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  • July 03 2012

    Meaningful Use (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?

    SK: Cerner’s 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 very well.

    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 available.

    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 3?

    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.

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