Integrating Systems and Services
Bruce Haviland knows that building a world-class medical center isn’t a job for the faint of heart. These days, the CIO for the University of Pittsburgh Medical Center (UPMC) Mercy Hospital finds himself sorting through an array of tools and technologies in the quest to improve health care and manage costs. “It’s critical to put information at the center of the organization and ensure that it’s available when and where it’s needed,” he says. “The ability to integrate systems goes a long way toward defining success.”
It’s a concept that Haviland takes seriously. The Pittsburgh facility, with 50,000 employees and 2,700 physicians, has turned to smartphones to connect medical professionals with electronic medical records (EMRs) and other data. It also has instituted a smart alert system that provides crucial information to caregivers.
UPMC Mercy isn’t alone. Health care reform and growing pressure to maximize productivity and profits are prompting health care providers to adopt an array of technologies, including EMRs, cloud computing, virtualization, analytics and mobility.
Today, says T. Baker Smith, a senior partner at Accenture Health, “Information technology must support virtually every function within a health care environment—from the back office to delivery of care.”
Accenture estimates that over the next three years, 90 percent of hospitals will require new investments or upgrades to meet EMR requirements associated with the American Reinvestment and Recovery Act of 2009. The stakes are high, Smith says, because health care organizations that meet standards will receive financial incentives, while those that do not risk penalties.
For IT executives, maximizing results is no simple task. “Health care providers must find a way to achieve seemingly contradictory goals,” says Daniel Matlis, president of consulting firm Axendia. “While there’s a need to integrate medical technology and improve patient care and outcomes, there’s also a need to lower costs.”
Of course, the need to maintain patient privacy—particularly as medical professionals tap into data at home, on the road and in remote offices—is also critical. “Maintaining adequate control over the infrastructure is essential,” Matlis says.
Rx for Mobile Success
Over the past few years, information technology has left its imprint on virtually every aspect of medicine. Today, health care providers must manage EMRs, radiological data, patient communication, telemedicine and an array of other tasks through digital tools that increasingly tap into mobile and wireless systems. IT has radically transformed the way doctors, nurses and technicians handle their daily tasks.
Nobody knows this fact better than UPMC’s Haviland. The medical center arms doctors with BlackBerry Curves so they can access EMRs and other data on the go. In many cases, smartphones have replaced mobile carts and eliminated pagers and landlines.
For instance, UPMC uses a smart alert system that informs a doctor when a patient is about to be wheeled into the operating room. This allows the physician to prepare and submit any necessary orders before the patient arrives, saving crucial time.
The medical center also uses alerts to manage aides and orderlies, who constantly transport patients throughout the facility. In the past, these workers finished with one patient before checking back to receive the next assignment. Now they’re able to indicate their status via their smartphone and receive a message informing them of their next assignment.
The system, which runs on a BlackBerry Enterprise Server (BES) and uses encryption to maintain compliance with the Health Insurance Portability and Accountability Act (HIPAA), replaces handwritten orders. The sender visits a Web page and selects from a template, clicks the desired dropdown box to select a message and then chooses recipients from a list of those currently available.
Doctors input orders through a computerized physician order entry system (CPOE), and nurses and other health care professionals receive the information instantly. Haviland estimates that the system has trimmed wasted time by 20 minutes per employee per day.
Another innovation at UPMC Mercy is a SmartRoom, which incorporates a SmartBoard system. The 55-inch plasma display replaces a traditional grease board. It lists patients’ initials (it is HIPAA-compliant) along with the name of the attending nurse or aide who is responsible for patient care. Nurses can check the system via their smartphones and view assignments and patient data. The tap of a button on the BlackBerry dials a number to the patient’s room.
Not surprisingly, UPMC Mercy is pushing smartphones out to other groups. For example, obstetrics nurses at the hospital now use a pregnancy wheel to calculate the gestation period for women. Another smartphone app reads text messages aloud while a doctor or nurse is driving. “Many of these apps are free, and they are extremely powerful,” Haviland says.
