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Early Attestation Interview

July 26, 2011
by Mark Hagland
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Leaders at Kane Community Hospital, Kane, Pa., view a demonstration It’s not only large hospitals and integrated health systems that are attesting early on the inpatient side of stage 1 of meaningful use; a number of smaller community hospitals are making the plunge as well. One of those that has made the leap is Kane Community Hospital, a 32-bed standalone hospital with 10 salaried physicians in eight clinics, based in Kane, Pa., a small city in northwestern Pennsylvania three hours northwest of Pittsburgh and two hours south of Erie.

There, Margaret Twidale, senior manager, information technology, has helped lead her colleagues on the 200-member hospital staff forward towards attestation, which was completed on July 5. Later this year, Twidale and her other colleague in the two-person IT department plan to attest on behalf of the eligible clinicians in their physician group (the physicians and other clinicians are salaried members of the Kane team) as well.

Twidale and her colleagues have received strong support from their long-term electronic health record (EHR) vendor, the Minneapolis-based Healthland, in this effort, Twidale reports. Building on the implementation of several key technology implementations, including those for computerized physician order entry (CPOE) and an electronic medication administration record (eMAR), the Kane Community Hospital team was able to move forward quickly to prepare for this summer’s attestation. Twidale spoke recently with HCI Editor-in-Chief Mark Hagland regarding her organization’s meaningful use journey. Below are excerpts from that interview.

How long have you been at Kane Community Hospital?
I’ve been here since January 4, 1992.

And how big a staff do you have?
Myself and one assistant. We manage a large network, with many computers. We’re connected via a direct fiber-optic telephonic connection, with a VPN [virtual private network].
Margaret Twidale

When did you attest?
I attested for us on July 5, 2011. I registered our organization on April 20, 2011.

How long was the period of preparation before you registered?
We were a beta site for Healthland’s product that was going to be certified. We had been getting ready for this and getting ourselves positioned, really, since 2009. And in 2009, the CEO sent out a letter that set an administrative tone throughout the organization regarding what this all meant. We started an EMR since 2000, and we had had the Healthland clinical product since 2000, and just kept upgrading and updating over the years until we had implemented the new product to be certified. We formed an IT team for meaningful use in March 2009, and what we did was that we evaluated all our types of medical records.
We asked, what did we have electronic at that time? What did we still need? And what did we need to do to be able to accomplish things? And then we added deadlines. We added Healthland’s surgery management practice product; we added the physician document product, which is CCHIT-certified, but isn’t totally certified yet for meaningful use. I have registered all the physicians; I have not attested for them yet. I’ll attest towards the end of this year, in the fourth quarter of this year, once Healthland’s physician documentation module is certified for meaningful use, we will attest.

In 2009, as the result of my proposed IT meaningful use plan, I requested in both hardware and software upgrades, approximately $379,000, in addition to what we had already invested, which had been over $1 million. We had been with Healthland since 1994, and we’d been on their clinicals since 2000. And we have every one of their modules except a nursing home package.

You already had CPOE and eMAR before you began to prepare for attestation?
Yes. The physicians went live with CPOE in January of this year. Many had already been doing it over the years, but we didn’t make it mandatory until this year. The eMAR we call the OMAR, online medication administration record, and the OMAR is supported by medication barcoding. We went live with that in February and March of this year.

On a scale of 1 to 10, how difficult would you say that it was to get to attestation?
Probably a 7 or an 8, pretty difficult.

Was it more difficult than you had expected?
No, it was about what I had expected.

What were the biggest challenges?
Probably the biggest challenge is just continuous reinforcement of getting the staff to do what they need to do. It’s always about reinforcing. Just when you have everyone on the same page, someone will deviate. So you get to a point and think you’re there… but it’s sometimes like a frog in a well. I used to teach mathematics in school, and I told my students, there’s a frog in a well, and every night, he could hop up a few inches. But the next morning, he will have slipped back a few inches. So how long will it take me to get the frog all the way out of the well? That’s what this is all about—keeping everyone focused on that unified purpose, and not having people slide back.

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