We couldn’t have done it without our staff” sounds like a line from an Oscar night acceptance speech, but it’s a sentiment expressed by all of Most Wired’s 2006 Innovator Awards winners. Success with new technology initiatives came only after they enlisted clinicians’ support early in the process—generally long before projects were actually put in place. It’s a lesson learned from a handful of pioneering hospitals that plunged ahead with IT projects on the assumption that their staffs would eventually jump on board.
“Communication is important,” says Nick Christiano, chief information officer of Health Quest, Poughkeepsie, N.Y., which won an Innovator Award for building a multifrequency wireless network to support medication bar coding. “You have to get the staff and trustees excited about doing it before you even start.”
This year’s three winning projects and three finalists reflect the new steps hospitals are taking in their slow but inexorable advance toward electronic medical records. Lehigh Valley Hospital and Health Network, Allentown, Pa., developed its advanced ICU program out of a desire to combine the EMR with telemedicine and computerized provider order entry. Texas Health Resources, Arlington, developed an electronic voting tool to use during teleconferences involving physicians at its far-flung hospitals, solely for the purpose of building consensus as it moves to adopt an EMR.
Speeding throughput—reducing length of stay in the hospital—while maintaining patient safety as the top priority was another driving objective among this year’s entries. Skaggs Community Health Center, Branson, Mo., dealt with an ever-worsening traffic jam in its emergency department by enabling employees to order medications from the bedside, eliminating delays and moving patients through the department more swiftly and efficiently. Crozer-Keystone Health System, Springfield, Pa., got a much better handle on patient flow by coming up with an enterprisewide bed and patient tracking system.
But a theme that emerged as consistently as any other from the group of six award-winning projects was their thoroughness, even caution, in obtaining employees’ support from the start.
Columbus (Ind.) Regional Hospital, for example, established a team of what it called “sharp end” front-line clinicians who got involved early in its medication reconciliation program and worked with a senior physician on a pilot unit. One of the goals was to inform and educate a large number of clinicians about the new process to convince them that it would improve care.
Without assurance that clinicians will embrace an innovation, the prudent step may be to try something else or wait until later. That’s what Health Quest did in adopting medication bar coding to improve patient safety; Dan Aronzon, M.D., CEO of the organization’s flagship hospital, Vasser Brothers Medical Center, would have preferred CPOE but decided it was too risky.
“Many hospitals have fallen on their face” after taking on CPOE without getting physicians to buy into it, he says. Bar coding, on the other hand, was “something we could get done without changing physician practice.”
Winner: Lehigh Valley Hospital and Health Network, Allentown, Pa.
Advanced ICU
Looking to use technology to improve care and efficiency, Lehigh Valley Hospital and Health Network devised an unprecedented initiative focusing on its sickest patients—those in the ICU. Its advanced ICU (aICU) takes telemedicine well beyond video capability in what it says is the first intensive care unit of this kind in the United States. While others have cameras for remote viewing, Lehigh Valley’s aICU integrates CPOE, medication administration recording, real-time documentation charting and medical device data while enabling patient monitoring.
“Having one system that integrates all the information we have with the ICU system—that’s been beneficial,” says Nadine Opstbaum, information systems project manager.
The teleintensivist program, as it also is known, provides round-the-clock coverage of ICUs throughout Lehigh Valley’s network, sending real-time video, audio and automated patient data from each critical care bed to an off-site command center where a medical intensivist and two critical care nurses evaluate patients and send orders back to the bedside. Overseeing the care of up to 90 critical care patients, it also allows families and patients to interact with physicians.
Part of a strategy to reduce mortality rates, the $3 million initiative is paying off: The network reported a 5 percent reduction in ICU mortality and numerous other positive repercussions after aICU went live in autumn 2004.
Stephen Matchett, M.D., medical director of telehealth services and chief of the division of critical care medicine, says the system came about when Lehigh Valley began considering a remote monitoring system but found it had too many shortcomings, including the need for manual data input, limited fixed alerts and little modification of the bedside clinical practice. The organization decided to create its own electronic bedside medical record for the ICU—a combination of best-of-breed components and a work process redesign—that would support both CPOE and telemedicine.
