Care providers ‘all in’ on infrastructure improvements

Across Southwest Washington, healthcare providers are making significant capital investments in infrastructure, in response to an increased number of patients (due the Affordable Care Act) and growing pressure for interoperability and integration among healthcare providers.

According to Ryan Ball, Peacehealth’s chief information officer, Peacehealth is in the midst of the second-largest capital investment project in the company’s history, focusing on infrastructure improvements throughout its facilities in Southwest Washington (Peacehealth Southwest Medical Center in Vancouver, St. John’s Hospital in Longview and numerous affiliated clinics). These improvements, said Ball, will drive the “triple aim” for healthcare – lower cost, better quality and improved patient satisfaction.

PeaceHealth’s investment project has many facets. One central aspect of it is implementing the EpicCare electronic medical record (EMR) system for in-patient services as well as for ambulatory clinics. By August 2015, said Ball, Peacehealth’s Columbia Network of Care will have total integration with the out-patient environment, so that patient records follow the patient seamlessly from physician visit to hospital procedure to follow-up visits. Both hospitals will have a computerized provider order entry system that Ball called a “huge milestone in convergence.”

Other aspects of Peacehealth’s technology makeover include:

  • Standardization across the enterprise – from phone systems to specialty care platforms to core systems such as the formulary and pricing model.
  • Launching, within the next nine months, a tool called “Healthy Planet” that will help Peacehealth focus on providing proactive population health management.
  • Replacement of the hospitals’ lab system as well as about 5,000 desktop computers, expanded network capabilities and higher-level security systems featuring advanced encryption.
  • Construction of a new tier-3 data center that aggregates smaller data centers spread throughout Southwest WA and Oregon.

Legacy Salmon Creek Medical Center is making similar changes to their infrastructure. Bryce Helgerson, Legacy Salmon Creek’s chief administrative officer, said that they have a three-fold focus. One is keeping a close eye on hospital capacity. Although Legacy has no current build-out plans, Helgerson did say that the Affordable Care Act has created more people with insurance who are seeking healthcare, but there is a “lack of primary care in our community that accepts these insurance programs.” Therefore, he said, more people are coming to the ER. Plus, last year Legacy signed a contract with Kaiser Permanente.

“We built a hospital we thought had capacity for many years. With the addition of Kaiser and the ACA – we’re looking at long-term effects. Do we need to invest in facility build-outs?” wondered Helgerson.

Legacy Salmon Creek opened in 2005 with 220 beds. In 2009, the hospital spent $20 million to finish the 6th floor (stroke and cardiac care units and a Total Joint Center for knee, hip and shoulder replacements). Last year, they completed a $7 million renovation to accommodate the new Kaiser contract. The latter renovation expanded the Family Birth Center, added space for improved triage in the Emergency Department and brought a mothballed unit into operation as a new step-down unit for the ICU. Brian Willoughby, Legacy Salmon Creek’s public relations and community relations specialist, estimated that the medical center will deliver more than 3,000 babies and will treat more than 60,000 ER patients.

Like Peacehealth, Legacy Salmon Creek is also “investing heavily” in EMR. But while hospitals receive incentives from the federal government to implement electronic records, Helgerson said it was an “expensive endeavor” for individual practices to follow suit.

“We’re working with community physicians to install EpicCare in their offices to help communication between providers and the hospital,” said Helgerson.

In 2013, Legacy Salmon Creek received the Healthcare Information and Management Systems Society’s (HIMSS) highest level of integration (level 7). HIMSS is a global, cause-based, not-for-profit organization focused on better health through information technology.

Helgerson said Legacy had to make “sacrifices in organizational investment” to fund the EMR installation.

“It was expensive, but was the right thing to do for patients,” he stated.

The move to EMR created a need for more training, so Legacy Health has invested in a training facility located in Northwest Portland.

“There’s a number of people there every day taking training of various sorts,” said Helgerson.

The third area of focus for Legacy Salmon Creek is becoming more patient-focused. For example, they recently launched a mobile app that “pushes” health information to patients wherever they are.

“They can use the app to look up providers’ phone numbers, link to the EMR and read their chart notes,” Helgerson explained.

Over the last few years, added Helgerson, Legacy Health’s facility master plan identified facilities that needed infrastructure updates that would make them more patient friendly.

“Many organizations struggle to keep up, and technology can be a differentiator,” said Helgerson. “The operating room of 30 or 40 years ago can’t accommodate new technology as well as the extra staff associated with such technology.”

Helgerson reported that Legacy’s facility master planning exercise scored over 100 projects, looking not only at financial ROI, but also quality of patient safety, patient experience and alignment with Legacy Health’s strategic plan.

“You can’t do such an evaluation just once,” cautioned Helgerson. “You have to do it every year because the market changes frequently.”

Hospitals and primary care clinics are not the only type of healthcare providers who see the value in upgrading infrastructure.

Casey DeGroot is the vice president of innovation and technology at Audigy Group and Stratus Dental (which provide business services and management consulting to audiology and dental practitioners). DeGroot said that his firm sees “a lot of practices that don’t have networked computers, or haven’t networked across their locations.”

Wanda Ketcham, Information Systems Director at Columbia Home Health and Hospice, said CHHH has invested in technology that can “maximize the time clinicians spend with patients while eliminating excessive paperwork through automation.” She said CHHH spent a year investigating EMR solutions. Homebase, the platform they selected, works with encrypted hand-held devices that enable staff to do patient point of care (usually in patients’ homes). The data can be collected during the home visit using voice-to-text data entry. The clinician uploads the visit information using a secured network, and patient data is available to supervisors within two minutes.

CHHH has also automated their document management system. Prior to automating, processing a fax took about four minutes. Documents were batched and often attached to the patient record days later. CHHH can now do the same process in 10-15 seconds and documents are attached the same day they are received. Telemonitoring technology, installed in the patient’s home, enables clinicians to remotely monitor patient vitals and ask key questions related to the patient’s chronic condition.

“This enables us to anticipate issues rather than just react once patients experience events,” said Ketcham. “Telemonitoring helps prevent unnecessary hospitalizations and emergency room visits.”

Ketcham estimates that the EMR has paid for itself in terms of cost efficiency and productivity in about 12-16 months. The ROI on the new document management service was a mere two months.

“Technology will continue to expand and change and as it does we plan to change with it,” said Ketcham. “I foresee more interfaces with providers, payers, pharmacists and facilities in the future. The need to share data is growing.”

“The healthcare industry is catching up to other industries,” said DeGroot. “I feel we’re making a lot of progress toward interoperability, there is less resistance moving to the cloud and an increased focus on security.”

And as interoperability and system communication expands, DeGroot added, the opportunity for finding previously hidden insights through big data analytics opens up a lot more.

“Any successful healthcare organization must be able to react to change quickly, be creative in the way they solve problems and must invest in technology,” concluded Ketcham.