Customer Spotlight: Meaningful Use … A Noble Pursuit

By:  Donna Carroll, Editor, The MEDITECH Community Bulletin

I recently had the opportunity to meet and visit with the Information Technology (IT) staff at Noble Hospital in Westfield, Massachusetts. I have always known about Noble Hospital as they’re located just ten minutes from my home. However, Noble Hospital had never held the reputation of being a premier MEDITECH site as they historically used a relatively small number of applications. Well, at least that was the case until now!

Noble Hospital is a 97-bed non-profit community hospital. They are the sole acute care facility in the Noble Health Systems organization. From its inception in 1893, Noble Hospital has grown and flourished due to the outpouring of support from its local community. Through the years, these contributions have allowed for many additions, updates and renovations. Today, Noble Hospital offers a modern and well-equipped facility complemented with a roster of highly competent and compassionate medical staff, nurses and medical support personnel. There are several other hospitals in the surrounding Pioneer Valley region, however, Noble Hospital strives to be the community hospital of choice for residents of the Greater Westfield area.

Our local newspaper printed a recent article about how Noble Hospital had just started to use CPOE. The article was very general in nature and never mentioned MEDITECH as the software vendor. Of course, I knew that Noble Hospital was a MEDITECH site and wondered how they got from point A to point B in such a relatively short period of time. So, I called Noble’s IT Director, Bob Borr, and within just a few days, I was on-site for a tour and interview with Bob and his Manager of Nursing Informatics, Lori Smith, RN.

So Much to Do, So Little Time

Bob Borr joined Noble Hospital as Director of IT in February 2010. Upon performing a current and future state analysis, he quickly realized that the hospital’s prior attempts to meet Meaningful Use requirements had been delayed to such an extent that he was practically starting at the ground floor.

Although Noble Hospital had been LIVE with MEDITECH since 1986, they were using a limited number of clinical applications, specifically LAB, RAD, PHA, OE, and PCI. In the Fall of 2009, they also went LIVE with NUR documentation for inpatient units.

So, in order to meet all of the Stage 1 Meaningful Use requirements, Noble Hospital would have to implement the following:

• Update to version 5.64 with ARRA Priority Pack,
• Electronic Medication Administration Record (eMAR),
• Bedside Medication Verification (BMV),
• Version 2 Allergies,
• Clinical Review (EPS),
• Physician Desktop (PWM),
• Provider Order Management (POM/CPOE),
• Ambulatory Order Management (AOM/RXM),
• Physician Documentation (PDOC),
• Public Health Interfaces,
• CCD Interface, and
• Data Repository (DR).

Furthermore, their timeline was to go LIVE with POM/CPOE by February 2011, and to complete any remaining requirements by the end of June 2011. If met, this timeline would allow the hospital to begin their 90-day reporting period beginning July 1, 2011 and to self-attest by October 2011.

First, Bob had to do some pretty fancy footwork to convince their MEDITECH representative that Noble would be ready to go LIVE with POM/CPOE by February 2011. Once he managed to get a commitment from MEDITECH to support their implementation, Bob then had to determine what resources would be needed to accomplish their goal. He had a small staff to begin with and only two Application Analysts at the time.

At the recommendation of several of his staff, Bob launched into action to re-hire a critical team member who had recently left the organization. Lori Smith, RN had been a member of Noble Hospital’s caregiving team for nearly 15 years prior to migrating to their IT Department in 2007. Enthused by the new project plans under Bob’s direction, Lori re-joined Noble Hospital in February 2010 as Manager of Nursing Informatics.

Lori recalls the week that she and fellow Analysts, Sheila Valente-Gamber and Hallie Joy, attended PCM dictionary training at MEDITECH. “We were simply amazed at the amount of work ahead of us. At the conclusion of training, the three of us made a pact that no matter how difficult the tasks, we would remember that we were teammates working together on the project and would try not to get too testy with each other, no matter how many hours were required to get the job done.”

