PINE BLUFF, AR – As one of the first hospitals in the country due to receive a stimulus check – having achieved Stage 1 meaningful use after implementing the Sunrise Clinical Manager EHR from Allscripts – Jefferson Regional Medical Center (JRMC), in Pine Bluff, Ark., is not sitting on its laurels.

While hospital executives and staff await approximately $3 million in Stage 1 incentives, Patrick Neece, JRMC's chief information officer, and Andy Jenkins, its administrative director of information systems, are already working toward landing $8 million more by reaching Stages 2 and 3.

[See also: Arkansas hospital to be among first to receive ARRA money.]

Neece and Jenkins offered some insight, advice and encouragement for other hospitals looking to follow in their footsteps.

Patrick Neece: We definitely are extremely proud of the accomplishment. It's some weight off our shoulders, but now we're looking at Stage 2 – so it's not over yet. But we do feel good about the first steps that we've made, and everybody on our staff here is very happy with the results.

You've mentioned that this took "a lot of hard work." Walk me through the process – describe your strategy, and highlight some of the milestones you reached along the way.

PN: From the time the Final Rule came out to the time we started our attestation period was about four months. There was a lot of hard work prior to that. We've been implementing various components of the system since 2003.

All the technology projects here at JRMC are given a high priority, as they are a means for us to achieve patient safety, outcomes and quality. We saw meeting meaningful use as a key initiative for all of the organization, because we really realized the impact it could have, clinically, operationally and financially.

Some of the milestones we went through were securing resources, both here at the hospital, as well as with our Allscripts partners, getting to that certified platform, putting in [Sunrise Enterprise's version 5.5 Service Pack 1 (SP1)] – we were among the first customers up on that, so that was a big milestone for us.

And, really, gaining a solid understanding of each of the measures was crucial. For a while, and even today, there's still some clarity coming out on the measures.

Developing a gap analysis, and then getting down to the implementation tasks, coming up with a detailed working plan, was important. Really working with our key stakeholders, like physicians, clinical staff, even our back office areas like business office, and medical records were impacted, so getting buy-in from them was important.

Understanding and completing the registration process – just getting out there and getting registered and getting all those pieces in place – we considered that a milestone.

And then, of course, implementation of these new processes, such as the electronic access to health records, the health information exchange, creating a meaningful problem list.

The problem list was a big part of this initiative. It really drove the whole CDS learning processes. Problems typically are back-end, retrospective in the medical records department. But we developed a workflow and implemented some tools that really pushed that out to the front-end, to the clinician, so we were putting a meaningful problem list together as soon as the patient arrives at the hospital.

And then working with state agencies and getting integrated with them was another big milestone.

This process really meant putting all of our other key projects on hold, and dedicating all our resources to meeting this effort. Our goal was not just to meet the meaningful use measures, but to exceed them, and to complete all 10 of the menu set items.

We didn't just go for the low-hanging fruit, that 30 percent. Our CPOE is at 99 percent. Medication allergies – the threshold was 80 percent and we're at 99 percent. Demographics, problem lists, we're at 99 percent. That was all part of our strategy.

What were some particularly challenging aspects, and how did you overcome them?

Andy Jenkins: Some of the measures were more challenging than others. As Patrick said, we've been implementing EHRs since 2003, so some were a little bit easier to attain. But we felt they were all achievable, no question, and that's why we went ahead and implemented all 10 of the menu set items, just to go above and beyond.

A significant challenge was – and still is – the rapidly changing and evolving developments related to the measures. We see, even today, that there's clarification still coming out on some of the measures, so it's difficult really to point to one in particular.

But if we look into the future, we definitely see some challenges and anticipate some workflow and technical changes around health [information] exchange. Exchanging data around systems, even within the walls of our hospital, is complicated. But when you consider regional health exchange and state involvement, the variables are exponentially greater at that point.

[See also: HIE Symposium abounds with lessons learned.]

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