Don't tell Susquehanna Health System that some people think small-city hospitals are technologically disadvantaged. After all, over the last decade, the five-time Most Wired winner headquartered in central Pennsylvania, has systematically installed wave after wave of new technologies at a pace that even large, well-funded urban hospitals might envy.
Driving these efforts is a fundamental belief from the board to the clinical staff that IT strength is a strategic tool for providing better patient care and competing with larger health systems, two of which are within 50 miles of the health system's Williamsport, Pa., headquarters. "We need a strong IT infrastructure to continue competing, so any tool we can use to our advantage ends up being major focus of our efforts," says Steve Johnson, acting president and chief executive officer. "Our excellent patient satisfaction numbers make us very confident we're making the right decisions about IT investments."
But SHS's success doesn't simply mean installing the latest and greatest technologies as they arrive on the market. It's become a pro at finding new and creative funding sources and at cultivating special relationships between the clinical and IT staffs to ensure that physicians and nurses become enthusiastic adopters of new technology.
Merger Might
SHS began in 1994 when three hospitals--the Williamsport Hospital & Medical Center, Divine Providence Hospital and Muncy Valley Hospital--joined forces to maximize their strengths and eliminate duplicate services. Today's health system staffs 450 acute care beds that serve 14,000 patients a year. SHS performs another 16,000 outpatient surgeries annually. In addition, 54,000 patients stream through the system's emergency departments.
Since its birth a decade ago, SHS has been successful in two sometimes conflicting goals--reducing costs and providing high-quality patient care. By eliminating duplicate services, SHS estimates it has saved more than $105 million over that time period--proof that cutting costs doesn't necessarily mean cutting corners. Press Ganey Associates Inc., in an inpatient satisfaction survey conducted for the system, recently placed SHS in Pennsylvania's top 3 percent in nursing care quality and in the top 6 percent in physician skill.
Although clinical and administrative success depends on a number of factors, executives from both camps say SHS's long-time policy of embracing new technology has played a significant role (see "Key IT Projects for the Susquehanna Health System"). "We see IT as a strategic tool, and that's a philosophy driven by the board of directors," says Pamela Wirth, vice president and chief information officer. "The board believes that IT is fundamental to giving employees the tools they need to do their jobs. We're not a big university hospital, but the board always finds ways to fund and support all of our big IT initiatives."
Key among them was a double-barreled effort to launch electronic medical records and then deliver them efficiently via a secure wireless network or Web portal.
SHS installed its first acute care EMR in 1994 and followed up with a separate version for outpatient services four years later. Over the past year, SHS moved its acute care EMRs to Siemens Soarian, a large health care information management system. Last July, SHS earned the distinction of being the first hospital to launch both the clinical and financial modules of Soarian, which SHS had been beta testing since 2001. The outpatient staff uses another Siemens product, Clinical Manager. From either application, physicians can call up approximately 10 years' worth of patient data, including prescription histories, patient assessments, treatment orders, lab results, ED documentation, operative reports, and even online EKG strips and PACS images from radiology. "Now when I look up Joe Jones in my office, I not only see his latest lab tests, but also his tests from the last nine years," explains Angela Haas, M.D., IT medical director. "I can look up an X-ray report from five years ago, a hospital discharge summary from four years ago, or a pathology report from two years ago. That has a huge impact on patient care."
But creating electronic patient records was only half the battle. SHS had to efficiently deliver the information to keep the busy health system humming. So seven years ago, it gave its nurses wireless notebook computers. Now, when nurses are at a patient's bedside, they view physician orders or update a chart using a tablet PC from Motion Computing. Physicians typically tap into the same 802.11 wireless network with Panasonic Toughbooks or Fujitsu LifeBooks, small form factor portable computers.
Three years ago, the health system launched secure clinical Web portals so nurses and doctors can call up EMRs when they're in offices outside the immediate hospital walls.
"Whether it's the Web or wireless, they receive the same information," Wirth says. "Although physicians and nurses primarily access EMRs, they also can see an extensive collection of medical library and research information, including content from the Ovid and MD Consult Web sites."
