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Hospital goes to school

Thursday, July 4, 2013

by The Sanders County Ledger

Staff members train for age of electronic health record keeping

An estimated 5000 hours of training is underway at Clark Fork Valley Hospital as employees gear up for the arrival of electronic health records (EHR) and count down to the "go live" date set for Aug. 3.

One of the adjacent buildings that formerly housed an assistant living center has been set up as a training center with 66 computer stations set up in several rooms in the building. Chief Financial Officer Carla Neiman joked that the work stations crammed into former bedrooms made for an "intimate" setting for the hands on learning. About six to eight trainers are on hand from 7 in the morning until 10 at night working with employees who will be using the Epic System that allows for electronic storage of medical records. Training started last week and will continue right up to the go live date when the hospital will do a full conversion to the electronic system.

Surgical nurses Shawna Tatum and Tony Pierini were working on a surgery scenario with an instructor and "driver" last week. Tatum said one of the challenges in a small hospital like Clark Fork is balancing the work load and training. "I got called out yesterday and then had to repeat a patient care module," said Tatum, but she is excited about the ease of access to patient records that will be an asset to nurses in caring for patients. She felt that while the actual patient care is not going to change the ease of scheduling and flow of documentation will be much better.

Down the hall, trainer Veronica Richards was working with nurses Jessica Steinebach and Julie Gannarelli on emergency room situations. They were first going through the steps they would take in documenting what Richards termed a "gnarly" stroke scenario and followed up with an simpler scenario of an ankle assessment. After learning each module, students take a EUPA (End User Proficiency Assessment) to test their knowledge of the materials. Employees will need to have passed multiple EUPAs depending on where they work and what type of patient care they perform. In Critical Hospitals like Clark Fork, employees often cross train and work in multiple areas making the training more intense.

Gannarelli remarked on there being so much information to learn but noted when it all comes together there will be better communication and a lot less misinterpretation. "Eventually there will be a lot less frustration, she noted. "At least they keep telling us that," she quipped. Steinbach is looking forward to learning the electronic documentation system that is so different from the written one now in place and learning it quickly.

Virtually anyone in direct patient care in addition to coders, billers and administrative staff will have to learn the new system. Neiman said that amounted to around 150 employees. About the only employees not being trained are maintenance and housekeeping crews. The nursing home has its own separate system but will use Epic to order tests and meds.

Neiman and Russell Logan who are heading up the scheduling for the training passed out squeeze ball stress relievers to employees as a way to lightly acknowledge that the learning curve and change will be a stressful one. "It's a little like having a baby," remarked Neiman. "It's a painful process but you need to stay focused on the result and you know in the meantime, they are not going to give you an epidural."

CFVH chose the Epic system that is also being used by St. Patrick Hospital in Missoula and several other hospitals in the western part of the state after evaluating several systems. That means that any other hospital using the Epic system will have access to those same patient records when a patient transfers to or uses another facility. The cost of the project is well over $1 million said Neiman, but noted that as a Critical Access Hospital, CFVH has access to significant reimbursement for capital costs from the Centers for Medicare & Medicaid Services that governs the EHR programs and allows hospitals to earn incentive payments by meeting specific criteria called "meaningful use."

Neiman noted that St. Pat's purchased the training equipment and is leasing it back to CFVH making the financial burden more workable.

Those meaningful use goals are down the road a bit for CFVH as the immediate task is to get everyone trained on the system. It changes the way many of them have practiced medicine day to day so it is a cultural shift as well as a technological change. The changes are particularly significant for physicians. Most hospitals have either implemented or are in the process of implementing EHR systems. The systems store patient data in one electronic record that allow the entire patient history to be viewed by medical providers. The record might include things like imaging records, lab results and physician notes as part of that patient history. Patients will also have access to an abbreviated form of the record so they can be more engaged with their care.

Neiman said historical data for patients dating back to 1999 will be brought in although not all of it, while there will be more complete history going forward. Lab tests, radiology results and physician notes will all be converted with reports going back two years and labs going back ten.

The Obama administration provided stimulus funding for EHRs as part of the American Recovery and Reinvestment Act of 2009 with the objective of using EHR to make the health system more efficient, safer for patients and ultimately to reduce costs and improve quality. The carrot/stick approach was used as funds were provided to help hospitals acquire the necessary technology, but there will be penalties starting in 2015 for those who have not achieved meaningful use.

The training has provided an economic boost for the area as the trainers explore the area and dine and lodge locally. Kathy Logan of Dog Hill Bistro has definitely noticed the impact. "Practically every day we get anywhere from 5-10 people either being trained or the trainers who have lunch or drop by for breakfast. They are super nice people," noted Logan. One of the trainers remarked that "a lot of us have corporate credit cards and per diems," which spells dollars for local vendors as most of the trainers are from Washington state and here for the duration.

For now the training goes on with a work flow dress rehearsal set for July 25 and a focus on that all important go live date of August 3.

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