Value

By Carole Cotter, CIO, Lifespan

If you've ever been stuck in traffic, heading to or from a city, you've probably wondered why developers build so many homes or offices without improving, upgrading, or increasing the number of roads that connect them. The answer is simple, and it's a mistake that's not confined to the building industry: people commonly concentrate on goals or endpoints without paying attention to the underlying infrastructure.

Most municipal planners don't want to build new roads without making sure they'll lead somewhere. Chief information officers, unfortunately, have no such luxury. For IT, the underlying infrastructure has to be sound before new applications can be built atop them. And I believe that it doesn't matter what industry you're in. Healthcare needs the same kind of industrial-strength reliability as banking, insurance, or any other industry that relies on communications to keep its employees productive.

I had a bit of an advantage in developing the infrastructure for Lifespan. We're a not-for-profit healthcare system based in Providence, Rhode Island, the result of a 1994 merger between Rhode Island Hospital and Miriam Hospital. We added Newport Hospital and Bradley Hospital to our system not long after the merger. Some key ideas for the IT strategic plan of the merged hospitals came out of a three-day retreat, to which we brought all the stakeholders in our future: researchers, payers, physicians, patients, their families, administrators, employees, even competitors. We spent time thinking about what healthcare would look like in 2010, and from those thoughts we created a vision of the future.

We believed that to work efficiently as a system of caregivers, we needed to communicate effectively. This led us to realize that we needed to build a network high-value, widely accessible, comprehensive, integrated information network. The hospitals had a diverse array of network components, and there were interoperability issues that they knew had to be addressed. As a result, we were able to start from scratch which is always easier when you're talking about information technology.

We knew that we needed to define the underlying architecture that would support our vision of the system as a network, so our initial projects were network-related. We envisioned a system in which physicians and clinicians would have the information they needed, when they needed it, wherever they were. We built it to be resilient and reliable, recognizing that if our business depended on communication, then information had to be available all the time. We built in redundancy and eliminated single points of failure (remember that sometimes you have no control over some devices, because they exist in the telecommunication provider's network). We made sure there was always an alternate way to get data from one site to another. We built a wide-area network connecting the hospitals. We consolidated onto a single e-mail application and we set up five-digit dialing.

Only after we had created an IT plan that enabled communications did we begin to deploy applications. We built a strong infrastructure and we continue to fund it and make improvements to it, which allows us to deploy a multitude of capabilities along the way.

We have implemented applications that help improve processes, increase patient safety, and help decision support. The best example I can share concerns patient safety initiatives, which most hospitals are facing. There's solid research to show that computerized physician order entry and other components of the closed loop of medication safety are effective.

Imagine a traditional system for physician orders. It relies on handwriting and pieces of paper. In terms of process, the paper needs to go to someone to be handled. On a busy day, these papers stack up, which delays treatment. We implemented our physician order management system, in which physicians enter orders online. Those orders are then transmitted electronically to the laboratory, radiology, and the pharmacy, as well as to other ancillary departments. Since the physician enters the information electronically, transcription errors are eliminated. We also discovered that this system helps decrease the turnaround time for getting back test results and for getting the first dose of medications to patients. In fact, we cut the time for patients receiving their first dose of medication from about 2 hours to 12 minutes. We know that brings value from a patient's perspective.

We've also tracked the rate of physician adoption of the order management system. Currently, about 90 percent of all orders are being entered electronically. Based on industry practice, I think that's a fantastic adoption rate. I attribute it to all the work we did in making sure the system has the proper functionality and architecture. Simply put, the application does what it's supposed to do, is available, has a good response time, and has wireless access that works without dead spots. If we had not put proper investment in the underlying infrastructure, there would have been endless frustration and that's a road that leads to disaster.