ROI Intuition
When it comes to deciding which IT projects to do and when, SHS doesn't use a strict financial formula to determine ROI, Johnson says. "Our decisions about IT are more intuitive than any other capital investment decisions we make," he explains. Johnson, SHS's longtime chief operating officer, stepped into his new role last August when Kirby Smith, CEO for the past three and a half years, resigned for personal reasons. "We apportion a major piece of our capital each year to make sure our IT infrastructure is as good as it can be," Johnson adds.
He believes that comprehensive IT systems go a long way toward helping hospitals measure care quality, which can improve clinical outcomes. "The connection between clinical quality and patient safety are inextricably linked," he says. "When we tie these areas together through our IT system, we get better patient outcomes delivered in a safer, more cost-effective manner." For example, a decade ago, Pennsylvania's health department reported that the occurrence and morbidity rates for strokes in central Pennsylvania were among the highest in the state. "We began tracking all kinds of details about the types of services we provided and the effect that these services had on outcomes," Johnson says. "For the next seven years, we worked to improve each step along the service delivery continuum. We're now at the point where the Volunteer Hospitals of America in Pennsylvania ran data on stroke outcomes and reported that SHS has one of best outcome sets in the state," while the Pennsylvania Health Care Cost Containment Council reports that SHS's average charges are among the lowest in the state.
SHS uses a variety of financing tools to come up with capital. Federal dollars help. This year, it received more than $2 million toward expanding its EMRs. A $500,000 federal IT grant will help pay for patient safety initiatives, including a new computerized physician order entry project.
SHS also forges unique relationships with IT vendors. It received valuable price discounts from Siemens by acting as a Soarian beta site. The price breaks also enable SHS to expand perhaps its most unusual funding stream: That of IT outsourcer for two other rural Pennsylvania hospitals. SHS outsources health care applications, including Soarian, to the hospitals that otherwise would face the expense and staff burden of buying and installing the complex applications themselves. "They get support and expertise from a local staff, as well as the obvious cost benefits," Wirth says, estimating that the hospitals save more than 50 percent compared to buying a product outright.
In return, SHS says it doesn't receive direct profits from what it calls the cost-based contracts. But the health system can justify additional IT staff to support the contractors as well as its own operations. "We defer overhead and reap the many benefits of doing installs jointly," Wirth adds. "There are significant savings as well in sharing hardware and offsetting maintenance costs."
Clinical Commitment
After getting executive commitment and adequate funding, the third leg of SHS's IT success relies on a strong buy-in to new technology by physicians and nurses. Rather than letting this critical phase happen haphazardly, SHS developed a formal strategy that it has honed over the last decade. The strategy will be more important than ever as the health system launches CPOE, a collection of process-altering technologies that have proven contentious at other hospitals. Pointing to some early success with pilot efforts, SHS says it is confident it can pull off CPOE. "We've done some pilots for prescription orders and the time for patients to get their medications has decreased significantly," Wirth says.
Some of that attitude results from the people network SHS already has in place. In addition to her medical practice, Haas acts as a clinical liaison between doctors and the IT staff to make sure any new initiatives make clinical sense. "If you don't have a physician who understands both sides of the fence, it's hard to get clinical staff buy-in," Haas says.
The nursing staff includes a similar liaison person and just to seal the deal, the IT department includes a handful of technologists who are also registered nurses. This clinical informatics force helped SHS become an early Soarian adopter even though nurses insisted on a number of custom-tailored features, including an assessment tool to identify patients at risk for skin ulcers during their hospital stay. "If the tool tells you that a certain patient is at risk for a pressure ulcer, the nurse immediately places an order for a nutrition consult and initiates a preventive skin-care plan," Haas says.
For CPOE, the hospital cultivated a group of six doctors it calls "Phase One" physicians, who are helping to shape the CPOE system, report back to their departments on the project's progress, and learn the new technologies and procedures so they can help train others. SHS didn't pick just any doc to be part of this group. "We were very selective," Haas says. "We didn't necessarily want technology geeks. We wanted physicians who understood the value of CPOE and were willing to work through some of the issues with us."
In return, SHS has a one-year contract with the physicians to be CPOE guinea pigs. "We wanted to make sure the physicians were really engaged, and to do that we had to put teeth into it," Haas says.