The work load was intense as this one initiative entails numerous projects, most occurring simultaneously. Fortunately, Bob Borr’s leadership approach is to lead by example with a ‘can do’ attitude. He calmly encourages his staff, helps maintain their focus on the critical tasks, ‘runs interference’ with organizational leadership, holds the vendor accountable for delivering the service required, and ensures his staff is well-equipped with the knowledge and resources necessary to get the job done. “It truly was a tremendous amount of work, but you have to remain positive and focused, and remind everyone that you really can see the light at the end of the tunnel.”

Removing Barriers and Enabling Mobility

One of the biggest challenges Bob’s team faced was garnering physician involvement in the initiative--a fairly common story! Bob and Lori are the first to admit that it would have been ideal to have the physicians participate in the design process. Unfortunately, however, it was very difficult to bring them all together and to dedicate any providers to the project. Since they were operating under a very strict timeline, the decision was made to forge ahead with the build process, incorporating all of the knowledge from other clinical staff to design a system that best suited the physicians’ current ordering practices. In addition to the IT team which was dedicated to the project, they managed to pull in some per-diem assistance from other department employees to participate in the design and build process. This helped tremendously when it came to understanding physicians’ ordering practices on different units.

So, a plan was needed to ensure the providers would be prepared to go LIVE with POM/CPOE once it was ready. Lori Smith developed the training curriculum, along with a very detailed training manual providing step-by-step instructions, chock full of screenshots and helpful tips. Prior to go-LIVE, they ran a pilot in TEST for two weeks to allow the providers to become familiar with the system. In addition, all providers were offered four hours of one-on-one training.

In February 2011, Noble Hospital went LIVE with seven hospitalists using POM/CPOE. The hospitalist team at Noble is responsible for approximately 80% of the patient population. Since that pilot group, they have added a few more providers. To date, Noble is entering 53% of unique patient orders for inpatients. That puts them far above the 30% threshold required for Meaningful Use.

A common objection from providers using CPOE is the lack of mobility. They often feel tethered to the computer and don’t like having to rely upon a workstation. Handheld devices are certainly convenient, but not very practical for CPOE. Enter the iPad. Lori Smith wanted to give MEDITECH a try on her own personal iPad. So, they asked Network Manager, Nick Symiakakis, to connect her iPad to the hospital’s network. While an iPad may not be the ideal device for all MEDITECH applications, it did prove to be successful for CPOE and other physician-facing applications. So, each provider has been issued their own iPad for use with MEDITECH. On the floors, each nurses’ station has at least two desktops as well as one workstation-on-wheels (a.k.a. WOW) for every nurse on day shift. This ensures that each nurse and provider have access to a device at all times.

The Road from Point A to Point B

Since my visit to Noble Hospital, they have completed implementation of RXM and Data Repository. They have also successfully completed testing of their Public Health and CCD interfaces. Noble is actually the first hospital in Massachusetts to complete both of these. So, the hospital began their 90-day reporting period at the end of May—a full month ahead of schedule. They have obtained their EHR Certification ID, and will attest to meeting all Stage I Meaningful Use requirements at the end of August. Noble Hospital hopes to see their first check some time in September or October 2011.

The road from point A to point B has been long, yet rewarding. Under Bob Borr’s leadership, Noble Hospital has transitioned from underutilizing their MEDITECH system to being on the forefront of Meaningful Use compliance. While the anticipated incentive payments will most definitely benefit the hospital, the primary reason for them pursuing Meaningful Use was patient safety. Lori Smith noted that once all patient orders are being entered online, she will sleep better at night. “It’s a matter of knowing that patient safety is of the utmost concern to our facility.”

Meaningful Use…a very noble pursuit, indeed! And this is just one of the reasons why Noble Hospital is the community hospital of choice in the Pioneer Valley region.

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To learn more about Noble Hospital, visit them online at http://www.noblehospital.org/.