Moving from EHR Fragmentation to EHR Optimization in Miss.

The CMIO of Memorial Hospital of Gulfport talks EHR optimization in the wake of a national disaster and widespread EHR fragmentation.

By Kyle Murphy, PhD on

Memorial Hospital of Gulfport currently finds itself in the position of improving inefficiencies in its EHR use following years of health IT maturation at the Mississippi health facility. The EHR optimization process represents a marked departure from the EHR fragmentation that characterized the multi-specialty medical complex in the southernmost part of the state.

As CMIO David Northington, MD, tells EHRIntelligence.com in this two-part interview, all that changed when Hurricane Katrina touched down in the Gulf and shone a light on the inefficiencies plaguing the healthcare infrastructure in especially hard hit areas.

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Many years later, Memorial Hospital of Gulfport is continuing to make significant strides in its clinical EHR use following an aggressive big bang Cerner implementation in 2014.* In the first part of the interview, Northington shares insight into the downstream effects of such a go-live and its consequences for EHR optimizations in the years that followed.

Editor's note: An earlier version of this article incorrectly stated 2010.

As Northington notes, EHR optimization is tied directly to EHR use and how the latter informs conversations about the role of the EHR in delivery high-quality patient care.

EHRIntelligence.com: What is the history of EHR use at Memorial Hospital of Gulfport?

David Northington: In 2005, Katrina wiped out the Mississippi coast line. We were at the time a 445-bed hospital that took care of sick people. I described it as we took them in here, we stabilized them, and then we opened the doors and put them out to the community and had no concept of continuation of care. They went back to their primary care doctors and the only way you would see them again was if they got sick or failed therapy and came back to the hospital.

Katrina was big part of changing that philosophy. Most of our physicians', nurses', and employees' homes were destroyed. We had a population that was moving. Clinics had been destroyed. We were still standing — we didn't have any windows left — and still functioning throughout that whole storm. It became very apparent as not only patients but also physicians were leaving the area secondary to the construction that we needed to do something to start stabilizing physicians' practices to maintain what we were trying to do in taking care of the community. With that abutted a physician alignment strategy, from employing doctors to actually doing contracts with certain service lines.

At the time, it was all about stabilization and caring about the community, but what we were transforming into at the time was developing a healthcare system — something that the south part of Mississippi had never seen before.

EHRIntelligence.com: What was the next step in the hospital's EHR evolution following Katrina?

DN: As we moved forward through the years and alignment became the big thing, we realized that we did not have any type of EHR in the outpatient system. We had a struggling inpatient EHR with McKesson, so we made a move to put the outpatient physicians on a platform and we used Allscripts. We did a go-live, put them in, and were up and running for a few years. But as we kept aligning our physicians, the population migrating to our hospital system, we realized that we were disconnected from the outpatient to the inpatient world. They did not communicate well. As I would put it and the physicians put it, we're all practicing with blinders on our patients, only seeing the world that the patient lived in either outpatient or inpatient — it was frustrating. Physicians wanted one platform or what I can a patient-centric chart. Around 2010, we went on the look to find that platform.

EHRIntelligence.com: What went into the EHR selection process at Memorial?

DN: We looked at Epic, Cerner, McKesson, as well as Allscripts. The community got together. We viewed all these different vendors and ended up voting on Cerner Millennium for multiple different reasons. But we chose to do something very different and hardly ever done before — we ended up pretty much purchasing their entire catalogue. We wanted inpatient and outpatient, one platform. And we wanted to build it and turn it on in one day. That was relatively new to the industry for institutions to try something like that, which now is becoming more of a common thing as a big bang solution. We wanted this because the sooner we turned on everything, the sooner the chart got to mature, had more information, blinders were taken off, and we could start sharing the information. We went go-live in June of 2014 with a big bang.

EHRIntelligence.com: Did the big bang EHR implementation approach contribute to EHR inefficiencies in the Cerner EHR?

DN: You know what you know when you know it. If you would have asked me back in 2013 to try to lead this team through certifying and getting everyone functional on the EHR, I would've told you everything was about the go-live and teaching Cerner 101 — meaning that every physician could get in, find their patient list, make sure all the patients were going to be seen, navigate through the chart, do their orders and documentation, and move on.

When you do this, there are problems with that that aren't recognized when you start this process. There is stewardship of the chart that people aren't doing. Problem lists start growing exponentially. There are [financial identification numbers] FIN numbers when we used to only use medical record numbers and that comes into FIN creation, selection, and how that goes through the revenue cycle. There are order management issues, which is something the nurse or unit secretary used to take for us when we changed drugs and all that. But now it's fallen into our lap. The chart, which I describe as a massive sponge that grabs onto every piece of information possible, also has to be managed — wringing out the sponge — so that you have all your useful information where you want it to be.

EHRIntelligence.com: How has the experience of EHR use over years impact the general conversation about its usefulness moving forward?

DN: Over the first month of the EHR go-live, the conversation is a very immature one.  It's about my patient, where is this result, I don't know how to order this test to FIN numbers, outpatient scheduling, who owns the FIN. This conversation matures. We couldn't have had this conversation in month one, but by month nine —then through fatigue and all that leads into efficiencies. The EHR governance team was borne out of these conversations in a way to take a horizontal approach and brining all these people — lab, radiology, nursing to revenue cycle — and looking at the individual problems we were having and managing the chart to come up with solutions and then teach them.

We have created an EHR governance team to evaluate some of our pain points.  As the chart matures the governance structure will evolve with our physicians and patient’s needs. We realized we wanted to improve and evolve the current efficiencies within our organization to see the benefits of our investments.  Cerner partnered with us to continue this growth and we are working together to evolve the next generation of the EHR. 

Check back later this week for the second part of this interview.

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