When it's time to move beyond phase one, SHS plans a staged CPOE rollout. By early winter, about 34 physicians will be using the system. Within a year, about 50 physicians--the top 50 in terms of patient admitting--will be on stream. This group will represent about 85 percent of all patients entering the hospital.
SHS hopes that time and peer pressure will get the remaining docs onboard. "It helps to have the most respected physicians at SHS, some of whom are in the CPOE group, saying this is really important," Haas says. But she also recognizes that some physicians will be stubborn. "At some point, we're just going to have to make CPOE mandatory," Haas says.
Patient Power
SHS's technology commitment won't end with CPOE. Johnson envisions future projects that cater more to the patient experience. "A lot of our IT investments have been in infrastructure, which for the most part is invisible to patients," he explains. That could soon change. Johnson imagines interactive TV monitors for inpatient care that allows patients to switch from TV programs to post-surgery or discharge planning instructions from their caregivers. Web access for research about their particular condition might also be available on the monitors. "Information technology that actually touches the patient. That will be our next wave of IT projects," Johnson believes.
Alan Joch is a freelance writer based in New Hampshire.
Percent Of Physicians And Nurses Who Use Wireless Technology To Access Medical History (Weighted Average)
| SUSQUEHANNA | 81-100% |
| 2004 MOST WIRED* | 41-60% |
| 2004 LEAST WIRED** | 1-20% |
Source: H&HN's 2004 Most Wired Survey and Benchmarking Study
*Aggregate data for the 100 highest scoring respondents.
**Aggregate data for the 100 lowest scoring respondents.
Vital Statistics
Susquehanna Health System, Williamsport, Pa.
Acting President & CEO: Steve Johnson
CIO: Pamela Wirth
Number Of Employees: 2,557
Number Of IT Employees: 55
Number Of Acute Care Beds: 450
Total Operating Budget (2004): $230 million
IT Operating Budget As Percent Of Total Operating Budget: 2.6%
Total Capital Budget (2004): $10 million
IT Capital Budget As Percent Of Total Capital Budget: 31.8%
Key IT Projects For The Susquehanna Health System
| Project | Description | Vendor | Target Date |
| Computerized Physician Order Entry | Electronic creation and delivery of physicians' orders, including prescriptions. | Siemens | Small-scale pilot now taking place; rollout to 34 physicians in winter '05 |
| Computerized Physician Order Entry | 10 years' worth of patient histories available electronically | Siemens | Initial acute care implementation in 1994; outpatient launch in 1998 |
| Electronic Pharmaceutical Supplier Transactions | Automated ordering and payment for medications | Cardinal | Pre-2000 |
| Web-Based Monitoring | High-risk cardiac and OB patients relay vital signs and other physical information via the Internet | HomMed LLC | Q1 2003 |
| Biometrics | Biometric-enabled mouse reads fingerprints for identify verification and single sign-on capabilities | Siemens | Limited launch in 2000; roll out to entire staff July 2004 |
| Voice Recognition | Automatic digitization and transcription of oral physician notes. | Philips | Begun this year, full implementation expected in 2005 |
| PACs | Digitized diagnostic imaging | Siemens | Q2 2003 |
| Online Payments | Patients can choose to pay bills via the SHS Web site | Lynk Systems | 2003 |
Source: Susquehanna Health System, 2004
Percent Of Physicians And Nurses Who Use Wireless Technology To Access Nurses' Notes (Weighted Average)
| SUSQUEHANNA | 81-100% |
| 2004 MOST WIRED* | 41-60% |
| 2004 LEAST WIRED** | 1-20% |
Source: H&HN's 2004 Most Wired Survey and Benchmarking Study
*Aggregate data for the 100 highest scoring respondents.
**Aggregate data for the 100 lowest scoring respondents.
Percent Of Physicians And Nurses Who Use Wireless Technology To Review Medical Images Online (Weighted Average)
| SUSQUEHANNA | 81-100% |
| 2004 MOST WIRED* | 21-40% |
| 2004 LEAST WIRED** | NONE |
Source: H&HN's 2004 Most Wired Survey and Benchmarking Study
*Aggregate data for the 100 highest scoring respondents.
**Aggregate data for the 100 lowest scoring respondents.
This article first appeared in the Fall issue of HHN's Most Wired Magazine.
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