Best of the Best: IT Solutions for 2000 – Editorial
HMT announces winners from its annual What Works competition.
What Works is more than a monthly case history feature at Health Management Technology. What Works is an episodic testament to the enduring power and influence of technology in healthcare.
Every month in the pages of HMT, healthcare providers and users chronicle their experiences and successes with technologies such as electronic medical records, wireless alert systems, e-procurement, document management and many more.
This year, HMT is pleased to name three award winners and four honorable mention winners. We invite you to enjoy a recap and update of each of the top three winners’ stories, along with a description of our esteemed panel of What Works judges for 2000. We also invite you to consider sending us your case histories as What Works entries for 2001.
All What Works winners receive specially engraved plaques noting their achievement, as well as display capability at HMT’s booth as it travels to industry trade shows throughout the year. The top three winners also receive monetary awards.
Judges were asked to score each case history based on these five weighted criteria.
Benefits or results to the user. Did the solution quantifiably help the healthcare organization to solve its problem and achieve its objective? Were the results as anticipated? What were the unexpected additional benefits? Was this the best solution for the particular problem faced by the healthcare organization?
Applicability. How applicable is the solution to other healthcare organizations with similar objectives?
Installation, implementation and ease of adoption. Was the hardware or software easily installed and easy to implement and use? To what extent did the vendor support, train and educate during this period?
Scalability. Can the solution be expanded to include more transactions, more users or greater impact within the organization without significantly higher costs or significant development enhancements?
Creative challenge. How well did the solution address and overcome technical or administrative challenges posed by the healthcare user–such as legacy systems, financial constraints, multiplicity of existing programs?
Submit Your Own What Works
Health Management Technology invites you to submit your own story as a What Works. You can submit directly online. Visit our website at www.healthmgttech.com, and click on the What Works tab. Click on “Submit Your Solution,” complete all the fill-in boxes and we will build the story for you.
You may also write the story yourself. Each What Works follows a formula:
* statement of the problem
* solutions considered and reasons for the choice made
* installation, implementation and training time
* costs, hardware and system requirements
* benefits and results
If you have an idea for a What Works and need help, please query any of the editors. We will assist you through the process and help you develop the most important elements. We can also work with you to get the story written.
All What Works published in 2001 are automatically entered in the 2001 competition. It could be your technology solution, your healthcare organization and your story featured in these very pages next year.
2000 What Works Honorable Mention Winners
St. Francis Health System, Pittsburgh, PA, for its use of FlexiLab (laboratory information system) from Sunquest Information Systems, Inc., www.sunquest.com, May 2000.
Danville Regional Medical System, Danville, VA, for the successful implementation ORSO[TM], the enterprise-wide surgery scheduling and resource management system from Per-Se Technologies, Inc., www.per-se.com, April 2000.
MacGregor Medical Association, Bellaire, TX, for automating referral authorizations with MedServe Link Referrals, a secure Internet-based product from MedServe Link, Inc., www.medservelink.com, May 2000.
Eye Clinic of Wisconsin, Wausau, WI, for its use of the Virtual Information Officer ASP product from The TriZetto Group, www.trizetto.com, October 2000.
BROOKE ARMY MEDICAL CENTER
FORT SAM HOUSTON, TX,
For rapid implementation of a clinical information system with no disruption in service. Supplier: CliniComp International, www.clinicomp.com, December 2000.
Brooke Army Medical Center needed a fully functional, multisolution-based clinical information system (CIS). When the legacy system proved unreliable, clinicians had returned to traditional paper chart files, which was neither practical nor efficient for a Level 1 Trauma Center.
Under the direction of Col. Darryl N. Ziegler, M.D., a “tiger team” of Brooke representatives worked to identify a vendor with a successful track record, proven technology and software solutions for real-time patient care. Brooke knew of CliniComp, Intl., through endorsements by 11 other Department of Defense sites and chose CliniComp based on positive referrals from colleagues.