Besides a lower mortality rate, the length of stay in the ICU dropped more than the organization targeted, saving a cumulative 3,000-plus patient days. The aICU saves nurses an estimated one hour per 12-hour shift by reducing the time needed for documentation, administrative work and running for meds and equipment, Lehigh Valley says. Going from paper to an electronic record also slashed the average time for administering a new antibiotic from 157 minutes to 66 minutes.
“It would have been much faster to just stick in some cameras,” Matchett says. “The advantage of taking this more laborious and complicated approach is that we have been able to make multiple interventions and we have both improved clinical care and improved patient safety—and created a system that is more efficient and resulted in a positive return on investment. It’s a clear win for patients, our staff and the accounting department.”
Winner: Health Quest, Poughkeepsie, N.Y.
Wireless in Motion
A visit to a Home Depot store, of all places, helped lay the groundwork for a patient safety initiative at Health Quest. The process began when Vasser Brothers Medical Center CEO Dan Aronzon decided to do something to improve patient safety, but with no physicians on staff at the community-based hospital, he didn’t think CPOE was the immediate answer.
Nick Christiano, Health Quest’s chief information officer, suggested medication bar coding instead. It would work well, he said, as long as a wireless network was built to support it. “The reason that wireless [was chosen] is everybody’s in motion—doctors, nurses, patients—and the concept of having a computer by a bedside to take care of patients doesn’t really work,” he explains.
Christiano took Aronzon to Home Depot so he could talk with clerks who were bar coding inventory with a wireless system they pushed around on a cart. With the CEO on board with the plan, Health Quest then proposed to make Vasser a completely wireless environment, able to support cell phones, pagers, medical telemetry equipment and radiofrequency identification.
Following a major infrastructure investment, the organization teamed up with IBM as its primary vendor and project manager and last fall instituted medication bar coding starting with the use of wireless devices. Bar codes on the patients’ wristbands, the medications and all clinicians’ ID cards are scanned using the wireless network.
“A patient comes to a hospital on eight to 10 medications on average,” Aronzon says. “Keeping track of that, in tune to a fluxing patient condition, is really very difficult. The use of the wireless network and medication bar-code system reduces medication errors by 87 percent.”
The cost was as substantial as for any of the 2006 Innovators’ projects: an estimated $1 million for the wireless system that supports multiple frequencies, $530,000 for a wireless telephone system with voice-activated commands and $1.7 million for the medication bar coding.
But the payoff has been large, too. Alerts showed that Vasser Brothers avoided 64 adverse drug events in the first month alone because of bar coding—a number that grew to 167 by this spring. In addition, voice-activated phones save approximately 85 minutes per nurse per shift, translating to projected annual savings of $955,000. Clinician and patient satisfaction levels are up, too.
“It makes the nurse feel good about working here, it makes the patient feel good about being here knowing that we have invested in the technology, and it makes the physician feel good about the improvement in patient safety,” Christiano says.
Reducing errors is a win not only medically but financially, too. Aronzon says a good nurse has only a 1.4 percent error rate when she passes out medication, but if you multiply that by the 2 million doses that a hospital the size of Vasser Brothers distributes each year, that’s 28,000 adverse drug reactions. Applying an average $5,000 cost to each adverse reaction makes for $140 million that could result from adverse drug events per year.
“If we can eliminate 87 percent of that through an investment in technology, we’re improving patient care … and patient safety,” says Aronzon.
Winner: Columbus (Ind.) Regional Hospital
Reconciling Safety
Medication reconciliation—recording what patients take at home and coordinating the data with their prescribed treatment—has long been a challenge for hospitals to achieve efficiently. Columbus Regional Hospital found a way to do so by automating and simplifying the process, and as a result, improved its safety record.
The stakes were substantial. Poor communication of medical information at transition points is responsible for as many as 50 percent of all medication errors and up to 20 percent of adverse drug events in hospitals, according to the Institute for Healthcare Improvement, which made reconciliation a key initiative in its 100,000 Lives Campaign. Errors may include omissions, duplications, dosing errors or drug interactions, and could be fatal.
Columbus focused on admissions and discharge, where up to half of all medication errors occur. There was no readymade solution so the organization customized one, CIO Tim Tarnowski says.
“We wanted to find a way to collect the list of at-home medications, record those in our electronic systems, share them with any hospital clinician who needed that information, create a simple process to reconcile them with the at-home meds and give the patient clear instructions at home on what they should do,” he says.
