Two Must Haves: Interoperability AND Usability

By Dean Gushee, MD, MS, FACEP
May 2012, Clinical Informatics Insights

Achieving meaningful use was the original driving force of our recent healthcare IT initiatives at Mason General Hospital & Family of Clinics, a 25-bed critical care facility in Shelton, Wash. However, we had several goals for the rollout of a new patient portal and electronic health record system in our emergency department.

One of our primary objectives was to provide better access to health information for the 22,000 patients that we treat annually in our ED. Another top priority was improving the quality and coordination of care that our 11 ED physicians and 30 nurses and aids deliver to patients.

In selecting a new ED information system, we worked hard to strike a balance between the hospital’s focus on interoperability and meaningful use with clinicians’ mindset of ensuring that the EDIS would not hinder productivity or the quality of care.

We sought extensive clinician input during the evaluation process, and we canvassed the market to find the right solution for our ED. We discovered that the user experience is the most important success factor for EHR implementations. Hospitals with hard-to-use systems that hinder productivity have low clinician adoption rates, while EHRs designed by and for clinicians have high adoption rates — essentially the key to successful implementations. The hospital ultimately selected a best-of-breed EHR that provided ED-specific charting functionality such as structured templates based on patients’ chief complaints common to emergency medicine. ­

What my fellow ED physicians found is that our EDIS had virtually no learning curve. Best of all, we’re not killing clinician productivity in the name of data exchange, interoperability and documentation. Because of the EDIS, our hospital is seeing more patients and generating increased reimbursement.

After implementing the EDIS, we sought a solution that would allow us to feed the ED patient summary from our EHR via HL7 data streams into a patient portal that would address meaningful use requirements and improve care coordination and patient loyalty at our hospital. We created MyMasonHealth.com, an online portal that gives patients and their families the ability to pre-register for surgical visits, download information to their secure personal health record and share it with other caregivers. The initial soft rollout of MyMasonHealth.com has been a resounding success, with more than 300 patients registering on the portal. Later, we are planning to make discharge instructions and lab results available.

We also participate in a rural healthcare network, called ED Information Exchange (EDIE), which is comprised of about 30 hospitals and four larger referral centers, to help us track patient utilization of emergency services, manage chronic disease through intervention and provide a comprehensive understanding of patient needs.

These initiatives have enabled Mason General to attest to Stage 1 of Meaningful Use and have put us on a solid path toward achieving Stage 2. We have also drastically improved cross-department communication and the ability to track patients. Following our EDIS implementation, we have seen measurable results, including improved patient throughput, with average door-to-doctor time of approximately 40 minutes, average length of stay of two hours and a left-without-being seen rate of less than 2 percent. In our experience, EHR usability is a critical component of our strategy in driving improved patient safety, higher quality of care and long-term sustainability.

Dean Gushee, MD, MS, FACEP, serves dual roles as the hospital and emergency department medical director at Mason General Hospital & Family of Clinics in Shelton, Wash. Dr. Gushee attended the University of Utah and trained in emergency medicine at Valley Medical Center in Fresno through the University of California, San Francisco.