Revolutionizing Care

— June 01, 2007

The country's only chartless facility, The Weston Regional Medical Center is using wireless technology to set precedents in patient-focused care.

When Ministry Health Care and the Marshfield Clinic announced in 2002 that they had plans to build a new medical facility in the Weston region of Wisconsin, they wanted the patient experience to be at the heart of a completely re-imagined healthcare organization. In a collaboration between the long-time partners, talk began of designing a campus that offered services from primary care to specialized cancer treatment and in which the workflow was optimized in every regard. Today, details from where the CAT scan machines are situated to the placement of elevators have been designed to create a more efficient and customer-friendly facility.

The Weston Medical Center includes the Ministry Medical Group, which is a group of family practice providers; Saint Clare's Hospital, where all inpatient work is done; the Marshfield Clinic, which is comprised of primary care physicians as well as 38 specialists; and the Diagnostic and Treatment Center (DTC), which is a joint venture between Ministry and the Marshfield Clinic where all ancillary services such as lab work, radiology, physical therapy, heart services and more are offered.

Central to this collaboration is the role of technology. With the mandate that no patient should ever be hurt due to a lack of information, Ministry and the Marshfield Clinic set about designing a completely chartless healthcare facility. The vision was that physicians and support staff would have access to patient information on mobile devices from anywhere on the campus.

"We wanted technology to provide a method for achieving the highest possible levels of operational efficiency, clinical excellence and customer service," explains Tanya Townsend, IT director of Saint Clare's Hospital and the Ministry Medical Group. "Traditionally, most hospital designs are based around central records storage rooms," she explains, "but we've redesigned the facility with customer flow in mind."

From the Ground Up
Creating a chartless environment takes more than just eliminating the records storage room. From the beginning, project leaders knew that three fundamental elements needed to be in place for the project to succeed. The first was a completely seamless wireless infrastructure, accessible from anywhere on campus, and for these capabilities the Weston Medical Center turned to Cisco Systems.

According to Paul Olinski, general manager of commercial information systems for the Marshfield Clinic, Cisco was chosen because of its proven experience in WLAN infrastructure.

ncorporating wireless into a hospital environment requires very specific planning in terms of interference issues with medical equipment. Due to the care they took in planning, biomedical interference hasn't been an issue, but Olinski offers this lesson learned: "We did a lot of site analysis prior to the building being completed, and then we did it again after the building was finished to validate the initial design. But after all the equipment was moved in, that created new interference patterns--things as subtle as coat racks being moved from one area to another. One of the lessons learned for us was make sure you do your final site survey after the building is fully equipped."

The second piece of the solution entailed purchasing mobile devices that could withstand the high-impact environment of emergency rooms but be flexible enough to also be used in the office of a family practice. The Marshfield Clinic had already rolled out Fujitsu Tablet PCs to some of its other campuses, but Saint Clare's, Ministry and the DTC researched other tablet options before also choosing Fujitsu LifeBooks.

"There were a number of other vendors that were considered," explains Olinski, "but [Fujitsu's] commitment to good engineering and support was strongest. It didn't hurt when the salesperson from Fujitsu took his convertible and slid it across the conference room table. It banged into the wall, he picked it up and just continued working with it. It was incredible."

And finally the new center needed an application robust enough to allow the facility to forgo paper records. "There are two choices in the healthcare industry," explains Townsend. "You go with a single vendor that's trying to achieve interoperability across departments, everything from the E.R. to the labs to the general practices." Or, IT pieces together different applications for each department. "Since there wasn't really a single vendor out there that could accommodate all of our needs," continues Townsend, "we started looking at systems that were already available to us within the Ministry Group and Marshfield Clinic, and then we started looking at the gaps that we needed to find solutions for."

Once the systems were defined, detailed process maps were developed based on workflow, and patient simulations were conducted. "We ran through every kind of scenario that could possibly occur with a patient," explains Stacy Marver, director of IT at the DTC. Since each department of the facility has differing and specific application needs, this piecemeal model was the best bet. But an application was still needed to tie together all those separate applications and make patient information easily accessible to all departments. And there was the goal of a seamless experience for patients. "The point of campus integration," continues Marver, "was a common registration process, common scheduling, common electronic medical records and common doctor-to-patient tools." This was a tall order for a facility offering such a variety of services.

Luckily, Marshfield Clinic's homegrown application was in place for just such an order. Since 1960, doctors and an internal design team at Marshfield Clinic have been working on automating healthcare processes to improve efficiency and cut down on healthcare errors due to misinformation or lack of information. The basic system displaying laboratory and radiology data began in the 1980s, and in 1994 the electronic medical record became the Clinic's legal patient medical record. Since Marshfield began using mobile hardware, Tablet PC--specific applications have been replacing old workstation versions and new apps have been created and added when necessary.

