27 Feb St. Mary's Hospital expansion also brings healthcare IT transformation
Madison, Wis. – Walk into the recently renovated St. Mary’s Hospital, and the first impression is that of a highly rated hotel or the executive wing of an office building. Oak-colored wood paneling and soothing earth tones are the norm for most areas, and gold plaques next to aged brick pillars proudly state they have been preserved since the hospital first opened in 1912.
But this impression is only the face of what several years of renovation have done to this hospital. Behind the new size and shine, St. Mary’s has received its most in-depth technological upgrade in almost a century of operation, with new systems for registering, treating and monitoring patients.
The upgrades, according to Dr. Frank Byrne, president of St. Mary’s, are designed with the ultimate goal of making sure that every patient in the hospital can receive the care they need as quickly as possible. “The cornerstone is the technology, which enhances our ability to wheel them into a room, register them, and treat them,” Byrne said.
Building faster patient care
The renovation of St. Mary’s, which saw groundbreaking in April 2005, was a project designed to deal with a projected jump in patients tied to the growth of Dane County’s population. According to the hospital, there is an expected 31 percent increase in inpatient care and a projected 47 percent rise in outpatient visits to the hospital by 2014.
Structural upgrades to the hospital that reflected this need for more treatment space include the emergency room expanding from 14 to 30 beds, and the addition of 22 surgical suites. A 235,000-square-foot inpatient building specializing in cardiovascular care was completed and opened in January, while an outpatient building of 185,000 square feet opened the month before.
For Byrne and the rest of the hospital, however, simply expanding the size of the hospital wasn’t enough to provide adequate patient care. The expansion also was seen as a chance to catch up with some of the technological advances over the last few years. This was especially important in the healthcare field, which Byrne said suffers from reluctance to implement new technology.
“Healthcare delivery was late to the party in acknowledging outcomes,” Byrne said. “Other organizations don’t do enough to acknowledge transitions, and in healthcare we may be even worse.”
This goal for streamlined patient processing drove several of the architectural changes to St. Mary’s, with surgical suites growing from 400 to 650 square feet to allow new machines to be installed. X-ray machines have been doubled in the emergency rooms and Byrne said they now also contain a CT scan, allowing surgeons to obtain three-dimensional scans right before surgery and eliminating the time a patient spends in transit.
Getting the scans made has become easier, and accessing their results has also been streamlined with the addition of a picture archiving and communication system (PACS). Activated in 2007, this allows imaging studies to be viewed through computer systems rather than film, meaning any of the terminals in St. Mary’s can be used to call up patient imaging records.
With terminals located all around the hospital – including in every patient room – caregivers are able to analyze and discuss the records without the need for larger equipment. “The cool part, as a patient, is that if the physician wants to show me the image, they can turn the computer around and show me that,” said Theresa Eckman, EMR project manager for SSM Healthcare of Wisconsin, the parent company of St. Mary’s Hospital.
Every file in one place
The implementation of PACS and other patient recording software is a prelude to the most extensive of the hospital’s expansions. On May 31, St. Mary’s will go live with new electronic medical records software from Epic Systems, an installation which will unite the documentation for every patient under the hospital’s roof and provide caregivers with access to the EMR anywhere in the hospital.
The end result of these records means that all relevant patient information, charts, and updates will be stored in the hospital network and accessible through any one of multiple terminals located in the hospital. Physicians will be able to review multiple records at any workstation, review the records directly with a patient, and make any updates or changes to the record from that station. Orders for prescriptions will go directly to pharmacies, and images and charts will be automatically teamed with previous records.
They will be able to access their patients’ records from anywhere, check on their status, and see almost 95 percent of the information online, Eckman said.
Dr. Larry Elfman, medical informatics director at Dean Health System, said this transition will unite several different aspects of patient care: electronic documentation, ordering of prescriptions, and lab and imaging studies; electronic communication of results as well as messaging between providers and providers’ staff. There will also be a MyChart patient portal, allowing patients to access their own charts.
According to Eckman, the new system will consist of several Epic software programs working concurrently. Epic’s Cadence and Prelude programs are already being used for scheduling and registration of patients, and future installations include EpicRx for the hospital pharmacy, Radient for radiology departments, ASAP for the emergency department, and HIM for monitoring and managing the overall record system.
Eckman added the implementation of the software worked particularly well in tandem with the hospital’s physical expansion, since St. Mary’s knew what was necessary and could set up the requisite infrastructure. When the system began network design in August 2006, the hospital collaborated with SSM Healthcare of Wisconsin to plan out wiring and Internet access, as well as technical assessments to see how many computers were needed per patient room.
The process of EMR installation was designed as a “clinical endeavor with IT support,” according to Dr. Elfman. A Physician Informatics group was founded in 2002 to deal with the program, and the group included several St. Mary’s physicians. Each specialty had a “physician champion,” a doctor in the field who understood the program’s needs and aided in customization.
“The project and electronic record itself is considered a single effort … rather than complimentary in nature, and will be approached the same way on a go-forward basis,” Elfman said.
The new system will also be linked up to SSM Healthcare’s other regional hospital, St. Clare Hospital and Health Services in Baraboo, allowing the two hospitals to share records when St. Clare’s own EMR program goes live in October. Eckman said they have already collected four to five years of high-level data from both hospitals in a clinical data repository, all of which will be accessible through the new system.
Efficiency and patient comfort
Though the changing structure of the hospital is the largest modification to St. Mary’s, the expansion has also led to some smaller high-tech additions. Among these is the da Vinci Surgical System, a robotic operating system consisting of four mechanical arms that can be fitted with specialized surgical instruments or endoscopes to scan the treated areas.
Designed for delicate procedures such as gynecological and cardiovascular, the system is remotely operated by a physician for high accuracy and designed to be as minimally invasive as possible. Steve Van Dinter, regional director of media relations & public affairs for St. Mary’s, said the da Vinci has already been approved and is being put into use by the hospital’s urology department.
Outside the operating room, St. Mary’s has worked to streamline the hospital experience for patients and their families. The most noticeable change is the implementation of a wireless network covering the full hospital and patient areas, a move which will not only offer additional connectivity for physician computers but also allow visitors to use their own devices.
“People are here for extended periods of time … they want to be close to the new baby, and now dad’s bringing the laptop in,” Van Dinter said. “Take the picture with a digital camera, plug it in, and send it off to Grandma and Grandpa.”
The need to keep family informed of a patient’s status also drove another hospital modification, this one located in St. Mary’s outpatient building. Each patient is assigned a five-digit identification number upon hospital registration, and these numbers are circulated on a series of plasma-screen televisions. In much the same way as an airport updates travelers on flight times, the screens will show if a patient is in surgery, pre-op, or post-op status.
Though the formal opening of the new structures only took place last month, Byrne is confident in the capabilities of the new installments. Years of planning means they will be looked after with the utmost care, and fit in with the old idea of hand-crafted healthcare. Regarding the EMR installation, Byrne said their use will be a welcome change from the days when he was practicing medicine and had to accept any faxes from other doctors as the most accurate patient records.
The hospital has come a long way since eight Franciscan Sisters of Mary came to Madison to establish a 75-bed hospital in 1912, but Byrne feels that the new technology reflects the same spirit of the hospital’s creation.
“Not taking risks, not implementing them… that would be disrespectful of our culture,” Byrne said.
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