In picturesque and evergreen Western Washington state, a 25-bed critical access hospital is setting a new standard for being tech savvy and independent, characteristics that form the basis of a multiyear strategy for improved population health.
Mason General Hospital in Shelton, a rural community founded on the logging, fishing and oyster trade about 20 miles west of Olympia, launched its health information technology strategy 17 years ago. Today, the Most Wired-designated hospital has a robust, cloud-based electronic health record system; clinical decision support; telemedicine; virtual visits; and soon will launch disease registries and a data warehouse.
“Our whole purpose is to create relationships rather than affiliations, so we can remain independent and best serve our community,“ says Tom Hornburg, chief information officer at Mason General. “Our technology initiatives reflect that."
Despite having a small number of beds, Mason General keeps busy. The hospital has about 27,000 active patients; 22,000 emergency department visits per year; 10 outpatient clinics; and 650 employees. About 80 percent of patients are covered by Medicare or Medicaid, typical for rural providers.
While health IT had been a focus for many years, Mason General's efforts in this area gained sharper focus about a year and a half ago when it joined the Rocky Mountain Accountable Care Organization. The collaborative organization is made up of six hospitals in rural central Rockies region of Western Colorado and five hospitals in rural Washington state. The ACO’s patients are in traditional Medicare.
“We view it as a learning opportunity,“ says Dean Gushee, Mason General's chief medical officer, of the ACO. The hospital currently carries no financial risk for participation.
The ACO participation has pushed Mason General further into care coordination and population health management, Gushee says. This requires hiring care coordinators, nurse educators, licensed clinical social workers and nutritionists. It also means building a database to manage and track the ACO population and report results to Medicare.
Mason General soon will have an enterprise data warehouse to access internal and payer data on quality and costs. It is also building patient registries for common chronic conditions such as diabetes, and will be able to cross-reference the registries to identify the highest-risk patients for tailored interventions.
“We are removing burdens and barriers for providers to conduct work on social determinants of health,“ Gushee says.
A big issue is identifying gaps in care to be able to close them, and that's where improved data access can help, says Hornburg. For instance, the hospital has embedded a pharmacist and a nurse in two clinics to conduct patient medication management and reconciliation to boost adherence to prescribed treatments.
Getting buy-in from nurses and physicians has been important to the IT strategy. Prior to choosing a new EHR vendor in 2013, nurses and physicians had the opportunity to demo products and respond to a survey about their preferred options. The hospital chose the vendor that appealed most to staff.
Similarly, prior to rolling out its virtual visit platform early this year, the hospital first piloted the program with its employees, who pay $10 per visit. My Mason Virtual Care, now available to all patients for a $35 flat fee, is run through a vendor with providers outside the Mason General system but integrated with the hospital's EHR. Patients can access the service online from most devices with an Internet connection.
“It was very important for us to tie the visits back to our own systems,“ Hornburg says.
So far, virtual visits only account for about 10 patient visits per month, although that is growing by about one to two per month, Hornburg says.
Telemedicine, too, is a staple at Mason General, with access to specialists for telestroke, telepharmacy, telesepsis management and telepsychiatry. And an online patient portal allows for physician emailing, viewing health records and accessing test results.
An active community board and a CEO who support technology innovation have been important factors in Mason General's success, says Hornburg.
“It seems we are nimble on getting things done,“ he adds. “We push for change and we don't accept 'no' for an answer."