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From the April 2003 Issue Deploying Secure, Reliable Wireless LANs in the Healthcare Environment |
No More Plain Vanilla Choosing an HIS is a decision of epic proportion. While the system is still the proverbial workhorse, CIOs today look to the HIS for specific results and a demonstrable payoff in the future. By Richard R. Rogoski
Healthcare information systems of 2003 are no longer the plain vanilla versions of a decade ago or more. Considered the workhorse of many hospitals and integrated delivery networks, the HIS nevertheless has been viewed as a tad boring—the necessary underpinning of an industrious healthcare organization, but rarely colorful enough in itself to warrant an in-depth examination. That was then. This is now. With healthcare IT—including wireless, computerized physician order entry, bar coding, EMRs, contract management and e-health initiatives among others—blooming all around it, today’s HIS is an integral and pivotal player in helping healthcare organizations maintain their day-to-day survival and achieve their long-term success. As CIOs lead teams of healthcare executives in pursuit of objectives, they are crystal clear about desired outcomes, about the results they require from their HIS, both alone and in concert with other applications. Some CIOs rely on products from vendors with whom they already have a working relationship. Others watch market trends and decide to invest in products whose developers are forward-looking.
Healthcare Globalization Walton says when Siemens Medical Solutions Health Services Corp. acquired SMS and General Electric entered the healthcare market, “The rules of the game of the future were written. We saw strong, international players getting into the field, players that understood healthcare. Once we saw major players with major resources and healthcare understanding stepping up to the plate, we knew that the time of healthcare globalization was here.” As a result, Walton chose Siemens’ Soarian as Carilion’s HIS. For Sid Tuesley, CIO of Lutheran Health Network in Fort Wayne, IN, the decision to install an HIS from McKesson Corp. was a Lutheran Hospital and corporate (Quorum Health Systems) decision made prior to his being hired—and his being hired was largely based on familiarity with the product and with McKesson (which was HBOC at that time). Tuesley had previously worked at St. Joseph’s Hospital, a 250-bed facility now owned by Lutheran Health Network. About 14 years ago, that hospital installed McKesson’s STAR HIS, a scalable, integrated clinical and financial system that runs on a Unix platform. Being familiar with the product’s capabilities helped when Tuesley was hired by Lutheran. “I came to Lutheran about four years ago, just when they were starting the STAR implementation,” he says. Since then, Tuesley has been adding modules, but he is still relying on McKesson as his vendor of choice. “We made the decision that since our parent company picked McKesson, it was a good fit. That’s why we stay with McKesson whenever we can.” Rod Dykehouse, vice president of information systems and the CIO of Froedtert Hospital in Milwaukee, says Y2K led him to choose Affinity from QuadraMed Corp. “We were on the Allegra system and were running it locally,” he says. “But we had to go through a major upgrade for Y2K that opened the door to looking at other products.” Dykehouse says he looked at products from four or five different vendors before choosing Affinity. But, he admits, he was looking for more than just an HIS. “Vendors make statements saying how this will benefit your organization. But if it doesn’t work, it’s your responsibility. We asked them to back up their words in the contract.” Few vendors were willing to do that—but QuadraMed was. Medicine Meets IT As a $1.2 billion healthcare organization, Carilion Health System is comprised of nine hospitals including Carilion Medical Center, the 600-bed flagship hospital. In choosing Siemens’ Soarian, Walton wanted a system that could grow with the organization and adapt to changes in technology. “Information technology is running in parallel universes,” he says. But with increased automation and the development of “smart” medical devices, these two universes have begun to converge. Referring to this convergence between computing and functions as “medicine meets IT,” Walton says, “We have given considerable thought about what would happen as the computerized patient record evolved. An enormous piece of the patient chart is information that comes from equipment and machines like X-rays, EKGs and ventilators. We must be able to take medical devices and input their output directly into patient records.” Walton says Siemens recognized the complexity and challenges of workflow in hospitals and embedded a workflow engine into Soarian. “There are rules-based engines, but this is really the first workflow engine,” he says. Siemens says its integration engine, OPENLink, is able to gather patient data from all disparate sources and then integrate them into a single, uniform view. Turn It On But some integration work was still needed to interface a few of Carilion’s non-Siemens systems, admits Walton. Since his organization has embraced a “best of cluster” strategy, Walton says, “We think we should be able to build a composite, automated IDN with no more than five vendors in total.” Right now, Carilion’s PACS and document imaging systems are not Siemens, but pharmacy, HIS and radiology are, so most of the clinical and ancillary systems are a fit.
