Hospital Information Systems
An Intelligent Patient Focus
By David Baum, April 2010
Cambridge Memorial Hospital is increasing efficiency and improving patient care with a new emergency room tracking board and business-intelligence system.
Like many emergency rooms throughout North America, Cambridge Memorial Hospital had a practical, hands-on system for tracking patients and treatments: a large whiteboard mounted on the wall that could be quickly updated with felt-tip markers. The whiteboard was easy to see, easy to modify and it enabled both clinicians and administrators to keep a close eye on emergency room (ER) activities. The problem was that the whiteboard was not extensible. Staff could not obtain information from the board unless they were standing in front of it and the board could only be updated with information already known to staff in the ER. This traditional manual whiteboard did not present any new information to the department's providers.
The ER staff did not consider these limitations to have any impact on the overall speed of delivering patient care until a few tenacious members of the IT department pointed out the advantages to automating ER patient tracking using business-intelligence (BI) technology. BI refers to a broad category of software that is used for analyzing information, making decisions and managing performance. In a healthcare setting, BI reports are the most common way for businesses to display and distribute formatted information from enterprise data sources, such as the MEDITECH healthcare information system that helps this 155-bed facility in Ontario to manage its operation.
"Our organization had two distinct needs that led us to BI technology," recalls Ed Norwich, manager of information-management technology at Cambridge Memorial Hospital. "We needed to accommodate the obvious requirement — an emergency room tracking board. We also wanted to develop a dashboard to present human resources data. This is a key component of the management-reporting system and it is also critical to improved decision making around resource management — in this case, sick leave and overtime. We knew a BI tool would help us extract and analyze business and clinical data."
BI software selected
To meet these needs, Norwich and his team evaluated packaged BI solutions along with BI tools from Microsoft, Cognos, Information Builders and a few other software vendors. After a successful demonstration and proof of concept, they selected Information Builders' WebFOCUS BI software and asked Information Builders for help developing new BI solutions.
"WebFOCUS looked easy to use and it integrated well with our surrounding IT infrastructure," says Norwich. "It appeared we could use it to meet the BI needs of the hospital with relative ease."
Information Builders' professional services department worked closely with the hospital's clinical and administrative staff to identify their needs, understand their priorities and map out BI solutions that met their requirements. For the ER tracking board, one significant hurdle involved overcoming skepticism from the staff, particularly the ER staff, already happy with the manual whiteboard and existing management reports. In short, they did not see the need to replace what they already had, Norwich says.
"The ER department is extremely busy, and at first the staff couldn't really envision how this BI technology would help them," admits Jennifer Hope, IMT project lead at Cambridge Memorial. "It took a few iterations to get the teams to identify how the BI technology could go above and beyond their critical needs and enhance the existing whiteboard functions. The clinical staff was entrenched in their own day-to-day processes, so they initially viewed the addition of a new tool as potentially more work without truly understanding what an electronic tracking board would do."
For the ER tracking board, one significant hurdle involved overcoming skepticism from the staff, particularly the ER staff, already happy with the manual whiteboard and existing management reports.
The team pushed ahead, working with Information Builders to create the ER tracking board and integrate it with the existing IT systems and infrastructure. They created a system that displays real-time information about patients in the emergency department, both online and on a large wall monitor, including those in the waiting room.
The early skepticism of the ER staff was soon forgotten when the ER tracking board went live, Hope says. As medical and administrative staff members update patient records within the MEDITECH healthcare-information system, current information is dynamically reflected in the results on the board, which means all authorized personnel continually have up-to-date information about the ER operation.
The board provides information about the status of laboratory and diagnostic tests, the services each patient has received, and when lab or test results are available, which speeds up the physician's response. To preserve patient confidentiality, the actual results and other clinical information are not displayed on the ER tracking board. Authorized personnel can drill through to obtain test results and other information on demand.
Patients tracked continuously
"Physicians no longer have to log into a system or manually flip through a chart to find out which tests or exams have been completed," says Norwich. "They know as soon as the results are in."
Authorized hospital staff members now use the ER tracking board to track patients from the moment they walk into the ER until the time they are discharged. After a brief orientation, most of the ER staff — including physicians, nurses, clerical assistants and registration personnel — adopted the new technology.
"The ER tracking board shows us everything from basic patient demographics, to high-level detail about their visits, to what diagnostic or lab tests are in progress and which results are available," says Hope. "It gives ER personnel a real-time, up-to-date picture of what is happening in both the outpatient areas of the ER and the inpatient hold area."
In addition to the ER team, several other users rely on the ER tracking board for utilization and bed management. The executive team also uses it to keep an eye on ER patient volumes and the potential impact on diagnostic and inpatient services.
"We always know who has been admitted, who is waiting for treatment, and key information such as the patients' length of stay and their level of urgency," adds Hope. "This helps the clinical teams make decisions faster. All the pertinent information is readily available on the electronic board."
Nurses know what room a patient is in, for example, how long he or she has been there, what lab or diagnostic results are pending, and the severity of a patient's condition relative to other patients in the ER as measured by the Canadian Triage and Acuity Scale (CTAS) national guidelines. For example, CTAS Level 1 refers to patients that need to be seen by a physician immediately, while CTAS Level 5 refers to patients that need to be seen by a physician within 120 minutes. Displaying the CTAS levels helps the ER staff make appropriate judgment calls about where attention should be focused.
Within the province of Ontario, hospitals must report on their compliance with standards governed by these CTAS metrics. The BI system lets them actively monitor the CTAS scores as both a real-time decision-making tool and a quality metric.
"Not only from the point of view of care, but also from the standpoint of efficiency and reporting to the province, this has been an effective measure," explains Norwich.
System expansion explored
As the IT team obtains feedback about how the staff is using the ER tracking board, they are pondering ways to make real-time patient information available to other domains throughout the hospital.
"Now that the ER tracking board is in production, we can customize the presentation for various departments to reflect the specific types of information they need," says Norwich. "While the pressing need was to provide a real-time look at what is going on in the ER, our long-term plans include creating a complete patient-tracking system.
"The key element for safety and patient care is that everyone in the hospital has the right information for the right patient in the right place and at the right time in order to drive the right decision," he continues. "BI initiatives allow them to make those decisions, thereby supporting the business objectives of the hospital. The ER tracking board results in better patient care, more accurate decisions and better patient flow using real-time data.
"The ER tracking board shows us everything from basic patient demographics, to high-level detail about their visits, to what diagnostic or lab tests are in progress and which results are available."
"The challenge is to find a way to empower end-users to create their own customized information, without requiring them to become business intelligence experts," adds Norwich. "Throughout the years, advancements in BI technology have made data access easier. Using a dashboard approach reduces the need to create and produce static reports."
In collaboration with the business and clinical stakeholders, Norwich selected Information Builders' WebFOCUS business-intelligence environment for its "guided ad hoc technology," which lets users create dynamic reports by selecting parameters from a drop-down menu. They can choose columns, sort criteria, measures and output formats to generate their own personal reports.
Additionally, menu selections enable repeat delivery via e-mail in any preferred format, including Excel, PDF, HTML, Word or as an "active report" that permits offline analysis. A single guided ad hoc reporting template can generate thousands of different reports to meet many different business requirements. Built-in security keeps data protected at all times, granting access to authorized users based on their role within the organization.
Ultimately, Cambridge Memorial plans to deploy a managed reporting portal that lets users organize and navigate through guided ad hoc reports, dashboards and archived report libraries.
David Baum is a freelance business writer based in Santa Barbara, Calif. He frequently writes about information technology and its impact on healthcare.
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