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Assessing MU Stage 2 Challenges

March 29, 2012
by Jennifer Prestigiacomo
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Bay Medical Center tackles physician progress notes
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As some hospitals have moved past attesting to Stage 1 meaningful use, their leaders are now gearing up for challenges in Stage 2. Even before the requirements have been finalized, organizations, like Bay Medical Center, are starting to assess what to tackle next.  

Bay Medical Center, a 323-bed regional medical center located in Panama City, Fla. (a seven-county region in Northwest Florida), began its IT journey in 2004 to enhance the delivery of care and have access to the information necessary to improve outcomes. To help achieve its clinical and IT goals, Bay Medical selected its partners: an enterprise electronic health record (EHR) solution from the San Francisco-based McKesson and a consultant (the Norwalk, Conn.-based Xerox) to provide technical and strategic expertise that Bay Medical didn’t have in-house. Bay Medical has an onsite IT team of 24 people, a clinical informatics group of five, and central support services like data center maintenance, network administration, and a help desk provided by Xerox.
Bay Medical did a big-bang implementation with its core systems that included laboratory, radiology, pharmacy, and nursing documentation in April 2007, and has been building on this core implementation since.

Bay Medical attested for Stage 1 meaningful use in October 2011, finding the most challenge with meeting specific clinical quality metrics for stroke and VDI [Virtual Desktop Infrastructure]. It was not actually meeting the metric, says Tom Bialorucki, Bay Medical’s CIO, it was implementing the necessary systems to capture the specific information needed.

“Making sure those iForms [a tool in the CPOE system to guide the physician by providing clinically-relevant options] were presented to the physicians, who were doing computerized physician order entry, at the appropriate time, probably presented our greatest challenge,” says Bialorucki. “It wasn’t something that we built or customized, it was provided by the vendor in order to be able to specifically meet meaningful use criteria. Without having the flexibility to be able to customize it the way physicians might want to see it, that’s where we met some resistance with those two specific quality metrics [stroke and VDI].”
Physician Progress Notes
After tackling CPOE, next on the list for Stage 2 are physician progress notes, which have only been implemented in the ED so far. “With the more traditional physicians, that change is already being voiced,” says Bialorucki. “We know that there is going to be resistance to actually enter their notes electronically.”  

Bay Medical is now piloting speech recognition-aided physician notes in the ED to help facilitate physician adoption. ED physicians have been using the Dragon solution (from the Burlington, Mass.-based Nuance) to enrich documentation in the ED clinical information system within free text boxes. Early reports from physicians are that the speech recognition tool helps to speed up the visit. “They have embraced it and speak very highly of it, and they feel it makes a difference in terms of the number of patients they can actually see,” says Bialorucki. The next area where speech recognition will be piloted is within the inpatient CPOE workflow.

To help drive these implementation best practices, Bay Medical has done many things like employing a stringent project management methodology, ensuring executive-level support, and deploying committees where appropriate. One example has been its clinical informatics group, whose mission is to address the future workflow processes.

“We do daily rounding to interact with the end-users to see what frustrates them, and to see what they would like done to make it easier to use the systems,” says Bialorucki. “We actually have publications that go out once a week to give them helpful tips to help leverage and use the systems.”