You might say the CIO and IT team at Harrisburg Medical Center are hands on. When it came to tackling the toughest piece of meaningful use Stage 2, they added a staff member to connect with patients at home.
With mostly Medicare patients, and some of them nursing home residents, it seemed like the best approach to meeting the patient engagement requirement of meaningful use, which requires 5 percent of unique patients to send digital messages through the hospital portal.
It might seem like a low threshold, Harrisburg Medical Center CIO Richard Pyle, acknowledged, but with so many Medicare patients and many without access to a computer, he knew this piece of meaningful use would be particularly demanding.
[See also: Stage 2: Rubber meets the road.]
"One of the biggest things is getting the patient to come back in, and view, download and transmit their summary of care," he said.
The hospital's utilization review staffer followed up with the discharged patients at home with a wireless laptop to show them how to get to their information on the portal, Pyle explained. For those who owned a laptop or PC, the staffer showed them how to access the portal on their own computer.
"We set up their program with them – and we walk them through individually," he said.
Harrisburg ended up with 8.54 percent of its discharged patients using the portal.
And, there were added benefits to being one-on-one with discharged patients.
The utilization review staffer, who is also an RN, went over the discharge summary with them, made sure they understood the instructions and were taking any medicine as prescribed.
Pyle expects this will cut down on readmissions.
[See also: Small hospital, big focus on Stage 2.]
As for the nursing home patients, Pyle talked with the administrators, and together they set up a direct messaging email account.
"So when we do our transfer, he said, I can actually send their discharge instruction, and they end up at the nursing home before the patient does, so they have an idea what the patient's coming back with."
Harrisburg Medical Center is a 75-bed hospital. Pyle oversees a seven-member IT team. The electronic health record system is from CPSI, and Harrisburg served as a beta site.
“Harrisburg Medical Center has always been technologically advanced," Harrisburg Medical Center CEO Rodney Smith said in a CPSI news release announcing the medical center's successful attestation. "We’ve been working towards this before meaningful use started,” he said, noting that Harrisburg implemented electronic charting in nursing in 2001.
Back in 2004, after President George W. Bush had called for an electronic health record for every American, Smith asked Pyle to give him a five-year plan for getting the hospital on board with digital records.
"We're a small hospital," Pyle said. "At that time, there was no meaningful use incentive money out there. So, it was only one project a year I would put in my budget to move it to there. The chart link and CPOE was the last thing we rolled out."
Today 90 percent of providers at Harrisburg use the CPOE system, and it will soon be 100 percent.
"If you're not using our software and putting your orders in, you have to hand your patient off to the hospitalist," Pyle explained.
Pyle counts himself lucky to have an IT team made up of both technical and clinical staff.
"I have two RNs and a person that came out of lab, which makes it very easy when we have clinical-type problems," he said. "Or, when we're running this kind of stuff where we need answers pulled out of flow charts or e-forms."
Pyle considers himself fortunate also to have a security staffer who came to Harrisburg Medical Center by way of the military.
"So, he is running my risk assessment," he said. "Healthcare federal is the same as military federal because they still talk NIST and security, so that was right up his alley. Then there are two network administrators and one database administrator, "who are way younger than I am," Pyle said. "The good thing about that is, they're fresh out of school with a bachelor's degree. They're up on the latest and greatest. You can throw stuff at them, and it doesn't seem to shake them any."
Virtualization has been a boon for the hospital, Pyle said. "It made it a lot easier for doing any kind of upgrade," he said. "So we can do a lot of things without affecting people's work. We can do this behind the scenes. They don't even know that we just restarted their server for a problem or an upgrade because it was only down for such a short time, they didn't even know it was down."
What's next? Pyle is looking to work with a couple of other hospitals on a telehealth initiative, and he is also working with nearby nursing homes. They are not yet digital, but he figures they will soon have to be.
Right now, they're all paper," he said, "and if I can get them the same software as the hospital, we will be their IS, whether it be a turnkey, where we provide the hardware and the software and be their expertise, or we can just house the software here. If they were an inpatient, you can see all of that at the same place. So, it kind of ties that record all in one place."
