Kanabec Hospital Prepares for Meaningful Use

Recognized as first critical access hospital in the nation to reach stage 6 designation

With an eye on federal incentives and a commitment to embracing technology to support care delivery, Kanabec Hospital knew it needed a complete electronic medical record (EMR).

The hospital has been aggressively adopting health information technology (HIT). Through benchmarking, Kanabec Hospital learned that it is among the leading hospitals in the nation with regard to its EMR use. It was recognized for achieving Stage 6 designation for excellence in EMR adoption, through the Healthcare Information and Management Systems Society (HIMSS) Analytics. It is the first critical access hospital (CAH) in the nation to achieve Stage 6 designation.

Nationally, hospitals scored an average of 2.75 on a scale of 0-7. Similarly, Minnesota hospitals scored 2.72. CAHs only averaged 1.84 nationally. The goal is to reach Stage 7—working in an environment where paper charts are no longer used to deliver and manage patient care, clinical data is used for quality improvement and patient safety, and clinical information can be readily shared through standardized electronic transactions.

HIMSS EMR Scores Quarter 4 2009

A study conducted by the Flex Monitoring Team, a consortium of the Rural Health Research Centers, found that fewer than 14 percent of CAHs have an EMR with a clinical data repository and clinical decision support capability. Fewer than three percent have an EMR with Computerized Physician Order Entry (CPOE) and an electronic medication administration record (eMAR). Kanabec Hospital has all of these.

Kanabec Hospital CEO Randy Ulseth credits the hospital’s success to strong leadership throughout the organization, the strong technical staff and progressive approach of SISU Medical Systems—a consortium of medical centers in greater Minnesota working together to share information technology resources, and the relationships of SISU members.

“Through SISU, we have interrelationships with 16 other hospitals like ours, which creates shared experience and knowledge,” Ulseth said.

“Kanabec Hospital’s staff is dedicated to using technology, from the CEO on down,” noted Mark Schmidt, SISU CIO. “The administration recognizes the value of technology in supporting their job at the hospital—providing patient care and providing efficient systems.”

Gap analysis

Everyone is awaiting the final federal definition of EMR “meaningful use,” to understand how to qualify for incentive money from the 2009 American Recovery and Reinvestment Act and how to avoid reductions in Medicare payments beginning in fiscal year 2015.

“The number one goal is to make sure that our members do not lose money when 2015 comes around,” noted Schmidt.

To help assess where they stood in relation to proposed criteria for meaningful use, the 17 independent rural hospitals that are members of SISU submitted data to the HIMSS Analytics’ Electronic Medical Record Adoption Model (EMRAM) to assess their progress in using EMR.

Rural challenges

SISU worked with HIMSS to modify the EMRAM to work for rural health care providers. Some criteria did not apply to rural hospitals, such as requiring both digital radiography and computer radiography. Few rural hospitals have digital radiography because computer radiography meets the needs. HIMSS changed its scoring so that if a service was provided then the facility was scored on whether or not it had the appropriate technology.

The Flex Monitoring Team report outlines significant challenges that rural hospitals face in getting up to speed to meet the goal of meaningful use. Schmidt said, “It’s hard to imagine how critical access hospitals will get to meaningful use on their own.”

Pulling ahead

Kanabec Hospital has evolved its HIT adoption processes, learning from past mistakes when new implementations failed to account for every process. Now all departments are represented at IT meetings for new modules to make sure all the key people are involved.

The hospital’s leadership volunteers its staff to try out new projects. They acknowledge that it puts a lot of work on people, but staff understand the big picture. The hospital recently implemented a new record locator service to help it exchange health information.

“It wasn’t a difficult decision to make each additional investment in health information technology,” Ulseth said. “We are willing to take the risk of being the first to try new processes.”

Kanabec Hospital intends to use the acknowledgement of its achievement to continue to be a leader, including helping other SISU members reach Stage 6, then Stage 7. Ulseth noted, “Being the first critical access hospital in the country to reach Stage 6 has allowed us to interact with other systems on a different level to talk about better interoperability.”

The proposed federal stages of meaningful use do not align with the HIMSS EMR stages.