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Early Attestation in a Small Community Hospital

September 19, 2011
by Mark Hagland
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The 41-bed Faith Community Hospital in tiny (population 4,500) Jacksboro, Tex., may be far from major metropolitan centers (being situated 100 miles west-northwest of Dallas and 65 miles south of Wichita Falls, Tex.), but it has a distinction that many hospitals of larger size or more central location lack; and that is early attestation this summer under stage 1 of the meaningful use process under the Medicare incentive program. And that attestation has taken place in the context of a hospital district responsible for charity and indigent care in its community.

Frank Beaman, who on Jan. 1 became CEO of Faith Community Hospital, has led the meaningful use process forward at his organization, which has a staff of about 80 FTEs, and just two IT professionals. The hospital counts four full-time staff physicians and one staff nurse practitioner, plus about a dozen consulting and courtesy physicians. Fortunately, it is also true that initiatives can often be moved forward more quickly in a small-organization environment, and that has indeed been the case at Faith. Faith Community Hospital is using the ChartAccess® Comprehensive EHR from the Houston-based Prognosis Health Information Systems. Beaman spoke recently with HCI Editor-in-Chief Mark Hagland regarding the MU effort at his organization. Below are excerpts from that interview.

What made you decide to go for early attestation?

Obviously, the incentive was part of it. This was one of those times where the government, instead of issuing an unfunded mandate, actually put its money where its mouth was. And of course, it’s a multi-year attestation process, and it’s front-loaded. So, we wanted to have this done early, one because of the incentive, and two, to get it done early and to get the bugs worked out.

And this is no option, and no fad. This is part of a long-term journey. You have to do this, or your Medicare payments will be reduced.

What made you choose Prognosis?

Actually, I was not involved in the vendor selection; that happened before I came in. We changed out the accounting system, and went with CSS, Custom Software Solutions, and part of what went with that package was this Prognosis EHR; they’re partner companies. Prognosis’ product is called ChartAccess.

When was the go-live?

The go-live was March 1, with attestation on June 5. My goal was June 1, and I made it clear that it was not an option for us not to attest this year. But there had to be some philosophical changes within the building. There had not been a system in place that could carry you from point A to point B; so a lot of this process was being built on the fly.

And one of the things that is highly important if you didn’t do first-year attestation, is that you’d better know exactly where you are with regard to the level of sophistication in your IT department, and with the attitude on the part of your entire staff towards new technology. Because this is a paradigm with great implications.

So you had to have some good conversations and dialogue with your clinical staff?

Yes, we had to do some training and education, to make sure they understood the implications of this. You have to change the attitude towards where this is all going.

And remember, we went through not only an EMR implementation, but also a financial system implementation. But hats off to my chief nursing officer and to my chief financial officer, for understanding and capturing the vision and sharing it.

Were there any particular challenges in reaching the point of attestation?

The system was put in place in October. And the obstacles that we faced… It’s important to understand the implications of this—it is an enormous change of your processes, not to mention the hundreds of thousands of dollars you spend in equipment, the time management changes, the training—there’s a lot to this.

What would you say about the fact that you’re a 41-bed hospital, and you were able to do this?

A couple of thoughts come to mind. First of all, those who didn’t attest for the first year, are probably regretting it a bit; because CMS [the federal Centers for Medicare and Medicaid Services] is now delaying year 2, so it appears that if you didn’t catch this in the first year, you may have lost some money. But whether you’re a 1,000-bed hospital or a 41-bed hospital, you realize that this is a pretty major change. And to turn a speedboat around 180 degrees takes a little less time and space than to turn around a cruise ship.

And in 23 years of executive management, I have the best board of directors I’ve ever worked with. But if I hadn’t had the support at the board level and the confidence of the board, and the confidence of the staff directly handling this, this never would have happened. But that’s allowed this to be a speedboat and not a cruise ship. And I’ve been in a 400-bed hospital, so I absolutely know what you’re talking about. So I can be more nimble and make decisions more quickly. And again, having a trusting board—that confidence allows me to make quick decisions.

Did you run into any surprises at all?

We didn’t know what to expect; we’re all cutting trees as we go along, to create a path in a new landscape. And keep in mind, we did double duty here. And all of these systems—clinic, lab, radiology, nursing, plus our accounting system, are all independent components. So therefore, you have all the interfacing issues. We had issues going on because of the accounting system being used in both the hospital and clinic.

It must have felt great to attest on June 5.

Our goal was June 1, and we were working with Prognosis, and they were very, very helpful. And we got 95 percent there, and then there were some glitches. We got right up to the attestation time, and they had put together a dashboard for us, but there were some glitches that came up at the very last second. They couldn’t get it programmed and fixed fast enough; so we went back with me, my CIO, CNO, and CFO, and got it fixed. And when we saw the screen that said, “You have successfully attested,” we gave each other a few high-fives, and then kept going. I think we all went out to lunch when the bank deposit was made.

What have been the major lessons learned?

When the hospital opted to go with these systems in October, they chose not to go with parallel accounting systems. By not running parallel systems, they went offline with the old system, and online with the new one, and ended up going two months without sending out a bill. So I would say, number one, make sure you run parallel systems. Number two, properly identify and evaluate your current situation in your IT department. Number three, make sure that your vendor understands where you are with that level of sophistication, and let them become part of the team helping people move forward, because you’re changing the way people think as well as how they function.

Do you feel pretty confident about stages 2 and 3?

I absolutely do. And I will say, hats off to my medical staff, because they’ve absolutely embraced it. And our clinic is completely paperless, and all of our clinicians, including nurses, have iPads. What’s more, our board is now paperless as well; the board members all have iPads and receive all reports in a paperless format. And most of the hospitals that attested early far exceeded the minimum core measures and parameters, and that was true for us, too. So I have all the confidence in the world we’ll make it to the next level as well. And I’ve got a great group of people who were willing to follow along and catch what really is, and a board that was really supportive.

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