SearchHealthIT and the College of Healthcare Information Management Executives have collaborated to bring you a series of interviews with CHIME fellows as a preview to National Health IT Week, Sept. 16-20, in Washington, D.C. The series will also offer thoughts on the legacy of outgoing National Coordinator for Health IT Farzad Mostashari, M.D. This interview features CHIME board member Randy McCleese, vice president of IS and CIO at St. Claire Regional Medical Center in Morehead, Ky., discussing patient identifiers, among other things.
What, in your mind, was Dr. Mostashari's most significant contribution to health IT during his ONC tenure?
Randy McCleese: His bowtie! [Laughs] I think Farzad's enthusiasm, passion, his energy for health IT is what he's brought forth. He was the evangelist, and he surrounded himself with doers. He went across the country touting the benefits of health IT, not just to the HIT [health IT] community but to everybody, explaining why it works. He's got some personal stories that back that up.
He tells the story of his mother, and how he tried to get her records together when he was trying to coordinate her care. I can empathize with that because I tried to do the same thing for my mother.
Doing that takes the dry, boring technology stuff out of the discussion and inserts a human element, putting the focus on people and patients. Would you agree?
McCleese: It does, it does. It was his mother, he was trying to coordinate the care, it had nothing to do with technology. But then he can go back and [think about] how technology would have helped to do a better job of taking care of her.
Imagine you're a fly on the wall at ONC as they select his successor. What advice would you give the decision makers?
McCleese: I think it's got to be somebody who can move forward the things he's pointed out that have to be done. I think the message is out there why we have to do it, and he's put a lot into how we have to do it. Now we have to have somebody to make sure it happens. Somebody that can follow the cookbook and make sure the cake turns out the way it was written in the recipe.
Dr. Mostashari was a physician and a technologist, kind of a rare combination. Which one is more important in a national health IT coordinator?
McCleese: I think we're to the point where we need someone who can relate more to the nuts and bolts of IT, and how do we do this. I think he's gotten across to the medical community why we've got to do this.
What is the top challenge the next coordinator will face?
McCleese: Health information exchange. That is coming up in [meaningful use] stage 2. As a part of that, it's not as pertinent to me as it is to some of the folks in the larger cities because we tend to keep a lot of our patients here and not send them elsewhere. But the ones that we do send elsewhere, we want to be able to transmit their data and not have any problems with that data on the other end -- both from a standpoint of interoperability of the data itself, and also identifying those patients and making sure we've got the consents all in place. Those two items -- consent and identification -- are two of the bigger things I see we will have to tackle very quickly.
The clinical folks don't even know what kind of questions they will come up against, and they don't know what technology can do to provide answers to what they haven't thought of yet.
vice president of IS and CIO, St. Claire Regional Medical Center
We send a lot of patients out of here to Lexington to the University of Kentucky, and of course, we use two totally different systems. Making sure that patient data can flow from one system to the other via identification, and did we get the consent to treat that patient the same way University of Kentucky needs it -- those are the top two issues we need deal with.
Our previous interviewee, Charles Christian, ranked the lack of a national patient ID as his top health IT concern, too. Why is it so important?
McCleese: Just being able to say that I'm the same Randy McCleese at the University of Kentucky or when I'm visiting Orlando [Fla.], that I'm the same person -- and I know there's another Randy McCleese in this world -- I want to make sure they've got my records and not the one who lives in Marion, Ohio.
The lack of data interoperability between EHRs is a complex problem. Do you see it more as a technology problem or a business problem, where healthcare providers and vendors are fighting it and the technology piece is simpler to solve?
McCleese: It's a combination. In our case, as small as we are, we're dealing with two different vendor products in our clinic operations and our hospital operations. We have a real problem identifying the data that's flowing across and getting that interoperability going there. That's a technical issue. Until we get that technical issue worked out, it's going to be more difficult from a business standpoint to make sure that a piece of data in one system is exactly the same as it is in the other. Theoretically, HL7 [Health Level 7] takes care of a lot of that, but it's just theoretical. Every vendor has their flavor of HL7. So, we're constantly trying to make sure the data in system A equals the data in system B.
On the business side, there's competition between the providers that gets into the business and culture. Our physicians here, in a lot of cases, don't trust the methods or the data that comes from our competitors. It's going to take some time to get over the hurdle of [trusting other hospitals' data] and that data, whether it's from Epic, Allscripts or Eclipsys, they can rely on it and their systems should be able to interpret it the same.
Over the next five years, what will IT's role be in supporting the various emerging performance-based reimbursement models from Medicare and commercial payers that require quality measures of population health management?
McCleese: We're getting involved in an [accountable care organization] ACO. I can see where from a technology standpoint we need to point out where the business can do a better job of taking care of the patients. We've got to be more proactive in letting the business and the clinical folks know what technology can do to provide them with the data.
In a lot of cases, the clinical folks don't even know what kind of questions they will come up against, and they don't know what technology can do to provide answers to what they haven't thought of yet. IT needs to show them: Here are the possibilities. So they can start thinking and get outside the box in their thought process and understanding how they can better take care of the patients.
In 2014, healthcare will implement ICD-10, kick off meaningful use stage 2, implement new HIPAA data security policies and software, all while continuing down the ACO path. How would you advise a new healthcare provider CIO deal with prioritizing these implementations?
McCleese: Looking back on it -- and I did come in from a different industry 18 years ago, if I were walking into it today, I'd be asking which one to tackle first. I don't think I could tell someone which to tackle first. Based on experience, I would say look at what's common between each of them and make sure you can take full advantage of the common elements to satisfy the needs of each one as individuals. Then look at which one has the shortest deadline on it, and make sure you get things in place from the commonality standpoint that would take care of the short time frame as well as the longer time frames. Therefore, you're using one set of resources to take care of multiple issues.
We're using some of the same things for the ACO we're also putting in place for meaningful use and ICD-10. In our case, a person we've put in place is one example. His role is to provide data from a business standpoint from each of these different areas. He understands, he's been in the industry long enough that he can understand the commonality of those. Some of the [requirements] are different, but he can develop queries and reports to provide each of those different groups the data they need to make their decisions.
Where's the return on investment for you in attending National Health IT Week?
McCleese: CHIME activities surrounding the board and public policy. They're scheduling us to do as many Hill visits as we can, but CHIME is working with CMS and ONC to meet with the CHIME folks who are going to be there. I'm going to get out of that how we're going to move forward with patient identification, patient consent. I know they're making some progress, but we want to keep that discussion going with them and make sure they keep it on the top of their priority list. Not just for me, but for CIOs across the country. We want to lead the way on that as much as we can.
Next: An interview with Indranil (Neal) Ganguly, vice president and CIO at CentraState Healthcare System. Previously: An interview with Charles Christian, longtime contributor to Indiana's health information exchange efforts, and current VP and CIO at St. Francis Hospital in Columbus, Ga.
This was first published in September 2013