Nurses charged with helping their hospitals meet ?meaningful use? standards for electronic health records say that while they think the federal timeline is aggressive, their staffs are on track to meet the deadlines and qualify for incentives.
Meeting ?meaningful use? is a way to ensure that beyond just implementation of EHRs, hospitals are using the system to improve patient care and outcomes. Phase 1, which focuses on capturing and sharing data, requires clinicians to use e-prescribing and computerized physician order entry processes. Phase 2 focuses on advanced clinical processes, and phase 3 looks at meaningful use of an EHR in the context of improved healthcare outcomes.
The stakes are high in getting the funds. A 275-bed hospital, for instance, stands to gain about $6 million of the $27 billion set aside for incentives over 10 years.
The requirements are particularly tough for smaller hospitals to meet since they have smaller budgets and fewer resources to dedicate to EHRs.
The nursing staff at the 180-bed New York Downtown Hospital in Lower Manhattan, for instance, must find ways to make sure patient care isn?t compromised while staff members get training and nurses are pulled off the floor to help build data screens and implement the new EHR system they purchased last year to meet the federal requirements.
?One of the first things everyone at every level has to do is take nine hours worth of modules on learning the new system,? said Leah Borenstein, RN, MPA, CNOR, director of nursing and patient care services. ?Where does a nurse manager find nine hours without being interrupted by phone calls or issues on the floor?? She said the hospital is on an 18-month conversion schedule and set a personal target date of October 2011 to meet meaningful use. That would make it eligible to apply for incentives within the qualifying window for stimulus dollars.
Final rules for qualifying for the money, which was made available by the American Recovery and Reinvestment Act of 2009, were released July 13. That version ? which can be reviewed at www.cms.gov/EHRIncentivePrograms ? relaxed some of the rules proposed earlier this year after complaints that they were far too rigid.
Hospitals that demonstrate they have met phase 1 requirements for capturing and sharing data, e-prescribing and CPOE for ?meaningful use? may be eligible to apply for stimulus money starting fiscal year 2011 (which begins Oct. 1 of this year). In 2015, bonuses turn into penalties for not meeting the requirements.
[caption id="attachment_" align="alignright" width="195"] Maureen Gaffney, RN[/caption]
A rush to make the changes to get the stimulus money quickly worries Maureen Gaffney, RN, RPAC, PA, chief medical information officer for Winthrop-University Hospital in Mineola, N.Y. At Winthrop, electronic conversion started five years ago and changes have been made methodically with multidisciplinary input.
?My biggest fear is we?re going to have vendors capitalizing on (the deadlines) ? presenting systems that are touted as a plug-and-play and without a true assessment on how this system will support your work flow and how you take care of patients,? she said. ?You can?t have the tool dictate the process. The tool should support the process.?
Borenstein said it?s important for the liaison to the vendor to be strong in terms of setting a timetable and getting across what the hospital needs the system to do.
?Our vendor tried to get us to do it in a year, but we had to push for 18 months to do it the right way,? Borenstein said. ?Don?t let someone tell you [that] you only need two trainers on-site when you know you need four, for instance.?
Gaffney also worries that changes made quickly could lead to errors. ?It really is good technology, but if you?re not diligent in maintaining quality assurance, it could potentially create new errors,? she said.
She gave an example of being one decimal point or milligram off on a medication dosage by hitting an incorrect key. If time hasn?t been devoted to installing a safety mechanism to flag the error, she said, patients could receive a dangerous dose.
Nurses say these are some of the reasons that nurses? input from design through every stage is critical to the success of a system.
[caption id="attachment_" align="alignright" width="195"] Clare Cruz, RN[/caption]
At Trinitas Regional Medical Center in Elizabeth, N.J., Hana Baudendistel, RN, BSN, CNA, and Clare Cruz, RN, MSN, have been liaisons between the clinical departments and the IT department in achieving meaningful use.
?We have both been here more than 20 years,? Cruz said. ?And we were former nurse managers so we understand the clinical part and we can see where the problems in the system are.?
Nurses at Trinitas helped design the system and have been involved every step of the way.
?User input is critical to implementing any information system,? Baudendistel said. ?That?s where many organizations fall short ? they don?t include their users during design and implementation.?
[caption id="attachment_" align="alignright" width="195"] Jayne Daube, RN[/caption]
Jayne Daube, RN, BS, MSN, is director of information technology clinical systems at St. Peter?s Healthcare System in New Brunswick, N.J.
She said St. Peter?s is well-positioned to meet phase 1 and phase 2 requirements. Administrators there decided to get a new system rather than manipulating the current one. The current system is able to meet the meaningful use requirements, she said, but they are replacing the new system in October to better handle the robust reporting measures the new rule requires.
That?s the downside for facilities that have been early adopters. They purchased systems before ?meaningful use? existed. Now they must adapt the old system or buy a new one. Because no hospital has yet been certified for meaningful use, the playing field, for the moment, has been leveled.
This is a chance for hospitals to design a system that enables uniform coding for sharing data, with patients? permission, with other providers while also supporting the individualized workflow needs of a particular hospital. Daube gave an example of collecting vital signs. If a facility?s rooms are small and hand-held devices aren?t affordable, nurses probably work around the problem by writing down the numbers, sticking them in a pocket and eventually entering them into the system, she said. The right system will eliminate the workarounds.
?An electronic system should truly support the way a clinician practices,? she said.