The system had to be in place before June 1999, when a new wave of interns and residents would arrive. The goal was installation and transition to a new system in 45 days, including a single weekend for the completed work. In anticipation of the transition, clinicians discharged as many patients as medically possible, and postponed admission of new patients except for trauma and true medical or surgical emergencies.
During the installation period, the vendor performed custom configuration for 19 different clinical environments and provided extensive user education to prepare the staff. The vendor also built a virtual private network (VPN) connecting its headquarters with the medical center, over which it downloaded software onto nearly 3,000 workstations.
On May 5, 1999 the legacy system was taken down and the vendor’s CIS was brought to life with hardly a missed beat, as documented patient care continued over the brief transition period.
The system fully supports all patient care functions for charting, managing orders and analyzing clinical information. The CIS integrates real-time data and historical records, making them available at the point-of-care, nursing stations or remote locations. It also includes interfaces to financial and administrative information systems and operates through a simple graphical user interface (GUI) and archives to a global database.
Brooke has experienced a wide range of benefits, including:
Improved processing: The CIS has reduced incomplete, inaccurate and delinquent patient charts. The patient administration division can submit claims for third-party billing earlier by sending supporting clinical documentation with the claim.
Enhanced documentation: The Department of Medicine (DOM) is using the CIS for all narrative discharge summaries. Consultations and notes are efficiently combined and entered, and inpatient visits are easily archived. Brooke has enjoyed a 60 percent to 70 percent drop in incomplete or delinquent patient records for those departments who have adopted this example.
Access without boundaries: Clinicians can analyze patient charts and test results, and perform research regardless of their location.
Mandated usage: In August 1999, DOM mandated use of the CIS system for all new admissions and patient transfers, prompted by DOM clinical users who appreciated the advantages of the new system.
Brooke Army Medical Center recently completed its JCAHO review and received high marks on the CIS. “JCAHO surveyors were overall very impressed with the documentation in the CliniComp CIS,” says Col. Ziegler. “They liked the prompts that came up for advanced directives and other forms. The Education Note was well received, and the reviewers liked the fact that documentation of all education was on a single page. Since the outpatient medical record is only in hard copy, but the inpatient record is largely in a computerized system, they recommended we go to a completely paperless system.”
The Department of Defense will soon implement CHCS II (Composite Health Care System II), which will address the outpatient domain. Col. Ziegler says that working out an interface with CliniComp CIS should be readily accomplished after which data should flow freely between the inpatient and outpatient care arenas.
MAIMONIDES MEDICAL CENTER
For eliminating mountains of paper with a Web-based viewer. Supplier: Allen Systems Group, www.asg.com, April 2000.
Too much paper–that’s what the computer mainframe at Maimonides Medical Center in Brooklyn, NY, generated. The result was too many lost or late reports, too many reports to be copied and distributed to departments and offsite clinics, overuse of storage space and wasted staff time. In addition, the cost for paper usage and printer ribbons totaled $120,000 a year, combined with the use of expensive high-speed printers in the data center, which required continuous maintenance and attention.
Maimonides already had a server-based paperless report viewing system, but the cost of upgrading all PCs and buying software licenses for all users, especially those who only occasionally needed access to reports, was prohibitive. As a result, Webmaster Ed Lane researched inexpensive Web-based solutions that could be accessed through their existing intranet.
Lane reviewed three products, attending paperless-host printing seminars and vendor demos, before deciding on Report. Web by Network Software Associates, Inc., now a division of Allen Systems Group, Inc. Maimonides made the decision based on ease of use for administration and users, functionality, cost, low software and hardware requirements, and the commitment of the vendor to support the product.
Report.Web, a paperless report viewer, gave users Web-enabled access on demand to reports in electronic format from their desktops. Users can now select and print only those reports or pages they need. Additionally, they can import report data directly into spreadsheets for analysis instead of re-keying the information from paper.
