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 Welcome to this week in Health IT News, where we take a look at the news that will impact health it. This is another field report where we talk to leaders from health systems on the front lines. My name is Bill Russell Healthcare cio, coach and creator of this week in Health. It a set of podcast videos and collaboration events dedicated to developing the next generation of health leaders.

As you know, we've been producing a lot of shows over the last three weeks and series. Healthcare has stepped up to sponsor and support this week in Health It, and I want to thank them for, uh, giving this the opportunity to, to capture and share the experience, stories, and wisdom of the industry during this crisis.

If your system would like to participate in the field reports, it's really easy. Just shoot me an email at Bill at this week in health it.com. Now on to today's show. Today's conversation is with Interim CIO at Twin Lakes Regional Medical Center in Litchfield, Kentucky. Uh, Randy Cleese. Randy, uh, welcome.

Welcome to the show. Thank you. Thank you. I appreciate the opportunity to. Well, I, I, I appreciate, uh, you know, you taking the time. I know that these are really busy times for CIOs at this point. Um, and I really, I appreciate the opportunity to get a perspective of a smaller health system. So tell us a little bit about, uh, twin Lakes, uh, regional and then, and then we'll go into, you know, what you guys are doing around Covid, uh, response and preparedness, uh, is kind of unique.

I. One of the surviving, uh, community hospitals. Twin is a 75 bed independent community hospital, and, uh, some of those go it's an hour from anywhere. Uh, . We're about an hour south of Louisville, uh, close to an hour north of Bowling Green and an hour, uh, east Southeast of, uh, Owensboro. So we, but it's a community hospital in rural West Central Kentucky, uh, providing most of the basic services that you find at a community hospital, but having to rely upon larger healthcare organizations for any of the more advanced things that go on with patients.

It's fortunately one of those community hospitals that has maintained its profitability, uh, which has been good. Yeah. And well, and these are trying times for, uh, for community hospitals, uh, given, given this situation. So, so give us a little context. What's the, what's the covid situation in, in your, uh, area?

What, what, what's the, um.

Situation, have they, you know, sheltered in place, are they, uh, whatnot? And, and what's the, you know, what's, what's currently going on in your area? Uh, from the Kentucky standpoint, um, uh, the governor started, uh, relatively early in this process and making sure things got shut down and, uh. Uh, stopping movement.

Uh, of course there's a, a kind of, uh, what I call a shelter in place order that's going on in Kentucky. If you cross the state boundaries, uh, you have to self isolate for, uh, 14 days. Uh, also all non-essential, uh, what's being termed is non-essential. Businesses have been shut down. Uh, and of course, uh, we're able to move about, uh, for such things as healthcare and, and some of those essential functions that have to go on.

But, you know, I've noticed, uh, traffic especially, uh, is significantly reduced. Um, the other thing that's going on is we've seen a lot more cooperation as far as the healthcare providers themselves go and the going on. The patients themselves, uh, within the state as well as within the region itself. Uh. Uh, from the governor's standpoint, he does a daily 5:00 PM, uh, conference, uh, news conference, uh, to let everybody know what's going on.

Uh, we compare ourselves, of course, to Tennessee because of the rivalry there, and also with Indiana. And fortunately, Kentucky is significantly lower than either one of those states with the number of cases and the number of Covid deaths. So, uh, we're kind of proud of that. But yet, on the other hand too, uh, it is restricting, uh, very much for everybody.

Yep. Absolutely. So how are you coordinating with the, the other hospitals, say in the region? As you say, you're an hour from an hour from everything, which means you're in a beautiful spot of the country, but you know, if you get sick, you know, you have to coordinate with a lot of, uh, a lot of the health systems that are about an hour away from you.

So how is that coordination going? Well, the coordination from the, uh, clinical standpoint is being handled, of course, through the physicians on up through to the CEO. Um, and, uh, they're working through the State Hospital Association, making sure that we know where the resources are. And also the CEO just put out, uh, an email to all the employees, uh, letting them know what the situation would be at Twin Lakes and Twin Lakes being the size organization it is, doesn't have all the capacity necessary to take care of some of the more severe covid patients.

So, uh, twin Lake has entered into an agreement with. To take those more advanced patients, uh, and in turn, uh, if need be, uh, twin Lakes would take some of the, uh, non covid, less severe patients from, uh, SBO and bring them back here to the hospital. So working in conjunction with other healthcare organizations like that is what's going on from the.

You know, I've been in contact with some of my counterparts in this area. You know, what are you guys doing getting ready for this? And, and how's your staff working? Your IT staff as well as the, uh, staff in general? So it's just communicating via phone. Uh, and we, we've had to go with video conferences like this, uh, as much as we can, but, uh, it, it just communicating with others.

