The slow uptick in the number of eligible hospitals and professionals attesting for Stage 2 Meaningful Use has raised concerns about whether the requirements of this next phase of the EHR Incentive Programs are too demanding. But for one hospital recently having completed attestation for Stage 2, the greatest challenge was actually the process of moving from paper to electronic records as part of Stage 1.
“Honestly, Stage 1 for us was the hardest because our facility was using paper before so we went directly from that to a completely computerized electronic health record,” says Megan Shepard, RN, CSD, Clinical Service Director at Odessa Memorial Healthcare Center. “We were going through all these stages all at once — going from paper to starting to use the EHR and then throwing meaningful use on top of that.”
Odessa Memorial Healthcare Center is a critical access hospital in the rural reaches of upstate Washington whose limited resources are evident in the lack of onsite IT support. To achieve meaningful use and claim valuable incentive dollars, the CAH contracts with a division of Inland Northwest Health Services, Engage, to implement and adopt a Meditech EHR system.
“What we are finding right now is that the critical access community by and large does not have the individual or community expertise, exposure, or experience to produce the technology requirements necessary to meet the federal Stage 2 program,” explains Marcia Cheadle, Senior Director of Meaningful Use and Advanced Clinicals for Engage.
According to Cheadle, the trouble with Stage 2 Meaningful Use is predominately on side of EHR vendors rather than that of providers.
“Most facilities would believe that Stage 1 is more difficult because it is all focused on implementation and adoption of programs,” she continues. “However, from a technology standpoint, Stage 2 was significantly more difficult. From a maturity standpoint in the vendor community, the systems were just not truly ready or in sync with the federal requirements.”
In the day-to-day lives of clinicians, the adoption of an EHR system after decades of relying on paper records and workflows represents a significant shift. Adding meaningful use into the mix further complicated matters.
“We had to get them to understand what was important and what we made sure we had to document so things flowed through and we could attest to meaningful use,” Shepard reveals. “For so long, physicians have been so used to writing an order and throwing it to the nurse to verify, validate, and go through the whole process. Now, it is all computerized, so getting them to enter their own orders at the very beginning was a hassle. They didn’t want anything to do with it.”
Despite the pushback, the Washington CAH could not afford to pass on the dollars made available for eligible hospitals in meaningful use.
“Simply implementing an electronic health record in a facility such as ours where are volumes are so small was a tremendous cost,” says Shepard. “Being able to get the reimbursement for it to show that we’re doing everything we need to take care of patients makes a huge difference to our facility and keeping our doors open and us alive.”
Once the obstacles were surmounted in Stage 1, Odessa Memorial Healthcare Center discovered that working toward success in Stage 2 was less of a shock than that initial transition away from paper.
“We were doing so well with Stage 1 so that Stage 2 was pretty simple,” Shepard maintains. “We just kept on doing what we were doing with a couple extra added things. Stage 2 for us wasn’t as hard as Stage 1 because of the amount of changes we were going through at the very beginning.”
Looking forward, Shepard believes the challenge for her facility centers on keeping the momentum going for meaningful use and avoiding any bad habits that could undermine their previous successes. “You have to maintain this standard, this level of care, because even though we attested we still need to attest again. It is not a one-time thing. We need to continue to meet these goals,” she adds.
