Stage 2 “Can Be Done,” says the First Critical Access Hospital to Attest

While the number of eligible providers (EPs) and eligible hospitals (EHs) that have attested to Stage 2 of meaningful use continues to lag behind, one rural hospital found a way to get it done.

Odessa Memorial Healthcare Center, is a 25-bed critical access hospital (CAH) in Odessa, Wash., a tiny hamlet located approximately 70 miles to the west of Spokane with a population of less than 1,000. According to Megan Shepard, R.N., clinical services director at Odessa Memorial, the hospital’s volume is so low that most of the managers oversee multiple departments and projects.

In fact, Shepard says the hospital doesn’t even have an IT department. Shepard was part of the electronic health record (EHR) team that has helped the hospital attest to meaningful use Stages 1 and 2. It also used outside assistance.  “INHS (Inland Northwest Health Services) was our IT department. They were the ones who have been doing our IT support for meaningful use and information gathering to reach the goals,” Shepard says.

INHS is a Spokane-based nonprofit corporation made up of member hospitals in the region that collaborate on services such as IT guidance. INHS has a division, Engage, which acts as a health IT software vendor to organizations like Odessa, providing EHR and meaningful use guidance. Engage has a partnership with the Westwood, Mass.-based Meditech, and administers the company’s clinical and finance software for end-users, especially at rural hospitals like Odessa.

Despite utilizing this kind of assistance, Odessa had its struggles. It still had to get patients to use its portal. This, Shepard confirms, was the hardest part of Stage 2, which requires EPs and EHs to have five percent of their patients view, download, and transmit their health data electronically.

Indeed, this seems to be what’s holding up most providers. A recent study by researchers, led by Julia Adler-Milstein, Ph.D. University of Michigan School of Public Health assistant professor of information, looked at adoption of EHR systems in hospitals since the enactment of the Health Information Technology for Economic and Clinical Health (HITECH). They found that a measly 10 percent of hospitals surveyed met the threshold for having patients view, download, and transmit their health information electronically. It had the lowest percent of adoption among every single Stage 2 measure by hospitals, just in front of the transitions of care measure.

“The hardest thing for us was getting patients interested in using the portal,” Shepard says. “The population we serve is elderly, many didn’t grow up using a computer, and many don’t even have email.”

This forced Odessa to recruit family members and directly engage with someone younger, especiallyif they had experience in using a computer. Because of the small staff, Shepard says it was easy to recruit providers and get them on board with this mission and the overall meaningful use project. In fact, she notes that a radiology technician calls ER patients every week and tries to see if they are interested in using the patient portal.

Despite this effort, it wasn’t easy to get past that five percent view, download, transmit threshold. Other meaningful use measures, Shepard says, were easier because it was simply building on top of Stage 1. Even the transitions of care measures weren’t as hard. “If you did [the other measures] well in Stage 1, it’s just a matter of the numbers increasing and the percentages increasing,” she notes.

Of course, for many, it’s more complex. In its most recent data release, the Centers for Medicare and Medicaid Services (CMS) indicated that 78 out of approximately 3,000 eligible hospitals have attested to Stage 2. Marcy Cheadle, R.N., the director of meaningful use and advanced clinicals for Engage, says that there is a lot up in the air in regards to Stage 2.

“From a pure canvas, check it off the list standpoint, Stage 2 is doable. However, from a can we make the information and usability case for clinicians and our patients meaningful, that’s yet to be determined,” says Cheadle. “We have a lot of work to do in analyzing information from Stage 2, particularly related to quality measures. We have a tremendous amount of work in understanding the transitions of care summary, the continuity-of-care document exchange, and quality data going to the federal government.”

Marcy Cheadle

Cheadle says Stage 2 attestations will continue to lag behind Stage 1 and predicts a number of sites are going to forgo the incentive dollars in 2014. In terms of the Stage 2 flexibility announced in May that is currently being finalized, she adds that “it came very late in the game,” especially for hospitals who run on a fiscal quarter. She also says it was a bit confusing in its wording and the lack of clarity may even get some hospitals to step back completely.

Naturally, this kind of uncertainty doesn’t apply to the tiny hospital in the tiny town of Odessa, Wash. They will march on and continue to take the meaningful use program one step at a time, says Shepard, who believes Stage 2 can be done.

“I don’t see why [the deadlines and requirements around Stage 2] are not fair,” Shepard says. “But it is a huge change and getting everyone used to the changes that are the requirements for meaningful use. Like I said, we’re a small hospital and can easily communicate with our clinicians. In these bigger health systems, I can see where it’d be a problem.”