So Rayna, I'm, so you're, you're in the office. I can, unless you have a, a block, you know, house. So, but you're, you're actually in the office. Is, is your staff still in the office or are they, or are some of 'em working remotely? Well, that, that's interesting. I, I was talking to David m uh, a few days ago and, and, uh, he and I were talking about it and about two weeks ago, uh, you know, here at Twin Legs.

We have a very small IT staff compared to, you know, some of the big organizations. Yeah. And I mean, there's 10 of us total and we're all in the same office suite. And it just kind of dawned on me a couple weeks ago when we were sitting here talking. I'm thinking, what if one of us comes down with Covid?

Then all the rest of us has to go into oscillation, which means that. We don't have any support for the doctors and the nurses trying to take care of patients. So some of y'all gotta go home. Um, and that's what we did immediately was, uh, we, we sent some staff home to work. Uh, we, we've got a couple that, uh, we're just saying you're gonna work at home.

Therefore, if those of us in the office have to go into isolation, you're, we've take care of, uh. Nurses and the doctors and all the other care providers to make sure that they've got computer equipment. And, you know, we're talking about, uh, we, we may have to walk you through how to hook up a, hook up a computer or to do something.

We may have to do that via video, uh, with one of our technicians at home if we have to go into isolation. So we're making changes and, and working. It's kind of, you know, make these changes as we go because we don't always know what we're gonna need to do. Yeah, it's interesting with, with only 10 staff, it really is an all hands on deck kind of thing.

If, if, you know, because you with 10 people, that's your analytics team. It's your EHR team. It's your, your PACS team, it's your, uh, you know, it's, it's, it's everything. It's your desktop support team. It's your, your phone team, your network. Um, yeah. So you don't have the luxury of, of sending everybody home because some of those people have to, you're around.

That's, that's one of the things I think that's, that's distinct. Uh, what specific solutions have you put in place? Uh, you know, we've heard from some of the larger health systems, you know, massive telehealth expansion and, uh, work from home. Um, what kind of solutions have.

Well, as quickly as we, uh, could get it in place, uh, you know, after the Medicare regulations, uh, kind of got relaxed for this, uh, pandemic, we got video in place for the providers to be able to see their patients. And it kind of surprised me because I, you know, I was really concerned, uh, we were spinning our wheels a little bit because I didn't think it would happen very quickly.

Uh, we did it on Wednesday. And when I was checking on Thursday morning, we had one of our providers that already had eight patients scheduled for that Thursday. Uh, seeing them virtually. And that to me is quick turnaround. And, and we were doing it, you know, we, we had FaceTime available very quickly. Then one of the providers also brought in the doxy me, uh, ability, and we've implemented that as well because they were familiar with it.

So we, we did that very quickly and got them up and running very quickly. And fortunately for us, uh, our, uh, cellular provider in the area had some older, uh, they're not real old, but some older, uh, iPads. And we quickly, uh, got with that cellular provider and, and we've got, you know, more than a dozen of those and got 'em into the hands of those providers very quickly.

Seely tremendously. Out of this facility and, and still be able to see 'em as need be. Yeah. So, so, uh, doxy is a, uh, is that open source and free or am I, am I wrong on that? HIPAA compliant. That's one of the things that we had to be sure of. It is, uh. Yeah, it's HIPAA compliant. Uh, and it's one of the ones that's listed.

So, uh, we haven't got into the too much of the details other than making sure that we could, uh, do this securely enough to meet the HIPAA requirements. Yeah. Uh, but yet it's easy. It's very easy for the providers to use. Yeah. It's interesting. You guys are, you guys are being really resourceful. Um, you know what, what, what kind of things are.

Have you discovered, let's say, over the past, you know, eight weeks as you've gone through this, um, maybe that you didn't anticipate that you're sort of surprised to find as we move, move through it? One of the things that, uh, has surprised me, uh, is the ability of the patients, uh, to be able to do this, uh, virtual visits.

Uh, the demand is far greater than, uh, than I anticipated it being, uh, the providers, uh, I knew they would do it, uh, but I didn't know how, um, how well they would be accepting of it. They really jumped all over it. Uh, and to me, this is just something that. And, and from the Chime standpoint, as you know, I've been involved with Chime for years.

I'm glad to see this because I don't, after this is over, uh, I think we're that demand both.

Continue some form of virtual visits. Uh, I just think it's so, uh, opportunistic for us to, to go down the route. And the other thing that's somewhat No, please go ahead. Uh, the other thing that's somewhat surprised me is, uh, administration and management, understanding and realizing that far more of their people can work from home or work remotely.

