Last night Cerner managed a major upgrade to its Community Works clients. As our brave employees huddled over their computers, validating the upgrade at 1:30 a.m. this morning, it occurred to me that we are a lucky crew to have selected the ASP model for our EHR solution.

Yes, sharing the domain can be frustrating when we request a change that impacts other clients in the shared space … but it is also nice when other clients have suggestions that benefit us.

Yes, it would be nice to have an IT department onsite to handle all this folderol and hoopla instead of our registration clerk, lab manager, financial manager and night nurse … but then we would have to recruit, pay and keep happy a highly skilled employee in a very rural area of the country.

Yes, frustration levels increase when changes are implemented in the domain … but then again, our software is up to date on Cerner’s dime, all the time. We don’t have to keep current on patches and updates to the system like we would if we had the software installed on our own servers.

We recently participated in our 21^st reference event since going live January 2011. These events can be phone calls, emails or site visits from other health care organizations considering Cerner as their EHR partner. We answer questions, connect their employees with peer employees at Syringa, and share the good and the frustrating with them.

Syringa’s employees focus on providing quality patient care and service, so it is sometimes hard to see how far we have come on this journey. With HIMSS 6 and Stage 1 Meaningful Use Attestation under our belts, we are a model implementation; but now we have the basics under our belt, we strive for ways to better serve our patients.

Dare I mention our old friend, Alice in Through the Looking Glass? She spent some time with the White Queen – the Queen who practiced believing as many as six impossible things before breakfast. This Queen had a fantastic memory, one which roamed toward the past, but also into the future. She could remember things that had not happened yet, and found Alice’s memory “a poor sort that only works backward.”

If backward memory is experience, then forward memory is anticipation. We must anticipate what our patient’s need, the health care sector will require of us, and the economic factors that affect the bottom line.

This is where we are now. We have plenty of backward memory. It is time to move into forward memory mode: anticipating improved patient outcomes by making use of our EHR experience and information.

Here’s an excerpt:

A San Francisco cable car holds 60 people. This blog was viewed about 3,300 times in 2011. If it were a cable car, it would take about 55 trips to carry that many people.

Click here to see the complete report.

We pushed the “SEND” button on our Meaningful Use attestation this morning, September 16, 2011. This is a historical event – we are the first hospital in Idaho to so attest.

The reports and documents will go to Medicare, who will then determine if we are using the EHR in a meaningful (according to them) manner. See the PDF of our Dashboard, produced out of Cerner.

The effort to reach this milestone has proven exceedingly meaningful for us. Our patient care provision, workflows and development of consistent data entry processes attests to that fact. And the data we retrieve from the system is valuable in improving patient outcomes and safety, and may help us in developing new service lines.

On another note: A group of top notch folks from Cerner visited their Idaho clients this week – North Canyon Medical Center in Gooding, and Syringa Hospital & Clinics.

We focused most of our day long meeting on the frustrating and outstanding issues in the Pro-Fit module – billing, claims, charges – mentioned in the last post. Cerner’s team listened attentively and solved several of the workflow puzzles for us. They took notes on areas to investigate from their programming and engineering perspectives. Viv, our Patient Financial Services Manager, and her staff were encouraged by the visit, and look forward to working with Cerner’s team to help improve the product.

This was a win-win meeting. Cerner has the resources needed to make their outstanding EHR system exceptional. This meeting provided them with input on how to do just that from their clients’ perspective.

The win for us: a reminder that Cerner is a terrific partner for Syringa in our endeavor to improve quality, safety, service, and value for all our patients.

And another FIRST to report for Syringa: We are the first and ONLY hospital in Idaho to reach HIMSS Level 6 (out of 7). We received our letter from HIMSS Analytics in July, and at that time, we were one of 229 hospitals in the world to share this achievement. Here is an article Joe, our CEO, wrote about the award and what it means to our patients.

Things continue to move along in EHR Land.

THE GOOD:

Our proficiency level continues to rise all across the organization, our efficiency continues to increase, and our overall comfort and satisfaction with the system is good.

In a phone call last week we were awarded the HIMSS 6 designation, the first hospital in Idaho to receive the honor, and one of the very few Critical Access Hospitals in the nation to do so. For more information on the designation, go to www.himssanalytics.org.

THE BAD:

The last difficult solution area continues to be Cerner’s ProFit – billing, claims, charges, etc. I believe our difficulty is the result of an incomplete training cycle. It is impossible to train on or test a refund interface when there are no refunds in the system yet. Revenue takes a few weeks to begin generating, but Cerner was long gone before the dollars began to roll in.

