Three providers, three creative and practical IT strategies

Driven by budget constraints and demands for safer health care delivery, hospitals continue to find innovative ways to use network and computer technologies. This year's winners and finalists of the 2013 Most Wired Innovator Award range from insourcing information technology and creating smartphone apps to network makeovers and mattress tracking.

|WINNER | Kootenai Health| Project: IT Outsourcing

While many other health care organizations are turning to outsourcing to cut costs, Kootenai Health, a 246-bed nonprofit, community-owned hospital in Coeur d'Alene, Idaho, looked in the opposite direction. Kootenai decided to keep all responsibilities for IT technology and services in-house.

The IT localization strategy is meant to ensure accountability and the delivery of consistent, reliable and controlled services.

"We are invested in the success of the community because we are a part of it and we are able to build trust in a way that an outsourcing company never could," says Chief Information Officer Steve Garske. "In the end, it is not just technology that we deliver, but service."

From March to December 2012, Kootenai endured a $5.9 million innovation explosion, which included tripling the size of the information services staff to 75; instituting ITIL (Information Technology Infrastructure Library) core processes; reclaiming IT services from vendor control (which cut outsourcing costs by nearly 60 percent and saved the enterprise $2.7 million); insourcing server, network support and help desk; transitioning to single sign-on, virtual desktops and Voice over Internet Protocol; replacing email with a unified communication system; and implementing a full hardware replacement project.

Garske says without careful planning, financial stability and complete support from the executive team, the insourcing project could not have succeeded to the degree it did. It's also important, he says, that CIOs be technically savvy.

"The decision to insource should not be taken lightly," Garske says. Before deciding to insource, it's important to determine whether the organization has the stability and resources to make the required capital investment, whether long-term benefits will outweigh costs, whether IT leaders have a thorough grasp of current and emerging technologies, and whether the intricacies of vendor contracts are understood well enough to achieve extrication.

"The greatest challenge, however, is finding a way to measurably demonstrate to key decision-makers the value of long-term IT investments at a time when outsourcing seems like such a temptingly easy answer," Garske says.

Kootenai's current lower annual operating costs are directly attributable to insourcing information technologies and IT support services, Garske says, predicting that within five years the initial capital investment will be offset by decreasing operating costs and increased revenue.

In the first year alone, the IT department boosted organizational revenue by more than $3.6 million and reduced operating expenses by more than $2.7 million — while at the same time improving patient care and satisfaction. "We are now able to provide a full range of low-cost IT services to our community without the industry standard profit margins of 25 to 65 percent," Garske says. "This leads to an improved bottom line and a higher quality of service than otherwise could be afforded by a small health care provider."

|WINNER | Texas Children's Hospital|Project: Rapid Communication system

Rapid and efficient communication among on-the-go health care providers is always a challenge. Phone calls go unanswered, returned calls are missed, pagers have time lags and space limitations, and emails sit unnoticed on unattended workstations — all potential liabilities in life-and-death hospital environments.

Texas Children's Hospital, Houston, solved the problem with its Rapid Communication System. RCS uses standard iPhones and a proprietary application from Voalte to handle voice, two-way texting, alarm queues, staff availability and directory access.

"From the sender's perspective, we needed a system to answer two primary questions: Is the recipient available and was the message received?" says Myra Davis, senior vice president of information services. From the recipient's perspective, Texas Children's needed a system that provided all-in-one access to calls, text messaging and clinical alarms, as well as a way to indicate sender ID and message priority.

Davis says RCS provides senders information about who's online, their availability status and message-received confirmation. "For recipients, RCS provides a single device that consolidates voice, two-way text messaging and alarm management, as well as sender identification," she says.

iPhones were distributed to staff to carry at all times, each loaded with special software that not only restricts the device to the hospital wireless infrastructure, but also disables the phone's entertainment options. The devices are cloaked in a protective case with a built-in battery that extends the charge life cycle through an entire shift.

RCS provides directory management, including contact name, title and photo to ensure the right message gets to the right recipient. Real-time updates let users know who is online and available, busy at bedside or in a meeting.

High-priority alarms appear first in the alarm manager. Users can accept or reject any alarm with the touch of the screen. If the intended user is unavailable, the alarm manager automatically escalates to the next available user to ensure prompt response.

The network backbone is composed of redundant voice and data server pairs, integrated with the existing hospital PBX using SIP (Session Initiated Protocol) technology, standard telephony components and commercially available hardware.

"Rather than being based on closed, proprietary standards, the Voalte application is built on industry standards, uses commercially available phones and integrates with other middleware platforms," Davis says.

All legacy communication devices are to be replaced in the enterprise by the end of 2013. The $2.9 million system includes approximately 2,000 iPhones, plus integration with existing platforms, such as nurse call, data center infrastructure and implementation services.

"The system also is staged to leverage the iPhone for more advanced workflows, ranging from simple reference material like rapid transfusion protocol to working with EHR vendors to provide seamless access to the electronic health record," Davis says.

|WINNER | University of Utah Health Care Project: Value-Driven Outcomes

One of the biggest challenges for any business is understanding and managing the cost of services. For hospitals, the problem is compounded by the levels of complexity behind the services.

