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Web portal helps move patients out of ER

November 02, 2009 Molly Merrill, Associate Editor

NEWARK, NJ – A Web portal is helping to move patients out of Newark Beth Israel Medical Center’s emergency department and into health centers in the city.

The Web portal was a pilot project in Health-e-cITi-NJ, a health information exchange for the Greater Newark area, which aims to make it easier for providers, patients and hospitals to exchange information with the Newark Community Health Center and the Federally Qualified Health Centers (FQHCs) in Newark.

Newark Beth Israel, a 673-bed not for profit teaching hospital, was awarded a state grant to help divert patients from the ED to FQHCs for primary care treatment.

Tom Gregorio, vice president and CIO, Newark Beth Israel Medical Center, said the hospital invested the $60,000 grant in a Web portal that would allow a patient’s ED case to be sent to the FQHC electronically instead of via fax.

“The day we went live we had a no-show and when we reviewed the record we found out the patient had been to the ED instead. The portal allowed us to follow up with that patient,” said Gregorio. This “immediately accomplished” what hospital officials had intended the Web portal to do, he said.

The portal is from Piscataway, N.J.- based IGI Health and uses Intel’s SOA Expressway for Healthcare to retrieve data for display from a variety of hospital systems including EHR, database, or HL7-based sources. The portal is unique, Gregorio said, in that it provides a patient’s Medicaid medication history such as dosing information and patient compliance. The portal is also plugged into the state immunization system and can pull information about a patient’s record sets.

“Whenever a patient comes into a physician’s office they are able to use the portal to enter patient demographics, and they need not have all immunization record sets of the patient available,” said Sita Kapoor, CIO, InfoTech Global.

Kapoor says the portal allows physicians to retrieve immunization records to help treat patients as well as send immunization records, “hence providing complete immunization record sets for any child that is going to be given any treatment no matter where they are in the country,” she says.

Newark Beth Israel is using Intel’s new version 2.2 SOA Expressway. Joshua Painter, senior architect at Intel, says the new version has three core improvements – it has better support for Windows, more reliable messaging and provides pre-built modules, workflows and predefined data maps that help to reduce the time of integration.

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Time for an IT Revolution in Healthcare!

“Just call me, Eddie”

I need to write about this, because this day still haunts me, years later. And it is amazing the clarity I still have of the entire day, of every word said, and how it made me feel.

My dad had a heart attack the same week President Clinton had been scheduled to have his heart surgery, but Clinton had to wait an extra few days until the blood thinner had left his body (important to note). My dad was on a fishing trip vacation with friends out of his home state at the time. His closest family and friends were hundreds of miles away. When he was rushed to the local emergency department and immediately admitted to the Intensive Care Unit, where the nurse gave him a blood thinner IV and said it would help with his heart palpitations. As it turns out, he had to have heart surgery, immediately, to save his life.

I flew from Florida to Michigan to be with him prior to his surgery. While he was waiting for surgery, he joked a lot with all the nurses who came into his room. Each nurse he met would call him, “Mr. Poore”, and he would immediately say, “please just call me, Eddie”. They would always reply, “Okay, Eddie. And I’ll make sure the next nurse knows that too.” Of course, the next nurse would come around and again address him as “Mr. Poore”, and Dad would reply, “Just call me, Eddie,”and this new Nurse would say, “Okay, Eddie. I’ll tell the night nurse”. They never got it right. After a while, my Dad became really frustrated and a bit concerned about his care team.

Personal Jewelry

Each employee who entered my Dads room would also tell my Dad that he would need to take off his two gold necklaces prior to surgery and they would offer to take them off him right then and send them to security for safe keeping. My father was very attached to each necklace (one from his mom and the other from his deceased wife, a nurse) and did not want them taken off, ever! It was agreed (by one nurse) that the necklaces would be taped to his leg during the surgery so that he’d always have them on him. This too, of course, was never communicated to other medical staff, and every time someone new walked into his room, they would kindly suggest that he would have to “take off those gold necklaces”, finally my Dad just freaked out!

I would watch his monitor above his bed: His blood pressure would rise, his pulse would rise… there were clinical implications to their poor team communication.

The two most important things to him were his good name and his gold necklaces and they couldn’t get either of these right.

Finally, now in surgery, as I am saying my final ‘goodbyes’, a nurse anesthetist came up and said, “Hi, Mr. Poore (not "Eddie"), I’m the nurse anesthetist. Do you know what I’m going to do?” My father replied, “Put me to sleep, I guess”. And she continued, “Yep, that’s right. And I see you have some gold necklaces on….” While she was still speaking, My father turned to me with a huge look of fear on his face and said, “Oh lord, they can’t even get these necklaces right, Jake!” That was almost the last thing he said on this earth.

