Sometimes I just feel like a dumb pig farmer from Iowa who got in way over his head. All of this meaningful-use stuff—24 criteria, 14 requiring numerators and denominators, some menu (10), some core (14). Pick four from this group; pick one from that group. It's kind of like playing the lottery, and if you win, you might get some money. At the end of the day, what does it all mean to a critical-access hospital in southeast Iowa?
The meaningful-use adventure in rural America
Webster's defines transformation as "a complete or major change in someone or something's appearance, form, etc.” Webster must have been thinking about meaningful use when he crafted this definition. As an executive at a critical-access hospital, I am here to tell you that meaningful use is a transformational experience.
When we began our journey in 2004, like almost everyone else, we were completely paper-based on just about everything. The safest place to be during a nuclear attack was in our medical records department, because the tons of paper would shield you from any radiation. It may seem a bit cynical, but that is really what it was like.
But then, we had an epiphany. What could make the patient experience and outcome better? What could make us the provider and employer of choice? What could make us a place where physicians wanted to practice medicine? The idea of electronic health records was born. Born of great vision, great leadership and really without a clue about the enormity of the task in front of us. Even so, we pursued the vision and goal.
I began writing this musing as one hospital chief information officer in rural America on April 15, which is an auspicious day because it's usually the last day to file income taxes. But for some reason, that day and the start of attestation for meaningful use fall on the same day this year—go figure. I sit prepared to file our attestation on Monday, April 18, at 8:30 a.m. ET. The thought has come to me—what have we really accomplished? I believe the answer lies in improved patient outcomes and service; at the very least, that has been our experience.
The journey is arduous but worth the effort. Our patient satisfaction scores, associate satisfaction scores and especially medical staff satisfaction have improved significantly. We are living proof that a small critical-access hospital can accomplish what is required and then reap the benefits. If you start with a patient-centric vision that is totally supported by senior leadership and the board, it is all doable. There will be bumps in the road along the way, but they are surmountable. Committed medical and clinical staffs also are crucial ingredients to success. I was blessed with all of these.
I do believe that, in the end, costs will be favorably impacted as well, but full realization of that lofty goal is a ways out. I would encourage all to take the trip not because of incentive dollars (although that helps) but because it is the right thing to do for the patient. Vision is the key, but the result is all about the patient.
Monday, April 18, 2011: Attestation Experience. Much to my pleasant surprise, the CMS website functioned well on Day 1. The process took about 40 minutes, start to finish. Advice to those getting ready: Have all of your data at your fingertips, especially the quality measures. There are more than 50 total numbers to enter, so take your time and check your work. However, it is not nearly the daunting task that I feared it would be. The biggest trick was finding the certification number for my EHR. (It was not the number that appears on the CHPL list. It's not difficult to find the correct number, but it does take some additional time). It was well worth the time spent—just a bit tedious. Again, all doable with patience (a quality some say I lack at times).
I wish I could say the journey ends here, but alas, it does not. My team is already reviewing Stage 2 requirements and assessing process and workflow changes to make this function even better for our patients, medical staff and all associates. There remains much to be done going forward, but there is satisfaction in arriving at this level. Yes, satisfaction, for a brief period, but then the question becomes, "What have you done lately?" as we continue our journey. But look at it this way: For health IT, it is great job security (assuming you get it close to right for the patients and users).
Stephen StewartChief information officerHenry County Health CenterMount Pleasant, Iowa
Send us a letter
Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.