I won't say necessarily from home, but they can work remotely, uh, than they thought could. Uh, whether that's full-time or part-time, uh, and I think that's gonna be a, uh, a staff satisfier that we're gonna have to look at going down the, the road too, uh, because people are gonna want to do that if it's no more than part-time.

Yeah. Uh, your community, I'm just curious, telehealth is a huge satisfier. Um, is, is the, the average age of your community? Older, younger, uh, you know, what, what are you finding who's using telehealth? Uh, it's, it's primarily the older people that are using the telehealth and, uh, unfortunately the issues that we've run into when it comes to the older ones that are using it and are not familiar with it in the past, had we rolled that out, they would've been able to call on their children or their grandchildren to help them.

Of course, now they can't do that. Uh, so there's been a little bit of having to walk them through how to do that. They want to do it, but they just. Um, so that, that's been a little bit of an issue. Not tremendous, because most of 'em are very accepting to it, and, and most of them, you know, uh, they have a, an Android or an iPhone and, and they're familiar with video because they've done FaceTime with their grandkids or something like that in the past.

So it's not all new to them, and, and they're, they seem to be enjoying it. They like that they don't have to get out. And uh, one of the things that we were looking at is because there are some nursing homes in this area, uh, of putting, uh, that capability out. So there's nursing homes too, and I think that's something I mentioned, you know, that's going on after the pandemic.

I think that's something we're be looking at because a lot of those patients have to be brought to the hospital that we could see, uh, if we had some kind of video right there. Yeah. This is gonna be interesting. It's gonna be interesting to see how things, uh, evolve. As you said, you know, this is a huge satisfier.

If the reimbursements stay the same or similar for, um, for telehealth, uh, you know, I, it will be interesting as ACIO baking that into. The post crisis workflow because, you know, do you think your, your, uh, doctors and everyone are thinking No. Eventually we'll just go back to the, the norm, or is this gonna be sort of a new norm for, uh, for your medical center?

Oh, I think it's gonna be a new norm because I've already heard some comments that. We wanna continue this. Uh, and I can't blame 'em because frankly, if it's scheduled correctly, they're seeing more patients. And I mentioned, uh, a few minutes ago about the eight patients that that one doctor had scheduled.

Those were all within half a day. And that doctor normally doesn't see that many patients within half a day. So, uh, they're gonna be able to see more patients, just quick turnover going from one video to the next with patients and still be able to do what they need to do. So Randy, what's one thing you would share with other, uh, regional medical centers, smaller rural, uh, type, uh, providers in terms of the things that you really feel like you did well and, and maybe that they should be looking at?

Well, one of the things is that I've. Make sure that you've got some of them working remotely, because if your staff on site have to go out for isolation or anything like that, then you've got to have somebody that takes care of the doctors and nurses and puts hardware in place for them to work. Uh, because as a provider, we have to make sure we can take care of patients.

Uh, that, that would be number one for me. Um, and then making sure that, uh, we, we've got everything up to date. And one of the questions, uh, that, uh, you had sent out and I thought was very interesting, what is the one thing you wish you had done and ? One thing I wish that had happened here is we had the remote, uh, software more up to date.

Uh, because we, we were actually in the process of updating that software, but we were, uh, about a week into a three week upgrade process when this all hit. And we are just this week getting that software fully functional on the upgraded version and we should have been in place two months ago. Uh, so, you know, making sure you get through those kinds of things quickly, especially when it comes to remote access and being able to provide that service.

Yeah. Anything specific in working with your EHR provider? Have they provided some tools for you or anything in that respect? Uh, we, we've worked with the EHR provider, uh, and, and we're on Meditech here. So, um, I, you know, from that standpoint, it's, uh, I've learned a lot through the news, uh, user group and the things that other people are doing.

And, uh, Meditech has, uh, offered, uh, virtual visits. Uh, we don't have that capability here through Meditech.

Uh, they have offered that opportunity to us, and we use Meditech in the hospital. We use Allscripts in the clinics. Uh, so we, we've not taken advantage of that yet. Uh, but we may end up, uh, doing that with Meditech at some point. Just haven't made that decision yet because we're doing it through Allscripts right now.

Wow. Fantastic. Well, Randy, thank you for taking the time. I appreciate these short, uh, even though it's only 10 minutes, I busy.

Well, I appreciate the opportunity to Bill and, and if there's anything I can do to help others, you know, I'm available to do that. Thank you. Thanks, Randy. That's all for this show. Special thanks to our channel sponsors VMware Starbridge Advisors, Galen Healthcare Health lyrics and pro talent advisors for choosing to invest in developing the next generation of health leaders.

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