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.

Twenty-five 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 clinician.

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 proxies. Although we 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 System hospitals.

One helpful 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  intensive-care units. These mock-ups, along with their emergency room counterparts , gave us flexibility in trying out technology with our proxy health care providers.

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.

S ome 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, plumbing and electrical systems This would allow cabling to 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 distribution room. 

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 were designed to resemble ceiling tiles and provide 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 (billing), clinical, business (human resources and financial ) and ancillary applications.

A 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 when there is a change, and it contains information such as a patient's name, ID number and room . 

Another key element 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 billable items.

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 system 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 checklists.

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.

Among the important activities were day-In-the-life scenarios: all-day simulations of key hospital processes, such as admitting patients, delivering a baby and performing diagnostics. 

Underlying everything was the digital nervous system to make it all work. We needed to ensure the IT systems talked with each other . For example, the 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 time.

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.

Three years later, Henry Ford West Bloomfield Hospital continues to outpace other local hospitals, its Press-Ganey 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 tom.barnett@earthlink.net.