"There were some things I read in detail but it didn't quite register," he says. For example, "All the stuff you printed out had to have the vendor's logo on the document. I didn't recall reading that. Fortunately for us, Medhost was able to go back and rebuild those documents with the logo on it."

Medhost helped in many ways, say Ryan. "We've had a long history with our vendor. Our nurses were on electronic health records a decade ago. And we just recently moved forward with the physicians a little over a year ago. (Medhost has) had some changes in leadership and they've rebranded themselves, but they've really stepped up."

It didn't hurt, she adds, that "I have a world-class IT department. It's run by a great CIO who knows a lot about software and a lot about programming, so we were immediately respected. When (Medhost) was putting out a new product, they would come to Cottage and ask us to be a beta site. We were sometimes able to say, 'As a provider we don't think like that. Maybe a programmer might think like that, but hospitals are really complex and this is how we think as providers.' It was a really symbiotic relationship between us."

"Cottage Hospital proves that combining healthcare IT leadership and expertise with a deep clinical commitment can power facilities to significant operational and clinical accomplishments," said Craig Herrod, president of Medhost, in a press statement congratulating the hospital for its successful Stage 2 attestation.

Even as a tiny critical access hospital, Ryan says there are lessons larger organizations could learn from its example.

"You have to have the right people at the table," she says. "You have to have the clinical folks, the IT folks and your vendor – you've got to put a lot of pressure on your vendor and you've got to keep pushing forward."

Clinical buy-in was key. "Our informatics nurse set up an email address where people could write in their concerns, or call a number, and she would get back to everybody," says Ryan. "There was constantly communication happening. The medical staff had an IT component to it, and we had a hospitalist who was really heading things and able to teach it in that provider language."

Rigorous timelines are also critically important, she says. "Time passes so quickly. We're all wearing multiple hats. A project could easily slip away from you. You've got to have consistent meetings, and people have to be held accountable."

"It was Maria's mandate that we were going to attest to MU 2, and we did," says Frederick. "The support was up top. The investment was substantial, but the facility was behind it all the way. Not having that to battle with was a big win up front: Rather than going to the CFO and asking for a million dollars for hardware, it was more like, 'Here's what it will take.' And we just got it done."

[See also: Stage 2 is too tough]