Making MU Look Easy

At Health IT Outcomes, we’ve made it our mission to provide the healthcare industry with expert guidance on technology system selection, integration, project management, and change management. To help achieve this goal, we speak with industry leaders on everything from EHRs to HIEs to HIM, and then share these conversations with you. We recently traveled to Chicago to attend HIMSS15 where we had the privilege to speak with Dr. Randy Lee, chief of staff at Hamilton General Hospital. Lee shared with us how Hamilton tackled becoming one of the first rural hospitals to attest to Meaningful Use (MU) Stage 1.

Health IT Voices: Tell us a little about yourself, Dr. Lee.

Lee: I started my practice in Hamilton, TX 18 years ago with one partner. Hamilton is a rural town, approximately 3,000 people, but interestingly enough, we have evolved into a rural regional medical center serving a six to seven county area. My team has grown from two to eight family practitioners with additional services of nurse practitioners and PA’s. We have a very evolved, progressive system that is focused on chronic disease management promoting outcomes and improvement in care delivery. It’s very unusual from the standpoint of my group performing hospitalist services as well as staffing the three rural regional health clinics and emergency room services.

Health IT Voices: Despite being a rural hospital, Hamilton General tackled MU early on. Why did you decide to such an aggressive approach?

Lee: Well, information is very powerful, and it allows us to take better care of our patients, promote safety, exchange information, and make everything more efficient. The Stage 1 process was actually relatively easy for us, because we had already found an EHR vendor willing to work with a rural provider and not automatically discount us for being small.

We needed the same power a tertiary facility did because of our rural regional status. The key for our successes in early attestation was physician engagement. We started out involving the entire medical staff in the vendor selection right from the start. We had ongoing meetings to try to mature order sets and share concerns our staff had that were perceived barriers to adoption.

What I have seen is, throughout this whole process, institutions have to be very malleable in their evolution of best practice. As a version of an EMR changes, you have to adapt. You have to look at your parallel processes, make sure they are still valid, and change them if they’re not.

If it’s something that will make the doctors’ lives easier and allow them to take care of their patients more efficiently, it’s a win-win. You have to engage your doctors in order to have success.

Health IT Voices: Why are so many hospitals and other providers looking at this as a challenge and as a burden and as an obstacle they have to overcome?

Lee: It’s a challenge because of all the moving pieces. Interoperability is a buzzword, but the reality is that’s where the industry is failing, but there are bright spots. When you have interoperability problems, you have another system that providers have to use which leads to provider dissatisfaction and avoidance behavior.

Education of your entire care team is critical for success. If you do a typical go-live with a product and turn them loose, they’ll use it to their level of ability and then stop because they’re getting the work done. But are they truly benefitting from what’s available in that toolkit they have? Initially, we were aggressive in looking over docs’ shoulders to identify people that needed help and maximize the benefit of the toolkit within the EMR. It was very successful.

Health IT Voices: People don’t adapt to change very well, yet your organization went right into Stage 2. How did you accomplish that?

Lee: Again, physician engagement was a key point, but I’ll not say it was without bumps. Dr. Monty Horn, one of my partners who would rather have a big chief tablet and number two pencil for his EMR, had to be “carroted” rather than sticked.

We allocated resources to people who we saw struggling to use the tool, but we also basically had a user group, where the docs would meet with whatever frequency that they felt compelled to and discuss things such as how modify order sets, what needed improved, and how to best use all the tools. That’s a very powerful thing.

Health IT Voices: We don’t want to get away without talking about Medhost, your EHR partner. You use a number of their products — what’s been the most important part of your relationship with them?

Lee: Reciprocity of communication of information. Throughout the whole attestation, since we were such an early adopter, we had to have a very facile relationship with them. We could say, “Hey, this report doesn’t look like it’s reflecting what’s going on,” and they would look at it. Obviously they wanted us to succeed with our early adoption efforts, and it was definitely a good relationship. Choosing your vendor is like getting married.