Behind the Wires
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Dionne Viator has a financial background, but when it comes to managing technology, she’s all about workflow, accountability and timelines. That’s not to say there’s no fiscal component; ask Viator about the return on investment of IT, and she’ll trot out a thick compendium of details. Viator, the senior vice president and chief financial officer at Baton Rouge (LA) General Medical Center/General Health System, has plenty to measure—and worry about—these days. The two-hospital community health system is embarking on a $16 million-plus overhaul of its clinical information systems. And Viator is the lead executive on the project, second only to the health system’s chief executive officer, Bill Holman.
It’s a high-stakes effort as Baton Rouge General looks to automate practically every nook and cranny of clinical documentation. Deploying some two dozen applications over the next two years in an initiative dubbed “Hit” (for health information technology), the once-sleepy (and nearly insolvent) community hospital is looking to make a quantum—and rapid—leap from the paper chart to the electronic medical record. “We want to automate in as short a time frame as reasonably possible to avoid burnout and fatigue,” she says. “We are taking a risk, but it is a calculated risk.”
In addition to retiring paper inpatient records, Baton Rouge is abandoning a longstanding tradition of using “best-of-breed” IT. Hamstrung by more than 100 costly interfaces, the community hospital is deploying a suite of integrated applications from McKesson Corp., one of three major vendors it considered. McKesson’s ability to automate pharmacy workflows from warehouse to bedside gave it the edge over Cerner Corp. and Meditech, Viator says. But the edge is partly theoretical, as Baton Rouge will become McKesson’s first community hospital customer to roll out such a comprehensive line of applications. Although Baton Rouge thoroughly vetted McKesson’s applications, it could find no single hospital that has pulled off such an ambitious IT makeover, which includes a fully automated “closed loop” medication administration system.
In a nutshell, Baton Rouge is building a consolidated patient record across the inpatient and outpatient settings, looking to enable its affiliated physicians to have access—on their counterpart clinic EMR—to hospital data. The hospital’s emergency department also is getting a new documentation and scheduling system. The massive project is laid out in neat spreadsheets that show timelines, full-time equivalents and dispute resolution procedures.
The diagrams, Viator explains, are valuable tools in helping everyone envision the complicated rollout. Viator is leaning heavily on McKesson, but during an early planning meeting she is careful to remind them who the customer is here. “This is about workflow and processes, not packages of software,” she says. During the next few years, Viator—and the rest of Baton Rouge General’s 2,600 employees—will be deeply entrenched in both.
1. Physician and patient portal
Neatly marked in green on Baton Rouge General’s timeline, the physician portal is among the first applications to launch in project Hit. Previously, the hospital’s physicians had limited access to patient records post-discharge (through an image-scanning system, also from McKesson) that enabled electronic signatures for chart completion. With the portal, Baton Rouge will give physicians real-time access to concurrent information in the inpatient chart, Viator explains. Initially, they will be able to view labs, radiology results and transcribed notes. In essence, Viator is whetting the physicians’ appetites for all things digital. By getting the portal up first and linking to a handful of critical data fields, she hopes to demonstrate the benefit of IT. More difficult applications, such as physician order entry through the portal, will wait. “We want to get the medical staff comfortable first,” she explains.
But the portal will serve more than physicians. Baton Rouge will also enable patient access. Patients can see portions of their medical record, request appointments and get healthcare advisories about their condition. Unlike many hospitals, which put patient access low on the IT priority list, Baton Rouge is putting customer access front and center. However, Viator cautions that, for the patient portal to work, many workflows must be addressed. Although Viator doesn’t come out and say it, the patient portal seems to be a subtle reminder about the real purpose of the overhaul, which is built around patient service at every turn.
2. Pharmacy system
The hospital’s new pharmacy system will test the premise of IT as patient safety enabler. Scheduled for a rollout that will be mostly completed by this fall, the barcode-driven pharmacy system will keep track of drugs from the time they arrive at the hospital’s distribution center through point of administration on the inpatient floor. It will include a medication robot that will pick and package drugs, automated dispensing cabinets, and an order entry system. When nurses administer the drugs, the system will check for the five rights—patient, medication, dosage, time and route.
Baton Rouge has laid out the proposed workflow on an oversized full-color graphic. It’s the handiwork of some 15 staff members, says Viator, who has an amazing ability to recall numbers. They spent two weeks in discussion about the complex chain of events that lead up to medications being administered, she says. When Viator and her staff were checking on McKesson references, they could only see bits and pieces of the medication administration system in action at any one hospital. It’s why she refers to project Hit as a “calculated risk.”
Baton Rouge’s executive governance structure is helping to mitigate that risk. At the grassroots level are project teams led by local personnel most directly affected by the new technology. The project teams, in turn, report to a project management office that coordinates all activity. If the project management office runs into a snag, it will defer decisions to a leadership committee led by Viator. At the top of the hierarchy sits Baton Rouge CEO Holman, who heads a governance board that he leads in conjunction with a designated McKesson executive. But Viator encourages her staff to resolve issues at the grassroots level. “Ninety-five percent of our issues should be resolved right there,” she says.
3. Clinical documentation system
Over time, Baton Rouge General is building a comprehensive clinical database. It will span both the inpatient and outpatient sides of care delivery, enabling physicians, nurses and ancillary providers to document their care electronically. In the first phase, the medical center will push out a clinic EMR to its own base of some 50 employed physicians. Later, it will offer to host the EMR for community physicians. During a vendor meeting, Viator’s not shy about leaning on McKesson for insight into cultivating physician support of the project. Communication is key, the McKesson executives say, and Viator nods to her communications director. It’s a hallmark of her leadership style: She’s not one to overwhelm people with directives and oratory, but she can talk endlessly about the benefits of automating clinical documentation.
On the hospital floor, nurses will use wireless carts to pull up charts, while physicians may use PDAs, Viator says. But there will be plenty of other data sources as well. For example, the technology is set up to receive digital feeds from various patient monitors (from GE Healthcare). Thus, longitudinal patient data can be trapped electronically.
Baton Rouge took a step toward the digital chart when it deployed a picture archiving system a few years back, Viator explains. But in this new world, images and radiologists’ reports are just the tip of the iceberg. By getting information into clinicians’ hands electronically and eliminating the errors associated with paper charts, Viator figures the hospital will be able to deliver superior care and reduce expenses. In her detailed ROI calculations, for example, are studies that project as much as $1.6 million in benefits around automating medication administration alone. In total, Baton Rouge is eying a $3 million annual benefit from its IT investment, with a break-even point some three to five years away.
At this early stage, the projections are speculative. But by making such careful measurements of current workflows and related costs, Baton Rouge has set the stage for objectively documenting its forward march into the EMR.
Gary Baldwin is technology editor of HealthLeaders magazine. He can be reached at firstname.lastname@example.org.
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