Last month, in South St. Louis County, Mo., the Centers for Medicare & Medicaid Services (CMS) certified St. Anthony’s Medical Center as one of the first 78 hospitals out of 4,993 in the U.S. (top 2 percent) to attest to Stage 2 of meaningful use of electronic health records (EHR).
As the third-largest medical center in the St. Louis metropolitan area with 767 licensed beds serving a population of nearly one million people, it took a significant commitment and investment for St. Anthony’s to achieve Stage 2, says the medical center’s CIO, Jim Weldon. “We put together a pretty extensive team, which included providers, nurses, and IT operational folks to work through this journey. And it really is a journey from Stage 1 to 2,” Weldon says. “We were positioned very well to have the right talent in room to achieve Stage 2 requirements, as many of them build on Stage 1.”
For St. Anthony’s, the Stage 2 journey was completed when the organization attested in June, during the second reporting period in 2014. Included in the medical center’s Stage 2 results are: reaching 19 core objectives, which include processes such as automatically tracking medications electronically from order to administration; giving patients the ability to view online, download and transmit their health information within 36 hours after discharge from the hospital; recording electronic notes in patient records; making imaging results accessible through certified electronic health records technology (CEHRT); and recording patient family health history.
Two Tough Pieces
It’s no secret that many hospitals struggle with the view/download/transmit piece of meaningful use that requires at least 5 percent of a given provider's patients to be engaged in their own care either through an online portal or EHR. In fact, a recent study published in Health Affairs found that only 10 percent of hospitals have met the patient view/download/transmit criteria for Stage 2.
To get patients more engaged at St. Anthony’s, Weldon says that a care manager was assigned to every patient before they would be discharged. At that point, the full time equivalent (FTE) would introduce the patient to the portal, get him or her to sign up, and inform the patient on how to retrieve his or her information. “Having a dedicated FTE taking on that responsibility was a difference maker for us,” Weldon says. “And because it helped patients participate in their own care, it actually helped the providers too.”
The second piece of Stage 2 that gave St. Anthony’s trouble was the transition of care summaries, provided each time the patient moves along the care continuum. The Stage 2 requirement states that eligible providers and hospitals have to electronically send a summary of care document for 10 percent of transitions of care. Weldon says that the organization’s EHR on the inpatient side—the Verona, Wis.-based Epic Systems—was a big reason why St. Anthony’s was able to meet this requirement. “St Louis is a heavily saturated Epic market, so we were able to leverage the Care Everywhere tool with the other installs in St Louis to help reach that number,” he says. According to Epic, Care Everywhere provides a framework for interoperability, so that wherever the patient goes, the clinicians providing care can have the information they need.
Atop the EHR Mountain
Not only has St. Anthony’s become one of the first hospitals in the country to attest to Stage 2, but it also has achieved Stage 6 out of 7 levels of the Healthcare Information and Management Systems Society (HIMMS) Analytics EHR Adoption Model; Stage 6 and 7 recognition accounts for only 15 percent of U.S. hospitals.
According to Weldon—who says that the medical center moved rapidly from Stage 3 to Stage 6—much of the organization’s success can be attributed to the desire and commitment to maximize its investment in technology. “I think that EHRs have been around long enough that the adoption mountain has been climbed—most providers are accepting these digital tools in our environment,” he says. “Now it’s time to help providers get the best information possible at their fingertips to make the highest quality decisions no matter where patients are across the continuum of care. It’s less about adoption, and more about [leveraging] tools to treat patients more effectively,” Weldon says, adding that the next level is seeing what you can get out of your system from an analytics standpoint to help manage populations of patients.
As far as the low number of eligible providers and hospitals to attest to Stage 2 thus far, Weldon admits that it’s concerning. “It’s a concern to me that we wouldn’t have more hospitals attempting to do their attestation before the final reporting period,” he says. “I would think as a CIO, you would want that cushion. Now that hasn’t happened, and the cushion is gone.”
Additionally, Weldon thinks that the patient engagement view/download/transmit requirement is a piece that has snuck up on many organizations. “If you weren’t ahead of the curve with that, you were falling behind,” he says. “The bottom line is that if you’re getting into the game late on the EHR side, and you’re still climbing the adoption mountain, it’s going to be very difficult to hit these Stage 2 requirements.”With that said, Weldon believes that a large amount of hospitals will attest in the last reporting period, similar to what happened in Stage 1.
Weldon advises other patient care organizations to view meaningful use as a clinical quality project rather than an IT project. “Our view was that it’s a quality project to benefit our patients, and we really do believe that everything in these requirements benefits both patients and providers,” he says. Weldon does admit that it can get very overwhelming at times, though. “You only have so much capacity when you’re talking about ICD-10 requirements and everything else as well,” he says. “That’s why you need to keep your eye on the prize—it’s a team effort from IT to clinical, and keeping an eye on everything daily will let you be part of this elite group that we’re in.”