Leslie Stark, right, CPSI nurse manager, assists Texas County Memorial Hospital LPNs Stephanie Thurman, left and Jessica Williams with a computer on wheels, a component of the electronic medical records at the hospital. TCMH is one of 3.8 percent of hospitals in the nation that have reached "stage five" in a seven-stage process of full electronic medical records adoption.

Texas County Memorial Hospital is one of 3.8 percent of hospitals in the country with “Stage 5” electronic medical records adoption model, board members heard at their recent monthly meeting.

The data comes from Healthcare Information and Management Systems Society (HIMSS) Analytics, a non-profit organization that studies organizations to help them determine where they are in EMR adoption process. According to the EMR adoption model by HIMSS, there are seven stages required to be recognized as a facility with an advanced patient record environment — with Stage 7 being the highest stage of advancement.

In 2009, HIMSS studied 5,235 hospitals across the nation, including TCMH, where the EMR adoption model is at a stage five of seven stages. The five stages include EMR capabilities such as closed loop medication administration, customized physician order entry, nursing/clinic flow sheets, picture archiving communications available outside of radiology and error checking.

There is a national push for EMR in all healthcare facilities. Special funding has been set aside in the “American Recovery and Reinvestment Act” to reward and assist healthcare facilities with EMR. A model similar to the HIMSS model will be used to determine how much federal technology funding will be doled out to TCMH in upcoming years.

“It’s amazing to think that TCMH — a small hospital in rural America — could be so technologically advanced to rank in the top 3.8 percent of the nation’s hospitals,” said Wes Murray, chief executive officer at TCMH.

According to Doretta Todd-Willis, chief nursing officer at TCMH, it’s possible that the local hospital could receive a higher reimbursement for Medicare patients due to the hospital’s advanced EMR adoption.

EMR adoption at TCMH began in 2005, and today EMR can be found throughout the hospital’s departments from the ambulances to the pharmacy to the clinics.

“I would like to give recognition to Cliff and Leslie Stark for all of their hard work and dedication to get TCMH to Stage 5 on the EMR adoption model,” Todd-Willis said.

Cliff Stark is the director of the information technology department at TCMH. His wife, Leslie, is a registered nurse that works closely with hospital physicians and staff, training them in using EMR at TCMH and in developing customized functions in EMR.

“It has not been a simple process to reach this technology level at TCMH,” Murray said. “Credit goes to our physicians and our staff for accepting this technology, recognizing that it creates better quality of care for our patients”

Murray noted that EMR availability at TCMH plays a role in the hospital’s ability to recruit physicians; many residency programs train physicians exclusively with EMR.

“I have recruited physicians that have never used a paper chart,” said Joleen Senter Durham, director of physician recruiting at TCMH. “Some physicians won’t even consider an opportunity if EMR is not available.”

The hospital’s clinic EMR system is a General Electric product called “Centricity,” the same program the residents at Cox Hospital in Springfield use.

In a physician recruiting update, Durham reported that a physician was coming to TCMH on March 5 to look at the Mountain Grove opportunity. Durham and Murray also provided lunch for the family medicine residents at Cox in early February.

“We made some good contacts with first-year residents at Cox, and we hope that some of them will come to TCMH for a rural residency rotation or moonlighting in the emergency room,” Durham said.

Incoming TCMH physicians, Dr. Schaun Flaim, Dr. Gretchen Price and Dr. John Paulson, are interested in working with medical students and residents. Dr. Charlie Rasmussen of the TCMH Medical Complex has already hosted several students while working at TCMH and also hopes to work with more students and residents.

Paulson made the decision to work full-time at TCMH after completing a rural residency rotation where he worked with Dr. Charles Mueller in surgery and Rasmussen in the clinic.

“If we can bring students and residents to TCMH to give them a taste of what’s available here, we greatly increase our chances of bringing them here permanently,” Durham said.

Murray reported that the Mountain Grove clinic and ambulance base construction project has lost some time due to continual low temperatures that have not allowed some outside work to be completed.

“We were hoping to have a mid-April clinic and ambulance base open house, but now we’re looking at early May,” Murray said.

Murray also reported that approximately 30 percent of ambulance runs from the Mountain Grove ambulance base continue to come to TCMH.

Rural ambulance service also took a financial hit as of Jan. 1, 2010, when an additional payment for ambulance runs for Medicare patients was not renewed. The payment, which equals $135 per ambulance run, was supposed to be included in the healthcare reform bill on the table in Congress at the end of 2009. The bill did not pass, and healthcare reform efforts have since stalled.

“This is affecting our ambulance service, and it’s affecting rural ambulance services across the nation,” Murray said.

Reimbursement for TCMH ambulance runs is down approximately 23 percent since January 1, reported Linda Pamperien, chief financial officer at TCMH. The net affect annualized to the hospital could be a $200,000 loss.

“We have been in touch with our federal congressional representatives asking them to make this special rural ambulance service reimbursement permanent rather than something that must be renewed,” Murray said.

In other news, although outpatient revenues were down in January, inpatient volumes, including swing bed utilization, were above budgeted expectations for the month, Pamperien reported.

For the month of January and year-to-date, TCMH had a positive bottom line of $3,970.

Present at the meeting were: Murray; Pamperien; Durham; Todd-Willis; and board members Janet Wiseman, Mark Hampton and Mark Forbes. Board members Omanez Fockler and Jane Kirkwood were not present.

The next meeting of the TCMH board of trustees is noon Tuesday, March 23, in the downstairs meeting room of the hospital.



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