Hospitals rely too heavily on patients to provide information and follow-through. Experts say the patients may be too sick, injured, young or disabled to participate actively in the process. Reconciliation eases that responsibility.
“Many patients are not always familiar with the complexities of the health care system or clinical areas. They know, ‘I’m taking the green one, I’m taking the blue one, two of those, one of those,’” says Tarnowski. “We provide them clear instructions now through a discharge meds list. They are starting to use that when they visit their clinician.”
In redesigning the existing medication reconciliation process at Columbus last year, a team of physicians, nurses and other professionals helped eliminate 34 of the 42 steps, using McKesson products. Procedures and automated reports were created and made available to physicians, who used them for medication admission, transfer and discharge orders. Hospital officials say the reports have significantly reduced problems with illegibility, transcription mistakes and duplicated efforts.
While errors haven’t been entirely eliminated, they’ve been greatly reduced since the change was completed in August 2005. Clinical staff have embraced the boost in efficiency and patient safety.
“We’re really seeing improvements,” says Susan Piirto, R.N., nursing systems analyst. “We’re keeping our patients safe when they come into the facility and helping them to have a complete record when they leave. The patients are buying into it, and the physicians like the concept of having the information readily available.”
Finalist: Crozer-Keystone Health System, Springfield, Pa.
Online Bed Tracking
Crowded emergency departments caused bottlenecks at Crozer-Keystone Health System’s hospitals and accounted for two-thirds of its admissions. So the health system used technology to unclog the EDs, devising a bed tracking application to speed patient flow. The Web-based platform, eBed, gives staff at the three participating hospitals a real-time view of the patient flow process, eliminating communications problems and admissions delays associated with the previous, manual system.
“It’s helping facilitate getting the patients where they need to be, getting them into the room, getting them situated, right through to getting them discharged and getting the room cleaned,” says Joshua Snow, director of Web development.
A team of in-house software engineers spent about four months creating the application to track ED patients. When patients are admitted, their information is entered into Crozer-Keystone’s hospital information system and then fed into eBed. A color-coded bed tracking module shows the patient’s gender, the room’s cleaning status and the patient’s transport status. With a click of the computer, nurses trigger a page to housekeeping or transport staff. The system uses voice recognition technology and telephony integration to allow housekeeping to easily update a bed’s status. Additionally, an electronic bed board—updated automatically—provides an at-a-glance overview of all clinical units for patient flow coordinators and registration and admissions.
Snow says eBed reduces the need for time-consuming phone calls and gets information out quickly on a variety of communications devices, including wireless tablets and PDAs.
Crozer-Keystone spent about $100,000 on the project and expects a full return on its investment by streamlining the throughput procedure, saving its nursing staff time and raising satisfaction levels among both clinicians and patients.
CIO Robert Wilson notes that the application enables one hospital to look up bed availability in another hospital within the system, which is useful at busy times and helps Crozer-Keystone avoid sending patients to another health system.
Finalist: Texas Health Resources, Arlington
Electronic Voting Tool
Videoconferences haven’t been the same at Texas Health Resources since the organization devised a way to do real-time polling of participants looking in from its 13 hospitals—and that’s a good thing. The organization’s hospitals unanimously agree that the technological innovation brings greater and more accurate feedback, ensuring consensus at every step as it moves to adopt an electronic health record.
“We feel that techniques like this help us to be more tightly aligned,” says Mike Alverson, vice president of information services.
The suite of software applications that enables the instant electronic feedback is a byproduct of the hospital’s Electronic Health Record Implementation Committee, dubbed EHRIConHand. Physicians from distant sites use their PDAs or laptops with Web access to register their votes on questions such as, “How long will it take us to achieve 80 percent adoption of CPOE?”
Texas Health officials say getting an accurate read on such matters was well worth the more than $40,000 cost, which included $18,000 for 30 PDAs. Instead of only hearing the impassioned feedback of physicians who might be resistant to technology, they get everyone’s input.
“It’s helped us become much more objective in our decision-making process,” says Ferdinand Velasco, M.D., chief medical information officer. “This allows the opportunity to make sure there’s a democratic process, that everybody’s heard whether or not they’ve chosen to speak up.”
The voting tool also has changed the way meetings are run, making them more decision-oriented and less about formal presentations. Previously, one senior physician complained, sitting in on the videoconferences was “like watching C-SPAN.” Now, thanks to EHRIConHand, members are engaged in the discussions and focused on vote results, which are displayed for all to see.