For the Weston deployment the Marshfield application acts as a repository for information from all other applications. This means that all patient information--including radiology images, laboratory work and audio dictation files that doctors create about their observations--can be reviewed through this one application. Also, because Marshfield has its own internal developers, when doctors find that an application could benefit from a feature, the functionality can be built directly into the application suite.

Each department of the Weston Center still uses applications from other vendors, but Marshfield's application is possibly the closest thing to a total healthcare solution available
on the market. It's the first internally developed electronic health record system to be certified by
the Certification Commission for Healthcare Information Technology. And it's the Marshfield application that enabled the facility to go chartless.

Team Building
As the only medical facility in the country to be chartless, training doctors and staff entailed more than just running through applications and security procedures. Before the campus buildings were completed, staff worked together in a temporary facility where the spirit of collaboration was really put into play.

"In the temporary facility a lot of bonds were developed, and cultural issues were worked out along with technical ones," asserts Olinski. "None of this would be possible without the close collaboration of each company and each department within each facility."

Training was set up along functional lines, rather than by department. Employees with common access needs were grouped together for classes. The Weston facility also used a "super user" system. Experts called Blue Shirts were available in each department around the clock for the first few months the solution went live. After that, super users were trained in each department to act as the go-to people for the rest of the staff.

Solution building
Since Oct. 4, 2005, the Weston Center has been seeing the vision through. Over 200 access points provide seamless connectivity across the campus. All four entities also use Cisco's VoIP phone system. At Saint Clare's the Nurse Call system has been integrated into the VoIP system, so when a patient pushes the call button, it buzzes the nurse's portable IP phone.

More than 655 mobile devices are in use across the campus. Doctors have their own Tablet PCs, while nurses check out devices from a shared pool at the beginning of each shift. The DTC also uses Symbol PPT8846 data collectors with barcode scanners to run certain lab functions. When a technician scans a patient's ID wristband, his or her chart automatically pops up to confirm the patient's identity and that the right test is being administered.

Each entity of Ministry Health Care uses a slightly different suite of applications, but all use the Marshfield Clinic's application to access patient information. The system continuously syncs so that current information is always available. Remote connectivity is available to physicians and certain staff members, enabling doctors to check patient information such as test results from off campus and input orders without traveling to and from the facility at off hours.

Seeing Results
It's difficult to put a dollar figure on the project's ROI, because it is such a unique approach to healthcare. But eliminating paper records alone offers a huge savings. "Building, maintaining and staffing a records room is [a huge expense]," explains Olinski. "In addition to the capital initially, the national estimate for the total cost of pulling a patient's record is about $5 per pull. With more than 10,000 patients coming through just the Marshfield Clinic's doors every day, that adds up quickly." Olinski estimates a savings of about $1.3 million per year. And though surveys have been limited, he also cites physician productivity increases of about 5 to 10 percent per doctor.
Townsend notes how much is saved by having patient information always available. "Costs add up quickly on how often tests are duplicated and reordered when information isn't available from healthcare visit to healthcare visit," she says. "In fact, our first hospital patient was an adolescent boy who had chronic respiratory problems. With the shared electronic medical record from his Marshfield Clinic physician, the emergency room physician was able to pull up his history, medications and allergies and see all of the exams and tests that had been completed. This allowed this patient to have expedited care and avoid unnecessary testing." Olinski and Marver had similar stories, both citing that in a traditional healthcare environment it could take days for records to catch up to a patient. Which is not a situation you want to imagine from the emergency room.

Additionally, Saint Clare's has reduced its order administration process--the time it takes from when the doctor places an order for antibiotics to the time when the pharmacist verifies the prescription and has it available for the nurse to administer to the patient. In a paper-based facility, this can take anywhere from 90 minutes to three hours. On average, Saint Clare's now completes the process in five minutes.

"Reports from the Institute of Medicine estimate that roughly 50
percent of all medication orders can result in medication errors, which are preventable," says Townsend. Though we're talking about more than just money here, the Institute of Medicine estimates the average cost of an adverse medication error is between $3,000 and $5,000.
No dollar figure, however, can express the value of a life saved because of accurate information the first time. "It's really all about the patient," asserts Townsend. "It's not about the technology or the tools, it's about providing the best care that we can for the patient." //

Teresa von Fuchs is a writer in Texas.

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