Twin Lakes Regional This Week in Health IT
April 20, 2020

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April 16, 2020: Community hospitals face a particular set of challenges and have had to find innovative ways to respond to the COVID crisis without the same resources of larger institutions. Today’s guest, Randy McCleese, interim CIO at Twin Lakes Regional Medical Center in Leitchfield, Kentucky, is here to share with us how they have dealt with the crisis. In this episode, Randy gives us insights into the COVID situation in Kentucky and how the Governor has dealt with it. The proactive approach has meant that they are faring better than their neighboring states. Randy also sheds light on the coordination efforts Twin Lakes are undertaking with other hospitals. They have arranged to take non-COVID patients from a neighboring town while Twin Lakes’ patients will go to the larger hospital an hour away. We also discuss the surprising response to telehealth and the quick mobilization efforts around it, the remote work challenges that come with working in a community hospital, and the changes Randy hopes will stay post-crisis. It’s always great to hear diverse experiences, so be sure to tune in today!

Key Points From This Episode:

  • Learn about Twin Lakes, where they’re located, and their services as a community hospital.
  • Find out what the COVID situation is like in the region and the state of Kentucky generally.
  • A look at the coordination efforts of Twin Lakes as a community hospital.
  • How Twin Lakes is balancing remote work with those who have to come into the office.
  • Some of the measures that Twin Health has put in place to deal with the crisis.
  • The most surprising responses that Randy has seen during the pandemic.
  • How the older generation is responding to telehealth and some challenges.
  • Randy’s advice for other rural hospitals and what he wishes they’d done differently.

Field Report: Twin Lakes Regional Hospital

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Field Report: Twin Lakes Regional Hospital

Episode 229: Transcript – April 16, 2020

This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.

[0:00:04.5] BR: Welcome to This Week in Health IT news, where we look at the news which will impact health IT. This is another field report where we talk to leaders in 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 podcasts, 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 Sirius Healthcare has stepped up to sponsor and support This Week in Health IT. And I want to thank them for giving us the opportunity 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 report, it’s really easy, just shoot me an email at [email protected] Now, on to today’s show.


[0:00:55.2] BR: Today’s conversation is with interim CIO at Twin Lakes Regional Center in Leitchfield, Kentucky, Randy McCleese. Randy, welcome to the show.


[0:01:05.5] RM: Thank you. I appreciate the opportunity to talk just a little bit with you, Bill.


[0:01:09.8] BR: Well, I appreciate you taking the time. I know that these are really busy times for CIO’s at this point. I really, I appreciate the opportunity to get a perspective of a smaller health system. Tell us a little bit about Twin Lakes Regional and then we’ll go into what you guys are doing around COVID response and preparedness.


[0:01:32.4] RM: Twin Lakes is kind of unique. It’s one of the surviving community hospitals. Twin Lakes is a 75-bed independent, community hospital and some of those things go – It’s an hour from anywhere. We’re about an hour south of Louisville. Close to an hour north of Bloomfield and an hour east southeast of Owensboro.


But It’s a community hospital in rural West-Central Kentucky, providing most of the basic services that you find in a community hospital but having to rely up on larger healthcare organizations for any of the more advanced things that go on with patients. It’s originally one of those community hospitals that has maintained its profitability, which has been good.


[0:02:23.6] BR: Yeah, these are trying times for community hospitals. Given this situation. Give us a little context, what’s the COVID situation in your area? What’s the current state situation? Have they sheltered in place? Are they what not? And what’s currently going on in your area?


[0:02:52.1] RM: From the Kentucky standpoint, the Governor started relatively early in this process and making sure things got shut down and stopping movement. Of course, there’s a kind of what I call a shelter in place order that’s gone on in Kentucky. If you cross the state boundaries, you have to self-isolate for 14 days. Also, all nonessential, what’s been termed as non-essential businesses have been shut down. And of course, we’re able to be move about for things such things as healthcare and some of those essential functions have to go on. But you know, I’ve noticed traffic, especially is significantly reduced. 


The other thing that’s gone on is we’ve seen a lot more cooperation as far as the healthcare providers themselves go and things that are going on with the patients themselves within the state and as well in the region itself. 


But from the Governor standpoint, he does a daily 5 PM conference, news conference to let everybody know what’s going on. We compare ourselves of course to Tennessee because we’re an hour away, 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. We’re kind of proud of that. But on the other hand, too, it is restricting very much for everybody.


[0:04:20.6] BR: Absolutely. How are you coordinating with the other hospitals, say in the region? You say you’re an hour from everything which means you’re in a beautiful spot in the country but you know, if you get sick, you know, you have to coordinate with a lot of the health systems that are about an hour away from you.


