Cover Story

Most Wired 2003

By Alden Solovy,tabulations by Suzanna Hoppszallern

For the nation's 100 Most Wired hospitals and health systems, technology isn't the point. A commitment to patient safety, clinical quality and customer service--that's what gets these CIOs jazzed up for work. Providing clinical tools for doctors and nurses. Providing management tools for executives and staff. The depth and breadth of projects that these organizations are tackling is matched only by the commitment and energy of the CIOs and their teams.

But there's an irony that comes with the dedication to clinical excellence and process improvement. To provide technology-based tools, the infrastructure must be robust and solid. Infrastructure, say CIOs for the nation's top tech hospitals, is the basis of all technology strategy. While these organizations are on the cutting edge of innovation, they're also taking care of the basics, building a foundation for long-term technology success.

This is the fifth year that Hospitals & Health Networks has conducted the Most Wired Survey and Benchmarking Study, teaming with McKesson Information Solutions and HIMSS to poll the nation's hospitals on their use of IT to address the key goals of safety and quality, customer service, business processes, work force and disaster readiness. Based on the results of this eight-page survey, H&HN names the nation's 100 Most Wired hospitals and health systems. In addition, H&HN recognizes innovation, improvement, use of wireless technologies and technology efforts by small and rural hospitals. This year more than 400 hospitals and health systems completed the survey, representing 1,128 hospitals (see sidebar, "About the survey").

In the last year, the Most Wired have worked to maintain their lead over other hospitals in the development and use of technology, bringing Web-enabled patient education to the bedside, linking medical monitoring equipment directly into the patient record and providing a vast array of self-care resources over their public Web sites (see sidebar, "Survey highlights"). These CIOs have become key stakeholders in issues ranging from revenue cycle management and admissions office process redesign, to medication administration and nursing work flow.

H&HN asked the 100 Most Wired to identify their three priorities. Virtually every hospital has at least one clinical project in process, including picture archiving and communication systems (PACs), computerized physician order entry (CPOE), clinical decision-support, targeted medication administration projects and specific departmental systems (see figure 1, Top Priorities Among the 100 Most Wired).

"Hospitals are making a wide variety of individual investments in clinical systems," says Barry Chaiken, M.D., vice president, medical affairs, for McKesson Information Solutions, Alpharetta, Ga. Behind each of these initiatives is the drive to improve patient safety and quality, he says. The systems are easier to use and they're more reliable, flexible and powerful.

But real results don't come easily. "In order to be successful with the tools, not only do you have to choose them wisely, but you have to implement them wisely," Chaiken says, adding that the Most Wired are willing to take risks and learn because they believe that their organizations will ultimately be successful with an investment in clinical technology. "That's why you see hospitals on the Most Wired list three, four and five times," he adds.

Throughout the five years of the Most Wired survey, 35 hospitals and health systems have been on the list three years, 28 have been on the list four years and 15 have been on the list all five years.

Supporting IT with infrastructure investments is a major priority for many Most Wired organizations. Memorial Health Services, Long Beach, Calif., is upgrading its infrastructure. The goal, according Scott Joslyn, senior vice president and CIO, is "to provide a level of capacity, reliability and redundancy that will be required for new clinical systems that are woven into the fabric of care delivery processes."

Joslyn defines the issue this way: "Any unplanned downtime or other service interruption will become unacceptable and potentially dangerous as our dependence increases dramatically on various interconnected technologies, from the point of care back to remote data centers."

The emphasis on infrastructure goes hand in hand with the top project at Memorial. "The most important project we are undertaking is a replacement of our clinical systems across our five hospitals. That project entails addressing the obvious targets of patient safety, computerized physician order entry, quality and outcomes," Joslyn says. "We also intend to tackle the complexities of multidisciplinary care planning and documentation. We expect to revamp our care processes to take full advantage of a new system."

The interdependence of clinical information technology and infrastructure is also reflected in the plans of Texas Health Resources, Dallas. "THR has embarked on an aggressive journey of clinical transformation," says David Muntz, senior vice president and CIO. "Our clinical transformation is defined as the integration of clinical and nonclinical process improvements with enabling technologies. This comprehensive set of projects--from infrastructure to real-time interactive decision support at the point of service--has improving safety and satisfaction as its primary goal."

Timothy L. Thompson, senior vice president and CIO, Palmetto Health, Columbia, S.C., agrees. "We are very focused on updating the infrastructure to ensure the success of the new suite of systems," he says.

Projects include a new state-of-the-art data center, a new contract for disaster recovery services, implementing all new wireless technology to support new clinical systems, completing a new core network replacement, implementing a storage area network and developing a corporate backup strategy.

