Memorial Hospital at Gulfport Takes Meaningful Use Challenge in Stride By Richard Ferrans, MD, ScM
Vice President & Medical Information Officer
Memorial Hospital at Gulfport
Between the software upgrades, interrelated projects and an aggressive schedule, chasing meaningful use can make you feel like you’re being battered by a hurricane. For Memorial Hospital at Gulfport, the metaphor was all too real. When Hurricane Katrina slammed into the Gulf Coast of Mississippi in August 2005, we withstood the brunt of it and managed to keep our doors open. For two weeks, we operated solely on generators, providing not just emergency care but food, shelter and free prescriptions to thousands of evacuees.
Many people have forgotten that Katrina served as the catalyst for widespread adoption of interoperable electronic health records (EHRs). In 2004, then President George W. Bush created the Office of the National Coordinator by executive order, calling for “every American to have an electronic health record by 2014.” However, it was after the paper medical records of residents from Louisiana, Alabama and Mississippi were washed away by Katrina that momentum began in earnest.
Memorial already had many components of our EHR in place at the time, and they were up and running throughout the crisis. But because we couldn’t communicate with other regional providers, we still grappled with the lack of basic patient information. As a result of this experience, we’ve taken a leading role in launching the Mississippi Coastal Health Information Exchange (HIE), which I currently chair. Today, we can share patient lab results, radiology reports and discharge summaries with five other hospitals that participate in the HIE, as well as prescription information from retail pharmacies.
Working Together as One Team
Even though we had begun our EHR journey years earlier, meeting the American Recovery and Reinvestment Act (ARRA) Stage 1 requirements meant upgrading our inpatient and outpatient systems and installing an emergency department information system. To keep all the moving parts on track, we had to forge a much closer relationship with our vendor, McKesson, than we had previously experienced. Early on, we flew to Atlanta and met face-to-face to establish joint governance and begin working as one team.
By using McKesson’s ARRA Stage 1 tools, assigning adequate resources to each project and agreeing on accountability, we were able to meet the federal FY2011 reporting deadline for Stage 1 and successfully attested in early October 2011. We also kept three success factors in mind every step of the way:
End-user support. Given the need for so many clinicians to hit so many metrics using so many new solutions to achieve meaningful use, you can't overdo the amount of support you provide. We leveraged both McKesson and third-party resources, and it was well worth it. The volume of change has been hard for the medical and nursing staff to absorb, so we leveraged our goodwill IT ambassadors, as they have credibility with clinicians because of their past patient care experience. About five years ago, we started hiring nurses to provide clinical IT support. We still need to bring on more clinicians in order to provide 24/7 support, which I believe is the best practice.
Executive buy-in. CIOs are typically held accountable for meaningful use, but it’s clearly an organization-wide effort. The CEO, board of trustees and senior executives must agree on the goals and make that known. Without their support we could not have put the organization through the amount of rapid change that it withstood. Earning leadership’s buy-in required open and frequent communication.
Physician alignment. That open and frequent communication applies to our medical staff as well. We’ve been focused on our alignment strategy for some time and can speak frankly with each other. When we sat down to discuss the Stage 1 objectives, I told our physicians: “The more you squirm, the more it’s going to hurt.” Finally we came to an understanding. They said: “You make sure the systems perform and that we have enough support, and we’ll make sure we hit the metrics.”
The role of the IT department is to ensure systems are fast and reliable, not to guarantee a 30% adoption rate for computerized physician order entry (CPOE) on medication orders. It’s tough to maintain productivity with objectives like medication reconciliation, but the clinician sees the value of a much safer discharge process. Even though medication reconciliation is one of the more challenging menu objectives, we decided to move forward with it because it involves CPOE. Our CPOE adoption rate was low, and we saw it as an opportunity to retrain physicians.
On to ICD-10
You can look at meaningful use as a freight train, with ICD-10 barreling along behind it on the same track. When we saw what was necessary for each, we decided to tackle them sequentially. With ARRA Stage 1 behind us, we can devote 2012 to ICD-10 and other projects, like automating physician notes. We survived Katrina, and it made us tougher. Thanks to ARRA, we have matured. If we can do this, so can you.
Richard Ferrans, MD, is the vice president and medical information officer for Memorial Hospital at Gulfport (MHG). Dr. Ferrans is a board-certified internist trained at Tulane Medical School and George Washington University Medical Center. He was an Assistant Professor of Medicine and Public Health at LSU Health Sciences Center and Chief of Medical Informatics and Telemedicine for LSU and the Charity Hospital System. Dr. Ferrans has served as a consultant to the Department of Veterans Affairs and has also worked with the Department of Defense on health information systems. Dr. Ferrans served as a staff member of the National Committee for Vital and Health Statistics (1998-2000), which oversees HIPAA and health data policy.
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