MU Stage 2: The Roller Coaster Ride to Direct Messaging

[Brandi Boren]

We went live with meaningful use stage 2 on March 13, 2014, but getting to that point was kind of a roller coaster ride.  Health Information didn’t have a huge part in the upgrade, but we were there for all the meetings and phone calls with McKesson and of course coding some test patients during integrated testing.  McKesson divided the calls between eight hospitals.  For the most part they were like a round table meeting and they went around to each of those hospital for updates, open issues, new problems, etc.  Some of the meetings has a slides attached others were just agendas for the call. 

Direct messaging was one aspect of the meaningful use stage 2 upgrade.  What that means is there is a direct messaging link that the facilities use to send CDAs or summary of care records when transferring a patient from one facility to another.  Each facility has its own specific link.  In order for us to meet the requirements for meaningful use stage 2 we have to have 10 percent of the CDAs or summary of care records send electronically for all inpatients and ER patients that we transfer.  Once sent electronically it is automatically logged in Paragon ROI and that is where the reports show what percentage we are at and if we meet the requirements.  We also made a form for the nurses to fill out if they sent the information with the patient by paper.  Those forms have to manually logged into Paragon ROI in HIM in order for those to count as well.  The forms had a place for the patient’s identification sticker, where the patient was being transferred, what information was being sent, how it was being sent, and the signature, date, and time.  It also had to be turned into the HIM department within 48 hours of sending the information.  

Another part that HIM played was calling area facilities that we transfer patients too.  We had to find out if we could do some direct messaging testing with them.  We thought not a big deal because we have some pretty big hospitals that we transfer patients too and they are probably way ahead of us.  That was not the case at all.  I called probably 20 facilities and only found one of them that we could test with.  Some didn’t know what I was talking about, some never returned my calls, and some I just got passed from one person to the next.  Most of our nursing homes are not electronic yet and one hospital was a CHS hospital and did not want to work with anyone outside of a CHS facility. 

From being on the McKesson calls we found that other facilities were having the same issues so it was decided just for test purposes we would test with those facilities that were on the calls and continue to try and find facilities in our area that we could test with.  During the process of testing direct messaging we found that we could send CDAs or summary of care records out and it showed that they went, but they really were not being sent.  It worked in a live environment, but not in test.  McKesson finally got this fixed as of March 17, 2014, four days after go live.  We were then able to test the direct messaging portion with those eight hospitals that were on the calls and it was a success.  The problem is we still only have one hospital in our area that we transfer patients too that we have been able to use.  The search continues for more area facilities and we think that the issue is just finding the right person at the facility who knows about meaningful use stage 2 that can help us.

Most of meaningful use stage 2 was clinical and I am not clinical so I couldn’t begin to tell you what all went into building and testing rules and measures.  I just know that each part of meaningful use stage 2 had a certain percentage that we had to be at in order to meet the requirements.  I will end with saying best of luck to all those who are beginning meaningful use stage 2.    

Brandi Boren has worked for Jennie Stuart Medical Center in Medical Records for eight years and has five years experience with McKesson including Horizon Patient Folder, Paragon Medical Records, and Webstation for Physicians.