Winner: Skaggs Community Health Center, Branson, Mo.
Speeding ED Care
M ore than 7 million tourists annually visit the Midwest resort town of Branson, Mo. Meeting the health care needs of this influx of tourists, coupled with those of area residents, had created significant workflow challenges in the emergency department at Skaggs Community Health Center. The rural organization responded by adding context management software to coordinate two new documentation systems, allowing staff to focus on patient care while reducing data entry errors and saving crucial time.
“Time is muscle, especially when it comes to cardiac patients, and any time that we can save clinically improves patient care,” says Amy Plott, R.N., clinical project manager.
The health center introduced both electronic documentation and a new order entry system within a few months of each other, creating the likelihood of additional distractions and delays in the crowded ED. Skaggs concluded that the new computer applications could eliminate delays but only in conjunction with software developed by its Clinical Context Object Working Group. That context management tool gives users visual access to individual patients’ data across disparate clinical applications, synchronizing the information.
Clinical staff are now able to single-handedly order from the bedside, bypassing support staff and ensuring quicker response time and greater accuracy. Patients’ wait time for lab results dramatically decreased, and their trust in the system was increased by the ability to order from the bedside. Patient care also has improved in the ED, Skaggs says. That’s a significant payback on an investment of less than $10,000, which included the addition of four wireless access points and eight laptops.
“The emergency department is usually the first place a patient enters, so what better place to do something that will coordinate care better?” says Crystal Stallings, chief information officer.
Dave Carpenter is a writer based in Chicago.
About the Innovator Awards
Hospitals & Health Networks recognizes six organizations with Innovator Awards, a joint project of Accenture, Cisco Systems, CHIME, H&HN and McKesson Corp. Hospitals are encouraged to submit a 10-page essay that highlights a specific information technology project. The essays must describe the project, provide a business objective, and list key obstacles and solutions.
This year, a panel of 22 hospital and information technology leaders evaluated 38 essays to name three winners and three finalists. Each project was judged on universality and achievement of the stated business objective, creativity and uniqueness of concept, impact on the organization, scope of the solution, state of implementation and technical creativity.
Innovator Awards Judges
Donna Agnew, Director of IT planning, Presbyterian Healthcare Services, Albuquerque, N.M.
George Arges, Senior director, health data management group, American Hospital Association, Chicago
Chris Baldwin, Vice president of corporate MIS, Northeast Health, Troy, N.Y.
Russ Branzell, CIO, Poudre Valley Health System, Fort Collins, Colo.
Kay Carr, Senior vice president and CIO, St. Luke’s Episcopal Health System, Houston
Carole Cotter, Senior vice president and CIO, Lifespan, Providence, R.I.
Cynthia Davis, Vice president of information technology and CIO, DeKalb Medical Center, Decatur, Ga.
John Glaser, Vice president and CIO, Partners HealthCare, Boston
Angela Haas, M.D., Vice president, physician resources, and CMIO, Susquehanna Health System, Williamsport, Pa.
Dennis L’Heureux, Vice president and CIO, Rockford (Ill.) Health
Deane Morrison, CIO, Concord (N.H.) Hospital
Tom Ogg, Vice president and CIO, Memorial Healthcare, Owosso, Mich.
Rod Piechowski, Vice president of technology leadership, National Alliance for Health Information Technology, Chicago
Keith Rivera, E-business director, Presbyterian Healthcare Services, Albuquerque, N.M.
Dick Shurson, Director of information systems, Kishwaukee Health System, DeKalb, Ill.
Bill Spooner, Vice president and CIO, Sharp Healthcare, San Diego
Kelly Styles, CIO, Children’s National Medical Center, Washington, D.C.
Rebecca Sykes, Senior vice president and CIO, Catholic Health Partners, Cincinnati
John Wade, Vice president and CIO, Saint Luke’s Health System, Kansas City, Mo.
Bob Wilson, Vice president and CIO, Crozer-Keystone Health System, Springfield, Pa.
Eric Yablonka, Vice president and CIO, University of Chicago Hospitals, Chicago
Tim Zoph, Vice president, information services, Northwestern Memorial Hospital, Chicago
This article first appeared in the Summer issue of HHN's Most Wired Magazine.
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