earle:  I work closely with our business development department and the vice president in that area and what we do is exactly what you indicated. We go around — I may even go to varying hospitals to communicate or doctors’ offices to communicate the strategy, find out what are the challenges of connecting. And then pretty much be the champion to let them know how we can help facilitate the connections, how we can create the relationships with the RHIOs or our secondary strategy, and try to sit down with the primary principals of the practices and make them understand why we need to go down this road; why it’s so difficult to not have an actual HIE strategy and a methodology of connecting. 

When you do sit down with these facilities and have partners like our RHIO come to the table, they get it. They get it. They just need somebody to help walk them through it and traverse all of the verbiage that they’re not used to because these physicians are not technical people for the most part. They’re used to ‘set it and forget it’ methodology when it comes to these systems.

If you have somebody like a CIO who goes on the road just like a road show, it helps alleviate some of the anxieties associated with this direction. And then they have to make some decisions; obviously that’s where we back out. We can’t help them make that decision, but we can try to influence it as much as possible so that they make the best business decision in understanding what’s going to happen in the next few years, because that’s the key. It’s where are we going in the industry and how are they going to be more efficient as we talk about the triple aim in moving from a fee-for-service to a value-based methodology. Physicians are reluctant to do that, but I think for the most part they understand it because for those who have been practicing for a while, they understand this concept with capitation and knowing where that goes with the HMOs and the debacle of the eighties and where health care was.

Again, we’re now here to help them, and we’ve been doing a pretty good job with that. I’m pretty excited. As a matter of fact, we’ve had positive feedback in going to other smaller facilities like rehab hospitals. It’s been very good and I feel good that we’re doing the right thing for the particular region.

Chapter 2