'Late Adopters'—How Small Hospitals Can Navigate Meaningful Use

Hospitals and health systems just now getting around to meaningful use have clearer guidance from CMS, a better selection of off-the-shelf EHR software, and the cautionary lessons learned from HMA.

Judging by last week's readership on HealthLeadersMedia.com, more than a few of you were keenly interested in HMA's $31 million giveback to the Centers for Medicare & Medicaid Services last week for failing to tell the truth about its meaningful use attestation.

While we ponder the fallout at HMA, how can you avoid being next?

The good news is, CMS now has a web page to help you navigate your way around (or through) a meaningful use audit.

Scroll down to the heading "Audit Information and Guidance," where you'll find:

• Supporting Documentation for Audits
• Sample Audit Letter for EPs
• Sample Audit Letter for Eligible Hospitals & CAHs
• Audit Overview Fact Sheet

That's just where El Centro (CA) Regional Medical Center went at the start of its meaningful use journey. It's poetic justice, or something, that those just now getting around to meaningful use have a better selection of off-the-shelf electronic health record software, resources such as those from CMS, and the lessons learned from HMA—and, no doubt, other cautionary tales to come.

Tura Morice is CIO of ECRMC, a municipally owned hospital located less than 15 miles from the Mexican border in California. With 162 beds, two general outpatient centers, and two specialty outpatient clinics, ECRMC successfully attested for Stage 1/Year 1 of meaningful use on October 25 for the reporting period of June 4 to Sept. 3. As a Year 1 site, ECRMC's reporting period was 90 days.

"I tease my coworkers that there's real value in being a late adopter," Morice says. "Our physicians have been using CPOE in their practices and our hospitalists at other sites, so they were way ahead of the game compared to us, and were more than ready to adopt [our] CPOE pilot." A full rollout of inpatient CPOE is scheduled for next month.

CMS "outlined specifically what they're going to look for in an audit so that you can have all the screenshots and information ready," Morice says. "The early adopters didn't really have clear instructions on what an audit would look like, so I think unfortunate for them, now that they can't go back and redo their attestation screenshots a couple of years down the road.

"For us, we followed the formulary so if we ever get audited, we'll be ready."

In its clinics, ECRMC is using eClinicalWorks, and on the inpatient side, Siemens Soarian Clinicals. Morice is all too aware that Stage 1 of meaningful use is the data collection stage, and that true benefits of being a meaningful user probably won't kick in until Stage 3, when people may experience "the absolute change in the industry that we're all hoping for: removing a lot of these manual processes, automating healthcare information, and involving the patient more."

This year, ECRMC started with required core measures on the inpatient side: stroke, ED, and VTE. Next year, like all meaningful users, ECRMC will start reporting its clinical quality measures through its EHRs. "It's part of what we're all groaning under, trying to get our EMRs ready for that," she says. "I do see that as a huge leap forward in making the EMR more sophisticated with workflows, order sets, alerts, and all the benefits that are supposed to improve patient care and core measure compliance."

Speaking with Morice, I was reminded that CPOE itself isn't a one-and-done act, but more of a process. "You can use your CPOE order sets to help you meet those core measures," she says. "This year we're still abstracting charts manually, where human eyes have to go through the electronic chart and determine whether or not we've met our quality measures. And next year, that abstraction process has to be completely automated. That will involve a huge amount of EMR build effort between now and then to ensure that all required information is in the chart in codified electronic form in order for it to be counted."

And it's not all about quality: In 2014, 16 out of 29 core measures required will be value-based purchasing core measures, Morice notes.

While some larger systems have been able to banish paper all at once, ECRMC takes an approach that makes more sense for a system of its size. "There's unbelievable amounts of paper that flows through a healthcare system, and sometimes you just have to start in one place," Morice says.

"For some of us, that started with the medical record. Our charts are all completely electronic. Our physicians sign them all electronically. And then there are parts of the chart that we are still scanning, still paper-bound, but as time goes on and as opportunities present, our goal is to make that all paperless. But again, it's an ongoing process, and you have to fit those kinds of activities in where you can with all of the other regulatory activities. There's only so many resources, so it's not nearly going as fast as we'd like, but that's where we are."

Morice also gives credit to an outside consultancy that offered integrated system testing and a clinical help desk service, which helped ECRMC through the EHR deployment process.

"We didn't have the internal resources to man a 24-by-7 clincal help desk so we were able to outsource that to them, and now my system builders, instead of being distracted by maintenance and support, can continue building," Morice says."We brought Stoltenberg [Consulting] back in to help us with the CPOE build and on demand to support some of our other clinical systems that we don't currently have internal resources for."

So, take heart, all you CIOs of smaller hospitals just struggling through the meaningful use Stage 1 process. At the end of the process, you don't have to end up being the next HMA. The resources are there to make you as successful.