My father died on the operating table that day. After his surgery the doctor didn’t even come out to talk to me. He sent one of his assistants out instead. When I asked what happened, we were told, “your Dad couldn’t hold his sutures, he was bleeding to death.” I asked if the blood thinner he was given the day before had anything to do with that, and she said, “Blood thinner, what blood thinner?” I couldn’t help but saying, “You guys didn’t even communicate the name he wanted to be called or stop asking him about his gold necklaces, maybe you didn’t communicate the blood thinner, either.”

Thanks for sharing this, Jake. Your story breaks my heart; maybe because my grandfather, who had a genuine fear of doctors, was named Eddie. How many other “Eddies” will it take?
I’m not certain that electronic medical records would have prevented what happened to Eddie or will prevent every medical error, but having access to all of a patient’s information at the point of care would prevent most of them. That, along with vastly improved caregiver communication and collaboration tools and better solutions to manage decision support, clinical workflow processes and quality would go a long way in improving patient safety. Paper kills. So does apathy and ineptitude. The time has come for an information technology revolution in healthcare.

Bill Crounse, MD Senior Director, Worldwide Health

Going Green in Healthcare IT and improving organizational efficiency along the way

By Chris Sullivan, first published in ADVANCE for Health Information Executives
Orignially Posted Wednesday, July 2009 by hlthblog

Going green isn't just good for the environment.

It can also make great business sense as the recession forces many industries to change the way they go about their business practices. Companies everywhere are looking to implement more efficient practices and reduce overall IT costs, and health care is no exception.

Contrary to a common misconception, health care organizations are not recession-proof. Many of our nation's largest hospitals and providers are not-for-profit and heavily rely upon donations and investments as their primary source of income. And with these funding sources drying up, health care providers are struggling to lower costs, reduce energy consumption and consolidate infrastructure. CIOs today have far less to spend on new IT investments; at the same time, they're tasked with using IT to significantly reduce overhead and operating costs.

In addition, the recently passed economic stimulus plan emphasizes the need for businesses to adopt green technology. Health care providers, in particular, have an enormous opportunity to pursue this goal by doing more with the technology in which they've already invested.

Many IT solutions that are helping health care organizations achieve these ends also provide significant environmental benefits, such as driving reductions in energy consumption, reducing travel and cutting carbon dioxide emissions. In short, being "lean and green" is good for both business and the environment.

It's not easy speaking green

It's important to note that there's no formal definition of green IT. It really boils down to using technology to reduce costs and overhead expenses, lessen the amount of waste produced, and mitigate the negative impacts of modern services, industry and manufacturing on the environment.

We lack clear metrics by which to measure both the environmental impact of IT and the results of moving to a greener strategy. There are, however, emerging frameworks that can be useful, including the U.S. Energy Star system and the Climate Savers Computing Initiative, to name just two.

But, ultimately, green IT has to save dollars and help make IT sustainable. Health care organizations are taking advantage of the enormous opportunity to cut costs and reduce energy consumption, reduce employee travel and consolidate infrastructure to increase energy efficiency.

How can your organization ensure it's taking the right steps to meet its business and compliance needs as well as the needs of the environment?

The answer lies in implementing technology - including software, server and desktop virtualization and remote-access solutions - and best practices that enable the most efficient use of infrastructure, boost employee productivity and, at the same time, cut capital expenses and reduce the impact on the environment.

Big (Green) Brother

Aside from health organizations' need to lower costs and streamline business processes, they face additional pressure from the government, legislators and company shareholders to ensure that environmental responsibility is a guiding principle in corporate practices. To help meet these dual demands, software is playing an increasingly important role in reducing energy consumption and operating costs - and in cutting down the associated environmental impacts.

Software can be a critical tool for health care organizations in meeting these environmental challenges. Current software solutions can reduce energy use through power management, analyze operational or environmental footprints and their impact, and facilitate increased productivity through remote access, virtual meetings and paperless offices.

In this way, software is foundational to solving today's environmental challenges and enabling long-term sustainability. It's increasingly important to find new ways to reduce energy consumed by technology, rethink business practices and research new solutions.

Virtualization achieves real results

For many IT departments, the biggest obstacle in improving the efficiency of their IT operations is the data center. In fact, it's estimated that just one medium-sized server has roughly the same annual carbon footprint as an SUV that gets 15 miles to the gallon.

Server virtualization is one of the most common ways health care organizations are going green. By virtualizing servers in their data centers, organizations lower the actual number of physical servers used, which not only reduces physical hardware costs but can also decrease the footprint of a data center.

