Last month, two prominent health IT associations—the College of Healthcare Information Management Executives (CHIME) and the Healthcare Information and Management Systems Society (HIMSS)—handed out their annual John E. Gall Jr. CIO of the Year Award to Randy McCleese, CIO of Methodist Hospital in Henderson, Ky.
The award—named after John E. Gall Jr., who pioneered implementation of the first fully integrated medical system in the world in El Camino Hospital in California in the 1960s—is given annually to a CIO who has shown significant leadership and commitment to the healthcare industry during his or her career.
The associations mentioned in a press release at the time that one key factor that sets McCleese apart from many other CIOs is that he has been able to overcome the several obstacles that come with being in a clinical IT role at a rural healthcare system. They noted that he faces the same demands as his larger and urban organization brethren, but on top of that, he also must consider the needs of patients in remote towns and how to sustain those facilities and services.
In the announcement, the associations said that McCleese has addressed policy makers in Washington, D.C., executives in health systems, his peers at health IT conferences and IT students at his local university. “As a CIO, he has led strategic initiatives to bring innovations that improve efficiency and patient care to small and rural hospitals. And he has managed to do these herculean tasks—with limited resources—while also devoting countless hours to organizations that share his passion for healthcare IT and professional excellence,” HIMSS and CHIME officials attested.
To this end, McCleese recently spoke with Healthcare Informatics Managing Editor Rajiv Leventhal about these specific challenges, what winning this award means to him, how he’s been able to have success in this role, and how he sees the policy landscape shaking out. Below are excerpts from that discussion.
First off, congratulations to you for getting this award. What does it mean to you?
I am not sure that it’s really sinking in yet. It’s difficult to try to describe how I feel. I am elated, proud, and thankful that my peers have considered me to be in this unique group of people who have received this award. When I saw the list of past winners, I thought, wow, how in the world can I be on this [list] of giants in the industry who have received this award in the past? It’s flattering to be among them. I have spent my healthcare career in small hospitals and community hospitals, and in rural environments, which is not a glamourous place to be, but at the same time, it’s so vital to what we’re doing with health IT.
The associations noted that you face unique challenges as CIO of a small and rural healthcare system. Can you explain those challenges in some more detail?
I have said this and I think some have picked up on it—in the small hospitals we have to do as much work to meet the regulatory requirements, and interoperability and security, as the large organizations do. But we can’t become specialists at any one of those since we can’t afford the staff to be become specialists in security or interoperability. Those duties may be associated with three or four other primary duties for a person who does that kind of work.
For example, I have one person on staff here whose focus is on interoperability, but that means what does he have to do to work with the ACO (accountable care organization), what does he have to do with the submission of data for quality measures, what does he have to do with multiple HIEs (health information exchanges), and what does he have to do to share our data with payers and others who need to have the data coming out of our system? So we can’t have one person focused on each of those, but rather one person focused on all of them. Contrast that with someone at a large organization, and they may have a person who does nothing but security, one person who does nothing but ACO work, and one person who does nothing but HIE work. That is a challenge to find and keep people who are good at doing those kinds of things.
What other factors do you think have been keys to the success you have been able to have as a CIO?
One of the biggest things that has gone into this is my persistence. Over the years, I have been very persistent and vocal at all levels, be it local, within the state or in Washington, D.C., and emphasizing the differences, or at least the uniqueness, in the things we’re trying to do from a rural healthcare standpoint. And I have also tried to [emphasize] some of the burdens that have been placed on us by regulations in the rural and smaller hospital environment. I think that carrying that same message every time I have had the chance to has made a difference. I have had the chance to represent a huge chunk of healthcare in this country. Even though we are in unique geographical locations, we all have same issues.
You helped found the Northeast Kentucky Regional Health Information Organization (RHIO) and you serve on the Kentucky Health Information Exchange (KHIE). How do you see the future of regional HIEs?
As the Northeast Kentucky Regional Health Information Organization has developed over the years, we had intended that to become a health information exchange. And then as HITECH (the Health Information Technology for Economic and Clinical Health Act) came out, and as the Kentucky Health Information Exchange got off the ground, the Northeast Kentucky RHIO morphed itself more into a regional extension center-type support mechanism, supporting primarily physicians and making sure providers in the region were meeting meaningful use requirements. We tried the health information exchange, but at the time we were trying to do it, that was the time in which KHIE was getting off the ground. So the Northeast Kentucky RHIO left some of that work to the state HIE by default.
And as I look at the state HIEs, especially in Kentucky, they are providing a significant number of services in addition to just exchanging data between providers. They are also the intermediary between providers and the state agencies that require data from the providers. So we don’t submit anything separately; we just submit out data to KHIE, and they submit whatever subset is needed to the stage agencies that need to have data from the providers. So I see that part as still continuing, but as we move forward with other things going on in the industry, and I know that KHIE has joined forces with the Indiana HIE, and is working with [an HIE] in Ohio, they are coming together as consortiums of HIEs and sharing data across the country. And that exactly what needs to happen; we as people are mobile. So I see the market adapting and getting us to the point where we get the care we need [wherever we are].
You have been involved with various health IT policy initiatives. Do you think the industry is in a good place right now with MACRA, meaningful use Stage 3, and the 21st Century Cures Act? What would you like to see changed, if anything?
It is causing a lot of burden and stress on us, especially from a requirements standpoint. Just last week we had a conversation with some folks doing some research for CMS (the Centers for Medicare & Medicaid Services). And I sat in room with five clinicians, four of them being nurses, and I emphasized to the person who was working for CMS that I have five folks who are clinical people but are gathering data for quality measures. None of them are doing anything relevant that has to do with hands-on patient care. And in an environment of our size, that’s a significant number of people who are essentially pushing paper so that we meet the quality measures that we have to meet.
I know in the long run we have to do these things, but we are spending lot of time just verifying that we are taking good care of patients, when we can better utilize the skills of those clinical folks in direct patient care. So that concerns me; the reporting burden being placed upon us is huge and a lot of is dotting the I’s and crossing the T’s when we need to being paying attention to how to do a better job of taking care of patients.
How can these concerns that you and many of your colleagues have be better portrayed in government regulations?
The regulations are forcing us as providers to do things must faster than the speed at which the culture is changing. We would like to snap our fingers and get every doctor to fully utilize an EMR (electronic medical record), but that will take quite a bit of time to adapt to the technology and the terminology. I am concerned we are pushing providers too hard to meet the regulatory requirements when we need to give them more time.
When I think about meaningful use Stage 3, I think leaps are being required. And I think it needs to be delayed for a while, maybe a few years, so we can perfect what we are trying to do now.
Can you offer one or two pieces of advice for other CIOs who might be struggling to succeed in this always-changing healthcare environment?
Get to know the business and network as much as you can. There is not one of us that’s as good as all of us. By having a vast network of different people around the country, I can call on others when I don’t know the answer. Building that network is one of the best things a CIO can do.