Implementation of the new system has resulted in: information reaching desktops throughout the 200 staff-member network promptly; increased productivity with immediate online access to vast amounts of information; elimination of lost or late reports; reduction of paper usage. With the cost reduction in paper and printer ribbons and elimination of 1.5 full-time equivalents for printing and distributing large reports, the system paid for itself in 2.5 years. Since Maimonides began using Report. Web five years ago, it has saved $304,000 in expenses.
“We upgraded to an IBM Netfinity 5600 server with dual Pentium III 866 Mhz processors and 1 Ghz RAM with 30 gig of hard disk space,” says Lane. “This new upgrade has enhanced search capabilities, searching by word or name using XML technology.”
Using their secure intranet, more than 500 Report.Web users generated 115,576 hits in the past six months. Report. Web can take any text file produced by any hospital-based system, including legacy applications, and convert text to HTML/XML/ PDF formats.
Lane says, “We have expanded the information available to our users to include daily operating room schedules from Surgi Server, clinic pull-chart lists, pre-edit billing rejections, radiology charge rejections, transfer interface errors; physician schedules, ambulatory Medicare tape remittance errors, no-show patients and patient re-admits in the last month.
“Having this kind of information available has enabled us to improve cash flow, correct billing and interface errors immediately, and to improve our business and clinical processes.”
Maimonides also has recently integrated the use of handheld devices, wireless technology and Web-based applications into the Report.Web network. Lane says, “Now clinical reports will be available anytime. What once took pounds of paper now fits in my shirt pocket.” Using the new Compaq iPAQ Pocket PC 3650 HTML, XML XLS spreadsheets and PDF files can be viewed in Report.Web on WinCE/ Pocket PC devices using Pocket Internet Explorer. 128-bit encryption has also been added to Pocket Internet Explorer on the Pocket PC for added security over wired and wireless networks.
HIGH DESERT MEDICAL GROUP
For executing an e-procurement solution that services 24 locations and saves more than $210,000 per year. Supplier: Everything4MDs, www.everything 4MDs.com, October 2000.
High Desert Medical Group (HDMG) is a California-based independent practice association (IPA) of 50 primary care and specialty physicians that serves 45,000 patients and spends $85,000 monthly in medical and office supplies. With 24 separate shipping locations, each with different supply and administrative requirements, acquisition of medical and office supplies was a gargantuan task.
For most of its history, HDMG department staff faxed orders for medical supplies to a centralized purchasing department. Medical supplies were ordered Wednesday and Thursday each week, and the ordering process took two full days. Each item was reviewed to determine the proper supplier and then faxed to the correct supplier. Ordering office supplies was just as time-consuming. Each requesting department forwarded its orders to the operations department, which would determine the lowest price supplier for each item and place the orders. Order placement took one full-time employee.
In late 1999, HDMG began to search for a cost-effective solution that yielded time savings, too. The search involved checking online resources, consulting colleagues and contracting trade and professional associations for counsel.
E-procurement surfaced as a progressive option with long-term benefits. The team evaluated several vendors, reviewed input from a number of colleagues and appraised competitive sites. In early 2000, they decided on Everything4MDs (E4MDs) for several reasons, pricing being a primary one.
The second factor was ordering convenience. Now no one has to research suppliers. Both medical and office supplies are entered online and shipped directly to the correct office. Also, the IPA saves considerable time. The purchasing department still enters on Wednesdays and Thursdays, but only for a few hours; operations enters for a brief time on Fridays. Now, HDMG receives one invoice a month for supplies. Orders can be tracked online by E4MDs, and the IPA knows its costs immediately. They receive supplies two or three days after ordering.
HDMG experienced no training hurdles or implementation barriers; staff logged on, registered and began ordering. They currently order medical supplies, office supplies, vaccines and injectables, and reference books from the vendor.
Panel of Judges
HDMG was able to save 20 percent monthly, or more than $210,000 annually, on medical supplies and equipment. In addition, it obtained management tools not available from the paper-based fax ordering system previously used that have eased the workload for administrative staff. Inventory tracking and controls have helped HDMG staff know what products they have on hand, what levels of inventory to maintain and when they may be over-ordering.
