Texas Health Resources received more than $19.5 million in Medicare incentive payments at the end of May for meeting first stage meaningful use. But according to Ferdinand Velasco, MD, vice president and CMIO, the heath system didn’t do it for the money.

Velasco said Texas Health invested more than $200 million in its EHR adoption, which began in 2006 and involved more than 4.7 million electronic patient records.

“We didn’t undertake EHR adoption because of HITECH,” he told Healthcare IT News. “As an organization, we thought it was the right thing to do, and critical to advancing our health system as a high quality care organization. It just so happened that our trajectory aligned with federal incentives.”

Texas Health Resources is one of the first health systems nationwide to receive incentives, with 11 of its hospitals achieving meaningful use Stage 1. Currently physician CPOE adoption rate is approximately 90 percent, Velasco said.

[See also: ACOs and meaningful use to go hand in hand.]

Align with "signals" before MU regulations come out

Velasco said one of the keys to qualifying so early was closely following the signals coming out of the Health IT Policy Committee and the Centers for Medicare (CMS) and Medicaid Services, to anticipate what would be included in Stage 1 requirements. The hospital then began striving to align with those requirements in advance.

Velasco said achieving meaningful use Stage 1 was not difficult with the way Texas Health approached it. “Last year was mainly about crossing the Ts and dotting the I’s,” he said.

To start, the health system established a steering committee of various disciplines to champion the EHR adoption, Velasco said.

The health system then hired a dedicated project manager to go over meaningful use requirements. “We were very intimately familiar with the regulation,” he said, “However some things were not entirely clear.” That’s why it was important to closely follow the guidance coming out of CMS, various federal webinars and FAQ webpages. Texas Health also worked very closely with its vendor.

Get doctor buy-in on problem list

According to Velasco, the most difficult part of achieving MU was getting doctors to buy in to keeping a patient problem list. “It’s a relatively new concept, particularly in community healthcare,” he said.

“We weren’t quite sure how was it supposed to be used, but as we gained experience, we gained a better appreciation for its power,” said Velasco.

Selling the benefits of the problem list to doctors was helpful in persuading them to try it. The problem list is a good method for improving communication between caregivers, according to Velasco. It’s one place to go for all providers to see what’s going on with the patient.

The problem list can also promote clinical decision support, and can have built-in trigger alerts and reminders relevant for patients in certain disease categories, he added.

Velasco said getting doctors to use a problem list “was a matter of evangelizing and communicating” to them through health IT champions partnering with hospital leaders. It was critical that each hospital had its own health IT physician leaders, he said.

Another thing that helped was hardwiring data capture for the problem list into order entry. When doctors made an order to admit a patient to the hospital, 90 percent of the time it automatically entered at least one problem on the patient’s problem list.

After two or three years of promoting adoption of the problem list system-wide, several of the health system’s hospitals now range from 80 to 90 percent adoption. Others are hovering in the high 70s, Velasco said.

Public health reporting a challenge, but aim high

Reporting public health measures was another difficulty for achieving MU because the technology is still relevantly new, Velasco said.

“Obviously, when there is not a readiness within local health structure it is difficult to meet the criteria,” he said. “The bar is low now, and we are submitting data. We are not just trying to meet the bar, we’re trying to achieve and satisfy the spirit of meaningful use.”

Velasco was recently named chair of the Quality, Cost, Safety Committee of the Healthcare Information and Management Systems Society (HIMSS). Follow him on Twitter @ftvelasco.

[See also: Federal panel votes to delay Stage 2 meaningful use by a year.]

Follow Diana Manos, senior editor of Healthcare IT News, on Twitter @DManos_IT_News.