2010 Lessons Learned
By: Donald E. Kinser, PE, MBA – President & CEO, EDI, Ltd.
In a previous EDItion Newsletter, I shared some thoughts about Healthcare IT Lessons Learned and some key drivers in healthcare IT. Most, if not all of these lessons learned are still applicable today, and to be sure, some things have changed over the last 18 months.
One significant change is that the “slow and persistent march” toward a full Electronic Health Record (EHR) that I discussed in 2008 has now become a mad dash toward “meaningful use” in order to avoid the significant penalties that begin in 2015 under the HITECH act. The other key drivers of healthcare IT - increase workflow efficiency and improved safety and quality - remain intact and are more important today than ever before.
So, here are some lessons learned in 2010, in no particular order:
There is light at the end of the tunnel
The healthcare design and construction industry is beginning to improve with projects starting to move forward again. We are seeing much more activity today, and it appears that the light up ahead is actually the end of the tunnel and not an oncoming train.
HIT reaches “tipping point”
It has been nearly 2 years since the HITECH act was passed as part of the Obama stimulus package. David Blumenthal, MD (National Coordinator for Health Information Technology), summed it up in his comments to the House Committee on Science and Technology last September 30: “The HITECH act represents an historic and unparalleled investment in HIT.”
This investment, along with the looming penalties for those that don’t adopt the use of health information technology, is driving EHR adoption and the development of Health Information Exchanges (HIE) across the country at a pace never seen before. There has been more significant improvement in the HIMSS Analytic EMR Adoption Model (EMRAM) scores in the last year than any time before.
Lots of heavy lifting needed
The mad dash to meaningful use means a lot of hard work ahead for healthcare IT CIOs and staff. This has led to IT staff shortages and intense pressure on CIOs to get the work accomplished. A recent College of Health Information Management Executives (CHIME) survey shows that more than 60 percent of responding CIOs reported IT staffing deficiencies will possibly (51%) or definitely (10%) affect their chances to implement an EHR and receive stimulus funding.
Based on the HIMSS Analytic EMR Adoption Model scores at the end of 3Q10, less than 18% of US hospitals have achieved Stage 4 on the EMRAM scale. HIMSS believes that a Stage 4 hospital can meet most, if not all, of the Health & Human Services’ meaningful use criteria. While CIOs, for the most part, are optimistic they will meet the deadlines, the healthcare industry clearly has a long way to go.
This further reinforces the fact that hospital IT staffs are overworked and understaffed, and more importantly, their attention is focused on achieving meaningful use and not the design and construction of a new hospital or major expansion project. This makes hiring a consultant like EDI more important than ever before. Hospital’s IT staffs simply do not have the manpower to deal with a major design and construction project.
Physicians finally get “IT”
For many years physician resistance has been a significant impediment to health IT adoption. While this remains the case to a significant degree among smaller physician practices, this is changing rapidly in larger physician practices and in the hospital setting. We are seeing more physicians as technology champions.
Furthermore, future physicians are extraordinarily tech savvy. A recent survey of more than 700 medical students reveals that not only do these medical students believe in the value of electronic medical records, but that they also expect availability of an EHR when they begin to practice. More than 70% of these medical students said that having an electronic medical record is an important factor when deciding where they will practice medicine.
Healthcare Facility Guidelines finally address technology
For the first time, technology concerns regarding space and building system infrastructure are now part of the recently published 2010 Edition of the FGI Guidelines for Design and Construction of Health Care Facilities. The newly revised guidelines establish minimum requirements for the quantity, size, and location of technology spaces throughout a hospital facility. The guidelines also establish basic mechanical, electrical, and security requirements for these technology spaces. These physical requirements include UPS power, 24/7 HVAC, and other requirements aimed at increasing the reliability of the network systems.
Convergence is accelerating
For years we have talked about the convergence of once disparate and standalone systems like voice, data, security, audio-visual, nurse call, etc. This is now the norm and not the trend. For example, all the major nurse call manufacturers now have some type of IP-based system on the market (although still proprietary in most cases with only the parts of the system that actually ride on the hospital IP network at this point). While these systems are still not fully integrated with the hospital LAN due to the requirement of UL1069 certification, most have the capability for significant integration with other systems through the hospital LAN. VoIP phones and IP-based security systems are now standard. Most audio-visual systems now ride on the hospital IP network.
Soon, everything will simply be an application that rides on the enterprise IP network. However, convergence today is not just about infrastructure and networks but the software applications themselves. Most of our clients are moving away from a “best-of-breed” approach with interfaces between different standalone applications and towards a single, integrated software application across all the functions and departments. This places significant new demands on the hospital network.
Data centers are still a big deal
Data centers are still a train about to run over the healthcare industry, and it is getting closer. Some forward thinking healthcare organizations have addressed this need. However, most have “kicked the can down the road” as they focus on achieving meaningful use and lack the needed capital to invest in a high reliability data center.
Green is also the big new thing in data centers as we come to grips with the huge amount of energy consumed by data centers.
