July 03, 2012
Meaningful Use Q&A: Sue Kurruk, Director of Quality and Risk Management, Syringa Hospital and Clinics
(MU) continues to be a hot topic in health care circles, especially as debate
over Stage 2 kicks into high gear. With that in mind, we had the opportunity to
chat with Sue Kurruk from Syringa Hospital and Clinics about the Stage 1 attestation process, as well as what
Stage 2 (and even Stage 3) might bring.
Tell us a little bit about your hospital.
Sue Kurruk: Syringa Hospital and Clinics (SHC) is a stand-alone,
unaffiliated critical access district hospital. Our district covers 7,500
square miles, covering a population of more than 16,000 people. The nearest
non-CAH hospital is over an hour away; the nearest tertiary medical centers are
about 4 hours away (Spokane and Boise). SHC has an employed medical staff and offers
med-surg, ER, OB, swingbed, therapy, telepsych, and hospice services. Additionally
SHC operates two hospital-based primary care clinics and a VA clinic.
What was the Stage 1
attestation process like for you/your facility?
SK: We went live
with our Cerner electronic health record system in January 2011. At go-live, we were both exhilarated and
exhausted from building, training and transitioning every aspect of our
operations from paper to the electronic world. Our goal was to attest for Stage
1 MU before September 30 that same year, so we had a MU Project Team in place
to address MU criteria right from the start.
As our intense efforts toward
effective use of the EHR continued, the primary focus was to learn where and
how MU elements needed to be documented in the EHR. We had laid the groundwork
by stressing that MU was not a separate temporary or optional project—it was an
integral part of how we would be using the EHR going forward. We reminded staff
that achieving MU would benefit our patients, as well as offer a return on our
financial investment in the EHR technology. MU was on the agenda for every
departmental, medical staff and board meeting. We provided frequent feedback on
the project to the entire organization, emphasizing our progress. Our MU
project SMEs were accountable to drill down with education and reinforcement
regarding required documentation. By early June, we were meeting and sustaining
core measure scores, learning how to use Cerner’s quality reporting tools (Lighthouse,
quality dashboards) and working to understand VTE and ED throughput measure
reporting. By July, we were waiting on clinical measures reports to be
completed, while working on our attestation support documentation and studying
the CMS attestation submission process.
How did Cerner help you achieve successful attestation?
support was critical to our success. For one thing, once we went live, we lost
access to the Cerner implementation team and were transitioned to the AMS team.
This transition away from people we had been working with so closely could have
been quite stressful, but since we worked with our client rep from well before
go-live, and continue to do so through MU and on to today, the journey has gone
We sent three attendees to the
Cerner Health Conference in 2010, where there were numerous MU education
sessions. Additionally, SHC opted to use the services of Cerner’s MU consulting
services. The Cerner consultation team visited us in April 2011 and conducted a
gap analysis. They provided us with a dashboard displaying our current status
on each Stage 1 MU criteria, and we were amazed to see what we had already accomplished.
We used the dashboard to keep the entire staff at SHC informed on weekly, then
monthly, progress. We participated in regular phone meetings with the Cerner
team to discuss workflow, and better identify how and where we needed to
document within the EHR to capture a “met” for criteria. Cerner also provided
an attestation support documentation format to help us gather all required
evidence of our attestation status. This tool was extraordinarily useful.
What was the biggest challenge during the process?
SK: Our main
challenge involved limitations or conflicts within/between some Cerner areas that
prevented capture of “met.” Because CAH nurses and providers cross over between
several solutions (PowerChart, PowerChart Ambulatory, FirstNet, SurgiNet) they
encountered differences in how the same documentation must be recorded
differently in order to capture a “met.” One example involved documentation of
smoking status in FirstNet vs. PowerChart. Another challenge was a delay in
access, training and time to trial use of functional Lighthouse reports.
How did you overcome it?
SK: We used our
conference calls to identify solution documentation conflicts and other documentation
barriers and to work on finding resolutions. They were very responsive to our
feedback. Regarding the Lighthouse issue, it was nerve racking to wait for this
solution because we were otherwise ready to attest, but unable to generate ED
throughput or VTE data. We appreciated our client reps’ ongoing feedback on
progress, and their assistance on testing the reports once they became
What are your reactions to the proposed Stage 2 measures?
SK: Many thresholds
will be raised and many menu items will become core. In anticipation of Stage,
2, Syringa worked from the beginning to exceed all Stage 1 core menu criteria and
thresholds. Most of the Stage 2 changes to existing criteria should not be
difficult for us.
Of greater concern are the new Stage
2 criteria related to patient portal use, and exchanging electronic info with
non-Cerner, non-affiliated entities. For example a threshold measure for patients
to view/download or transmit their data is an ambitious requirement for
something that needs product build, training and patient engagement in the
process. Likewise, exchanging electronic info with non-Cerner entities is unrealistically
ambitious, as both entities need to be ready to do this and the overall
technology is in its infancy. Syringa is just getting involved with a (new)
health information exchange that I hope might be a possible option for meeting
this MU requirement.
Why is it important to continue building on the momentum
from Stage 1 on into Stage 2?
SK: Momentum is
important because change is coming. The reimbursement carrot will become a
punitive stick for those who do not stay involved. Also, the goal for the MU program
is a good one—to improve quality and reduce cost of the US health care delivery
system by improving our ability to safely generate and exchange patient data
with all the healthcare partners involved with the patient.
How is your hospital preparing for Stage 2, and even Stage
SK: We are close
followers of available information: Cerner reports and webinars, industry news
and webinars, peer networking. We share ongoing information throughout the
organization from Board to end user. And, we continue to actively dialogue with
Cerner via clinical councils, uCern, AMS on what is working well, and what
could work better in the EHR, particularly as it applies to EH and hospital MU.
Because we do not have an IT department, Syringa recently created a new role of
HIT Specialist. We sent two employees for additional Cerner training to become
stronger resources for IT support and ongoing user training.
Other than the incentive payment, what is one benefit your
hospital has realized from being a meaningful user of health IT?
SK: Through the
MU journey, Syringa reaffirmed that we were an awesome team who could rise to
the challenge and meet the criteria for MU reimbursement, and could
successfully sustain changes that improve our care for our patients. EHR/IT
have given us powerful tools and reports to improve patient safety (bar code
scanning, prescribing alerts) and enhance communications (critical test
reporting, chart search, messaging). We are just beginning to scratch the
surface of the EHR’s potential and look forward to learning and growing in our
use of it.