First-Day Attestation: Pam Crawford, R.N., Ph.D.

June 25, 2013
The Mansfield, Ohio-based MedCentral Health System, a 351-bed system that consists of a main community hospital and a critical-access hospital (MedCentral Mansfield Hospital, Mansfield, and MedCentral Shelby Hospital, Shelby), is the largest health system between Cleveland and Columbus. Pam Crawford, R.N., Ph.D., the health system’s vice president of nursing and social services, spoke recently with HCI Editor-in-Chief Mark Hagland regarding her organization’s preparations for attestation, and confirmed on April 18, the first day that attestation of the fulfillment of the Stage 1 requirements for meaningful use under the HITECH Act was possible, that her organization had completed the process.
The Mansfield, Ohio-based MedCentral Health System, a 351-bed system that consists of a main community hospital and a critical-access hospital (MedCentral Mansfield Hospital, Mansfield, and MedCentral Shelby Hospital, Shelby), is the largest health system between Cleveland and Columbus. A customer of the Malvern, Pa.-based Siemens Healthcare, MedCentral chose to implement Siemens’ solutions comprehensively across its enterprise.Pam Crawford, R.N., Ph.D., the health system’s vice president of nursing and social services, spoke recently with HCI Editor-in-Chief Mark Hagland regarding her organization’s preparations for attestation, and confirmed on April 18, the first day that attestation of the fulfillment of the Stage 1 requirements for meaningful use under the Health Information Technology for Economic and Clinical Health (HITECH) Act was possible, that her organization had completed the process. Below are excerpts from their recent interview.How did you successfully achieve attestation on day one of live attestation capability?Our advantage point was having a vision and a strategic plan on information technology, across the inpatient and outpatient spheres, including physician offices. So we were already well ahead of the game when the meaningful use requirements became known. In fact, we had spent quite a long time making that selection, and a big part of the selection was having an integrated system and not a lot of standalone systems. In the physician office sphere, we’re a customer of NextGen [the Horsham, Pa.-basedNextGen Healthcare].NextGen is aligned with the Siemens products, so it’s just been a really great flow. The metrics and outcomes have been very exciting. We started our 90-day timeline December 7.
Pam CrawfordWhat was your basic process?We started with a list of the core measures, and the menu. Then we looked at that core list, with Mike Mistretta [Michael Mistretta, vice president and CIO of MedCentral], nurses, physicians, clinicians, non-clinicians, and we just went through the menu items and chose. We used a color-coded system to indicate readiness—green, yellow, red. And using that system, we were able to define the seven menu items among the measures from the menu that we thought we could most feasibly hit. We’ve achieved all the menu and mandatory items. The menu items we focused in on including those around drug formulary, advance directives, and clinical lab test results, among others.Our biggest challenge has been in providing the electronic copy of the patient record to patients. We’re not initially offering that outright; we’re going to provide it if they request it, and that’s the criterion. In terms of medication reconciliation, we’re one of the leaders of that [among Siemens customer organizations].In terms of the core requirements, we’re well over 30 percent on CPOE [computerized physician order entry]; in fact, our hospitalist group is at 100 percent on CPOE. And we’re ready in terms of drug-drug and drug-allergy alerts, which we already had in place, and patient demographics. We’re ready in terms of problem lists, though being ready in terms of up-to-date problem lists was one of the most difficult requirements to achieve.Why was that requirement more difficult?We currently have a plan of care that is nursing-oriented. And, for example, if it’s necessary to note a mental status change for a patient, we weren’t in the place yet where the notation of that change could trigger actions, because that was the one element that was still paper-based. We had to rework that process in order to make the workflow harmonize with the set of tasks around patient assessment with regard to that particular element.What lessons have been learned, and what would your advice be to CIOs, CMIOs, and other IT and clinical informaticist leaders?Focus, focus, focus! Prioritization, having the right people driving the bus, and constantly doing your checks and balances, are all important. We have constant meetings to check in on progress, with a green/yellow/red system, like a dashboard, with tools, and we’re also constantly checking in with Siemens.We just had a Joint Commission site visit. And I said, I can’t wait ‘til they come. Because I felt that our technology was driving performance and outcomes. And they commented to us that they had never seen such excellent clinician documentation. And mind you, three years ago when they were here, we were just a mishmash. And this time around they commented that they had visited other Soarian clients, and they had not seen this high level of documentation.Do you have any special message for CIOs and CMIOs?I would say, embrace the challenge. And keep the focus. And this is all about our patients—all of this [meaningful use] is so that we can have a network and framework for bettering care for our patients. And don’t see this as something to financially survive.

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