Healthcare delivery is going to change
The recently passed Patient Protection and Affordable Care Act (PPACA) will certainly have a profound impact on our healthcare delivery system in the US. Healthcare delivery will change dramatically as the system begins to cope with the huge influx of the newly insured. Other impacts will include the move to Accountable Care Organizations and other new industry payment and reimbursement models. The problem here is nobody really knows just how the system will change and there is much uncertainty. One thing is for sure though: information technology will play a major role is the reengineering of the Nation’s healthcare delivery system, and we are excited to be part of that ride.
Nurse call continues to advance
Today’s nurse call systems are all about improving clinical workflow, increasing safety and quality, and improved clinical communications. As mentioned above, all the major manufacturers now have some type of IP (network) based system in production. Nurse call continues to be a big deal, and as we predicted in 2008, the IT Department is becoming increasingly responsible for these systems.
We are also seeing a trend toward centralized call answer triage (call center) approaches for nurse call alerts and notifications. This approach is sometimes referred to as the “patient focused care” model as calls are answered at a “call center” by an operator who triages the call and determines the appropriate staff member to respond. This approach allows caregivers, especially RNs, to spend more time caring for their patients rather than answering calls that do not require an RN. To put this in perspective, nurse call statistics from October 2010 at an Illinois hospital, with over 900 call stations receiving over 90,000 calls per month, have shown that over 64% of all calls do not require an RN and the average answer time is less than 15 seconds with the right caregiver in the room within 7 minutes. Not only have their patient satisfaction scores increased, but they estimate they save approximately $12,000 per month in nurse resources.
Additionally, there is more integration with medical equipment (smart beds, for example) and the HIS applications. Not too long ago, care providers were “happy” to have medical equipment alarms integrate with the nurse call system so they did not have to wander the halls listening for these alarms. Today, they not only want the alarm function integrated, but want more information passed to their handheld devices, such as the type or level of alarm. The integration of medical equipment with nurse call systems is allowing for care providers to go to “one place” to find information rather than multiple places as in the past.
The integration of nurse call systems with patient education/entertainment systems continues to develop rapidly, and the nurse call manufacturers, in conjunction with the pillow speaker manufacturers, are finally starting to address this issue by making their product more compatible with these systems (for example, providing navigation buttons integrated into the speaker). Nursing Departments have clearly realized that they must be involved more in the nurse call system decisions. This must be carefully managed to avoid delays in decision-making.
Nursing Departments have clearly realized that they must be involved more in the nurse call system decisions. Hospitals are forming nurse call committees that include nursing, IT, and bio-med when looking into the purchase of a new system, as each department now plays a role with these systems. This decision-making process must be carefully managed to avoid delays as the project progresses and ensure compatibility with other hospital systems.
RTLS has reached a tipping point
Real Time Location Services (RTLS) (patient, staff, and asset tracking) have clearly moved from the “talking about it” stage to the “doing it” stage. Improved clinical workflow efficiency and quality are the primary drivers for this technology.
Rural healthcare and telemedicine have a long way to go
Two things are clear from our work in Louisiana and Arkansas helping those states to develop their statewide telemedicine networks: rural areas have a long way to go in order to be connected, and they are severely underserved by broadband connectivity. Also, many regulatory issues impede health information exchange (HIE)/telemedicine adoption, as well as increase connectivity costs.
This stuff is still expensive
While prices for IT infrastructure softened in 2009 and 2010 and hospitals that were able to move forward with projects benefited greatly from these reduced cost. The fact remains that all this technology is still expensive and the conditions of 2009/2010 won’t last. Exercise extreme caution when using costs from the last 18-24 months when projecting budgets for future projects.
Don’t relocate those existing desktop PCs
Many of our clients try to reduce cost by relocating existing PC desktops and equipment. However, we have learned that by the time you figure in the cost to inventory, relocate, and reconfigure these desktops you would be far better off simply buying buy new ones for the new facility. So, delay that desktop refresh for a year or two (if you can) until the new facility opens.
The intersection of clinical care and technology
The healthcare industry is still clearly experimenting with technology at the point-of-care and trying to figure out the best approach to end-user (caregiver) and EMR interaction. Clearly, there will not be one single prevailing solution, and multiple technology approaches at the point-of-care are required. For example, fixed workstations and mobile workstations/devices will both be required in multiple locations (i.e., bedside, hallway, nurse stations, meds rooms, break rooms, conference rooms, etc.). Anyone that says that they have the one right answer is just plain wrong.
Much debate about bedside computing continues, and many clinicians have resisted the notion on the grounds that it interferes with their relationship with the patient. However, the need for a bedside computing device will be a given at some point, so plan for it regardless of what the current state might be or what the current staff says about it. Whether it is charting, medication administration, etc., some type of bedside computing will happen. You need to provide the proper blocking in walls, power, network connectivity, etc. regardless of whether or not the hospital deploys bedside devices on day one in the new facility. If you don’t, you will add them later, after construction, at a much higher price – both in dollars and impact on ongoing operations.
For further information or discussion, please contact us at info@ediltd.com .