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.
- Connected care with kiosks
- Small organizations — “We’re able to do great things without jumping through hoops.”
- MU “forcing the hand” of vendors & providers
- “I’m okay with pushing the envelope.”
- Patient portal success
- NY’s Rx monitoring program
- “This is an exciting time and everybody should be excited.”
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We’re able to pull off the gloves and do a lot of great things without jumping through hoops. From that perspective it’s been very good. But there are differences because scale and scope are also a challenge when you’re dealing with a smaller organization.
This has forced the hand of the vendors to say, you have to be able to ingest information as well as extract it. Without Meaningful Use, we wouldn’t be there. The vendors would have taken their time. Hospitals and providers would have taken their time.
When things are all said and done, I believe in optimization and progress, and I believe that with these kind of tools, it’s going to change things. It’s going to make things better.
They want to have information. This is the new norm, and this is the example you’re seeing with social media and the internet. People are used to getting access to information. What they do with it is a different scenario, and that’s what can be scary.
We’re here. We’re doing it now. This is an exciting time and everybody should be excited. Is it hard? Yes. Is it difficult? Yes. Is it achievable? Yes.
Gamble: If you’re part of a larger organization, that also means more red tape and to have that quick of a turnaround probably doesn’t happen. That’s a really interesting perspective.
Earle: It is. There’s another technology that we use. We’ve put it in place, an actual kiosk that does BMI, weight, blood pressure, height, all of these things as well as tying it into teleradiology. It’s a kiosk that we’re able to have patients as well as our employees use for employee health. We understand that we need to help the patients, but it also starts within. So we’re monitoring our patients. We’re monitoring our employees, and we hope to have this solution be able to ramp up into an actual telemedicine solution. Once our care coordinators get involved in pushing the technology in the community, we envision them going in malls — some other facilities have done this as well, and putting them in pharmacies so that people can actually start to use these devices. And with the end result of finding out if they’re hypertensive or whatever, taking the next step at having the technology help guide them to a care coordination team member and do the telemedicine so that they can help guide them in their care.
We have those devices here in our hospitals, and we’re going to be pushing them out to the community. It’s very exciting use of technology with all of the various clinical coordination that we have going on in the area.
Gamble: Definitely, especially since you talked about having some rural population too. Any time you can use telemedicine technologies, that’s a big plus for outcomes.
Gamble: It sounds like you guys have a lot of really great things going on. I wanted to talk a little bit about your background. You said you’ve been at St. Luke’s about 2 and a half or 3 years?
Earle: I’ve been here for three years. I came from New York City side. They recruited me up about three years ago. I was at Wyckoff Heights and BQHC (Brooklyn-Queens Health Care), which ended up buying two other hospitals from St. Vincent’s, St. John’s Queens and Mary Immaculate. We ended up purchasing them and closing them down, unfortunately. So we did that, and soon thereafter I came up to St. Luke’s Cornwall Hospital.
Gamble: I’m sure that was a transition going from a pretty large organization to a smaller to medium size. Is that something you wanted to do? What were your feelings about that?
Earle: It was a change. Obviously there are different cultures you have to deal with as well, but what happens here — again, I think I’ve indicated some of the benefits of having a smaller institution — is that we’re able to actually pull off the gloves and do a lot of great things without jumping through hoops. From that perspective it’s been very good, I have to say. But there are differences because scale and scope are also a challenge when you’re dealing with a smaller organization. Budget challenges are often the case.
When I first got here, just like every other hospital in the country, we had a significant challenge when it came to volume. Nationally, the patient volume was down throughout, and that obviously impacts the bottom line. But ironically, in the last year we’ve seen an extremely positive increase in our patient volume. As a result, things have been looking not that bad, not too gloomy.
What it boils down to is you never know just because you see what’s going on in other parts of New York State, particularly in the city. There are hospitals closing all over the place, and you just never know. A lot of it has to do with how well you’re able to turnaround with your patients and patient satisfaction. We do a really good job up here. And again, size may matter, because with HCAHPS scores focused on that, you’re able to have more of a community feel. Those are some of the many benefits you get that you may not be able to completely get your hand around at a larger facility.
Gamble: I can imagine you’ve benefited from being part of a bigger system and just being able to apply some of the things you’ve learned on a different scale.
Earle: Absolutely. You’re right.
Gamble: Okay, so the last question I wanted to ask is a big one. I wanted to get your overall thoughts on Meaningful Use and where the industry is going. I’ve heard some people say that they believe we’re on the right path, but it is not a very easy path or a clear path. So I just wanted to get your take on where things are headed.
Earle: My take is a little different than you may hear from some of my colleagues. I actually appreciate what Meaningful Use has been able to do because without Meaningful Use, we would not be in this position where we’re talking about clinical integration. It has pushed the industry as a whole to be integrated.
