Electronic Health Records

Adoption & Implementation News

Why Prioritizing Usability Effects Better Ambulatory EHR Use

By Kyle Murphy, PhD

- Winona Health in rural Minnesota is celebrating a major health IT milestone after having received recognition from HIMSS Analytics for its ambulatory EHR use. The rural community health center counts itself among the top-seven percent of healthcare systems in the country in achieving Stage 7 status on the Electronic Medical Record Adoption Model (EMRAM) for ambulatory settings.

For the lean organization, the achievement proves the importance of sticking to a plan — in this case, a health IT strategic plan and the use of a lean management system.

“Everybody wants the latest and greatest in software technology. We’re certainly not made of money as a non-profit,” says Winona Health Chief Quality & Safety Officer Kathleen Lanik. “Using that process, we were able to take a look at all the things out that we would love to do — inpatient, outpatient, long-term care, assisted living, etc. — and prioritize what would come first, second, and so on.”

At the highest level, the strategic goals at the Minnesotan healthcare organization aim to leverage IT systems to decrease waste, increase productivity and flow, and improve safety. The lean management system then becomes a means of aligning initiatives.

Alignment is also a characteristic of leadership at Winona Health, which at each level plays a critical role in ensuring that the goals of the health IT strategic plan are met. It is especially true at the very top of the organization.

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“Thankfully, our CEO has embraced technology and finds it to be a huge lever for us moving forward into the future. Leveraging technology has been on her level-one imperatives for at least three to four years,” explains Polly Peterson, Director of Information Technology.

Both Peterson and Lanik credit the decision-making of only three years ago in putting Winona Health on the right operational path. That and a no-nonsense approach to sharing organizational priorities.

“There were no secrets. We were fully transparent. The things that we prioritized got us to this point,” adds Lanik.

Usability of electronic clinical documentation

The difference for Winona Health between Stage 6 and 7 EMRAM was physician electronic clinical documentation. The functionality happened to be one of many requirements for demonstrating Stage 2 Meaningful Use. In achieving the latter, the healthcare organization enabled itself to be recognized for the former.

According to Peterson, both achievements were the end-result of significant physician engagement at the outset.

“We decided when we were planning for Stage 2 that we would move to digital documentation using some sort of electronic tools not knowing exactly what we were going to do,” she explains. “Winona brought in nine providers for one week into a lean event with other IT, HIM, support staff and leadership and they along with the rest of the group planned out the entire project. They were the ones driving this entire project instead of IT or HIM plating this out.”


Having a direct line of feedback from physicians eliminated any assumptions about EHR design and focused attention instead on EHR usability from a physician end-user’s perspective.

“When you talk about usability, in that first event we had the feedback of what would work or wouldn’t,” Peterson continues. “Until you have provider’s feedback on that, you’re making assumptions. Usability becomes what someone else thinks of as usability as compared to what a provider actually has to deal with when he is trying to see 25 to 50 patients in a day.”

Streamlining systems and feedback

As Winona Health moves deeper into 2015, its leadership understands that its recent achievements with EMRAM and the EHR Incentive Programs are milestones along the way, not the finish line.

“Now that we have implemented any of the things that we have done, there are of course 25 to 30 behind it that some would want prioritized. We’re constantly looking at that,” Lanik reveals.

Through the rest of the year, the rural health organization has set its sights on improvements within its own walls as well as efforts in health information exchange and population health management in partnership with the State of Minnesota.

Internally, the focus is on the timeliness of clinical feedback through the use of department-specific concierge services who have a direct line to the IT department. “They partner with IT to find out the things that they’re experiencing. We have a good idea of what’s working well and what’s not. The plan moving forward is how to improve that,” Peterson observes.

Externally, the challenge centers on ensuring data access for population health through HIE use.

“Getting access to data is one of the hardest things right now,” Peterson maintains. “We have a new partnership with the State of Minnesota on population health and continued growth of health information exchange to make it feasible for a small community organization to stand that kind of thing up.”

The difficulty of data access has an analogue in Winona Health’s work in data analytics and reporting — that is, making data actionable for providers with limited resources.

“Every organization right now is challenged with making data meaningful. We have gotten pretty far over the years, but we need to take next steps and reduce some of the bottlenecks while figuring out how we train or provide better resources to our users to identify what is meaningful reporting,” says Peterson.



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