Susheel: Randy, thank you for taking time out of your busy schedule to talk with us. DistilINFO appreciates it!
To start with, tell us about yourself, your career journey so far and your current role.
Randy: My IT career began when I was a geologist with an oil and gas company in the 1980’s. The first PC that I used was a Radio Shack TRS-80 with an 8-inch floppy disk. A spreadsheet software was the primary application and it allowed for 16 columns and 256 lines. It was amazing for the time but, within 10 years, we were using computer systems to extract data from databases to spatially display on maps. My interest in computer applications led to a career move from geology to managing computer systems. The oil and gas company did a major reorganization in the mid 1990’s which led to the elimination of my position. My pursuit of a new job led to the Director it IS at St. Claire Regional Medical Center in Morehead, KY. During the 21 years I was in this position, computer technology advanced significantly and became critical to do business. I led may efforts at St. Claire including Year 2000, electronic health records systems installations, human resource systems installation, network infrastructure overhaul, establishment of a regional health information exchange and installing a PACS (picture archiving and communication systems). During these years, I also was very involved with industry organizations such as HIMSS (Healthcare Information and Management Systems Society) and CHIME (College for Healthcare Information Management Executives) which allowed me to build a network of colleagues around the country. My involvement with these organizations, especially CHIME, provided the opportunity to get involved in healthcare public policy at the state and federal government levels. I was fortunate to spend 4 years on the CHIME Board of Trustees and chair the Board for one year in 2014. CHIME and HIMSS have presented me with multiple awards for industry service.
My career advanced during these years as my title changed Director to Director & CIO then to Vice President & CIO. But alas, all good things come to an end and the opportunity was presented to retire from St. Claire at the end of 2016. My energy levels were too high to completely leave the industry, so I became the CIO at Methodist Hospital in Henderson, KY in 2017. Methodist eliminated the CIO position in 2018 during a merger so I became a healthcare IT consultant in order to share my experience with others. I have been interim CIO with Twin Lakes Regional Medical Center in Leitchfield, KY since 2018.
Randy: I see a silver lining in the COVID-19 pandemic in as much as the healthcare industry is being forced to work and see patients differently. The industry was forced to rethink the way many people work and were forced to allow them to work from home. At the same time, the industry had to make virtual visits available for patients. These two things will change the way healthcare is delivered and the way people work in the industry. This is a game-changer for healthcare.
Susheel: The whole economy is finding a new normal amid this [COVID19] pandemic. How is this impacting the providers and their relationship with the patients?
Randy: Patients and providers are both being forced to use technology in ways that they have not before. The initial spike in virtual visits has dropped but we have learned that video visits are a great alternative (to in-person visits) for a significant number of scenarios. Reimbursement needs to be modified in order for providers to continue seeing patients virtually. Provider organizations have taken to using communications technology, such as texting, to alert patients that the provider is ready to see them. This prevents patients from congregating in waiting rooms or other similar areas.
Randy: The biggest current challenge is getting providers paid for virtual visits comparable to in-person visits. There has been a learning curve relevant to virtual visits but the angst about using the technology seems to have waned. Patients could well start demanding it (after having been seen virtually) only to be told by a provider that they cannot get paid for a virtual visit. This could well be a challenge. Providers will likely be challenged by the volume of modifications coming at them because of changes brought on by the pandemic.
Another challenge is the identification of patients who see multiple providers. Federal rules from the late 1990’s prevent a unique identification of patients which leads to multiple issues when patients move from one care provider to another. Lots of people have the same or very similar names and records get confused which could lead to inappropriate care. The industry spends a tremendous amount of time and money to ensure patient identification is correct. A significant amount of this work could be eliminated with unique patient identification.
Randy: Healthcare as an industry is different than other industries because of so many human factors involved. However, the healthcare industry needs to adopt technologies used by others. For example, the finance industry is years ahead of healthcare in “seamless” information exchange. Patients moving between healthcare providers expect their records to transmit seamlessly and get very frustrated when asked the same question multiple times.
Innovation in providing care will be coming from within as well as from outside the industry. Many in the healthcare workforce today have grown up with technology and should question the “old” ways of doing things. Those of us who moved from paper to computers adopted antiquated ways because that is all we know. Newcomers should question those methods and old-timers should listen because change could make the entire system better. Also, innovators moving into healthcare from other industries must question antiquated or inefficient ways of doing things.
Randy: Hospitals and healthcare providers in smaller communities are limited in their resources. Human resources are an acute area because rural/community hospitals generally do not have the applicant pool that is usually available to larger/metropolitan areas. Relevant also is the pay available in as much as my experience has been that community hospitals tend to afford 50-75% of pay for equivalent positions. Also, IT staff in community/rural healthcare settings need, and tend to be, talented in multiple different functions. Because staff have various responsible areas, they cannot become in-depth experts. The issue of information security during the past few years has pointed out the lack of in-depth knowledge in rural areas. Many community healthcare organizations have taken to contracting this work from vendors or larger healthcare organizations. The past several years have also seen community providers becoming part of larger organizations at an unprecedented rate. Part of this is due to the needs of small organizations to secure talent (in a lot of cases IT talent) available through the larger organization.
Human resources are an acute area because rural/community hospitals generally do not have the applicant pool that is usually available to larger/metropolitan areas. Relevant also is the pay available in as much as my experience has been that community hospitals tend to afford 50-75% of pay for equivalent positions
Randy: Executives should understand technology and how it can drive strategy. During the past few years as I have done interviews, one of the questions that I ask is “does strategy drive technology or does technology drive strategy?”. If strategy drives technology, then a lot of opportunities can be missed, and cost could be higher because retrofitting technology after the fact can be very expensive. Whereas, thinking about how technology can drive a strategy makes for a much more efficient effective operation.
does strategy drive technology or does technology drive strategy? If strategy drives technology, then a lot of opportunities can be missed, and cost could be higher because retrofitting technology after the fact can be very expensive.
Randy: Keep the vigil on healthcare organizations to implement technology solutions that make patient care cost effective and efficient. Work with all organizations to ensure they understand how changes can affect the bottom line which includes enhance patient care.
Randy: The future is bright for healthcare information technology but there is a tremendous amount of work that needs to be done. Innovation and entrepreneurship are needed.