Meaningful Use Tips from the IT Trenches

By Brian Schwartz, TierPoint Content & Social Media Marketing Manager

The U.S. government runs many programs aimed at improving health care quality and protecting patient privacy. Some are well-known regulations such as HIPAA, which requires medical organizations to meet certain standards, while others provide financial incentives for achievements.

One example of the latter is administered by the Centers for Medicare and Medicaid (part of the Department of Health and Human Services) and is commonly referred to as meaningful use. It gets its name because eligible providers can earn cash for the meaningful use of certified electronic health record (EHR) technology to improve patient care. As of November, 2014, the federal government has paid out more than $17 billion in incentives to more than 500,000 providers who have deployed technology and processes to utilize EHR, sometimes called electronic medical records (EMR).

Sounds great, right? Well, proving that you have met meaningful use requirements is a very difficult, time-consuming and expensive task. There are 18 different categories and different stages of items you have to show you have accomplished. And, each year you want the funds, you have to show that you are still meeting the requirements. This is leading some providers to say no thanks; yet the government says program participation is up. Currently, the government and the industry are working to update meaningful use requirements to make them more effective while reducing some of the burdens on providers that come with proving that the standards have been met.

Mark Lacombe

Mark Lacombe

Mark Lacombe is a Director of IT at Southcoast Health, a community based, non-profit that operates health care facilities throughout Southeastern Massachusetts and Eastern, Rhode Island. Southcoast has a team of people across departments to lead efforts to earn meaningful use funds. He focuses on IT issues particularly related to data center design and risk remediation relative to security of the EHR.

He says he has seen it all in his more than 25 years with the company and that meaningful use requires an enormous amount of work and planning but has significant value. “Meeting the meaningful use requirements can cost millions of dollars and can take years to plan & implement,” Lacombe said. “As a non-profit, the funds are very important to help us deliver great care while providing a secure environment that is protecting patient data.”

Southcoast selected an EMR solution from Epic Systems. Lacombe and his team’s job was to architect the infrastructure solution that would support the Epic software in a way that would satisfy meaningful use requirements. He shared some of his lessons learned and stories about the process.

Lessons Learned
“One of the smartest things we did was to study the application requirements before trying to design the infrastructure needed to support it. Epic has three key infrastructure build manuals that I have read multiple times. I know most organizations want to jump in and get right to implementing an application, but I have seen examples where organizations have delayed an implementation a year because they did not plan through their infrastructure requirements.”

He said that despite his team’s hard work, the technical implementation process quickly becomes complicated especially if you are planning for multiple locations. “It is really important to do the due diligence and leverage technical consultants to offset in-house skill sets that need to be re-tooled. Chances are you are going to need assistance from specialists. Good ones are tough to find, so developing these relationship early is key to shortening planning & implementation time.”

One of the other challenges his team had was to find a disaster recovery site that could quickly be put into use if a main production site went down. He had two data centers both located within 20 miles of each other and adjacent to the Atlantic Ocean.  He was certain one of them could not be upgraded enough to support the Epic requirements. So his choice was to either build a new data center or to outsource his disaster site. “Speed played a big role in this decision,” Lacombe said. “We completed the architecture design in December of 2013 and needed to be up and running by May of 2014.”

He said they went with TierPoint (formerly Xand) for their DR site, because of its location 50 miles inland and because it was the only way they could make their deadline. “They operated a secure facility in Marlborough [MA] located outside of a flood zone. All we had to do was ship them the hardware with their underlining data center infrastructure in place. We were able to leap ahead months versus building our own.”

Project Status
Lacombe says the project is going well. Last September, they were able to successfully get the ambulatory physician practices online. “That is a huge deal because the more physicians use the electronic record system, the more they can attest to its functionality and value. This is a crucial element of getting money from the government.” Additionally, his team recently completed a security risk assessment on the ambulatory Epic EHR. They keep a running remediation list of issues and track how issues are mitigated. The TierPoint data center was part of that review.

“We now have a higher level of security and redundancy than we used to have, and our failover capabilities are much better should we ever need them,” Lacombe said. Next on the timeline are two additional roll outs. “We have some specialty practices coming online in April; then we have a big-bang launch in October when all of our facilities should have access to the Epic EHR”

Final Thoughts on Meaningful Use at Southcoast
“Although I play a role on the IT side of meaningful use, it goes way beyond IT. Southcoast has a whole committee devoted to meaningful use implementation that includes product training and usage. It requires a lot of discipline, patience and plenty of cold pizza. I am fortunate to be a part of a great team. The investment we put into it is emblematic of our commitment to our patients and fellow employees. State-of-the-art patient care and privacy is hard to do.”