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September's HRSA Health IT Grantee Spotlight

Riverside’s Health System’s “Road to Meaningful Use”

Riverside Health Systems logoIn celebration of “National Health Information Technology Week”, HRSA is spotlighting Riverside Health System and their “Road to Meaningful Use”.  Riverside serves as a a role model for rural providers seeking to meaningfully use health IT to deliver high quality, integrated care. This year Riverside’s CAHs successfully attested and qualified as meaningful users under the Center for Medicare and Medicaid Service’s (CMS) Electronic Health Record (EHR) Incentive Program.

Riverside’s leadership overcame a number of barriers in order to successfully qualify as meaningful users of health information (IT). These challenges include:  

  • Modifying their health IT and business strategic plans; 
  • Adjusting their clinical workflows; 
  • Educating staff; 
  • Working with their EHR vendor to understand how to meet the gray areas of the Meaningful Use Stage 1 Final Rule. 

This spotlight focuses on the strategies and lessons learned from Riverside Health System’s journey in qualifying as a meaningful user of health IT.

About Riverside Health System

Riverside Health System, which receives grants from HRSA’s Office of Rural Health Policy and the Office for the Advancement of Telehealth, is located in Southwestern Virginia and includes a network of hospitals, physicians groups, school based clinics, and telemedicine facilities. Riverside’s health network contains three hospitals in rural Tappahannock, Eastern Shore and Gloucester as well as a regional medical center in Newport News. All four hospitals have successfully attested for Meaningful Use Stage 1.  

Meaningful Use and Critical Access Hospitals

In July 2010, the Centers of Medicare & Medicaid Services published a final rule which established three phases of an incentive program for using EHRs to improve quality and outcomes. CAHs and rural providers face many challenges in becoming meaningful users of health IT; nonetheless, the benefits of reaching this level are important. According to ORHP, “Advances in IT hold great promise for helping rural residents and rural providers transform the care they are able to provide patients. Over 95 percent of CAHs use health IT systems for administrative functions, but less than one-third use health IT for clinical care.” It is important for CAH’s to qualify for CMS’s EHR Incentive Program and use health IT in meaningful way to improve patient care. Furthermore, it is critical for CAH’s who serve a certain percentage of medicare patients. If CAHs do not become meaningful users of health IT, they may receive a -1% reduction in reimbursement payments after 2015, placing them on par with the rest of the CMS hospital payment schedule.  

For more information on meaningful use, please see CMS’s EHR Incentive Program webpage, ORHP’s Health IT website, The National Rural Health Resource Centerexit disclaimer, or HRSA’s Health IT website's Meaningful Use Section

Riverside Health System’s Lessons Learned in Becoming a Meaningful User of Health IT

Don’t Be Afraid to Modify Your Strategic Plan

Upon the release of the Meaningful Use Stage 1 Final Rule in July 2010, Riverside began assessing their strengths and weaknesses for meeting stage 1’s criteria. John Stanley, Riverside’s Chief Information Officer remarks, “Already, we had a robust health IT infrastructure and were in the process of implementing computerized order entry (CPOE)  throughout the four hospitals. When the meaningful use final rule was released, we began to assess how to adjust our IT and business strategic plans to become meaningful users and qualify for the CMS Incentive program.” Riverside’s leadership knew one of their strengths in preparing for meaningful use was that their management and staff had experience implementing health IT systems.  Riverside’s solution was to simply modify and integrate the meaningful use criteria into their existing CPOE implementation plan.

Understand the Details

In order to modify their CPOE implementation plan, Riverside first had to understand the details of Meaningful Use’s Stage 1 criteria.  Mr. Stanley emphasizes the importance and challenges of understanding of Meaningful Use Stage 1’s Final Rule’s details when it was first released. “We had to make sure we understood the nitty gritty of the Final Rule’s details- which was not easy at first. Initially, there were a lot of gray areas that CMS has since tried to clarify through frequently asked question documents.” Riverside found solutions to these Meaningful Use gray areas by working with their vendor and staff on creative, simple solutions that were easily adaptable within their clinical workflow.  

Allow extra time in your project planning

When Riverside set firm deadlines to meet objectives, they were realistic by acknowledging that it is very difficult to accurately determine how much time is required for a project. In allowing a time cushion, Riverside was prepared in case IT systems took longer than expected, staff had trouble adjusting, and other modifications needed to occur. In addition, during a health IT implementation a provider  relies  on the vendor to ensure that products are delivered as needed. While Riverside’s vendor did a tremendous job meeting deadlines, the time cushion allowed the deliverables to be of high quality and not rushed.

Work with Staff and Your Vendor For Finding Simple Solutions

One example of a gray area that Riverside encountered in meeting the Meaningful Use Stage 1criteria was how to provide a patient a digital copy of his/her health information upon discharge. Mr. Stanley remarks, “In not being able to determine what type of digital format a patient wanted, we provided our patients a choice. Our health system could email, place on a USB drive or CD, or some other digital format they prefer.” This minor adjustment of Riverside’s discharge workflow, is an example of an innovative, yet simple solution of how Riverside addressed this gray area.

Engage Management and Share Success When It’s Achieved

Another series of steps taken by Riverside leadership was engaging management from the start. Riverside’s leadership was transparent in educating and providing information to staff and the board on how meaningful use would change and benefit their clinical workflows. With the help of their vendor, Riverside’s leadership listened to staff concerns and measured implementation success through data mapping. Riverside’s leadership converted the data mapping results into a dashboard template in excel. These excel worksheets indicated where Riverside staff was either successful or deficient in adjusting to the new meaningful use workflow.

Riverside Health Systems Monitor Prorgress spread sheet

Mr. Stanley says, “One important aspect in a transformation such as this one, where you are changing how your staff does their jobs, is to let them know where we have been successful in the process.” For example, when Riverside’s staff began breaking away from using free text within their clinical notes to precoded data entries, Riverside’s leadership informed staff they effectively met this project’s objective. Riverside was proactive in sharing the project’s success with their staff, which provided a sense of accomplishment and a feeling of contributing to their organization as a whole.

Riverside Health Systems Monitor Prorgress chart graph

Conclusion

Riverside’s proactive approach in assessing their weaknesses and using their strengths to overcome these barriers was critical in successfully becoming a meaningful user and qualifying for CMS’s EHR Incentive Program. Riverside demonstrated the importance of invoking simple solutions for overcoming gray areas. In addition, Riverside engaged management and educated staff in why meaningful use is important for their hospital and patients, so that attaining meaningful use became a mission-driven priority. Riverside used basic project management skills and tools that allowed them to pin-point and share success stories with staff, but also analyze where they were falling short in meeting the project’s implementation objectives and deadlines. Riverside Health System has demonstrated, that through project planning and teamwork, meaningful use can be achievable and benefit the organization’s mission.

Please contact John Stanley, CIO of Riverside at John.Stanley@rivhs.com for more information.

Please see these Federal Resources for more information and resources on Meaningful Use for the Safety Net Community

For more information on meaningful use, please see CMS’s EHR Incentive Program webpage, ORHP’s Health IT website, The National Coordinator for Health ITor HRSA’s Health IT website's Meaningful Use Section.