On March 31, Citrus Valley Health Partners, a three-hospital system headquartered in Covina, Calif., completed its 90-day attestation period for year one of meaningful use stage 2, making the health system one of the first in the country to reach this milestone.
Not that the journey to stage 2 was easy for CVHP. The stage's focus on population health management and data exchange provided plenty of obstacles, particularly around transitions of care.
"That was definitely the biggest challenge for us," says Martin Kleinbart, DPM, chief strategy officer at CVHP. "There was a significant amount of learning going on about developing the process and doing the technical upgrades and working to get patients attributed to make sure the transition of care documents were sent to the right providers."
Much of this work was because it was the first attestation process for many of their vendors as well. "The vendors were all certified, but they hadn't done end-to-end," says Linda Nolton, HIE project manager at CVHP. "So Meditech knew they could compile a TOC document from discharge data and send it to the referring physician, they'd just never done the next step of confirming receipt and acknowledgement…it was the same thing on the Allscripts dbMotion side, they knew they could receive [the TOC document] but didn't know how it would register."
Therefore, the meaningful use preparations required significant coordination and communication between CVHP, vendors and affiliated physicians to ensure the TOC documents and other care coordination requirements could be performed successfully. "Our testing was all about, 'Did you get it? Did you get it? Do you have it?'" says Ms. Nolton. "There was a real learning curve for everything."
What helped CVHP get over the learning curve to be one of the country's first attesters is the organization's culture, says Dr. Kleinbart. "We have a CEO [Robert Curry] who is a visionary and who really led this with a sense of urgency," he says. "We worked quickly, and we were able to push it through."
The health system was also driven through a vested interest in population health management. The population served by CVHP is racially and socioeconomically diverse, with a high rate of chronic diseases. The prevalence of diabetes in the community is between 20 and 26 percent, about 2.5 times the state average. The meaningful use objectives are seen by the health system as tools to help the organization better care for its population.
"We have a significant interest in developing population health management capabilities, and we were an early adopter of health information exchange technology" says Dr. Kleinbart. "So to be able to have something like the electronic transfer of a TOC document along the continuum — we're very excited about that."
Additionally, Ms. Nolton points to CVHP's existing strong relationships with its vendors as being a key factor in its early attestation. "We're really partners with our vendors," she says. "We pushed the envelope with them and got a lot of people who might not usually work together because they compete against each other to work together to do this new, unusual process."
To other hospitals working on stage 2 attestation, Ms. Nolton recommends taking the time to explain to nurses and other clinical staff not only what to do, but why it should be done. At CVHP, IT leadership met with the nursing staff to explain the stage 2 requirements in terms of extra clicks or documentation as well as the ultimate benefit it will have to patient care. "You have to explain why this is valuable when you're asking them to do one or 10 more things," she says.
Dr. Kleinbart recommends doing what he wishes he had done more of — explaining to stakeholders what coordinated care, especially data exchange, will look like under meaningful use stage 2. "It's a major paradigm shift for people used to working in silos," he says. By convening stakeholders and having a cohesive vision of what stage 2 will look like in a clinician's day-to-day, hospitals and health systems can minimize resistance from caregivers. "It would have smoothed things for us overall," he says.
Most importantly, hospital leadership should seek out partnerships, with vendors and other organizations, to see attestation is doable. "[Meaningful use stage 2] demands you step outside your four walls to see what everyone else is doing," says Ms. Nolton. "Don't feel like you're alone."
More Articles on Meaningful Use:
New Report Calls for MU3 to Foster Interoperability, National Health IT Architecture
MU Attestation Not Associated With Care Quality, According to Brigham and Women's Hospital Study
IOM Recommends EHR Data Domains for MU3