Driving Better Clinical Decision-Making

Being connected in 2009 is a 24/7/365 proposition. While good connections in business relations can bring profits—effective IT-enabled connections across a multi-site healthcare organization allow significant reductions and efficiencies in operating and staff costs and better care for patients via expanded regional reach for many facilities. Faster clinical decision-making comes from quickly communicated results, more complete imaging history facilitates better decision-making, and improved physician satisfaction via tailored, comprehensive reports delivered swiftly in the means the physician prefers to review them ensures that referrals continue.

The Top 25 Connected Healthcare Facilities are intelligent and knowledge-enabled healthcare enterprises. They share efficiencies across departments and locations that can reduce patient wait times, overall length of stay, the need for repeat exams and thus alleviate added radiation dose to the patient. They can handle increases in patient volume with little or no increase in personnel, while refined patient and staff schedules push scanner utilization. Greater workflow efficiencies and tightly monitored billing and collections schemas set the stage for faster reimbursement payments and improvements in customer satisfaction scores among inpatients, outpatients and staff.

This year’s Top 25 Connected Healthcare Facilities include health systems, academic medical centers, a cancer care center, two community hospitals and an imaging center, spread across 15 states (although nominations were not limited to U.S.-based facilities). The winners are presented in alphabetical order; their listing in no way indicates a ranking. 

Nineteen of the Top Connected facilities have deployed EMRs that are Stage 5 (per HIMSS Analytics) or above. Four are Stage 7. Most of the facilities utilize clinical decision support, CPOE and structured reporting in a variety of clinical areas. Progressive users provide a link in the EMR to clinical images. The clinical departments most often connected via IT systems include cardiology, radiology, ICU, emergency, lab, orthopedics and surgery.

So where are the gaps? EP, dermatology, pathology, radiation therapy and oncology. In imaging and diagnostic systems, there’s a break in the chain often in the cath lab and EP lab, and in EKG and SPECT/CT imaging. But each year we see progress, so we’re getting there slowly and clearly.

Connections are making the difference in healthcare today, as well as differentiating top performers from the rest.

The Fine Print

Online nominations were accepted from May 22nd through June 22nd. The ballot included 18 multiple response questions. Nominations required the input of senior-level IT executives such as CIOs, chief medical or clinical information officers, chief technology officers, medical informatics officers, VPs of information systems and directors of IT. Among the factors differentiating the winners are stage of EMR deployment, the number of physicians with remote access to clinical images and patient data and the number of methods for physician access, the number and breadth of clinical IT systems deployed, the number of departments that share patient data and images with the EMR and PACS, the number of imaging technologies that share images and information with PACS and the economic and clinical impact of greater physician connectivity with images and patient data.

