Training on a Massive Scale
By Tom Barnett
In 2006, our IT department was offered the opportunity of a lifetime. The Michigan-based health care system where I work had just broken ground on an exciting new project. The objective was to build a state-of-the-art hospital that would fuse the cutting-edge health care of the Henry Ford Health System with the hospitality and service of the world’s finest hotels.
This was an ambitious project, to say the least. The IT team’s job was to plan, design and install all the information technology for the new facility. This was a huge undertaking, but it was more rewarding than we ever imagined.
miles northwest of Detroit is the township of West Bloomfield, Mich.,
where Henry Ford Health System
already had a large ambulatory clinic
situated on 160 acres of woodlands and
wetlands. The hospital planning team decided to expand from the existing
ambulatory facility and build a 300-bed
in-patient hospital that would be
built around the patient instead of
The motto for the new Henry Ford West Bloomfield Hospital was to “take health care beyond the bounds of imagination.”
As the director
for the IT program, I had the luxury
of being able to plan the program before physical
construction was under way. Two-and-a-half
years before the opening of the hospital, we started building the IT program
Our core IT team scoped and sized the program
and then tackled what
would need to be built.
Among the noteworthy
aspects of the program were the numerous facilitated sessions with
were building a hospital, the actual departmental employees
would not be hired
for another two years. As a result, we were gathering requirements, walking
through floor plans and checking likely workflow process
models with equivalent staff from other Henry Ford Health
feature that Henry Ford Health System and the construction company came up with
was the use of
actual full-size patient rooms constructed
in a local industrial building—that
included both general patient
along with their emergency room counterparts
us flexibility in trying out
technology with our proxy health care
What would work and what wouldn’t? How much space would it take up? Was it clumsy or awkward?
One thing to keep in mind is that it is difficult to approximate clinicians’ needs once they are in the finished hospital. Teams can predict how clinicians are likely to behave, but technology needs to adapt to changing workflows. So we met with pathology clinicians, pharmacists, nurses, case managers and others to plan.
basic planning pieces are critical to the success of
any program. First among these for us
was the work breakdown structure (WBS). In one diagram, we could break
down at a high level what we were to deliver for the hospital. From the WBS,
we were able to logically group similar work into
subprojects and know that all
the work was covered by someone’s project plan.
The WBS included areas for infrastructure, wireless, computing devices and networks. It also covered applications such as revenue, clinical and diagnostic systems.
Next was the integrated program schedule.The IT program
plan had to bridge the gap between the construction plan and the staffing and
hospital activation plans.
The construction contractor already had a
detailed building plan that crews were working
from. This would provide key input into the IT plan because the sequencing and
timing of the cable installation teams had to closely follow those of other
building mechanicals, such as HVAC,
electrical systems This
be completed before walls and drop ceilings were installed.
Laying the Groundwork
Obviously, we had to
get this right from the start. We were fortunate
that the contractor had a
tight timeline and that many of the infrastructure items
we needed to install followed the
build schedule closely. For example, after
construction crews had rough-framed
in a floor of the hospital (meaning the walls were framed), our
teams would begin pulling data cables to each room where the
network closets would eventually be. We
started at the main data center and telco
In all, the team installed
more than 4,400 data pulls and built
25 network closets. We
also installed 231
wireless access point (WAP) antennas that
to resemble ceiling tiles and
constant data and voice coverage, even in elevators.
Once the phone switch was installed, the team pulled 1,507 voice cables and put in just over 1,300 telephones.
We also had to plan for the implementation, configuration and testing of more than 72 applications that are necessary for hospital operations. We were lucky because most of the IT applications were already in use elsewhere in the health system.
Applications in a hospital setting largely
fall into four
categories: revenue cycle
(human resources and financial
) and ancillary applications.
critical chain of data
called the ADT (admission, discharge, transfer)
feed holds most of
these systems together
The ADT feed updates the
status of patients
there is a change, and it contains information such as a patient's name, ID
number and room
is the charge interface, which ensures
that any systems used to perform a billable service in the hospital have
the right patient and send back the correct
To orchestrate all these
systems, we registered
an imaginary patient, Fred Flintstone, in the revenue
cycle system. Then we
worked to ensure that laboratory,
radiology and dietary departments all
received this information, performed services and
sent back billing feeds. Clinical results also had to post back to the
electronic health record, and billable items had to post back
to the patient account.
Using this sequence, we were able to build
the program plan to properly gather specifications and configurations for each
and then test each application.
We had all performed integration testing on a
single application or set of new servers. But testing
something of this
scale and magnitude was new territory. We
needed a tight sequencing plan and an abundance of
The testing had to be planned
in the same way as
the sequencing of the applications. Testing
included the following areas:
registering a patient for
either an appointment or the emergency room, assigning a
bed, ordering diagnostic imaging and lab tests, ordering medications and food,
physician visits, and updating the electronic health
record, followed by patient discharge, accumulation of billable charges, and
finally the creation of the patient billing statement.
For testing purposes, we removed the wait and processing times and were able to simulate the entire process in nine to10 hours.
Once we knew we had everything working exactly as we planned, we were ready to open.
Training on a Massive Scale
As we moved closer to the opening date, training began on a massive scale. Almost 1,200 new and transplanted employees had to be trained—not just in new hospital processes, but also in the combination of IT systems that pertained to their department or area of work. Frequent checkpoints, team huddles and numerous conference calls ensured that all the work was coordinated.
Nearly 1,200 members
of the clinical and physician staff were
being trained in every available
conference room, lunch roomopen
space in or near the hospital.
the important activities
simulations of key
hospital processes, such as admitting patients,
delivering a baby and performing diagnostics.
was the digital nervous system to make it all work. We
needed to ensure the
IT systems talked with each other
nurse call system had to properly alert patients, and dietary orders (with food
allergy notes) had to make it to the kitchen accurately and on
When the hospital opened on
March 15, 2009, it was a fantastic experience for
all involved. It was
an undertaking that involved hundreds
of talented people,
including more than 100 engineers and managers.
The IT program executed very well,
with only the minor program
issues, which were to be expected for
something of this size. The fact that a complex,
varied collection of technologies came together and worked so
well on the delivery date can be traced back to careful planning, team
collaboration and open communication.
years later, Henry Ford West Bloomfield Hospital continues to outpace other
local hospitals, its
scores are setting national records and p
atient volumes have exceeded expectations.
Tom Barnett is the IT director at
the Detroit-based Henry
Ford Health System. He can be reached at firstname.lastname@example.org.