For Smaller Hospitals, The MU Burden Is Just as Large

We are a small, rural, critical access hospital located in Southeast Iowa. We have 25 acute beds and 49 long-term care beds. We may be small, but I submit that the challenges presented by MU stage 2 are the same in breadth and scope as they are for our much larger brethren.

We face the same 16 core objectives and six menu objectives (of which we must meet three) — same numbers. Same breadth of impact across the organization. Same number of objectives to research, thoroughly understand, plan for, address and document, regardless of the size of the organization.

What is different is the depth of resources available to deal with the same breadth of issues. I grant that our larger brethren may have more systems, more subspecialty process, the arena of research, etc. to deal with, but from a breadth and scope perspective of MU 2, the challenges remain the same regardless of size.

When I look at my organization, we have four IT and two clinical IT staff FTEs, which is actually very good for our size. I know larger facilities within 100 miles of us that have larger IT staffs than we have FTEs for the entire hospital. At the end of the day, to me this simply means we all have a horrendous amount of work to do regardless of size, and tight resource availability is a given, probably also regardless of size.

For the small guys out there, it’s more than “kind of daunting.” Some may say this is the impossible dream, or that the deck is stacked against the small folks. I have heard some say, let’s evaluate how bad the penalties will hit us and evaluate whether or not to proceed on a strictly business basis and look solely at return on investment. Certainly an understandable thought, at least initially.

However, I believe that the vast majority of us are in healthcare because of a higher calling. We are in it because we believe in providing world class care to the populations we serve. Further, most of us believe that in spite of the regulatory load created by MU 2 and other numerous issues, that EHR technology does provide and drive better patient care, better outcomes, and most of us still believe that ultimately it will assist us in bending the unsustainable current cost curve of healthcare in the US.

I know at my organization, we believe that from the board level down. We believe that patients are best served with world class technology, appropriately applied at the point of care, as well as before and after the point of care. Our journey to this point began in 2004, so admittedly, we had a head start. We had already done nursing documentation, eMAR, Radiology, Lab and Pharmacy right out of the block in an integrated package. We went live with CPOE in October of 2008, before ARRA was signed. That helped a lot, but there are also advantages of being small, and I would cite just a few:

• Our medical staff is small enough that I have the opportunity to know everyone personally, and so do all of the IT and Clinical IT staff. This makes communications much easier. They may not like our messages at times, but getting it to them, reinforcing it repeatedly, and coaxing the message along is easier than if we had thousands do communicate with.
• Our clinical/nursing staffs are also smaller; therefore, we have the same advantages as we do with medical staff from a messaging perspective.
• We are blessed with outstanding medical and clinical staffs that embrace this mission. For that I am eternally grateful.
• Being small, our governance structure tends to be flatter. Further, there are large overlaps in staff from committee to committee, further streamlining the messaging task. This in turn streamlines decision-making and process change.
• Being small, we have a tendency to be more agile and nimble than our larger brethren. Agility can go a long way to overcoming mass and force.

So at the end of the day, the tasks in front of us are huge regardless of where we are and the size of our organization. Rural/urban, large/small — the job is the same, and the needs of our patients are foremost. To my small counterparts I say, do not despair. Yes, the load is heavy, but there are some things working in our favor as well. Seize the moment and capitalize on the opportunities our size brings us. I am not saying the job is easy or for the faint of heart; it’s not. But it is doable, in every sense of the way, regardless of organizational size. Some may say we have an unfair advantage due to size, but I will have to work on that one.