Remote but Well-Connected

By Cynthia Hedges Greising

A small rural hospital successfully implements information technology in all its functional areas.

Cynthia Hedges Greising

Steele Memorial Medical Center (SMMC) faced some of the greatest hurdles a hospital can face in becoming wired. An 18-bed nonprofit in Salmon, Idaho, SMMC was geographically isolated, lacked funds and employed some people who had never touched a computer or sent an e-mail.

Still, SMMC's leaders forged ahead in their plan to implement information technology. They started with commitment from the board and the C-suite, included representatives from every department, rolled out the implementation gradually and made the process fun for employees. Their approach proved a success. Four years after initiating the switchover, SMMC's IT system has reduced patient transfers, improved the timeliness of treatment and provided physicians with work flexibility—all changes that have improved care.

SMMC may have only 160 employees, but its challenges in implementing IT were the same as those faced by larger hospitals. Its story offers lessons to any hospital gearing up to go live.

A Lesson in Connectivity

SMMC's IT project started when hospital leaders put together a strategic plan that included implementation. Abner King, chief information officer, was instrumental in developing it. To gain the board's support, King made many presentations at meetings and told board members, "This is a curve we do not want to get behind." The board was very supportive of the plan and saw IT implementation as necessary for quality and safety. According to Preston Becker, SMMC's chief financial officer, "None of this happens without the support of upper management and the board. And our hospital staff knew they were committed to making this happen."

Victoria Alexander-Lane, SMMC's chief executive officer, read an article detailing how IT implementation failed at hospital after hospital because the IT departments, though stellar, were not connected to other departments. As a result, SMMC decided to decentralize IT at its facility and use all available resources.

A first step was identifying the hospital's "super users"—those who have a natural affinity for the computer and can help train and motivate others. "We have taken that one step further," Becker said. Every hospital department has an IT department liaison, or informatics specialist. Department managers choose staff members who communicate well and have other skills to serve as these specialists. In return for additional compensation, the informatics specialist has a list of extra expectations and responsibilities related to IT. According to Becker, "We want them to feel at home in IT and in their department—to be a bridge between the two departments."

Informatics specialists spend a minimum of two hours per week in the IT offices, under direct supervision of the IT staff. Their main responsibilities are to address their own department's IT issues, represent their department's needs and concerns to IT, and be accountable to the information services manager. More specific roles of the informatics specialists include:

Serving as liaisons between their own departments and the IT department. They follow up on outstanding IT issues, collaborate with IT on status of departmental issues, and relay status updates and resolutions to their own departments.

Acting as initial troubleshooters for local IT issues. They resolve basic hardware issues, such as paper jams and PC connections, and help identify and gather information about software and application problems.

Assisting and coordinating implementation of enhancements and releases. They review notes and conduct initial testing of enhancements, communicate release notes and new features, coordinate trial use, and assist users in optimal use of enhancements during and after going live.

Identifying and addressing areas of special concern, such as training needs in their own departments, under-use of system features, patient safety issues, and unresolved disruption of workflows.

At SMMC, IT was implemented first in the laboratory, radiology and therapy departments. Nursing was the largest and one of the last departments to go live. "Everything had to be built," said Linda Astalos, chief operating officer and chief nursing officer at SMMC.

Easing Stress during Implementation

Becker noted that the hospital leaders took care to minimize the stress level when departments were going live. "We did not overdo it and do too much at once," he said. The informatics specialists in every department worked to ensure a smooth implementation process. Alexander-Lane concurred: "We provided the resources to ensure that each individual employee had a comfort level, whether it was staff in the nursing or housekeeping departments. We made sure everyone was computer literate."

The chief of medical staff, David Yanoff, M.D., was also intimately involved. Dr. Yanoff helped with challenges faced by physicians, such as providing patient care and using the computer at the same time. Leaders also supported staff by making the process rewarding and fun. For example, staff members were encouraged to name the hospital's computers-on-wheels—they became known as Matilda, Esmeralda and other names typically given to cows. "We gave the staff power and involvement," said Alexander-Lane.

Improving Patient Care

The new technology has improved patient care in many ways. Before, patients who arrived in the emergency room were sometimes transferred to a Montana hospital by helicopter without a complete assessment of their condition. Now data and tests on the patient are communicated via the Internet, and physicians can make better-informed decisions about whether they will handle treatment or transfer the patient. As a result, IT implementation has reduced patient transfers by 50 percent.

In addition, before SMMC implemented picture archiving and communication systems, patients would wait up to a week for results, and their care was delayed while the film was being read. With digital imaging, film now can be read immediately, providing instant clinical direction to practitioners and timely care for patients. Most importantly, physicians have the capacity to access films and labs from home or while traveling, allowing them work flexibility and giving patients higher quality care. This flexibility is essential for physicians at SMMC, as the hospital's remote location means a smaller medical staff.

Alexander-Lane said that SMMC's project was not only an example of successful IT implementation but also a cultural transformation at the hospital. The key is integrating the technology in all functional areas. If not, implementation will not be successful, "even if you have the best IT department in the world," she said. Steele Memorial Medical Center now is moving toward implementing a new clinical information system in the health clinics associated with the hospital.

Cynthia Hedges Greising is communications specialist with the AHA Quality Center.

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This article 1st appeared on February 22, 2010 in HHN Magazine online site.

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