First REACH Clients Attest to Meaningful Use

Congratulations to Glacial Ridge Health System and Northfield Hospital and Clinics

"Exhilarating" is how Heidi Engle, CIO for Glacial Ridge Health System, describes the feeling of having completed the attestation process for the 19-bed critical access, trauma hospital in Glenwood, Minnesota. Cindy Grolla, clinical informatics director for Northfield Hospital and Clinics, a 37-bed hospital, describes attestation as "a big relief."

"The attestation process is pretty simple," said Engle. "My greatest surprise was that it went smoothly." The meaningful use report provided by its EHR made assessing progress toward attestation easy. Glacial Ridge’s Meaningful Use Committee met weekly to review the report, then shared concerns with the entire staff. The report served as a learning tool for all of the staff to identify where documentation did not meet the meaningful use objectives.

When the report indicated that Glacial Ridge did not meet a measure for a patient, staff would review the records to see why. If a nurse was not charting appropriately, someone would follow up with the nurse to make corrections and conduct additional training if needed. "We also watched the report to make sure the patients that were hitting the report were appropriate, such as an inpatient that hit the report for the VTE 1* measure indicating no prophylaxis within 24 hours of arrival. If we looked up the admission and found that TED stockings had been ordered or the appropriate medication had been administered within the 24 hours, then we knew we needed to correct something in our setup," said Engle.

"During the first 30 days we had numerous corrections," noted Engle. "After that, it was little things here and there as staff learned how to use the system correctly." When Glacial Ridge saw that its percentages for meeting meaningful use criteria were always above where they needed to be, the hospital knew it was ready to attest using its last 90 days, referred to as the 90-day attestation period.

"Our biggest concern going into attestation was not knowing what to expect. Nobody had been through it before," said Engle.

Video of Glacial Ridge Event

Northfield picked its attestation start date to be two days after the hospital implemented computerized physician order entry (CPOE), discharge routines, and documentation needed for the quality measurements. “Northfield Hospital has been planning since early 2010, when we reviewed the interim rule. Communication and project planning included almost every department in the hospital. Our percentages have stayed high since implementation, so we knew we could attest,” said Grolla.

One of Northfield’s challenges in getting to attestation was using the best practices defined by its vendor. "We had to use the processes and system build outlined by the vendor in its documentation instead of processes that we had already developed to meet the requirements," said Grolla. "The functionality available from our vendor did not meet our providers' expectations, which caused some frustration with implementing required documentation and orders."

Both hospitals found the Centers for Medicare & Medicaid Services (CMS) guidebook helpful, with its examples for each attestation question.

Obtaining the CMS EHR certification ID number can be tricky if your EHR system is made up of multiple products. When Grolla went to the Certified Health IT Product List (CHPL) website to obtain Northfield Hospital's unique CMS EHR certification ID number, she had to investigate how to add four products into the shopping cart. "I couldn't figure out how to fit into one field the four product numbers for the different vendor products that make up our EHR."

Glacial Ridge used its EHR's meaningful use report to enter its results into the CMS system. "Once we got in there, we discovered that we needed additional information that wasn't included in the meaningful use report we had. We had to run a different report out of our financial system to find the information." Glacial Ridge followed up with its vendor so it can make improvements to the reporting pieces in the meaningful use portion of the EHR. Engle also will share information about the attestation process on the next MN/ND Regional User group call, organized by providers with the same EHR product.

"We plan to have a week-long celebration in September," said Engle. Glacial Ridge is used to celebrating. Nearly every quarter it has an EHR celebration, with team building activities and games and of course there's tons of food. "There will always be something to celebrate with EHR. There are always new features and new ways to use it more effectively."

Tips

• Delegate a meaningful use expert in your facility to be the go-to person for meaningful use and to do the meaningful use setup within the EHR and make tweaks to it.
• Review the relevant CMS Attestation User Guide
• Do a dry run using the CMS pretest, Meaningful Use Attestation Calculator
• Use the meaningful use report in your EHR or log your meaningful use measures into the CMS Eligible Hospital and CAH Attestation Worksheet to use as a reference when attesting for the Medicare EHR incentive program in the CMS system.
• Obtain your CMS EHR certification ID number for incentives online by identifying all of your EHR products. ONC CHPL EHR Certification IDs (the product numbers) are one of the inputs into the calculation that creates the CMS number.
  • You must meet 100% of the required criteria to obtain a CMS ID number. Even if some modules may not yet be needed for Stage 1 MU, you need to have purchased them.
  • If multiple products make up your EHR systems, use the “Return to Search” link to add another product to the list of products in your cart, on the ONC CHPL website. See screenshot below.
• The CMS attestation system times out after five minutes—have all of your information ready.
• Because Medicare can audit up to six years after attestation, print out reports or save screen shots of your system setup just prior to attesting.

* VTE - Venous thromboembolism prophylaxis within 24 hours of arrival