How is that coordination going?


[0:04:42.5] RM: Well, the coordination from the clinical standpoint is being handled of course through the physicians on up through to the CEO. And they’re working through the State Hospital Association, making sure that we know where the resources are. And also, the CEO just sent out an email to all the employees letting them know what the situation would be at Twin Lakes.


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. Twin Lakes has entered into an agreement with [inaudible0:05:19] Health to take those more advanced patients. And in turn, if need be, Twin Lakes will take some of the non-COVID less severe patients from Owensboro and bring them back here to the hospital. We’re working in conjunction with other healthcare organizations like that is what’s going on from the business standpoint.


Now, from the IT standpoint, I’ve been in contact with some of my counterparts in this area. “What are you guys doing, getting ready for this? And how’s your staff working, your IT staff as well as the staff in general?”


It’s just communicating via phone and we’ve had to go with video conferences like this as much as we can. But it’s just communicating with others.


[0:06:05.8] BR: You’re in the office? Unless you have a block house. But you’re actually in the office. Is your staff still in the office or they are some of them working remotely?


[0:06:19.9] RM: That’s interesting. I was talking to David Muntz a few days ago and he and I were talking about it. And about two weeks ago, here at Twin Lakes, we’re a very small IT staff compared to some of the big organizations 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 of weeks ago, we were sitting here talking, I’m thinking, “What if one of us comes down with COVID? Then all the rest of us have to go into isolation.”


Which means that we don’t have any support for the doctors and the nurses trying to take care of patients. Some of you all got to go home. That’s what we get immediately was we sent some staff home to work. We’ve got a couple that we’ll just say, “You’re going to work at home, therefore, those of us in the office have to go into isolation, you’re going to have to come in and work.” Because we’ve got to take care of those nurses and the doctors and all the other care providers to make sure that they’ve got computer equipment.


You know, we’re talking about – We may have to walk you through how to hook up a computer or do something. We may have to do that via video with one of our technicians at home if we have to go into isolation. We’re making changes and working. It’s kind of making changes as we go because we don’t always know what we’re going to need to do.


[0:07:42.0] BR: Yeah, it’s interesting. With only 10 staff, it really is all hands-on deck kind of thing if you know – Because with 10 people, that’s your analytics team, it’s your EHR team, it’s your PACS team. It’s everything. It’s your desktop support team. It’s your phone team, your network team. I mean, it’s everything. So yeah, you don’t have the luxury of sending everybody home because some of those people have to be around. That’s one of the things I think that’s distinct. 


What specific solutions have you put in place? You know, we’ve heard from some of the larger health systems, you know, massive telehealth expansion and work from home. What kind of solutions have you put in place at Twin Lakes?


[0:08:30.8] RM: Well, as quickly as we could get it in place, you know, after the Medicare regulations kind of got relaxed for this pandemic, we got video in place for the providers to be able to see their patients. And it kind of surprised me because I was really concerned that we were spinning a wheels a little bit because I didn’t think it would happen very quickly. 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, seeing them virtually.That to me is quick turnaround. 


We were doing it. We had FaceTime available to us very quickly. Then one of the providers also brought in the ability. We’ve implemented that as well because they were familiar with it. We did that very quickly and got them up and running very quickly. And fortunately for us, our cellular provider in the area had some older, they’re not real old but it’s an older iPads and we quickly got what that cellular provider did and we got more than a dozen coming into the hands of those providers pretty quickly so that they can see those patients virtually.


And that’s really helped us tremendously to keep those patients out of this facility and still be able to see them as need be.


[0:09:51.5] BR: Yeah, Doxy, is that open source and free or am I wrong on that?


[0:09:59.9] RM: It is HIPAA compliant, that’s one of the things that we had to be sure of because. It’s HIPAA compliant and it’s one of the ones that’s listed. So, we haven’t gone into the too much of the details other than making sure that we could do this securely enough to meet the HIPPA requirements. But yet, it’s easy, it’s very easy for the providers to use.


[0:10:19.7] BR: Yeah, it’s interesting. You guys are being really resourceful. You know, what kind of things are – have you discovered let’s say over the past eight weeks as you’ve gone through this? Maybe that you didn’t anticipate but you’re sort of surprised to find as we move through it?


[0:10:40.6] RM: One of the things that has surprised me is the ability of the patients to be able to do these virtual visits. The demand is far greater than I anticipated it being. The providers – I knew they would do it but it didn’t know how well they would be accepting of it. It’s really jumped all over it. 