“The ability to use wireless and location-based tools transforms work,” says Accenture’s Smith. “It’s especially valuable for home health care, where a practitioner shows up at a patient’s home and interacts with a doctor or other specialist through a tablet or smartphone.”
No Broken Records
Protecting data and complying with HIPAA requirements are major challenges facing the health care industry. Maimonides Medical Center, a 705-bed facility in Brooklyn, N.Y., has more than 90 applications that contain patient information, and all are interconnected to EMRs, notes Gabriel Sandu, senior director of technical services. The facility requires visibility into all these systems and records, but, in the past, it took weeks to prepare reports and satisfy HIPAA audits.
No longer. The medical center now relies on a User Activity Management (UAM) system from PacketMotion to streamline reporting and auditing. The application, PacketSentry, monitors and records user access, while enforcing policies for database access, including repositories holding public health information (PHI). The system identifies and audits PHI resources to protect patient information, while limiting communication to and from third-party devices that are not owned or controlled by the hospital’s IT staff.
“Instead of building a huge data warehouse, we decided to build a smaller repository and track the data in motion,” Sandu explains. Analysts at the facility can review who accessed, deleted and updated data—and examine questions and issues related to the entire data population. Combined with data encryption and other internal controls, “It has simplified and improved processes and controls dramatically,” he says.
Into the Cloud
The need to share documents and data is creating both opportunities and challenges for health care providers. As a result, some are turning to cloud computing to boost productivity.
At Bay Cove Human Services, a Boston not-for-profit organization that assists more than 4,000 individuals with developmental disabilities, behavioral disorders and substance abuse problems, approximately 1,600 employees share reports and other files across 140 offices. Many of these branches aren’t connected to the central network. Nevertheless, “Because these documents contain private health information, they must be fully protected,” says CIO Hilary Croach.
In the past, e-mailing and calendaring posed huge obstacles—particularly because there was no way to sync files or adopt effective version controls. To solve the problem, Bay Cove began using Google Apps. “It’s highly collaborative and it allows us to manage records in a powerful way,” Croach says.
The organization relies on CloudLock for Google Apps to secure the cloud-based environment. The application encrypts data and transmissions through the Web browser—making it suitable for use even at public WiFi hotspots. It also improves compliance and auditing capabilities.
This approach, Croach notes, saves more than $10,000 annually in email and word processing licensing fees, and it also eliminated a $100,000 licensing fee for the previous email product. The system helps Bay Cove analyze usage patterns, identify when data is exposed and fix problems immediately.
Integrating Systems and Services
Accenture’s Smith says that business and IT executives must place a premium on integrated delivery of services, understanding how data flows through the organization, and how EMRs and other data delivery tools fit in the overall picture.
“A lot of IT leaders think that once an EMR system is in place, the job is done,” he says. “In reality, it has just begun. Without tight integration between systems, there’s no way to maximize productivity and financial gains.”
A robust and interconnected IT infrastructure provides other benefits too, including the ability to tap into data streams that once escaped notice. Audrey Fisher, director of cardiovascular services at Sequoia Hospital in Redwood City, Calif., has witnessed a transformation in analytics capabilities at her medical facility.
Only a few years ago, “Collecting and understanding data about the quality of cardiovascular care was difficult and time-consuming,” she says. “The systems were inflexible, and the data was static. As a result, we weren’t able to maximize the use of information.”
Today, Sequoia is tapping IBM Analytics software to cull more than 200 data elements for any given patient, including demographic data, risk factors and general outcome information. The system, which contains data from more than 10,000 cardiac patients, helps surgeons determine which procedures and approaches are most likely to succeed in a given situation.
“The software creates a level of intelligence that otherwise wouldn’t exist,” Fisher says. The result? Predictive analytics has reduced mortality rates in cardiac surgeries by 50 percent.
Accenture’s Smith says that as organizations connect various pieces of the IT puzzle, they’re able to reap significant gains. Managing EMRs and other data across a mélange of systems requires a more strategic and sophisticated approach—along with an infrastructure that’s flexible and resilient enough to support ongoing change.
“It isn’t only about adopting new technology,” Smith concludes, “It’s about adopting and adapting the technology in the right way.”