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Keys to EHR Success

April 22, 2011
by Ann Fagan-Cook and Patrick Murfee
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How Two Rural Health Providers are Meeting the Challenges of Meaningful Use

Rural healthcare organizations are accustomed to feeling a lot like David, worried that their relatively small size precludes them from taking on large challenges. Certainly, as the healthcare industry struggles with the challenges associated with achieving the meaningful use of electronic records required to receive financial incentives available through the American Recovery and Reinvestment Act (ARRA), rural and community healthcare organizations are once again feeling the pain of dealing with a Goliath-like challenge.

To receive their share of the $27 billion-plus available through the stimulus bill, healthcare organizations must comply with a detailed set of requirements. Those standards are designed to ensure that organizations not only install electronic health records (EHRs), but also use them in a manner that produces meaningful data and ultimately significant results.

The challenge has resulted in much trepidation throughout the industry. Many industry leaders are worried that organizations simply won't have what it takes to meet the requirements, which are considered to be somewhat demanding.

Rural hospitals, with their limited financial and operational resources, are experiencing even more panic, as these organizations typically are not as far along in their information technology implementation journeys. Consider the following: among hospitals with fewer than 100 beds, only 4.9 percent have implemented an EHR compared with nearly 16 percent of hospitals with at least 400 beds, according to a study published in the New England Journal of Medicine.

Louis Wenzlow, director of health information technology at the Rural Wisconsin Health Cooperative, based in Sauk City, points out that because small and rural providers are starting at the low stages of EHR adoption, these providers will be less likely to meet the meaningful use requirements and least likely to access incentives and avoid penalties.

According to the National Rural HIT Coalition, Duluth, Minn., small hospitals face an uphill battle because:

  • The 2011 meaningful use draft requirements roughly correspond to reaching Stage 4 of the seven-stage Healthcare Information and Management Systems Society (HIMSS) Electronic Medical Record [EMR] Adoption Model. Critical access and rural acute care hospitals average 1.2 on the HIMSS EMR Adoption scale, whereas general medical-surgical hospitals average 2.5.

  • A reasonable time required for any hospital to implement from Stage 1 to Stage 4 is three to five years.

  • Many critical access hospitals and rural acute care hospitals will be required to essentially start from scratch after determining that their existing vendors will not provide what's needed to reach meaningful use.

  • Critical network infrastructure issues need to be addressed just to get an EHR running.

Small in Staff, Nimble in Implementation: Parkview Hospital

Although many healthcare leaders fret over how they will meet all of the government's requirements for meaningful use, I simply believe that we will meet the requirements. Why? It's the right thing to do. And, throughout my career in healthcare, I've adhered to a pretty simple philosophy: If you do what's right, you will improve care.

With this philosophy in place, we started on the EHR path here at Parkview long before the government added the ARRA financial incentives to the mix.

As a matter of fact, when I took over as CEO here about eight years ago, I suspected that technology could help move the hospital forward. To start, when I initially came on board, patient medication errors averaged about 4 percent. Nurses at our critical access hospital dispensed medications to patients, and a traveling pharmacist was on-site only eight hours a week.

To me, it was obvious that we needed to change. So, we started using a remote pharmacy service and implemented an automated pharmacy management system, and subsequently drove our medication error rates down to less than 1 percent.

Such results whet our appetite for more. After speaking with my chief nursing officer and business office manager, we all agreed that we needed to pursue a comprehensive EHR. More specifically, we felt that an EHR could help us in our mission: providing high quality care to the members of our rural community. Although initially expensive, we thought that an EHR was a sound long-term financial investment, as the efficiency and quality results could eventually help us lower costs and realize a positive return on our investment.


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