2009 Top 25 Connected Healthcare Facilities (alphabetical order)

	Alegent Health Omaha, Neb. | alegent.com Supported by Catholic Health Initiatives and Immanuel Health Systems, Alegent Health completes approximately 320,000 imaging procedures annually, with an average radiology report turn-around time of 12 hours. More than 96 percent of the 1,300 physicians within the 1,774-bed health system have remote access to clinical images and patient data. The not-for-profit system has reduced intraoperative image turn-around to less than two minutes, reduced days in accounts receivable by 4.5 days and saved approximately $2 million in accounts discharged not final billed.
	Baptist Health Little Rock, Ark. | baptist-health.com With more than 120 facilities, including eight hospitals and six outpatient imaging centers that perform 315,000 studies per year, Baptist Health has been delivering quality healthcare for more than 80 years. Many of the hospitals are more than 150 miles apart, so the implementation of a PACS combined with an EMR, allows physicians to access information from anywhere, eliminating unnecessary patient transfers, and has cut radiology report turn-around time by more than 66 percent.
	Brigham and Women's Hospital Boston | brighamandwomens.org This 777-bed teaching affiliate of Harvard Medical School sees inpatient admissions totaling 44,000, and employs approximately 2,500 physicians. With the adoption of digital imaging, enterprise image-viewing is available in all its clinics, as well as in more than 40 ORs. Clinicians electronically order imaging studies at a consistent rate of greater than 98 percent, and enterprise viewing is currently greater than 5 million images viewed per month.
	Cancer Treatment Centers of Americ Schaumburg, Ill. | cancercenter.com The Illinois CTCA performs approximately 72,000 imaging procedures annually and has seen an 11 to 15 percent increase in data growth in the last year. In implementing an EMR, 192-bed CTCA engineered a complete transformation of its IT application architecture all at once, instead of incrementally, to make digital records available across the enterprise for the first time. Report turn-around times have decreased from an average of 12 hours prior to EMR to 6.1 hours.
	Clarian Health Partners Indianapolis | clarian.org Over the past six years, enterprise film costs at the health system, which has an annual imaging procedure volume of 780,000, have declined from $7 million annually to less than $100,000, by implementing PACS. All facilities within the 1,719-bed system share the same infrastructure in terms of PACS, EMR, HIS and RIS. PACS, married with voice recognition technology, has reduced average report turn-around time from three days to less than four hours.
	INTEGRIS Health Oklahoma City | integrisok.com Oklahoma s largest not-for-profit healthcare organization has about 9,000 employees statewide. Comprised of 13 hospitals, rehabilitation centers, physician clinics, mental health facilities, independent living centers and home health agencies, the entities within INTEGRIS Health, which maintain more than 1,900 licensed beds and have medical staffs that number more than 2,500 physicians, have infused PACS, EMR, CR, DR, system data storage and voice recognition into its digital landscape to improve its inpatient, outpatient and ancillary services.
	Maimonides Medical Center Brooklyn, N.Y. | maimonidesmed.org Over the past three years, the 705-bed Maimonides Medical Center (MMC) has absorbed a 30 percent increase in exam volume with no staff or budget increases. With PACS and voice recognition, the radiology department expanded its remote coverage from one to two days per week with an 11-hour report turn-around time. By storing eight years worth of image data online instead of via an offsite archival storage location, MMC has reduced image retrieval costs by $15,000.
	Main Line Health Bryn Mawr, Pa. | MainLineHealth.org A team of approximately 10,260 employees and approximately 2,000 physicians care for patients throughout 1,078-bed Main Line Health s (MLH) continuum of care, from primary care disciplines to virtually all specialties such as cardiac, orthopedic, oncology, rehabilitation and women s health services. Comprised of five hospitals, the organization, which has an annual imaging volume of approximately 690,000, utilizes voice recognition and 3D imaging tools on integrated PACS workstations has decreased results turn-around time by 65 percent.
	Marshfield Clinic Marshfield, Wis. | marshfieldclinic.org The 500-bed Marshfield Clinic, by creating its own EMRs, is paperless in all of its 43 facilities which are linked by common information systems. As one of the largest private group medical practice in the United States, the Clinic owns and operates outpatient clinical, educational and research facilities, employing more than 780 physicians and 6,500 staff. With this infrastructure, Marshfield supports an annual imaging volume of approximately 400,000 studies and averages a 2-hour radiology report turn-around time.
	MedCentral Health System Mansfield, Ohio | medcentral.org MedCentral Health System, the largest medical community between Cleveland and Columbus, has a staff of nearly 2,600 committed to providing expert care to the people of north central Ohio. Its 225 physicians provide a range of primary and specialty care. Electronic physician reporting in the emergency department has simplified communication between physician and radiologists within the health system; ED preliminary reads by radiologists average about 20 minutes from exam end to preliminary read.
	Medical Diagnostic Associates, A Medical Corporation Woodland Hills, Calif. | mdia.com Medical Diagnostic Associates, A Medical Corporation, is a radiologist-owned network resource for diagnostic imaging and electrodiagnostic services. Approximately 2,000 physicians are a part of the national diagnostic imaging network and professional practice. With an annual imaging volume of about 13,000, the network has seen digital imaging procedures increase more than 50 percent in the last year and a 30 percent reduction in costs associated with electronic/digital solutions by implementing an EMR.
	Montefiore Medical Center Bronx, N.Y. | montefiore.org The 1,470-bed Montefiore Medical Center, which incorporates the University Hospital and Academic Medical Center for the Albert Einstein College of Medicine among other facilities, serves patients throughout New York City. The network of 2,500 physicians can access any of its 600,000-annual digital images, along with patient data, remotely. Since the switch to a digital environment, Montefiore has experienced a 30 percent increase in radiology imaging and a 15 percent increase in cardiology imaging, without the need for additional staff.