Rumor has it that Cerner has corrected this problem for later clients, returning to train in the ProFit area weeks after Go Live, but we continue to struggle. We are no longer part of an implementation – those folks moved on long ago. Our new Cerner team is focused on “issues” and “problems”, not education.

All we need is a Cerner trainer out here for a day or so, and I keep thinking, “How hard can it be, people?”

THE REALLY AWESOME!

Meaningful Use is practically in the bag now, too, which means lots of happy dancing on this side of the planet! Sue sent around an email with the Team Awesome T-shirt this morning, commending everyone from physicians to nurses to registration and HIM folks on their hard work and effort. We ROCK!

The Problem List has been our biggest challenge and the medical, nursing, and coding staff came through as a team to bring us over the line at 81% this morning! The threshold is 80%.

We must maintain meeting criteria for every MU element for the entire 90 day attestation period. We are monitoring daily to assure we are holding the line, and will select the 90-day period that achieves this. Our do or die beginning 90-day date is July 3.

We will be using a new feature in Cerner to track the required quality measures (seven stroke and five venous thrombosis prevention measures). There are no thresholds for these measures in Stage 1, we just need to show that we are able to track this data within the EHR and use the data to work on quality. In Stage 2 MU and beyond we will be required to submit the quality data to CMS electronically.

There are a few elements that require work on Cerner’s end:

• Vital signs tracking is not displaying outcomes (domain wide issue)
• Cerner is still working on setting up a system to give us the ability to provide electronic copies of discharge instructions and medical records upon request – this represents two core measures
• Sometime during the attestation period Cerner will conduct an exchange of our data with another Cerner client to demonstrate the ability to do so
• Cerner is building an interface to allow us to download immunization data directly into the State of Idaho’s immunization registry

While we still have a lot of work to do to make MU, we are Well Ahead and leading the way for all hospitals in Idaho, and especially those in rural areas.

Life’s a dance you learn as you go,
Sometimes you lead, sometimes you follow.

Our dancing partner is Cerner, and our music is Meaningful Use. Both are in place, but the choreography is not yet complete. Our knowledge and understanding of MU are emerging, as we both attempt to keep up with the heart of the legislation leading this effort.

And just like the song says, sometimes Syringa leads Cerner into a better understanding of how their product works in the “real world”, and sometimes Cerner leads us to look at our process and work flows in new ways. We are truly learning what Meaningful Use means, and the process to achieve it, as we go along.

Fortunately for Syringa, we have our Director of Quality and Risk Management leading the MU effort. Sue has spent many hours with nursing, registration and medical records staff to help them determine the best work flows and processes for patient care which also populates the required MU reports from Cerner. An avid process improvement professional, Sue has identified significant improvements for Syringa as well as for Cerner.

On Cerner’s side is a team of people who sit on Federal advisory boards and attend Capitol Hill meetings, then return to Kansas City and analyze their software code, develop reporting tools and support clients in rural Idaho, like us. We couldn’t ask for a better partner.

According to Dürer, and paraphrased here, usefulness is an element of Beauty, and, therefore, what is of “no use to man” is not beautiful.

Wow. Is it possible that Meaningful Use, a phrase coined by the Federal Government, best known for obfuscating truth with effluent verbiage, may be, according to Dürer’s estimation, true Beauty?

From my perspective, caring for humans is definitely an art form, beautiful to observe, whether the care is from teachers, beauticians, parents, or health care providers.

Care, as an action, takes not only skill, but also a bit of magic, some mind reading, acute observation skills attuned to what is obvious and what is not, and just the right dose of assistance and coaching to get to the goal.

Meaningful Use, will require the same.

Yes, we need to employ our skills learned in years of medical and nursing school to care for our patients. But we also need to understand and observe the data we collect within the context of our community and its health goals.

This will move us toward true Beauty that is eminently Useful and the ultimate goal of Meaningful Use: improved health for everyone.

What is Meaningful Use? According to the U.S. Government, Meaningful Use (MU) requires that medical providers show that they are “using certified EHR technology in ways that can be measured significantly in quality and in quantity.”

The current MU definition includes an extensive list of objectives which hospitals and physicians’ offices across the nation are required to meet. Each subsequent year, the criteria increase or additional are added so that, once on the MU track, an organization continues to make significant strides in improving patient care.