“We bought the clinical part of the system (Soarian Clinical Access), which includes a computerized data repository. The next phase will be to bring up order entry and parts of the nursing documentation components.” Because it has a browser-based interface, Soarian will fit into Carilion’s long-term plans. “Our general strategy is to move to a browser base. We’ve run as much as we can on a thin-client platform.” Walton also applauds the ease and rapidity with which the HIS was deployed. “We deployed in Franklin by sending them an e-mail telling them to turn it on. We turned the second piece on with a 20-minute meeting and another e-mail.” Single-Source Gains Following a long-term strategy also led Lutheran Health Network to commit to McKesson’s HIS, says Tuesley. With five hospitals in the network, including the flagship 358-bed Lutheran Hospital, Lutheran Health Network also has loose relationships with four other entities in the region, Tuesley explains. But it is within the five primary players that most of the McKesson products are installed. “By design, we decided to go with a single-source shop,” he says. “Best of breed is a great theory, and with work you can make it work. But we found that wherever McKesson had products that would fit our needs, it worked within our master plan to go with those products.” Although the decision to purchase McKesson’s STAR for Lutheran Hospital had already been made, this healthcare network was acquiring hospitals and planning ahead. Besides purchasing STAR, which utilizes a single, logical, enterprisewide database for management of clinical and financial operations, Lutheran also invested in McKesson’s: Horizon Passport, which gives the enterprise a single point of access to an enterprise master person index (EMPI); Horizon Lab; Horizon MobileCare Messaging; Horizon MobileCare Rounding; Horizon Clinical Documentation (Care Manager); Horizon Care Record; Horizon Patient Folder; Horizon Physician Portal; and Pathways Healthcare Scheduling. “Essentially, we installed all the products we now have in the five hospitals from scratch,” Tuesley says. “We did this to automate healthcare to the point that banks and retails have automated their own industries. Achieving this level of automation, not just in one hospital but in a healthcare system, requires a master plan.” Tuesley says the goal was to reduce paper, automate order entry and clinical documentation, and provide caregivers with added tools that make their jobs more efficient and more accurate. Lutheran developed a seven-year master plan and eventually got all five hospitals to sign on. To facilitate the process, Tuesley established a committee of representatives from the five hospitals that looked at “a good 50 iterations of potential rollouts or implementation plans,” he says. Lutheran is now four years into its seven-year plan and still looking ahead, having added Horizon MobileCare Rounding and the Horizon Physician Portal to its roster of McKesson applications. Financial Objectives The situation was different at Froedtert Hospital in Milwaukee. This 655-bed hospital is a not-for-profit specialty and teaching hospital affiliated with the Medical College of Wisconsin and Froedtert Community Health, a joint venture with Community Memorial Hospital of Menomonee Falls. As a result of these affiliations and the fact that half of the clinics are run by Froedtert and half by the Medical College, Dykehouse says he is using multiple systems. For example, Community Memorial Hospital has a long-term contract with Siemens, but along with Froedtert, it has opted to use a clinical system from Epic. “QuadraMed is not in that clinical ambulatory space,” he notes. The use of QuadraMed’s Affinity as Froedtert’s core HIS gives Dykehouse the solutions he had been seeking. “At the time we bought Affinity, we wanted new patient registration, patient accounting, order entry and nursing documentation applications. We had these functions in different products that would be going away with the purchase of Affinity.”