A smaller footprint results in lower energy costs for infrastructure. In addition, there's not as much equipment to heat in the cooler months, or to cool when the mercury rises. With fewer physical servers, personnel costs can also be reduced, since fewer servers require fewer administrators, as well as less maintenance and upkeep.

According to industry researcher The 451 Group's recent report titled "Eco-Efficient IT," each server eliminated through virtualization can reduce power consumption in a data center by 200 to 400 watts. This is the equivalent of about $380 per year, per server, factoring in the energy costs of air conditioning to cool the unit. The report uses the example of a data center with 1,000 servers, which would represent an annual savings of more than $125,000.

Besides energy and cost savings, virtualization can streamline data center management and ease the burden on already strained IT departments. Virtualization can also ensure the security of your confidential data through a virtualized, mirrored backup and disaster recovery strategy.

One example is Houston-based KSF Orthopaedic, a health care provider that used server virtualization to lower costs, consolidate physical assets and implement a disaster recovery strategy.

KSF virtualized its server infrastructure, reducing the number of servers from nine to two. That level of downsizing allows the practice to be mobile when necessary. Anticipating the severity of Hurricane Ike in September 2008, KSF also utilized server virtualization to successfully provide access to medical records.

Prior to Hurricane Ike, KSF leveraged Microsoft Server Virtualization. The practice's two-person IT staff consolidated servers in about 36 hours the Friday before the hurricane hit. Less than 48 hours after the storm hit, KSF was the only functioning orthopedic center in Houston, allowing it to perform operations on Ike victims and injured first responders with all their electronic records intact. KSF leveraged virtualization to become a greener organization and to be better prepared for the unimaginable.

Becoming 'virtual'

Another way health care is leveraging technology to go green is by utilizing Web conferencing, messaging and collaboration software to hold virtual employee meetings. This reduces the need for travel and cuts corresponding expenses from the budget.

Enabling virtual collaboration can also increase efficiency, since employees can connect with colleagues across town or across the country from nearly anywhere. In a 24/7 world, employees need to access information and applications anywhere and at any time, especially when it comes to health care. Implementing the ability for them to view clinical records and images while remaining connected with colleagues can increase productivity and lower costs.

Though this approach can involve additional security measures, it may be worth the extra effort if your organization's travel expenses are spiraling out of control.

Planting green technology on the desktop

Server virtualization delivers cost savings and environmentally friendly benefits, but it's often a "behind-the-scenes" solution that doesn't impact many front-line employees and caregivers. Desktop virtualization, another iteration of the technology, not only lowers energy costs but can increase productivity, slash capital expenses on PC hardware and ease IT headaches.

Desktop virtualization delivers on the promise of thin-client computing by centralizing management of all user desktop environments on a single platform contained and managed in the data center. Forrester Research recently published a report that compares thin clients to desktops, and found that thin clients consume between five and 60 watts per device compared with the 150 to 350 watts typically used by a desktop PC. For organizations that deploy thin-client technology, it's possible to see energy savings in the 24 percent range. And since thin clients last about seven years compared to the three or four years of a traditional desktop, that's less money spent on PC fleet upgrades.

Desktop virtualization also removes the need for each employee to have his/her own PC, which lowers both energy and maintenance costs. Employees can simply log into any terminal to access applications and data, thereby increasing their efficiency. IT administrators no longer have to waste time fixing or replacing broken machines; instead, they can focus on the centralized platform in the data center.

Security is another benefit gained from desktop virtualization. Since data's contained centrally, administrators don't have to worry that unauthorized users will gain access to unprotected employee PCs. Desktop virtualization also eliminates the threat of information theft and loss of laptops or mobile devices, since no data resides on such devices.

Growing green

As the health care industry evolves, it must leverage technology to reduce costs, increase efficiency and improve the quality of care.

In a recent report released by consulting firm McKinsey & Company, analysts reported that, based on projections from the United States Department of Energy, overall energy use in commercial environments will rise 1.6 percent per year for the next 22 years. The energy used in offices full of PCs and power-guzzling devices is expected to grow at twice that rate. If the projected growth is that high for office buildings and corporate centers, imagine the figures for health care organizations, clinics and hospitals which, in addition to PCs and back-end IT infrastructure, must power a myriad of medical devices.

And while reducing expenses is the leading reason corporations are seeking more environmentally friendly practices - with 55 percent stating that reducing their energy-related operating expenses is the main reason for pursuing green IT strategies - 50 percent say that "doing the right thing for the environment" is their top motivator. The growing awareness of environmental issues and the popular groundswell toward going green presents an incredible opportunity for health care organizations to contribute positively not just to the health and well-being of patients, staff and caregivers, but to the planet as well.

Software solutions, virtualization and virtual collaboration tools are key to developing strategies that will drive cutting-edge health care technology and help these organizations become leaner, greener and healthier.