Digital hospitals offer a range of opportunities, such as wireless and remote access to health records, consolidated workflow, summarized results of structured and unstructured data, detailed documents, and available medical images. It is, essentially, innovation integrated with operations.
Alegent Health's Lakeside Hospital is one of eight facilities in the system, which has been awarded "Most Wired" health system four out of the last five years. Lakeside opened in August 2004 with the goal of combining high technology with holistic patient care. The 77-bed facility is the first new full-service hospital in Omaha in 30 years. Its three primary IT objectives are to:
- implement electronic medical records to reduce reliance on paper and increase efficiency
- use advanced diagnostic imaging for less invasive testing options, provide online access to results and images, and support patient education
- focus on medical safety by employing robotic and bar code technology, store and collect allergy information one time, and enable a rules and alerts system
IT has numerous aspects to consider which all went live on day one. That includes software modules, modalities such as MRI, CT, and PACS, clinic management, and systems for ancillary departments such as lab, pharmacy, dietary, and respiratory therapy. The IT team installed mobile devices-computers on wheels-that users can roll right into patient rooms, stationary devices that serve as all-in-one computers at the nurse stations with 24-inch screens, and wireless tablet PCs that are available at selected locations. They are going to begin a pilot program for PDA use by the end of the year.
Biometric security measures were originally part of the IT strategy as well. Lakeside tried using fingerprint access due to the technology's accuracy, maturity and cost effectiveness. Another strategy is PROX cards for secured access to the building. Users log in to the system with a combination of the two. A single sign-on launches all applications except PACS which requires a separate login. The facility eventually switched back to a single login and keyed in password, dropping the biometric identification requirement when they realized it took users too long to get in to the system.
Demographic data from 2002 on was preloaded into Lakeside's system. The IT team provided a seamless link to electronic document managements and health information services. Approximately 75 percent to 80 percent of documents were electronically transferred into the system.
For data acquisition and management, Lakeside employs a distributed scanning approach. At the point of registration, identity information and consent forms are captured, the emergency department can scan information at the point of service, medication administration records are scanned daily, and orders and progress notes are scanned upon discharge-until computerized physician order entry is implemented. Bar codes on forms aid the indexing process.
To get Lakeside physicians on board with high technology, a physician design team representing every specialty was used together physician input. With the chief of staff's support, all physicians applying for medical privileges at Lakeside had to agree to use electronic records and complete their records electronically. They were rewarded with immediate benefits, such as remote access and completion. "They want to know when it will be available at our other hospitals," says Rosemary Borghoff, RHIA, HIM director.
Lakeside originally tried group education to train the physicians. The trainers quickly found that this didn't work as some would arrive late and others would leave the session early. So, they switched to one-on-one training which took anywhere from twenty minutes to two hours, depending on the physician. This individualized approach allowed the physicians to train with their own patients' data which made them more engaged and helped them see the value. The training team also provided a CD and quick reference cards. Once the facility was ready to go live, physicians had 24-hour support during the first week and 18-hour support the second week. For months, physician rounding support continued and a help desk triaged calls, moving calls from physicians to the top of the list.
In the future, Lakeside plans to implement online medication administration checks, computerized physician order entry, conversion to Soarian clinical documentation