He brought in a consultant for an internal workflow analysis to make sure a new HIS would help the hospital achieve its desired business metrics. Dykehouse contracted with QuadraMed to buy more than just the system—he also bought their expertise in configuring it to his specific business needs. At go-live, he had worked out a six-month time period during which the organization would decide whether to accept the system. “We looked at a snapshot of our A/R days at the start, then six months later,” Dykehouse says. “We told QuadraMed, ‘We will pay you incrementally for fine-tuning the system.’ Six months after go-live, we were down to 80 days. Now we are at 43 days and approaching best-practice metrics.” Dykehouse makes a point of saying that, historically, healthcare organizations spend a lot of money installing a new system, and “then they never want to spend another dime.” He stresses that Froedtert’s approach is different, that because the organization focuses on continual improvement, it expects to both reinvest and to leverage past IT investments for years to come. Overcoming Resistance “Any time you make a change, you’re going to get some resistance. We created an attitude among all hospital users that the HIS was a tool we could look to and continually configure to get change and improvement. This attitude still exists,” Dykehouse notes. He says his old Allegra system didn’t allow individual departments to change or configure their own applications, so they had to call someone from IT. But with the QuadraMed system, patient accounting, for example, took charge of its own applications. “They configured and changed the parameters,” Dykehouse says. “It wasn’t an IS problem, but we were there working hand-in-hand with them.” Tuesley also admits he has encountered some resistance. “There’s always resistance to change,” he says. “We knew rolling out the nursing product was going to be a big challenge. We were told it would take four to five years before nurses and physicians accepted the change. When you first start rolling out clinical systems, it’s not easier and it’s not more efficient than paper, but it does get easier and more efficient as you get more pieces automated.” Tuesley says nurses went through extensive training before the rollout and have been following those staff in ancillary departments like the lab, pharmacy and cardiopulmonary in accepting the system. Physicians, on the other hand, are a different story. “Some of our physicians also practice at other hospitals, but they have always done business with Lutheran in a certain way. Physicians seem to fall into two groups: those for whom you can’t roll out things fast enough, and those who won’t change.” Tuesley says now that his caregivers have had positive experiences with technology, more of them are taking time to be involved in the testing process. “For example, many physicians are now involved with our bringing up the physician portal.” Given the ease with which Carilion was able to roll out Soarian, Walton says he encountered little resistance to change. In fact, he says, “The docs say it’s easy to use.” But doctors at Carilion aren’t reluctant when it comes to adopting new technologies. “All our physician offices have an EMR and are quickly going paperless,” he says. “They have been doing that for seven years.” For more information about STAR and HIS solutions from McKesson, www.rsleads.com/304ht-205 For more information about Affinity from QuadraMed, www.rsleads.com/304ht-204 For more information about Soarian from Siemens, www.rsleads.com/304ht-206 Richard R. Rogoski is a free-lance writer and a contributing editor to HMT. Contact him at rogoski@aol.com. © 2003 Nelson Publishing, Inc |
When picking a healthcare information system (HIS) or hospital information system, chief information officers are not swayed by vendors’ lofty marketing campaigns. They know what they need—and what they want.
Greg Walton, senior vice president and CIO of Carilion Health System in Roanoke, VA, has done both. “We have been a longtime Siemens customer,” he says. “As such, we had been watching healthcare IT and had seen it going global, the way banking and financial systems have. We feel that Siemens marked the opening step in that process.”
Considering Carilion an alpha test site for Soarian, Walton says he has so far installed the system in two hospitals: Franklin Hospital, a 60-bed facility in Franklin County, VA, and Carilion Medical Center in Roanoke. He hopes to have it rolled out in at least six hospitals in the next couple of years.
Currently, Froedtert uses the Affinity Financial Information Management, Patient Information Management and Clinical Care Management modules. It also uses a portion of the EMPI Integrity Management module. “The biggest benefit we anticipated was on the billing and registration side. We worked on a risk/reward contract with QuadraMed. We identified several specific metrics for success. Days in accounts receivable (A/R) was the major one. At the time, our A/R days were close to 115,” says
Dykehouse.