Computer technology improves operations

Making switch is slow, but worthwhile

Spaulding Rehabilitation Hospital in Boston first implemented its new electronic data system two years ago, solely to replace the existing hospital information system for business operations.

The initial focus was on implementing billing and accounts receivable replacement, medical records and admission data, and discharge and transfer system information. Completed Oct. 1, 2001, the first full year of implementation resulted in a $6 million yield in cash receipts, says Rick Mason, corporate director in information systems for Partners HealthCare Systems in Boston, an organization created when MassGeneral and Brigham and Women’s Hospital merged, creating the parent company of Spaulding Rehab. Mason is the site chief information officer at Spaulding Rehab.

"The electronic system worked so effectively that the accounts receivable people have told me that our effective return on investment was six months, as the cost of the installation was $3 million," Mason says. "We brought in $6 million above and beyond what we would have expected from prior years’ results."

Spaulding had used an electronic system created by Medical Information Technology Inc. (MEDITECH) of Westwood, MA. The MEDITECH software applications can be used for financial, clinical, data storage, and other needs of a health care system. After that initial success, the rehab hospital began a second phase and implemented an executive support system in March 2002, and a pharmacy system in June 2002, Mason says.

"Then on July 23, 2002, we went live with a number of clinical applications, including clinical labs, microbiology, radiology, order entry, and patient care inquiry," Mason says. "The system looks at an aggregate of patient data from all the ancillary departments I mentioned and puts them into a series of screens that a physician can access easily using nothing more than arrow keys."

The hospital also switched to a hospitalwide wireless system, which included 30 carts with battery-powered laptop computers that could run all of the applications of a typical desktop computer over the wireless infrastructure for 16 hours straight before the batteries needed recharging, Mason says.

"The driving force to install it was the fact that we were limited for space, so placing desktop computers on nursing stations was not an option," Mason says. "The secondary limitation is that our heating and air systems in the building are operating nearly at capacity."

Desktop computers generate significant heat, and adding the necessary number of these computers to the hospital would require the heat and air conditioning system to undergo a $1.5 million upgrade, Mason says.

"Because we were battery-powered, there was no power drain during critical hours, and laptops don’t generate the heat that the typical monitor does, so the laptops were not straining the heating and air system," Mason explains.

The wireless alternative to desktop computers cost about $120,000 to install, Mason adds.

From the basement through the hospital’s 10th floor there are several antenna access points on each floor, making it possible for clinicians to roll the laptop into each patient’s room, the solarium, the therapy gym, and even the restroom, and still stay logged onto the network, Mason says.

"The added benefit is that physicians can use this system with laptops that are not cart-based, and they can walk floor to floor and in and out of patients’ rooms without having to log in and log out each time," Mason adds.

"The wireless system paves the way for a handheld solution, which we plan on implementing within the next 24 months," Mason says. "That will be tied into our wireless system."

Mason offers this description of some of the other features of the wireless electronic system, including some future clinical applications:

  • Clinical labs: The computer system supports the diagnostic analyses of specimens from patients, and these can be entered into the system and viewed from any of the computers. This way, physicians easily can check the lab results as they enter patients’ rooms.
  • Microbiology: Again, clinicians can obtain information about blood, urine, and tissue specimens that has been entered by lab techs into the wireless system.

"Prior to implementation of MEDITECH, we did have a lab system that wasn’t integrated and had a stand-alone microbiology system that wasn’t integrated into a single result reviewer," Mason says. "Now the orders are entered into one system, and they’re directly mapped into microbiology or labs, and the results all are viewable in a single area of the single application."

  • Patient data: Patient demographics are completely integrated into the system, so whenever a particular patient’s file is reviewed on the system, whether the information sought is clinical or financial, the patient’s demographics are included.

"It provides you with a tremendous source of value, and the true benefit to this application is a single source of truth," Mason says.

Data integration improves communication

Data integration: The electronic system provides greater efficiency and data integration, which in turn improves communication between departments, Mason says.

"Integration has a side benefit, as well," Mason adds. "Because when you start to develop interdisciplinary applications that reside with each other functionally, you start as a side benefit to force departments that have never worked closely with each other to understand how each works and to develop higher methodologies of communicating with each other."

For example, a physician was concerned that when a secretary was entering an order for him, a previous order had disappeared off the system, and he wanted to append the previous order but not delete it, Mason recalls.

The normal process is to call the lab to append the order, and if you want to change the order then you delete the series already in the system and create a new series.

However, due to the electronic system’s data integration, this process wasn’t necessary. And, as a result of the data integration and the physician’s inquiry into it, what happened is that the physician, along with nurses, pharmacists, and others, gained a better understanding of how the lab functions. What they discovered was that the lab automatically does a complete blood test whenever a more limited blood test is ordered. So if a physician wants to ask for more information on the blood drawn from a patient, most of the time that information already is available within the lab, Mason explains.

"The lab simply needs to post additional results, and nobody really understood that before," Mason says.

Radiology: The radiology department previously had no scheduling system, but with the electronic system changes, it now has a built-in scheduling system that permits radiologists to transcribe reports to the MEDITECH System, Mason says.

"We are working on a web-based imaging solution so physicians network-wide can view a patient’s radiology results or images from anywhere on the system, including wireless networks," Mason says. "We’re working on the imaging portion and expect to have that finished in a year."

Order entry: When a physician wants to order a lab test, radiology test, or microbiology test for a patient, all that is necessary is to put the order into the electronic system, and the order can be reviewed by the appropriate ancillary departments, Mason says.

"As a result of that, the ancillary departments will work on processing those results and have a timely turnaround of putting the results into the system so physicians and nurses can access the data quickly and easily," Mason says.

"The system allows us to communicate more quickly with ancillary departments, and it allows us to have higher-level analytical skills in planning upgrades or new operational changes to our hospital’s environment," Mason adds.

Pharmacy: The pharmacists, like nurses and physicians, now use wireless laptops. This frees them from being stationed solely in the pharmacy, so the hospital now has clinical pharmacists operating on the floors, available to provide enhanced clinical support to nurses and physicians, Mason says.

"The drug orders are placed the night before, and the pharmacist comes in early in the morning to work on them," Mason says.

Eventually, the system will permit physicians to place medication orders directly to the pharmacy through the electronic system.

Pharmacy techs prepare individual doses based on the orders, and the pharmacists check the orders before they’re placed on carts that go directly to the patient floors, Mason explains.

Then the pharmacists are free to visit the floors, where they can answer questions by clinicians and handle any issues that might arise, such as adverse reactions or allergic reactions. Occasionally they’ll even speak with patients, Mason says.

"The biggest advantage is safety, because of the fact that they’re supporting care providers on the floors," Mason says.

Another safety feature is that the electronic system will provide checks and balances for physician medication orders. It will permit physicians to review their drug orders, and it will assess the order for safety and appropriateness according to the patient data. If the system detects something unusual, it will provide a prompt to the physician, asking, "Are you sure you want to recommend this medication, based on the following," Mason says.

Need More Information?

  • Medical Information Technology Inc., MEDITECH Circle, Westwood, MA 02090. Telephone: (781) 821-3080. Web site: www.meditech.com.
  • Rick Mason, Corporate Director, Information Systems Department, Partners HealthCare systems; Site Chief Information Officer, Spaulding Rehabilitation Hospital, 125 Nashua St., Boston, MA 02114. Telephone: (617) 573-2555.