As an example, one of the pieces for Meaningful Use Stage 2 is having a data repository. Without that data repository, it forced the EMR vendor to provide us access to that data that sits outside of the EMR system, and we would not be able to do the data analytics that way, because it’s a challenge trying to work with vendors to get bidirectional information — getting information out more and getting information back into the system. This has forced the hand of the vendors to say, you know what? You have to be able to ingest information as well as extract it. Without Meaningful Use, we wouldn’t be there. The vendors would have taken their time. Hospitals and providers would have taken their time, as they have for the last hundred or so years.
So from that perspective, I don’t see it as much as doom and gloom. Is it difficult? Is it a challenge? Absolutely. Is it one of the hardest things you do? Absolutely. Is it insurmountable? Absolutely not. Five years, six years ago when we started to talk about Meaningful Use, you had the opponents. Many of the opponents of MU stage 1 stated, ‘how can Meaningful Use be done? It’s not possible. This is ridiculous. It just can’t happen. Now, five years later, not only have we done Meaningful Use 1 and did it with no problem, but we’ve achieved Meaningful Use 2.
The problem is. I’m okay with pushing the envelope. I’m okay with challenging people and industries to do things they’re not comfortable with, because that is how I see the only way things actually get done. But you have to be careful. You have to make sure it’s not disruptive. When things are all said and done, I believe in optimization and progress, and I believe that with these kind of tools, it’s going to change things. It’s going to make things better.
The patient portal is an example. For years — countless years — the challenge behind the patient portal has been that doctors and hospitals believe that that record belongs to them; they have not felt that record belongs to the patient. By doing the patient portal, that has changed. That’s changing the mindset and saying that it’s now going to allow the consumer to have an active role in their care.
I saw a conference with Geisinger and they basically had more than a 92 percent adoption rate in the patient portal. One of the reasons why was the fact that they were able to allow their patients to help in their care and managing their care and doing diagnosis. That’s the key. I think we don’t give patients enough credit. Once you do, you’ll have success. That’s where I differ.
We went with our patient portal and one of the biggest things here is that people thought it would not be acceptable at all. We’re a little over a month in for Meaningful Use; we have not only hit our 5 percent threshold, we’ve quadrupled it, and that’s amazing. That’s an amazing feature. When we give people the opportunity, people will take it, because they want to have information. This is the new norm, and this is the example you’re seeing with social media and the internet. People are used to getting access to information. What they do with it is a different scenario, and that’s what can be scary. I understand that and the trepidation associated with it, but it’s changing the way we think about an industry. And once we’ve done that, Meaningful Use can help us get there. It’s also things like ICD-10 which is a big issue coming down the pipe, or we have I-STOP. In New York State, as of March 27, no narcotics, no medications — all medications have to be e-prescribed. It’s a huge undertaking for people. We’re one of the only states to do this.
It’s amazing because later on once this is done, it’s going to mean better adoption, better consistency, and we’re going to be able to measure medication reconciliation. We’re going to be able to measure medication adherence or a part of medication adherence. These are the things that are going to help us take care of our patients better and work on better outcomes.
Gamble: I like hearing that take. I think that it’s really important to hear that viewpoint. We do get caught up sometimes in the challenges, but if you think about it, patient care is being transformed. It’s a very cool thing for me to be able to watch, and I’m sure for you, having an active role in it is a great opportunity.
Earle: Absolutely. I say to my team all the time that 20 years from now, we’re going to look back at this and say we were part of a new revolution. And the revolution of electronic tier is going to change. It’s similar to Henry Ford. I imagine the vision he had with the Ford and seeing exactly how it’s going to change. I’m confident that we’re looking at something that in the future when we watch these sci-fi films, this is literally just the beginning phase of those sci-fi films.
You talk about the tricorder in Star Trek — they’re building that. We’re actually going to use a contact list, sonar a military grade sonar system that’s going to be able to get patients’ vitals without any contact. We’re here. We’re doing it now. This is an exciting time and everybody should be excited. Is it hard? Yes. Is it difficult? Yes. Is it achievable? Yes.
Gamble: Very well said. Well, I know I’ve taken up a lot of your time, so I really appreciate it. I’ve really enjoyed talking to you.
Earle: Same here.
Gamble: I definitely would like to catch up again down the road, but this has been great, and thank you so much for your time.
Earle: Thank you. It’s been great. I love to share the information and I am sure other facilities are experiencing similar things. I talk to other CIOs all the time and there are so many of these positive outcomes, and if we start to highlight those outcomes, people will start to say, ‘You know what? This can happen. This makes sense. It can be painful, but it does make sense.’
Gamble: Right, absolutely. Thank you for sharing your story and I hope to actually maybe meet you in person at some point.
Earle: Same here. Thank you so much, Kate. I appreciate it.
Gamble: Thank you.
Earle: You have a great day.
Gamble: You too.