Healthcare’s new IT cure

Source: Technology Digital

Date :7/16/2007 3:27:01 PM

Englewood Hospital is among hundreds nationwide forced to implement major new systems to monitor patients, track medications, and document payments due from insurance provides

By David Weldon

In the city that never sleeps, health care professionals can’t afford to ever be caught napping.

That means keeping a constant vigil over every aspect of a hospital’s operations, and on every patient that passes through its door. From obtaining accurate patient information at admissions, to properly reading and reacting to x-rays and blood test results, to prescribing the correct medication doses or therapy treatments, there is little room for error.

Getting, and keeping, all of this information correct is critical for providing and maintaining proper patient care. It is also vital for a hospital to properly document the care it provides to each patient, in order to be reimbursed for those services.

For healthcare provides such as Englewood Hospital and Medical Center, in Englewood, NJ, which serve the New York City area, the challenge is especially tough. Englewood is a non-profit hospital, competing head-to-head with four other, for-profit, acute care hospitals within a 10-mile radius.

“We are only five miles from the George Washington Bridge, and we compete with New York hospitals as well as New Jersey hospitals,” notes Chief Information Officer Diane Caesar. “This is serious competition.”

This competition results in the need to keep operations as lean as possible, while keeping systems state-of-the-art, and actual patient care at constantly peak levels.

“Everything we are doing right now is patient safety related,” notes Barry Wilhelm, business and financial systems manager at Englewood.

Along with Caesar and IT infrastructure manager Neville Lee, “everything” for Wilhelm includes making enormous investments in information technology hardware, software and services. Driving these investments are several factors:

• The need for better access to patient data by nurses and physicians.

• The need to meet new federal and state regulations regarding electronic records management.

• The need to track proper medications, and doses, for each patient.

• The need to collect data on every interaction a patient has with every department during there stay (touch points).

• The need to connect a growing network of hardware devices and software applications from a growing number of remote locations.

• The need to better tie disparate systems to each other, to improve staff access, system-wide communication, and accurate billings.

“Our board has deemed this the next decade of IT,” says Caesar.

What is happening at Englewood provides an excellent look at the dramatic technology changes sweeping healthcare providers nationwide. These changes are driven as much by bottom-line concerns as they are by patient well-being. And the insurance industry is a major factor.

About Englewood

Englewood Hospital has 650 attending physicians, and a combined staff of approximately 2,400 employees. The hospital currently has 520 licensed beds and five centers of excellent in its care areas.

It is a teaching hospital, has affiliations with various local schools, and is known for both its humanitarian mission as a non-profit hospital, and for the outstanding quality of its staff and its care.

Englewood also has ambitious expansion plans, including a new cancer center, expanded ambulatory care facilities, breast care center, radiology department, diabetes care center, Ob-gyn care center, and same-day surgery facilities. Add to that list a new emergency room, a new data center, and expanded health services.

As part of its expanded services, Englewood has installed two WiFi systems throughout the hospital this year. One is a public access system, which enables the public to access the Internet from any public location, such as waiting rooms, lounges or coffee shops.

The second, and most robust, WiFi system is a private system for staff use. This system enables physicians and nurses to access clinical data systems wirelessly.

Other key technology projects right now include the medication management system, which is an electronic patient medication history, dose chart, and condition alert system, which tracks all information related to a patient’s medication needs from the time of admission.

Lee says the hospital is currently implementing the first phase of this system, which stores and manages the basic medication dosage and scheduling data. A second phase to come later would tie a medication bar-coding process into the application, to further automate the process and to help reduce errors.

Another system in development is an enterprise-wide scheduling system, which Caesar says would capture and display all data on a patient in terms of the various departments they need to be scheduled with during a stay, all tests and lab work related to their treatments, as well as therapy or specialist visits.

The system “captures all the data from the minute they enter the front door,” Caesar says, which is key. “It is at the front door that the revenue cycle begins.”

Insurance companies are getting increasingly demanding on how care providers document the services they are offering, if the insurance company is to reimburse those costs. That puts pressure on the hospital to get a patient’s electronic file accurate and complete the minute they are admitted, since all subsequent care and billings will build off that file, Wilhelm says.

Another system that is a top priority is the web clinical portal under development, to serve physicians and clinical staff. This portal will enable a physician to access all hospital clinical data, from any remote location, on any device. This system is expected to go live in September, Caesar says.

Lee says that the interfaces are currently being developed to tie a dozen existing hospital systems into this portal data repository. In its first phase, physicians will be able to hold real-time video conferences with peers, and will be able to access data and input medical inquiries. In the second phase to follow, the system will be able to provide historical trend data.

A higher calling

All of this focus on technology places a large demand on staff, and Englewood budgets for 39 full time IT workers (though it is currently staffed with 35 employees). There are a dozen systems application managers assigned to various specific departments which also, in actuality, are part of IT.

While the backgrounds of the IT staff are varied, as in any typical IT organization, there is a strong representation of healthcare experience among management. Many come from health technician backgrounds, and many wear the titles of clinical systems, rather than information systems, job roles.

Otherwise, the staff is largely comprised of database administrators, network engineers, and other “high level” IT pros, Caesar says. And in most all cases, “they’re high priced.”

On the recruiting front, while there are more IT works available in the job pool; they aren’t necessarily at the skill level needed. “They are out there, but everyone is looking for the same people,” Caesar says.

With new hires, Caesar says she is now more concerned with technical background than healthcare experience, since the needs are changing so much within the organization. She would prefer a candidate have a strong technical background, and then learn the specific medical environment in which they would be placed.

Most importantly, “we look for people with initiative,” Caesar says.

To retain the staff, Caesar says the hospital offers a lot of training, opportunities for IT workers to move around within the organization, and a team work approach to job roles.

A major recruiting tool, according to Wilhelm, is the advantage that any non-profit organization offers: “the noble cause.”

While non-profit organizations have historically been viewed as less competitive on the compensation front, Wilhelm says the personal satisfaction reward to the worker offsets that — for the right people.

Beyond that, as a hospital, Wilhelm says the quality of life factor in the working environment is hard to top. Plus, “we are a very family-oriented organization.”

Physician, heal thyself

It is a good thing for the hospital that staff is especially dedicated, Caesar says, because they work tremendously hard.

“We, in IT, have been working with so few people, and we are being forced to work much more efficiently,” Caesar says. “We are probably at the breaking point.”

That situation will hopefully ease, she says, as the numerous projects now underway begin to see completion.

In addition to the work involved with designing and installing the various new systems and applications, a lot of time also goes into training the users of the systems.

“There has been a great deal of hand-holding, they’re very busy people,” Caesar notes.

To handle the training demands on top of infrastructure work, Wilhelm says IT is using a train-the-trainer approach. Selected employees from the various user departments are initially trained in a new application, and they in turn help train others in their department.

Caesar says she can also see light at the end of the tunnel. Two years from now, the hospital should have most of these new initiatives completed, and staff comfortably using them.

At that point, she says she looks forward to the time when any physician or nurse will be able to access all data, on any patient, from any location, and share it with any colleague, in a manner that is totally automated and accurate, eliminates errors, and bills automatically.

At that point, she says the IT staff will consider the current ills that affect the enterprise to be in full remission.