More than 85 percent of critical access hospitals in New Hampshire have attested to meaningful use stage 1, a rate higher than the national average among all hospitals, critical access or not (80 percent). The high attestation rate among the state's CAHs has ranked the Regional Extension Center of New Hampshire among the best-performing RECs of the 62 such centers nationwide.
RECNH provides support, guidance, project management and technical assistance to the state's 13 CAHs, as well as public hospitals, community health centers, behavioral health centers and independent providers throughout the state.
"I had an unfair advantage," says Gary Tomlinson, RECNH's critical access hospital consultant, when speaking of the center's success in helping 10 of the 13 CAHs in the state achieve meaningful use stage 1. "I was the IT director for Cottage Hospital in Woodsville, N.H, the first CAH in the state and the second hospital overall in the state to reach meaningful use in July of 2011."
"It helped that I'd been there and done that," he adds. "I had a lot of credibility, and having hooked up myself with a REC to meet meaningful use stage 1 just added more credibility."
He did face several hurdles in moving the hospitals toward meaningful use, principally a persistent resistance to change. "People using any existing system have a level of comfort with it," he says. "This is especially true in clinical settings, and it definitely became an obstacle moving forward."
As an example, Mr. Tomlinson cites aversion to the use of computerized physician order entry across the hospitals with which he worked. He says some of the physicians were wary of alarm fatigue — misunderstanding the various levels of alarm and thereby missing an emergency that they wouldn't have missed otherwise.
Mr. Tomlinson stresses the importance of unified, clear leadership to overcome this resistance to change. "It's all too typical for an IT guy to come in and start mandating change," he says, which leads to staff feeling pressured, rather than guided, through the transition. "The directive to move forward has to come from the administration."
The administration was often aided by an aspect of CAHs often considered a determent — smaller size. "In a larger hospital, things work more from the top down," says Mr. Tomlinson. In a smaller hospital, it's more like a community, he says, with a staff more used to working with the administration and taking on new challenges.
The next challenge for these hospitals will be meaningful use stage 2. New obstacles include the patient portals, which may present a problem to many of the CAHs he works with not only because of limited resources but also because of the resources and demographics of the patient populations. "In a lot of the communities these hospitals are serving, people don't have the Internet," says Mr. Tomlinson, "and getting the required 10 percent of patients to use the portals once they're up could be a challenge."
Despite new challenges, Mr. Tomlinson believes these hospitals now have an easier path to attest to meaningful use stage 2 because they have successfully laid the groundwork through stage 1. Mr. Tomlinson and the RECNH have also begun providing training and education to administrators, physician leaders and meaningful use committees at these hospitals, detailing the specifics of the move to stage 2.
Because the majority of the hospitals are now in their second year of attestation on meaningful use stage 1, they'll have the experience and comfort level necessary to move on to stage 2. "Meaningful use stage 1 was the foundation," Mr. Tomlinson says. "Now it's ready to be built upon."
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