University of Utah Health Care, Salt Lake City, separated itself from the rest of the industry more than a year ago by deciding to understand the true cost of health care through an initiative called Value-Driven Outcomes, or VDO.

"To reform health care from a delivery perspective, we must do two things — develop transparency and know our costs," says CEO Vivian Lee, M.D. "To be transparent, we must know what we are being transparent about."

Lee says VDO gives the organization the ability to understand patient-level costs for physician and facility services across a variety of circumstances, including time, patient and provider. "The tool allows us to quickly identify potential opportunities for improvement," Lee says. In many cases, change can be implemented immediately, for example, by eliminating non-value-added testing. In other cases, VDO provides guidance to identify an opportunity to modify or redesign care and implement value-added changes in care delivery within a matter of weeks.

Lee says, unlike some third-party systems that can only determine charges, the internally designed VDO yields a perspective on cost. The Web-based tool also gives providers the ability to use graphical displays to explore data and drill down as needed.

VDO consists of concrete cost methodologies that calculate cost per unit at the patient-utilization level for services such as labor, supplies, pharmaceuticals, imaging and lab tests. Data warehousing expertise brings together clinical and financial data points for cost comparison. Business intelligence tools produce detailed end-user reports that show cost associated with each service. Lee says there were three keys to VDO success:

1. Obtain a mandate from senior leadership to prioritize the project, despite competing needs.

2. Develop a robust technology that provides in-depth visibility to physicians, administrators, managers and analysts on how they can be more cost-effective while improving outcomes.

3. Nurture an innovative and collaborative institutional culture where people with varied skills can come together and work efficiently toward a common goal. "For instance, our physician assistants are familiar with a different set of practices than the MDs or RNs, but their ability to all work together and share solutions for particular procedures is invaluable for determining and implementing change," Lee says. In this environment, VDO serves as an immediate conversation starter; by looking at variance in cost data, conversations about "Why?" can happen in real time, rather than the traditional way of waiting for reports, which often are based on charges rather than actual cost.

"In a collaborative culture, this serves as an accelerant to implement meaningful change," Lee says.


• Peconic Bay Medical Center | Network infrastructure makeover

When 182-bed Peconic Bay Medical Center, Riverhead, N.Y., realized the last major upgrade to its information infrastructure was more than 10 years ago, it undertook a six-month, $1.8 million makeover. The wide area network was upgraded, switches replaced and VLANs created. Tom Chiasera, director of network services and communications, replaced mobile medication carts with stationary devices in every patient room to ensure availabity to clinicians. The new network environment allowed him to virtualize 17 servers and create a virtual pool of 180 Windows 7 desktops. To meet the added power demands, Peconic uses Power over Ethernet, or PoE. "This way, we were able to achieve our goal without running additional power to every room," Chiasera says.

• Carolinas HealthCare System | CeQOL app

Since Todd Heniford, M.D., director of the Carolinas Hernia Center in Charlotte, N.C., part of Carolinas Healthcare System, announced the availability of his CeQOL smartphone app last year, it has been downloaded thousands of times in 57 countries. CeQOL (for Carolinas Equation for Quality of Life) helps male inguinal hernia patients better predict postoperative discomfort. Historically, surgical success was marked by a lack of hernia recurrence. The next phase is tracking the patient's quality of life. "If we can do this with hernia, then we should be able to also help patients make quality of life decisions about limb fracture, head trauma, chemotherapy and congestive heart failure," he says. CeQOL is free at iPhone and Android stores.

• Middlesex Hospital | Automatic mattress tracking

Middlesex Hospital, a 209-bed facility in Middletown, Conn., uses an inflatable patient transfer mattress to lift patients. The problem: More than half of the 200 mattresses were lost during a recent three-year period, most discarded accidentally, at a cost of $2,000 each. IT Director Rick Schubach decided to implement a real-time locating system. Wireless RTLS tags were attached to each mattress. Compliance for using them rose to about 90 percent, since staff can always find one, and better use can reduce staff-related lift injuries and associated workman's compensation claims. Also, an automatic alarm positioned near the dumpster sounds when a mattress is detected nearby. Since it was implemented, Middlesex has not lost another mattress through accidental discarding. "This alone paid for the $20,500 project," Schubach says.


The Most Wired Innovator Award honors hospitals that apply technology in innovative ways, finding creative solutions to serve their patients, staff and communities. A panel of CIOs and others evaluate submissions on a variety of criteria, including universality and achievement of business objectives, creativity and uniqueness of concept, impact on the organization, scope of the solution, stage of implementation, and technical creativity. Visit


H&HN's Most Wired Survey and Benchmarking Study is made possible through a partnership of Hospitals & Health Networks, the American Hospital Association, the College of Healthcare Information Management Executives, AT&T and McKesson Corp. CareTech Solutions provides additional support.