To me, this is just something that – from the CHIME standpoint – I’ve been involved with CHIME for years. I’m glad to see this because I don’t think it’s going to go away after this pandemic is over. I think we’re going to see that demand both from the patients and from the providers to let us continue some form of virtual visits. I just think it’s so opportunistic for us to go down the route.


The other thing that – 


[0:11:30.6] BR: No, please go ahead.


[0:11:32.8] RM: The other thing that somewhat surprised me is administration and management, understanding and realizing that far more of their people can work from home or work remotely. Not necessarily from home. But they can work remotely than they thought could whether that’s full-time or part-time.


And I think that’s going to be a staff side as far as we’re going to look at going down the road too. Because people are going to want to do that. If it’s no more than part-time.


[0:12:03.6] BR: Yeah, your community, I’m just curious. Telehealth is a huge satisfier. Is the average age of the community older, younger, you know, what do you find in – who is using telehealth?


[0:12:18.5] RM: It’s primarily the older people that are using the telehealth. And 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 have been able to call on their children or their grandchildren to help them. Of course, now, they can’t do that. There’s been a little bit of having to walk them through – have to do that. They want to do it but they just don’t know how.


It’s been a little bit of an issue, not tremendous because most of them are very accepting to it. Most of them, you know, they have an Android or an iPhone and they’re familiar with video and they’ve done FaceTime with their grandkids or something like that in the past. But that’s so – it’s not all new to them and they’re – they seem to be enjoying it. They like that they don’t have to get out.


And one of the things that we were looking at is because there are some nursing homes in this area, putting that capability out to the 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 what we’ll be looking at. Because a lot of the patients had to be brought to the hospital that we could see if we had some kind of video right There.


[0:13:28.9] BR: Yeah, this is going to be interesting. It’s going to be interesting to see how things evolve as you said, you know, this is a huge satisfier.  If the reimbursements stay the same or similar for telehealth, you know, it will be interesting as a CIO, baking that into the post-crisis workflow.


Because you know, do you think your doctors and everyone are thinking, “No, eventually we’ll just go back to the norm.” Or is this going to be sort of a new norm for your medical center?


[0:14:05.6] RM: I think this is going to be the new norm because I’ve already heard some comments that, “We want to continue this.” I can’t blame them because frankly, if it’s scheduled correctly, they’re seeing more patients. And I mentioned a few minutes ago about the eight patients that that one doctor had scheduled. Those are all within half a day. And doctor normally doesn’t see that many patients within half a day.


They’re going to 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. 


[0:14:35.8] BR: Randy, what’s one thing you would share with other regional medical centers, smaller, rural-type providers in terms of the things that you really feel like you did well and maybe that they should be looking at?


[0:14:51.2] RM: Well, one of the things is that idea that I mentioned to you earlier is if you’ve got a small staff, make sure that you’ve got some of them working remotely. Because if your staff on site have to go out or isolation or anything like that and you got to have somebody, that takes care of the doctors and nurses and hardware in place for them to work. Because as a provider, we have to make sure we can take care of patients. That would be number one for me.


And then making sure that we’ve got everything up to date and one of the questions that you had sent out and I thought was very interesting was what is the one thing you wish you had done? And one thing I wish I had happened here is we have the remote software more up to date because we were actually in the process of updating that software but we were about a week into a three-week upgrade process when this all hit.


We’re just – this week, getting that software fully functional on the upgraded version. We should have been in place two months ago. So, making sure you get to those kinds of things quickly, especially when it comes to remote access and being able to provide that service.


[0:16:03.7] BR: Yeah, anything specific in working with EHR provider? Have they provided some tools for you or anything in that respect?


[0:16:11.3] RM: We’ve worked with the EHR provider and we’re on MEDITECH here. You know, from that standpoint, I’ve learned a lot through the news group and the things that other people are doing. And MEDITECH has offered virtual visits, we don’t have that capability here through MEDITECH because we’re in an older version for the software but they have offered that opportunity to us.


Now, we use MEDITECH in hospital, we use Allscripts in the clinics. We’ve not taken advantage of that yet. But we may end up doing that with MEDITECH at some point. Just haven’t made that decision yet because we’re doing it through Allscripts right now.


[0:16:50.3] BR: Wow, fantastic. Well, Randy, thank you for taking the time, I appreciate these short, even though it’s only 10 minutes, I know you guys are busy and I appreciate you taking some time out to talk with us.


[0:17:03.1] RM: I appreciate the opportunity to Bill, and if there’s anything I can do to help others, I’m available to do that. Thank you.


[0:17:09.5] BR: Thanks, Randy. 




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