Syringa, now live with a fully integrated and certified EHR, intends to meet Stage 1 MU by October 1, 2011. To do this requires significant care and feeding of the EHR, the employees who are responsible for using the system, and the team spearheading the effort.

To make Stage 1 MU by the deadline, we will need to meet 14 Core objectives and 10 additional “menu” objectives. Not to bore you with these but they include collecting demographic data, placing medication orders electronically, plotting BMI, checking allergy and medication interactions and a whole lot more.

Luckily, Cerner, our EHR partner, is on the leading edge of this work. We have a MU team from Cerner that meets with us weekly, advising us in the development of policies and procedures, demonstrating the best ways to use the EHR to provide required measurement data, and keeping watch on this fluid area of Federal legislation.

Once we make MU, we will be eligible for significant incentive funds from Medicare to pay for the implementing the EHR.

All this just to document that Syringa Hospital and Clinics is an excellent healthcare provider in Idaho County, which WE already knew.

The really good news in all of this? Everyone wins, and personal health and wellness is improved for everyone who comes through our doors.

At the time of this narrative, Syringa has been live with Cerner for about ten weeks. All of the planned clinical and financial solutions have been implemented. Syringa is remote-hosted in Kansas City, MO and has an Application Management team that coordinates and performs adjustments to the software build for the Syringa team as they are identified. The original project team continues to manage some remaining issues and to address some needs that pre-date the support team.

As an Engagement Leader who has had the privilege to manage projects overseas and in the US over the last four years, the project at Syringa has provided me an opportunity to reflect on several levels of detail and performance. While many small hospitals may be intimidated by a project of this magnitude, the level of preparedness and the overall ‘we can do it’ attitude at Syringa has been fantastic. The hospital team listened to the experiences and Best Practices of others and incorporated relevant pieces into their newly transformed way of working. The staff at the hospital are a hard-working and knowledgeable group, and it’s common for each staff person to perform multiple functions (‘wearing many hats’). They also have a sense of humor about such things as the ‘Night Before Go Live’ poem can attest.

As with all projects of this type, it has been a learning experience for everyone involved, including the Cerner team. The town where Syringa is located (Grangeville, ID) is the county seat and serves as a hub in their area. A project of this type requires a lot of person-to-person coordination and communication; the fact that Cerner and Syringa are located 1,592 miles apart can make that a difficult process. Weekly calls with each specialty area to verify specifications, details, and to transfer solution knowledge kept the teams in contact with each other. Periodic onsite events (known as a ‘Cerner Invasion’) formalized many of those decisions and provided face-to-face opportunities to adjust course where needed.

There were bumps in the road—the financials portion of the project did not go as quickly as everyone would have preferred and decisions to delay implementation (Go Live) were ultimately the correct ones. In the end, Syringa had one of the smoothest conversions that I’ve been associated with. While it would be nice to take some credit for that, it’s not a reflection on the Cerner team—it’s a reflection on the Syringa team. Testing, testing some more, and testing (yet some more) helped them to not only have a better-prepared build but also to have a better-prepared team. Those results are evident each day as they become more proficient with their use of the EHR, as their questions become ever-higher quality, and as they identify the ‘next direction’ that they and their Critical Access Hospital colleagues need.

It will be a bit sad to move on to other assignments, but it certainly has been an enjoyable experience with the team in Grangeville. And we (the Cerner Syringa team) are confident that there are future chapters in learning and growth both for the client team and for our team. Congratulations to the entire Syringa team, you should be very proud of your achievements.

On February 2 we will celebrate ourselves and all that the Syringa staff have done to make this transition as smooth as possible. I ran some statistical reports out of Cerner today and, if they are correct, we have done some serious patient care while in the midst of this transition.

In fact, seeing the data coming out of the system is very exciting. We can see the number of patients by medical service, by attending physician, by diagnosis type. We can find an average Length of Stay in the ER, if height/weight is in the normal range, and if patients are receiving tobacco cessation counseling.

Patients seem to be enjoying the data they can see in their charts, too. When they visit their providers at the clinic they are eager to see their chart on the computer. They ask great questions and we are confident that, as they gain knowledge about their own health, they will become a key team members in the care of their health.

Thanks to all our patients for their patience, and their wonderful support for this effort. Keep your fingers crossed as we begin sending out bills and receiving payments from health insurance companies and Medicare.

And feel free to post any comments, good or not, here on the BLOG. Let us know what you are thinking and experiencing as we go through this major change in processess. We’d love to hear from you!