Achieving Meaningful Use: A How-To Guide For Community Hospitals

Edited by Erin Harris, Editor, Health IT Outcomes

Southern New Hampshire Medical Center implemented an electronic health record (EHR) solution to improve the quality of patient care and ended up achieving the first stage of Meaningful Use.

Meaningful Use (MU) incentives have been credited for the accomplishments made in healthcare IT investments and implementation. With the help of incentive pay to community hospitals that meet MU standards for EHR systems, widespread adoption of healthcare IT is coming closer to reality. Dr. Andrew Watt, M.D., VP of IS, and Lynne MacAllister, R.N., senior director of clinical informatics at Southern New Hampshire Health System, a 188-bed acute care hospital with an associated 59 multispecialty practices, explain how this community hospital achieved its MU objectives.

Q: Was MU the primary motivator for the addition of EHR technology at your community hospital?

Dr. Watt: MU was not the primary motivator for our EHR implementation, but improving patient care was. However, we used the EHR to interpret data in a meaningful way. Even though we had implemented the EHR in many areas, we were not always using it in the textbook definition of MU. The incentive involves not only owning the software, but also how it’s used. We decided to fulfill all the requirements of MU, and we did so because we believed it would improve patient care. For example, we thought it would improve patient care through CPOE (computerized physician order entry), which can improve utilization or decrease unnecessary waste in the system. It is safer for the patient if transcription errors are eliminated. In our case, from an MU perspective, CPOE was an important step for us to ensure we improved patient care.

MacAllister: Further, I do not think it should be understated how catalyzing the incentive package is. MU aligned the health IT industry for the first time by allowing us to have an external measure of how well we are doing. And, overall, it improves integration. For example, because a problem list is now encoded in a particular standard, it is much more likely that it can be freely interchanged with other entities. Just imagine if every hospital in the country came up with its own list of problems — it would be a mess. So now, because we know that these problems are going to be encoded in either SNOMED (Systematized Nomenclature of Medicine) or ICD-9, then theoretically they are translatable and exchangeable.

Q: How have you structured your EHR rollout in line with MU criteria?

Dr. Watt: When MU came about, our very top priority was to determine which projects we needed to complete for MU. That helped us to create a manageable work list and prioritize all the IT demands associated with MU. We are constantly asked to perform upgrades, but we were concentrated on uncovering the projects that would advance the directive — CPOE and problem list. While CPOE was an active project before the announcement of MU, our focus was extending EHR to the practices. On the hospital side, we were focused on CPOE and nursing documentation, such as automating plans of care and medication reconciliation. Inpatient physician documentation was a major strategic goal that was delayed by MU. MU forced us to focus on automation of quality reports and problems lists, and it accelerated our CPOE program.

Q: What advice do you have for other hospitals looking to achieve MU?

Dr. Watt: Do not minimize certain projects. CPOE is a prime example, because it is a large project, and you do not want to put it off or leave it until last because it has the longest ramp-up time of any major project. We were extremely lucky here because we already implemented CPOE to the point where we had enough to make the first stage MU numbers, but we realized that took quite some time. So we immediately included CPOE as part of our strategic plan, and we slowly continue to enhance it. So by the time we are at the point of attesting to Stage 2, we are at the right number.

MacAllister: Planning upgrades takes time. For example, we are working toward a Stage 2 upgrade. We needed to determine which projects are on the list for Stage 2. We needed to outline not only the major projects because they need serious consideration before we tackle them, but also consider some projects that can be done right now. Start communicating about workflow with your colleagues. Start small projects now in order to leave ample time for the projects you cannot do until your vendor delivers the upgrades.

Also, understand the role of your vendor. Ask the vendor what other hospitals similar to yours have done. Other hospitals can be very helpful in connecting you to the right people. For example, we had a requirement in Stage 1 to exchange data electronically, and we could have gone anywhere with that. We chose to exchange data with another Soarian Clinicals hospital, because we were able to speak the same language because we had the same vendor. It was a mutual benefit.

Q: What are the special MU challenges a community hospital might face that a large hospital may not?

Dr. Watt: As a small hospital, we have a very small IT staff. A small IT staff means you have a handful of people who are the clinical analysts. When MU use is incorporated, you start to get to the point of personal responsibility. You are asking one or two different individuals to basically carry the weight of the health system and to measure and achieve outcomes. We struggle with CPOE, keeping up with the building requirements because we run a lean IT department, and that is very challenging for a small hospital.

Q: Does the community hospital have advantages over large hospitals?

Dr. Watt: There is a lot of the personal accountability. It is very easy to interact with the lab group, for example, and get them to help you toward your goal. There isn’t much red tape. We talk on a first name basis with our colleagues and other groups, which is a plus.

Larger hospitals have deeper pockets and more resources. As a result, they have a bigger challenge in terms of getting through to other groups. They have a very large medical staff. Training a large staff can be very difficult.

The vendor you choose is also important. Larger hospitals with multiple disparate divisions probably use a best-of-breed model where they have acquired software solutions for their individual practice areas. Here in the community setting, we rely very heavily on our two core vendors — Siemens Soarian (inpatient EHR) and GE Centricity (outpatient EHR).

Q: Where is your facility in regards to achieving Stage 2 MU?

Dr. Watt: We started our Stage 1 measurement period in October 2011 and attested shortly after its completion. MU Stage 2 will present some challenges, but we are developing a detailed road map. We are still waiting on some specifics from our core vendors. Our initial gap analysis puts our organization in the following position: There will need to be a significant effort or strategic capital investment in about 1/3 of the measures. Another 1/3 of the measures will consume mild to moderate IT resources and staff. The final 1/3 has already been achieved from successful completion of Stage 1.