“Now we have actual usage reports,” says Terry Dahl, materials director for HDMG, “so we know what every cost center has ordered and used and with what frequency.” Dahl also says that with sophisticated formularies built into the system, “our formularies are there. We just click into our template, clear it and click in new quantities.” He says the only materials HDMG buys elsewhere are materials not stocked by E4MDs–and that those are few indeed.
But here’s the best part, where technology directly improves patient care. “Flu vaccine–E4MDs had flu vaccine for the areas of Lancaster, Bakersfield and Palm Springs, and nobody else did,” says Dahl. “In two months, we vaccinated more than 22,000 people in one location and more than 50,000 people statewide.” He says plenty of IPAs and group practices waited for their vaccine clear through the holidays and beyond.
“Having access to the vaccine directly helped us gain new patients,” says Dahl. “We have a lot of seniors in the Bakersfield area who needed the vaccine and have switched to our practice as a result of their positive experience.” E-procurement and E4MDs helped make it possible.
J. Dennis Bush is the senior vice president of The MEDSTAT Group of Ann Arbor, MI, where he directs development of new products and their delivery to MEDSTAT customers and provides senior-level consulting on analytical and methodological issues for key accounts. Dennis has held several positions with The MEDSTAT Group including vice president of product development, director of consulting services and director of client services. Previously he held executive positions during eight years with Blue Cross and Blue Shield of Michigan, with responsibility for monitoring the plan’s $3 billion benefit payout for private lines of business. Dennis holds a Master of Hospital Administration degree from the University of Michigan.
Jim Chesney, M.B.A., is the chief technology officer for the University of Alabama-Birmingham, Health System Information Services (HSIS). As CTO, he is responsible for IT direction and service delivery supporting the patient care and education missions of the health system. Prior to becoming CTO, he was a director of IS for HSIS for three years, responsible for applications, data integration, technical support, operations, clinical systems support, training, Web/intranet development and database services. He has worked in healthcare for 24 years, the last 11 of which have been serving as an information technology management executive in a community hospital and at an academic medical center.
Myra Jackson, R.N., is the director of central scheduling for OhioHealth Corp. of Columbia, OH, an integrated delivery network of 11 hospitals throughout Ohio. There she heads a department that provides centralized scheduling for 18 facilities, 40 divisions and 145 individual departments within the IDN. Previously, she spent four years with Grant/ Riverside Methodist Hospitals, the flagship institution of OhioHealth, as the project leader for a re-engineering process that included centralized scheduling, billing administration, case management and length-of-stay reduction. She also has substantial clinical experience as the manager of several medical pulmonary patient care units.
Sharon L. Stewart is the IS director of clinical information systems and interfaces at Texas Health Resources (THR), where she and her team select, develop, implement and support clinical information system applications for more than 15 hospitals and free-standing facilities. She has worked at THR for 12 years and has held the positions of IS manager of patient care and analyst/programmer. With a degree in business administration, she has also served as lead analyst for the Annuity Board of the Southern Baptist Convention of Dallas and in clinical data management capacities for two Texas hospitals.
David Swan, a resident of Seattle, WA, is the chief technology officer for HealthTalk Interactive where he oversees direct-to-consumer, permission-based information systems that provide health and disease management information to consumer, healthcare professionals and vendors. Previously he was an IT executive with Excell Data, which specialized in developing e-commerce infrastructures; when the company was acquired by Cambridge Technology Partners, he became a vice president in charge of e-commerce strategies and business solutions. Previously, he served as the CIO of Group Health Cooperative in Seattle and before that with Deloitte Consulting for eight years. David is also a member of HMT’s editorial advisory board.
The editorial staff of Health Management Technology gratefully acknowledges the contributions of an esteemed panel of judges for the 2000 What Works Awards. These healthcare IT professionals generously donated their time, expertise and evaluation experience in determining the What Works award winners for 2000 from among 22 contenders. We sincerely appreciate their efforts and results.
COPYRIGHT 2001 Nelson Publishing
COPYRIGHT 2002 Gale Group