Using Varian’s ARIA® oncology information system, St. Luke’s University Hospital Network in Pennsylvania was part of the first wave of health care providers to comply with U.S. meaningful use requirements and receive three incentive payments from the Centers for Medicare & Medicaid Services (CMS).
“ARIA has helped us to successfully complete three meaningful use attestations,” says Robyn Plesniarski, MS, HSA, R.T.(R)(T), manager of radiation oncology and community outreach for St. Luke’s. “I love using ARIA for meaningful use because it provides an organized and seamless flow of information for managing each patient's entire journey through our healthcare system.”
What is meaningful use?
“Meaningful Use” standards were established by the U.S. federal government some seven years ago. Eligible healthcare providers were encouraged to become "meaningful" users of information technology in order to begin receiving financial incentives established by the HITECH Act, which was part of the American Recovery and Reinvestment Act of 2009 (ARRA). Financial incentives began in 2011, after the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs were established to administer the program.
Healthcare providers can receive incentive payments by demonstrating meaningful use by using healthcare IT products, like ARIA, that meet the standards and certification criteria established by the Office of the National Coordinator’s (ONC) Authorized Testing and Certification Bodies (ATCBs). Certain versions of ARIA, coupled with the Equicare Health Patient Portal, have been certified to meet these federal requirements and have received ONC - ATCB (Authorized Testing and Certification Body) Complete Ambulatory EHR Certification for both medical and radiation oncology. (For further information, please see ARIA for Medical Oncology and ARIA for Radiation Oncology).
Caring for the whole patient
Initially, Plesniarski and her team began using ARIA for meaningful use compliance with the goal of increasing the consistency and continuity of their patient care. But they found that being in compliance meant so much more:
“Being in compliance allowed us to take care of the total patient, not just their diagnosis,” notes Plesniarski. “For example, in the past if a female patient entered our clinic with a diagnosis of a brain metastasis, she would be treated for that disease, but now with meaningful use compliance, we make sure that if she’s in a certain age range that she undergo screenings such as a colonoscopy or a mammogram.”
To keep track of these screenings, Plesniarski and her team use the encounters tab in ARIA, which allows them to build customized checklists of the clinical tasks that need to take place, enabling them to see what they’ve completed and what still needs to be done.
“Using ARIA software, we are taking better care of the whole patient at the same time we are fulfilling the meaningful use regulations and educating patients about their total health,” says Plesniarski. “We are also using the Karnofsky scale and toxicities as well as the cancer-only staging component, which we have not found in any other system except ARIA.”
The encounters checklist functionality in ARIA enables St. Luke’s physicians to have information such as patient vitals, lab work, etc. on one screen that they can pull from and allows them to maintain consistency in reporting, clinical decisions, screening, and education. The physicians enter the core measures into the ARIA system and the system automatically generates a clinical recommendation while the nurses complete chart preparation for each patient through ARIA.
“ARIA is a very powerful system that contains a wealth of information. The data management and customized reporting are so valuable, and the dashboards are also extremely helpful. Using ARIA has allowed us to organize and streamline our care delivery and really increase our patient care communications,” says Plesniarski. “Consequently, each of our attestations have gone smoothly.”
Using ARIA to demonstrate compliance with “meaningful use” criteria meant making a few workflow changes at St. Luke’s. Educating everyone on the staff was another important step in the process.
“We implemented the use of ARIA for meaningful use compliance in phases and took time to educate the staff,” Plesniarski recalls. “It was a two-year process to fully deploy the relevant functionality in ARIA, but it was well worth it.”
By moving to a paperless environment through ARIA, St. Luke’s workflows have become more efficient, and patient care is better coordinated as patients are able to much more easily navigate the healthcare system and get to the next step in their care. ARIA facilitates the paperless process through a dynamic documentation feature that automatically populates templates to document patient encounters.
“I know that our staff appreciates the multiple improvements ARIA has brought to our practice, such as prompting us to make clinical decisions and having a patient’s information in one place and on one screen rather than on multiple screens or pieces of paper,” remarks Plesniarski. “As an administrator, I appreciate the time that ARIA saves me because I can run my own reports, and I no longer have to wait for the tumor registry, which can take six months.”
Plesniarski served the project as the ARIA “super user” for meaningful use compliance and relied on the support of Varian consultants, including Corinne Sigel, one of Varian’s clinical applications specialists.
“Implementing meaningful use takes a huge amount of time and dedication, especially at a multi-site facility like St. Luke’s,” observes Sigel. “Meaningful use compliance at St. Luke’s was a slow process that involved a lot of workflow creation and workflow changes within a department that already had processes in place. Robyn’s determination made this process successful. She was willing to try new ways of doing things, then to make the necessary adjustments, and then to try again. And she had to train and inspire others to do the same.”
Plesniarski maintains that, when deploying ARIA for meaningful use, it is extremely helpful to designate specific champions from different staff divisions to help manage the project – for example, a nurse champion, physician champion, etc., who understand meaningful use and its goals, as well as the workflow and checks and balances.
“Having the right resources and network is so important, and the support I received from Varian made using ARIA for meaningful use compliance run smoothly,” says Plesniarski. “Our program continues to grow because of the partnership and technologies from Varian. We strive to make the best medical care accessible to all of our patients, and our network’s investment in Varian’s technology ensures that we are on the cutting edge of medical care.”