Finding Purpose in Meaningful Use
One practice comes out ahead after implementing stage I of the incentive program.
Since 1905, Advanced Radiology Consultants LLC (ARC) has provided imaging services to patients in southwestern Connecticut.
Now, its 31 radiologists, four physician assistants, and 29 radiology residents serve two hospitals as well as other freestanding imaging offices. Led by Alan D. Kaye, MD, FACR, and with the help of many others, ARC formally attested to its implementation of the Meaningful Use (MU) criteria in November 2011. The ACR Bulletin spoke with Kaye about the practice's transition to MU.
Q: Tell us about your organization and how you began implementing MU. What prompted you to start the process?
A: Radiology is an "IT business," and ARC embraced this concept early. We were the first practice in our state to implement PACS, and PACS has been an engine of our success and has facilitated subspecialization. PACS also allowed us to add new sites without having radiologists sit idle as the sites grew in local volume, while we enhanced connections with referring physicians.
We viewed the MU program as an extension of our culture of connectivity. In addition, radiology, as an IT business, must not disqualify itself from a central role in information services. In terms of MU, we saw all of the challenges witnessed by others in the imaging industry, and we also heard a lot of negative comments, many of which suggested it was not possible for a radiology group to qualify for MU. In fact, organized radiology and radiology management considered advocating for our specialty's exemption from the program.
We took that as a challenge, and more importantly, as a validation of our commitment to and radiology's central role in IT, as well as an extension of our efforts to improve the quality of care for our patients. We saw this as an opportunity to help reduce health inconsistencies and improve care coordination and communication between ourselves, the primary-care physician, the specialist, the local hospitals, and ultimately, the patient. So we made it a practice priority to learn about the program. The more we learned, the more we realized this was achievable and our expenses would be covered by the incentive offered by MU.
We charged our executive team with educating themselves about the program. In fact, one of our executive team members volunteered to serve on the Meaningful Use Committee of the e-Ordering Coalition as well as the ACR IT and Informatics Committee. The team seized these opportunities and the challenge and came back to our practice with what turned out to be a very aggressive yet achievable timeline during early summer 2011. That effort set things in motion to complete the initial reporting cycle.
Q: What did the implementation process entail for your organization?
A: We had several key individuals read through the requirements carefully, survey our practice's capabilities, and then begin an MU practice gap analysis as well as an assessment to determine which doctors would qualify for the early adopter incentive. From there, we began defining the appropriate operational details. Our staff met weekly to update one another on progress, and the executive team updated me weekly, as physician-CEO.
Q: What resources did you employ to navigate the process?
A: Very early in the process we determined that this initiative wasn't tied to a single business unit or department; therefore, we couldn't operate in silos. We assigned resources from the clinical and operations departments as well as a full complement of technical resources from the IT department. Participation in the formative committees allowed us to keep abreast of developments and even influence the process in positive ways.
Q: What difficulties did you encounter? How did you overcome them?
A: The biggest challenge was to change the way we collect data, from the perspectives of both patients and administrative and clinical staff. This was a technology-intensive initiative, but once the customization and configurations were out of the way, the rest was up to the frontline staff — technologists, receptionists, schedulers, etc. These individuals not only changed the way they entered data but also began collecting more and more information.
As we gathered more data, it became necessary to explain why patients were being asked by our staff if they have hypertension, what medications they were taking, and other questions seemingly unrelated to a radiological procedure. We took the time to educate them about MU and its benefits for patients. Meanwhile, ACR representatives had more screens to navigate and fill in, which meant more clicks, more questions, and more time from the radiologic technologist and ultimately the patient. However, with dedicated staff and informed patients, we managed to keep the average exam times the same as those before we began the project. The goal was to get us closer to our patients and to help us become advocates for better care.
Q: Did you revamp your entire Electronic Health Record (EHR) system? What software are you using to meet MU standards?
A: Our practice uses the Medinformatix RIS. We and the Medinformatix team learned a lot together, wading through the regulations and requirements and designing a repeatable method of collecting and measuring all of the elements we focused on for Stage I. Luckily, we had already begun implementing a patient portal, and online program allowing patients to interact and communicate with their health-care providers, which was a key component of MU and gave us a head start.
Q: Which MU requirements were you able to waive? How did you determine these?
A: We did a strategic assessment to identify which initiatives we felt best fit our overall mission of becoming better patient advocates. We were also realistic and knew that even if we managed to get everything in place, we still had the initial reporting period to complete. We needed to select measures we could achieve quickly if we were going to demonstrate MU in Year One.
Q: From start to finish, how long did the process take?
A: You may not believe this, but after our internal education about the program, our gap analysis, and the decision to move ahead, implementation took about six weeks. Planning and preparation were keys to success.
Q: What advice would you give similar organizations that are considering implementing MU?
A: Pick your EHR partner wisely, communicate clearly and often, and communicate internally. We were able to implement this so quickly by educating our staff and patients at every opportunity. The staff needs to understand why the project is important to the practice, and the patients need to understand why things are changing and why we need much more information from them.
Q: What trends, problems, and advantages have arisen since you began using the MU-friendly EHR system?
A: Honestly, I think that having accomplished this as a company made us stronger as a whole. We are a data-hungry organization, and as a result of this project, we collect more data. We also added processes to check, double-check, and validate that data. When we started this process, we decided we weren't simply doing this for an incentive check. If we were going to collect all of these additional data elements and put additional metrics in place, we determined that we would try to utilize this information to not only help drive the business but also to help provide better patient care. One intangible benefit was the organizational pride that came with doing something that (almost) no other practice had. Our extensive teamwork has led to a successful outcome as well as built staff morale and camaraderie. We are using the proceeds of the MU incentive to invest in the practice with new hardware and software.
Q: Who were the key players in implementing MU?
A: It was a company-wide initiative: mandate from leadership; stewardship from the executive team; and implementation, education, and dedication by the staff in all departments. If any single department hadn't contributed its share weight, we wouldn't have been successful.
However, I would like to acknowledge the specific efforts of other Radiologist Executive Committee members (Ian Karol, MD, and Gerard Muro, MD), former Chief Administrative Officer Nicholas Christiano, Chief Operating Officer Dennis Condon, Chief Information Officer Chris Craft, and the Radiologist IT Committee chaired by Muro.
Q: Looking back, what would you have done differently?
A: We would have started sooner.
Q: What else should our readers know about your experience implementing MU?
A: Don't do it for the incentive money. Do it to gain better data, and then do something with those data, perhaps to provide better care. The challenging process was not only financially rewarding, but also gratifying. It required vision, focus, planning, self-assessment, management, and the collaboration of all levels of staff in several departments. It was a great learning experience.