Tenet Healthcare operates 50 acute care hospitals in 11 states, generating 500,000 inpatient admissions and 4 million outpatient visits annually. The organization has attested for Medicaid electronic health records meaningful use in 49 hospitals and attested for Medicare in seven hospitals.

Medicaid attestation was an exercise in frustration, says Liz Johnson, R.N., vice president of applied clinical informatics at Tenet and a speaker at the Meaningful Use symposium Monday, Feb. 20 at HIMSS12. “We attested to Medicaid in 11 states and everyone one of those 11 states asked for different evidence.” To submit the evidence that Tenet has purchased or implemented meaningful use-certified EHRs, Tenet had to pull out the EHR contracts, redact proprietary vendor information and submit the contracts to the states.

Tenet also has replaced many departmental information systems and has put in bar coding, computerized physician order entry and electronic medication administration recording systems. “We always planned to do advanced clinicals, we hadn’t planned to do it on the meaningful use schedule,” Johnson says.

In 2012, Tenet will take 19 hospitals live with CPOE and also will implement electronic prescribing in the hospitals, which it expects to be a requirement of Stage 2 meaningful use. By year-end, the organization expects to be live with all the clinical systems in 38 hospitals and have 26 additional hospitals attest for Stage 1.

Another major initiative m with a strong meaningful use component is the development of an enterprisewide data warehouse that can analyze clinical/financial outcomes. It serves another function: compiling and documenting evidence of meaningful use. Johnson suggests that evidence be stored for six years in case a provider is audited for compliance.

Meaningful use has increased Tenet’s efforts to capture clinical elements: The health system captured 600 elements initially or meaningful use purposes but soon expanded to several thousand because of the need to match elements to various workflows. If data is not collected as part of the workflow, a hospital won’t meet meaningful use, Johnson says contends.

The trick is to design a data collection system based on clinical workflow, not to simply collect data for meaningful use compliance. For instance, the collection of data on smoking cessation was in the wrong part of the nurse assessment processes, so nurses weren’t capturing that data at all, she explains.


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