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- Tanya Townsend didn't have much time to pass the all-digital challenge, but she wasn't dreading it, either.
How many other information technology directors have an opportunity to start fresh with a new building, new network architecture, new people, and new processes?
Not many, and when the still-to-be completed Saint Clare's Hospital
in Weston went shopping for a chief technology executive in 2004, Townsend beat out all comers.
Her mission - and, yes, she chose to accept it - was to set the technological foundation for an all-digital hospital that would hit the ground running with electronic medical records, Computerized Physician Order Entry
, and the clinical processes needed to support them.
If that sounds a bit daunting, consider that as a member of the senior management team responsible for information technology, she had a little help from her new (management) friends, she was free to make assumptions that might bedevil the CIO of an established organization, and the opportunity to go with the big-bang approach was simply too good to pass up.
"It's a risky move because there is just so much new - new people, new processes, new systems, new everything," Townsend said. "We kind of did the big-bang theory and said `let's go for it' just because we had those advantages."The build up
In laying the groundwork for what would become Hospital and Health Networks magazine's
"Most Wired Hospital," the timing was such that Townsend had to make certain assumptions in the selection of technology applications. The decisions, which were made before much of the hospital staff was hired, were supported by a feasibility study conducted by a multi-disciplinary team comprised of Townsend and senior executive partners.
They interviewed clients that were using the same types of systems, and they contacted other hospitals that were all-digital or close to being all-digital. They also approached their task from a clinical standpoint to determine whether their newly devised clinical process flows for mobile care and CPOE would fit the IT systems.
Thanks to sister facilities, Townsend wasn't flying blind. Those IT systems included a mix of certain core systems used by other organizations in the Ministry Healthcare System
. One key decision was to implement the same core hospital information system, GE's Last Word, used by Saint Joseph's Hospital
in Marshfield, and other calls involved the deployment of a GE system for mother-child data and fetal monitoring in the family birth center, a PICIS system for surgical services and anesthesia documentation in the operating room, and MedHost, a niche application for emergency-room documentation.
All are tied together either through technological interfaces or process mapping.
"We leveraged what was already available to us, and then we basically did a gap analysis of what holes these systems were not going to fill based on our use of those systems elsewhere," Townsend explained. "Then we basically found systems and processes to bridge those gaps."Mobile care
Another decision, one that involved the primary tool for pulling up patient information, was inspired by the Marshfield Clinic
, whose physicians have been using Fujitsu tablet PCs for several years. Saint Clare's physicians take advantage of the 107-bed, acute-care hospital's wireless capabilities by taking the tablets to any healthcare setting, including the hospital or a clinic or even home, and using them at any point of care.
According to Townsend, there are no limitations to the patient information contained within the device - progress notes, scanned documents, and even large radiological images are available - and doctors and nurses can enter updated information at the point of care.
From an end-user's perspective, everything is seamless across the continuum of care. On the integrated, 56-acre medical campus that includes Saint Clare's Hospital and the Weston Regional Medical Center, which is comprised of a tertiary-care hospital, two medical clinics, and a diagnostic and treatment center, caregivers can roam from a clinic to the hospital or to the diagnostic and treatment center and still remain connected to various wireless access points.
"It's a huge patient-safety win because we have all that information available about patients at all times," Townsend said, "and it's also a huge customer satisfaction win because the patients aren't constantly repeating themselves and having to give their information every step along the way."
To access the system, the doctors simply enter a unique login that has all the credentials associated with individual physicians, and from there they reach their patient list for the day, GE Last Word, and other clinical applications.Caregiver view
Among caregivers, doctors catch some flack because they haven't always been willing to use technology, but Townsend believes that if the chief medical officers champion an application, and doctors feel supported as they navigate the learning curve, they will have no impulse to return to paper systems. Simulated patient-care visits were used to train doctors and nurses prior to the hospital's October 2005 opening.
Dr. Stewart Watson, medical director of St. Clare's emergengy department, said change is difficult for everyone, not just physicians, and he appreciates the way the interdisciplinary team communicated with caregivers. "It was critical that doctors and nurses be brought in on the decision making process of what products would be used and how they would be deployed," he said. "Tanya was proactive in working with clinicians to make sure their input was heard."
The benefits of the tablets, combined with electronic record applications, have brought multiple benefits, Watson said. He can input data in real time and have it available for people to see rather than spend time on follow up, he can do all of his ordering (medications and the scheduling of blood tests and X-rays) on the tablet, it is a legible and type-written record that doesn't require an interpreter on the other end, and the information is available in multiple settings.
Everyone in the ER uses electronic records, including secretaries, nurses, doctors, and paramedics - and multiple people can work on the same record at the same time. "We can all be documenting at the same time on a given record," he said.Business value
Since everything is accessible online at the physician's fingertips, Saint Clare's is completely chartless. There are no medical record filing or image-filing rooms needed for storage, so Townsend estimates that going digital saved $500,000 on construction costs alone.
Most business-value questions are tricky for Townsend because she has no benchmarks, no before-and-after picture with which to draw a comparison. However, additional savings have been realized because no staff resources are required to support paper- and image-record storage, and Townsend points to enhanced time and cost efficiencies made possible by real-time access to patient information.
With CPOE, which is designed to reduce drug-related medical errors, the relationship between national safety compliance and quality outcomes comes into clearer focus. All of the hospital's order sets are predicated on evidence-based medical guidelines, and Townsend said the hopsital is 99.6 percent compliant with its medication formularies.
"That means we basically have zero orders that are in conflict with the hospital formulary, which also is a significant cost savings in terms of our supply-chain efficiencies," Townsend said.
Improved turn-around times on drug orders are another benefit. Saint Clare's has determined that the average turn-around for an antibiotic - from the time the physician enters the order into a computer, to the time the pharmacist verifies it, to the time the nurse administers it - has been reduced to an average of five minutes. In a paper world, the same process could take anywhere from 90 minutes to three hours.Women in IT
Townsend holds a bachelor's degree in health information administration from the University of Wisconsin-Milwaukee
, and a master's degree in medical informatics from a joint program between the Medical College of Wisconsin
and the Milwaukee School of Engineering
. She hasn't had a lot of female company in the technology ranks during her previous stops at Aurora Health Care
in Milwaukee and Aurora Baycare Medical Center in Green Bay, but she thinks healthcare provides a unique opportunity to turn the tide.
"I think it's going to be more and more of a growing trend as we continue to bridge technology and healthcare together because healthcare, from a nursing standpoint, is traditionally a female role, and I think there is a lot of interest in blending those things together," she said. "I think it's only going to grow."