Getting Ready for Meaningful Use: Positioning Your Facility to Meet the Guidelines

Since the American Recovery and Reinvestment Act of 2009 first outlined the incentives providers would be able to receive for "meaningful use" of certified electronic health record technology, hospitals, physicians and other healthcare organizations have been gearing up and trying to figure out what the law will mean for them.

Providers concerned
In the months since the law authorizing the estimated $14 billion to $27 billion in incentives was signed, CMS and the Office of the National Coordinator for Health Information Technology have issued proposed rules defining the criteria for meeting "meaningful use" standards. CMS is expected to release a final rule on meaningful use in late spring that takes into account public comments. Qualified providers would begin receiving subsidies in fiscal year 2011, and penalties for failing to meet the requirements will begin in 2015.

Groups such as the American Hospital Association, the Federation of American Hospitals the American Medical Association and other provider organizations have registered some concern about the meaningful-use requirements, submitting a letter on May 3 to HHS Sec. Kathleen Sebelius requesting that some of the requirements be eased. They suggested abandoning the rule's "all-or-nothing" approach in favor of a more flexible one, and they asked for more time to transition into meaningful use, among other things.

Meanwhile, healthcare information technology vendors such as Cerner Corp. are working with their clients to make sure they will be able to avoid the penalties — which become stiffer over time — and are poised to reap the rewards of the incentive payments where possible.

Some are more ready than others
"Clearly, providers who have already made an investment and have committed resources and have made organizational shifts to embrace healthcare IT as an enabler to provide better quality and higher efficiency of patient care inside their organizations are going to be better positioned," says Chad Greeno, a Cerner executive who is closely following the meaningful use developments. One misconception, he says, is that meaningful use is all about information technology. "Meaningful use is not about healthcare IT," Mr. Greeno says. "It's about changing clinical practice to a patient-centered, safe healthcare system that's equitable and accessible…It's not about CPOE and it's not about an electronic copy of this or that."

Healthcare providers are in various stages along a spectrum of readiness, he says. "What we're encouraging them to do is deal with the information we have in hand and synthesize that with the attitudes, comments, and position laid out by the Secretary (of HHS) and the national coordinator."

Those that are farthest along in the journey toward meaningful use are not necessarily the usual suspects like large integrated systems. Just ask Darrel Morris, the CEO of Drumright Regional Hospital, 40 miles west of Tulsa, Okla. Drumright is proof that even a small, rural critical access hospital can take the lead in implementing meaningful healthcare information technology improvements.

HIT brings new life to critical access hospital
Drumright opened in 2005 as a replacement for a 50-year-old hospital that had closed in 2001. The hospital averages about eight patients a day and focuses on outpatient and inpatient surgeries, as well as lab and radiology procedures.

In 2008, with support from Oklahoma State University, Drumright applied for a grant from the Health Resources and Services Administration to help it finance implementation of an EHR. When the hospital received $300,000, it sought out a vendor and ultimately chose Cerner. Drumright's goals were functionality and usability, good support and training, quick implementation and HIPAA compliance, Mr. Morris says.

In Oct. 2008, Drumright went live with the new system at a physician clinic affiliated with the hospital. Within the clinic, the electronic system is used for everything from registration to physician documentation, e-prescribing and lab results. The IT system was then phased in over a four-month period at the hospital.

Planning is key
Among Mr. Morris' suggestions to other hospitals trying to implement a new IT system are involving physicians in the process — ideally by appointing a physician to champion the effort — as well as allowing enough preparation time. "We didn't budget a whole lot of money for that extra time," he says. "We had to bring nurses and lab techs in for training. That was more hours on the clock than we had prepared for." Hospitals should also be ready to modify some policies and procedures to allow for changes when processes move from paper to electronic format.

So far, the IT system has led to greater efficiencies and quality improvement, Mr. Morris says. "We have these safeguards in place that help us perform better," he says. The system automatically checks for drug interactions, and since the hospital does not have the resources for a full-time, on-site pharmacist, the system allows a remote pharmacist to review orders before drugs are administered to patients. In addition, the hospital and the physician clinic have seen improvements in their charge capture. The system's automated charge entry has also enabled the hospital to eliminate a business office position.

But how does Drumright's experience fit in with the pending meaningful use requirements? "Those of us in healthcare had known for a long time that at some point we'd have to go there," says Mr. Morris. "Meaningful use was still not clearly defined, but it was being talked about. We knew at some point we would have to get there, and this was a great opportunity for our hospital to do that with the help of the grant."

Drumright did not have resources to draw upon to pull staff away from their jobs to work on the IT project. "We wanted someone who would have those resources, who would be around and had the knowledge to make changes whenever those things (about meaningful use) were clearly defined," Mr. Morris says. In addition to providing ongoing technical support and modifications, Cerner hosts Drumright's server, so Drumright does not have to worry about maintaining and upgrading hardware, which was a big selling point, according to Mr. Morris.

Mr. Morris says he thinks Drumright is "very well poised" to take advantage of the federal incentives that will be available to hospitals under the meaningful use provisions. "Obviously, with things changing, we don't know what the final version is going to mean, and all the objectives of meeting meaningful use, but we're in great shape," he says. "A lot of the objectives we're already doing, and others we're working with Cerner to develop solutions."

While Drumright did not dive into its information technology overhaul with the specific requirements of meaningful use in mind, the hospital considers itself on the cutting edge of technology. "Obviously it would be great for us to get that incentive money, but it wasn't a driving factor," Mr. Morris says. "I would tend to say we're in the top tier of any of the critical access hospitals in our country to be positioned to meet meaningful use."

Contact Barbara Kirchheimer at barbara@beckersasc.com.