	The Mount Sinai Medical Center New York, NY | mountsinai.org Mount Sinai, the 1,100-bed academic medical center, with more than 3,000 full-time and voluntary physicians, treats nearly 47,000 inpatients and 427,000 outpatients annually. With their digital environment, the film library staff of 14 in 2001 was reduced to two individuals. The average time from exam completion to final (including resident driven workflow) is now under 24 hours, having been more than 72 hours three years ago. Also, the exam volume interpreted by same size radiology staff has increased 25 percent since 2002.
	Ohio Health Columbus, Ohio | ohiohealth.com OhioHealth is a family of 17 not-for-profit hospitals, 23 health and surgery centers, home-health providers, medical equipment and health service suppliers, with 2,300 physicians serving patients throughout a 40-county area. While the health system has realized a savings of nearly $7 million from its four Central Ohio hospitals by transitioning to PACS, average annual procedure volume has grown 6 to 8%. By implementing voice recognition technology, OhioHealth estimates it has saved an additional $430,000.
	Penn State University Milton S. Hershey Medical Center | Hershey, Pa. | pennstatehershey.org Penn State Milton S. Hershey Medical Center is a large academic medical center encompassing more than 2.2 million square feet on a 550-acre campus. The 501-bed center, which employees 611 physicians and a staff of 7,821, performs 350,000 imaging procedures annually. Over the last three years, patient volume has increased 35 percent with less than a 10 percent increase in personnel. Additionally, the center has decreased report turn-around times from 72 hours to less than 8 hours currently.
	Regions Hospital | St. Paul, Minn. | regionshospital.com A full-service, 477-bed private hospital, Regions is part of the Health Partners network. The hospital, which performs 488,000 imaging procedures annually, has added 19 clinic locations, as well as connected its EMR, RIS and dictation system into one over this past year. Through the change, the provider has reduced its radiology report turn-around times from two days to approximately 4.5 hours.
	St. Clare's Hospital & The Diagnostics and Treatment Center Weston, Wis. | ministryhealth.org/SCH/home.nws Opened in 2005, Saint Clare s, which is part of Ministry Health, is completely chartless with all patient data instantly updated in an EMR system. The facility was built without a film file room. Calculating film costs based on its 57,000 annual imaging procedure volume could total nearly $200,000 per year. The 84-bed facility employs more than 480 physicians, all of whom can access clinical images and patient data remotely.
	St. Joseph Mercy Oakland Hospital Pontiac, Mich. | stjoesoakland.org St. Joseph Mercy Oakland Hospital is a 433-bed community hospital and a member of Trinity Health, the fourth largest U.S. Catholic healthcare system. Its new 120,000-square-foot wing includes an emergency center, private patient tower, imaging center and retail pharmacy. Nearly all of its 760 physicians can access digital images and patient data remotely. With the implementation of digital images, the facility has reduced turn-around times for radiology reports from more than two days to 11 hours.
	St. Mary's Medical Center Evansville, Ind. | stmarys.org A member of Ascension Health, a Catholic-sponsored, not-for-profit health system, St. Mary s has a medical staff of more than 650 physicians. The 490-bed acute care medical center in Southern Indiana provides general, cardiac, surgical, diagnostic, rehabilitation, senior, mental health, oncology and emergency services, in addition to a separate but attached Hospital for Women and Children. The center performs approximately 130,000 imaging procedures annually and has an average report turn-around time of 4 hours.
	Summa Health System Akron, Ohio | summahealth.org Summa represents more than 1,800 licensed, inpatient beds across its Ohio facilities, including Summa Akron City, Summa St. Thomas, Summa Western Reserve Hospital, Summa Barberton, Summa Wadsworth Rittman, and Summa affiliate Robinson Memorial Hospital campuses. Since the installed of PACS in 2004, Summa has decreased film costs from $1.2 million in 2003 to $5,000 in 2008; and reduced radiology report turn-around times from approximately 55 hours to six hours. Its average ED radiology exam is dictated in less than one hour.
	Tenet Healthcare Dallas | tenethealth.com Tenet, through its subsidiaries, owns and operates acute-care hospitals and related ancillary healthcare businesses, which include ambulatory surgery centers and diagnostic imaging centers. With 51 acute-care hospitals in 12 states, in 2008 Tenet had 13,723 licensed beds and employed 60,297 employees. On an annual basis, the provider completes approximately 500,000 imaging procedures. In adopting a digital environment, Tenet achieved faster turn-around times of more 50 percent with its radiology reports.
	Trinity Health Minot, N.D. | trinityhealth.org Trinity is a 441-bed, community-based, non-profit healthcare organization, and is associated with the University of North Dakota School of Medicine as a sole sponsor of the Minot Center for Family Medicine. By adopting a digital clinical imaging and patient data environment across the health system continuum, the facility has experienced a 5 percent reduction in repeat x-rays and incurred savings of $400,000 in film costs during the first year.
	Unity Health Center Shawnee, Okla. | unityhealthcenter.com With 76 physicians on staff and more than 700 health professionals, the 114-bed not-for-profit Unity Health community hospital serves the Northern Central Oklahoma regions. The hospital s adoption of healthcare information system, integrated with its HIS, RIS, PACS and EHR, makes structured reporting capability available that physicians can access either remotely and or on campus. Also, the provider has reduced patient errors through the data entry elimination through the implementation of DICOM worklists.
	University Health System San Antonio | universityhealthsystem.com University Health, with facilities across Southern Texas, is a 604-bed acute-care hospital, that primarily serves as teaching facility for the University of Texas Health Science Center at San Antonio. The emergency center averages 70,000 emergency patients each year. Nearly all of its 1,600 physicians have remote access to the clinical images and patient data. The use of digital clinical images has allowed the facility reduce staff by about 13 members and decrease read time slightly longer than 3 hours.
	WellSpan Health York, Pa. | wellspan.org WellSpan is a 648-bed, not-for-profit health system serving the greater Adams-York County region in Pennsylvania through its two facilities: York Hospital and Gettysburg Hospital, and referral services and outpatient services that stretch into Northern Maryland. The system performs approximately 540,000 imaging procedures annually, and nearly all its 1,000 physicians can access those clinical images remotely. This year, WellSpan also is piloting installing full diagnostic workstations into select radiologist s homes.