First-Day Attestation: Ferdinand Velasco, M.D.

Among the small number of integrated health systems to complete the attestation process on April 18, the first day in which attestation of the fulfillment of the stage 1 requirements for meaningful use under the Health Information Technology for Economic and Clinical Health (HITECH) Act was possible, was the 11-hospital, 24-facility, 4,100-bed Texas Health Resources (THR), based in Arlington, Tex.

Ferdinand Velasco, M.D., the CMIO of Texas Health Resources spoke with HCI Editor-in-Chief Mark Hagland this week regarding his organization’s attestation last week. For its core clinical information systems, THR is a customer of the Verona, Wis.-based Epic Systems Corporation.

You attested on April 18?Yes, that’s correct. Even before the regulations came out, we felt pretty confident, given that we have placed a lot of effort into our electronic health record at Texas Health, that we were using it pretty meaningfully. We felt we were meaningful users, so why shouldn’t we attest? So once the final rule for stage 1 was published, we rolled up our sleeves and got to work. There were two parts to this—registration and attestation—and registration was actually the more complicated part of it. We had largely been interacting with CMS [the federal Centers for Medicare and Medicaid Services] non-electronically; so we actually had to submit some IRS forms to CMS. And some of our hospitals, the records CMS was keeping for them weren’t quite right; there was some confusion about the CMS number for some of our hospitals. So it took a couple of weeks to get everything lined up before attestation. Once registration is done, then attestation is the next part, and that is pretty straightforward. It’s just a matter of taking the numbers, the data, generated by the electronic health record system, and filling out the online forms. It took about an hour to complete the process for the first hospital in our system, and after that, it took about 30 minutes per hospital. So it took us about six hours for eleven hospitals, to get it done.

Ferdinand Velasco, M.D.What stage level are you in the HIMSS Analytics schematic [developed by HIMSS Analytics, a division of the Chicago-based Health Information and Management Systems Society]?We just got validated Friday [April 22, 2011] as stage 6.Were there any surprises in preparing for attestation under stage 1? And what were the biggest challenges?There were no surprises, but there were some big challenges. The biggest challenge was the problem lists [maintaining active problem lists for patients], mostly because doing so entailed a big change from paper; second, the threshold was pretty high; it’s at 80 percent, while they lowered the thresholds in some areas. As of October 1, the beginning of the reporting period, not all of our hospitals were at 80 percent, some were in the 70s, though some were in the 90s. We started out with some hospitals at 75, 76, but they were in the high 80s by December, and averaged out over 80. So across the board, across the 90 days, we averaged out over 80 percent. We knew that the problem list area would be a challenge in terms of the attestation. And we knew we were not perfect, and we had actually been paying a lot of attention to this for over a year.Another area of challenge was if the patient requests a copy of their discharge summary or of their health record; the only challenge is that it has to be done within three days. It’s just something we needed to do a lot of education on with our medical staff. It was just a matter of getting our staff educated. Our goal in our second year of the program, through October 1, 2011, is to move towards a web-based approach, so that the patients can securely request this through the Internet, rather than going through medical records to get a CD-ROM; that way they’ll have it instantaneously.Where are you in terms of CPOE [computerized physician order entry]?We’re in a good place, we’re in the high 80s, low 90s, overall [in terms of physician adoption of CPOE]. As you know, there’s only 10-percent requirement for CPOE in stage 1. So maintaining the active problem list will be more of a challenge for most organizations; and it’s just getting one medication order per patient, for CPOE, that’s the 10 percent. The problem list is 80 percent; 80 percent of patients have to have one unique problem list entry.Do you have any general advice for those organizations preparing to attest soon? I think it’s important to be organized. Don’t expect the CMIO to do everything. It’s going to require a team effort. That registration thing is gotcha, so don’t wait for that, get that out of the way. Be aware that if you do attest this year, it starts the clock ticking for stage 1 year 2, and stage 2. So those organizations that aren’t ready to attest this year may want to postpone until fiscal year 2012; that way, the clock doesn’t start ticking until then.How many clinical informaticists do you have, system-wide?There are about 20 such individuals in our organization, though not all work full-time in clinical informatics; about a half-dozen of us have formal titles reflecting our roles.So you don’t have a CMIO at each hospital?No, we only have have two CMIOs system-wide, and one isn’t even a full-time CMIO; he’s in charge of medical staff affairs and HIM [health information management].