Meeting Meaningful Use: Community Hospitals Shouldn't Lose Sight of Stage 1

With the release of the stage 2 meaningful use final rule, there is a lot of focus on meeting meaningful use — both stage 1 and stage 2. While some hospitals may begin to focus on stage 2 now, other hospitals and providers still need to attest to stage 1. According to Elizabeth Holland, director of health information technology initiatives for the office of e-health standards and services under CMS, the challenge going forward is to not lose sight of stage 1.

"I know providers are interested in stage 2 moving forward, but everyone starts in stage 1. Our focus is continuing to get [hospitals and providers] to stage 1 and then, moving them to stage 2," says Ms. Holland.

For a variety of reasons, some hospitals delayed initiating meaningful use stage 1. They may have been uncertain as how to proceed, lacked funds and the support or were told by consultants to delay the process until stage 2 was released. Whatever the reason, now that stage 2 has been released, those hospitals should begin planning their meaningful use process. However, the barriers of time, money and support may still exist.

"Smaller community hospitals do not always have the money for the resources that are typically needed to independently meet [meaningful use] requirements," says Sheri Stoltenberg, founder and CEO of Stoltenberg Consulting, a healthcare information system consulting firm. "In addition, hospitals do not always know the best process to implement software and information systems for meaningful use. A lot has been done to improve software, but the difficulty is that everyone implements it in the same way. It's a long, drawn-out process. [Smaller hospitals] do not have the resources for a lengthy implementation," she says.

How to "ACHIEVE" meaningful use

In order to move small community hospitals forward on the path to meaningful use attestation, Stoltenberg Consulting created ACHIEVE, which stands for Accelerated Community Hospital Implementation, Evidenced-based, Effective. The program was launched earlier this month. According to Ms. Stoltenberg, ACHIEVE was created to help hospitals with limited or non-existent resources — funds, equipment, staff, software and in-house expertise — achieve meaningful use by minimizing their obstacles and removing risk.

"Within ACHIEVE, [Stoltenberg Consulting] created the order sets needed for a typical community hospital. Think of ACHIEVE as a Windows drop down menu. You choose this or this. You get multiple choices, but you don't have to go through that entire design process," says Ms. Stoltenberg. "If you look at ACHIEVE at a glance, it is assessment support planning. [Hospitals] have the ability to move through their information system designs very quickly," she says.

According to Ms. Stoltenberg, community hospitals need to increase the efficiency and effectiveness of their information system implementation so they may accurately meet meaningful use requirements within a reasonable timeline. For instance, the hospital should be able to implement health information systems on a clinical as well as financial level. For community hospitals to streamline implementation of the technologies and information systems needed to meet meaningful use, the following elements should be included.

• Built-in order sets and clinical documentation;
• Standards-driven processes; and
• Evidence-based content.

Ms. Stoltenberg also recommends creating comprehensive implementation teams with experienced advisors; standardizing a process to share updates, setbacks and overall progress with executives; and utilizing a reporting method that streamlines the executive approval or assessment process. Something as simple as color-coded reports could help executives make meaningful use implementation decisions easily.

"[A hospital] could use red, green and yellow reports. Green would be ready, yellow is elements you have to work further on and red would be things that have fallen behind and need attention. The executive office likes to look at things in this way — you make it simple and quick for them to make decisions," says Ms. Stoltenberg.

In order for hospitals to overcome the barriers to meaningful use, they need the right tools. Certain programs can streamline implementation of information systems to nine months instead of two to three years, according to Ms. Stoltenberg. In addition, when collaboration among administrators and executives is easy, decisions are made effectively so implementation phases can begin and complete efficiently. When the implementation process is streamlined, hospitals utilize fewer resources and save money — they move forward with meaningful use.

More Articles on Community Hospitals Meeting Meaningful Use:

6 Highlights From CMS' Final Stage 2 Meaningful Use Rule
8 Lessons Learned from Hospital Executives on Meaningful Use

Meaningful Use of Electronic Health Records: Does it Improve Health Outcomes?

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