Disaster recovery is also a critical component of infrastructure development. "As we move closer to a paperless environment, our system availability requirements become more critical and disaster recovery has become a priority for our organization," says Kari Cassel, CIO, UAMS Medical Center, Little Rock, Ark. "We are in the process of rewriting our disaster recovery and business continuity plan, establishing a second data center, moving all of our critical data to mirrored storage area networks and duplicating our infrastructure where necessary."

Baylor Health Care System, Dallas, has completed a project to build a second-to-none infrastructure. Baylor's goal: provide the tools for all potential projects. "Now I don't have to say no to anything," says Bob Pickton, senior vice president and CIO. Baylor's three key projects: clinical transformation, business office consolidation and workforce management. (Read about Baylor's efforts in the Summer 2003 edition of H&HN's Most Wired Magazine, available in August.)

Clinical transformation appears to be the underlying motivation of most of the Most Wired. "We are developing a clinical IS plan that will prioritize new and replacement clinical information systems that will be installed over the next four years," says Arlyn Broekhuis, vice president and CIO, Sioux Valley Hospital USD Medical Center, Sioux Falls, S.D.

At Hamot Medical Center, Erie, Pa., the top three goals are implementation of bedside medication administration, implementation of a physician order entry system and integrating a PACs system with the clinical information system.

What one hospital calls clinical transformation another calls patient safety. "Our top priority is patient safety, which is multifaceted from an IT perspective," says Steve Pelton, CIO, Saint Joseph's Hospital, Marshfield, Wis. "This drive [includes] three interrelated projects." They are: completion of a campuswide wireless network, CPOE and a real-time expert rules system. These rules are the key to avoiding medical errors and improving compliance with research-based protocols," he says.

CPOE is the number one priority at Lifespan, says Carole Cotter, senior vice president and CIO of the Providence, R.I.-based system. The system is used in the intensive care units. Physicians and physician assistants enter roughly 25 percent of all orders electronically. "We have just implemented a new pharmacy system and the electronic two-way interface between [CPOE] and pharmacy is weeks away from implementation. Once that is done we will continue the aggressive rollout to the rest of our medical and surgical beds," Cotter says. The next step is to bring CPOE into the emergency departments and then the ambulatory clinics.

St. Mary's Health System, Knoxville, Tenn., is developing a clinical alert system to be incorporated into the current wireless system used for nursing documentation. Rollout of physician order entry is scheduled for December.

Projects to improve medication administration are high on the list of priority projects for the 2003 Most Wired, including Spartanburg (S.C.) Regional Healthcare System, which is converting from wireless laptops to wireless handheld devices.

"The current solution using laptops is too cumbersome and difficult to manage in some patient care areas, like critical care," says Raymond A. Shingler, senior vice president and CIO. "These new devices will make this process much more user friendly."

Jim Cramer, vice president and CIO, Scottsdale (Ariz.) Healthcare, says that they are in the pilot stages of a physician-rounding product that uses a variety of personal devices including wireless equipment. The organization rolled out a physician portal earlier this year including a single sign-on to the system, census, orders and results, transcription, vitals, medication profile, PACs images and electronic signature.

The U.S. Department of Veterans Affairs, VISN 3, Bronx, N.Y., is building on its successful bar code medication administration system. "The product continues to evolve," says Charles DeSanno, CIO. "Within the past year, the functionality has been expanded to include IV medications and complex dosing formats seen in critical care areas. This led to the need to deploy additional wireless equipment." To minimize the risks associated with wireless communications, VISN 3 recently installed additional hardware and software to increase security for encrypted wireless data.

At North Carolina Baptist Hospital Medical Center, Winston-Salem, a CPOE pilot in cardiology resulted in a 41 percent decrease in adverse drug events. "We hope this trend continues as we are now poised to roll out CPOE housewide, beginning with the medicine service this summer. Physician involvement and acceptance has been high, for which we are very fortunate."

Electronic health records and revenue cycle management projects are also high on the agenda for the 2003 Most Wired, including the University of Pittsburgh Medical Center. "The electronic revenue cycle [project] integrates and automates patient billing processes to ensure more detailed and accurate claims processing, decreased billing cycles and improve the overall financial status across UPMC," says Beth Nairn, project manager. "The goal is to provide an integrated solution for revenue cycle, which includes scheduling, registration and billing to improve cash collections."

The lessons are clear. The CIOs at the 100 Most Wired are not sanguine with their position as technology leaders. They are learning, experimenting and pioneering both clinical and managerial IT tools. They are building the technology infrastructure. They are vital participants in work flow redesign and care process improvement.

The CIOs at the nation's top tech hospitals are working to stay Most Wired.

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