"Hospitals used to use their OR systems just for scheduling and preference cards and intraoperative documentation-maybe 10 percent of the capabilities that were available-but now they're doing pre- and post-op documentation, and more materials management," says Randall Heiser, president of Sullivan Healthcare Consulting, Ann Arbor, Mich., which specializes in perioperative consulting and implementation management. And newer versions promise even greater things. "The latest generation is adding more reporting and analytics and other decision support features."
Many hospitals are looking at replacements, from either niche vendors or their enterprise system vendor, if it has an OR offering. Modules for anesthesiology, which draw data directly from OR patient monitoring equipment, are a particularly hot item, as hospitals try to expand intraoperative documentation and add that information to electronic medical records.
"We're seeing more hospitals implement anesthesiology [modules] this past year than in the last ten years put together," Heiser says. Many hospitals purchased an anesthesiology module with their original system-perhaps years ago-but are only now getting it up and running, after making the rest of the system stable, he adds.
Opting for Best of Breed
Virtua Health, a four-hospital system headquartered in Marlton, N.J., has a profusion of vendors represented in its IT environment, including GE, Siemens and Cerner, all tied together with a Microsoft Amalga data repository. It's now in the process of adding yet another, with an OR system from PICIS, Wakefield, Mass. The new system will constitute the first OR automation in any of its hospitals.
"We looked at a lot of products but went with PICIS because it worked best with our workflow," says Ninfa Saunders, chief operating officer. "You can't talk OR nurses into anything-they know what they want-but fortunately the nurses and the doctors agreed on the core functionality they wanted." The selection process took eight months, and included a side-by-side demonstration of several products to see how well they correlated with the staff's requirements.
The heart of the implementation process is underway, and Saunders hopes to have about half of the functionality implemented and tested by April. One of her goals is to maximize the use of all Virtua's surgical resources. "Our clinicians are very aware that I'm going for 75 percent or better," she says.
Saunders has plenty of OR capacity to juggle to meet her goal. Virtua has more than 50 rooms across all its facilities to manage with the PICIS software, straddling an array of inpatient and outpatient operating rooms and procedure rooms. Saunders will use the system's capabilities to do capacity planning, look at costs and resource use, and measure quality of care.
Because the four hospitals are managed as one enterprise, Virtua hopes to use its new bounty of surgical information to make sure its resources are used to the best advantage. For example, if a new surgeon joins Virtua and wants to start doing a new procedure, Saunders will be able to look at system-wide capacity and easily figure out the best place to accommodate it. "If our practitioners are doing well, the patients will do better, too."
Entering the 21st Century
Plenty of hospitals find themselves with OR software that has been orphaned, either because its vendor was acquired by another company or because the vendor just stopped keeping up with technological changes. Such was the plight of Northshore LIJ Health System, a New York-based system of 12 owned hospitals and one affiliated hospital serving Long Island, Queens and Staten Island. The system's old OR software was being shelved by its vendor, and in any case didn't run on the Windows operating system that had become a standard in the organization. It was also a nuisance to extract data from, says Susan Almquist-Baldwin, vice president of perioperative services.
In 2004, NSLIJ started implementation of a new OR system from Surgical Information Systems, Alpharetta, Ga. The installation is at different stages in the various hospitals, though the farthest along is the system flagship, 840-bed Long Island Jewish Hospital in New Hyde Park, N.Y. The scheduling function is live throughout the health system, and most of the facilities are using the system to capture charges. "Our big initiative for 2010 is to get the whole revenue capture piece smooth, so that we can quantify the opportunities that we've been missing with manual input" of billing data, says Almquist-Baldwin.
The organization decided not to bother trying to move any of its old information into the new system, and instead started from scratch. That brought the planning committee to the most challenging part of the process: making sure everything about the implementation was standardized so that it would run exactly the same in each hospital and not have to be constantly tweaked. "As you roll out more and more facilities, it becomes more and more complicated to make a change," she says. "Sometimes you have to tell someone 'no,' but for the most part, we've been able to find something that works for everyone."
State reporting requirements for endoscopy cases led to an unexpected complication that ultimately involved the vendor as well as the system's planning committee. Each hospital has to track the endoscopy cases that converted to open surgeries, and whether they were urgent or scheduled procedures. Tracking it manually would have been a "a nightmare," so the software had to be jiggered to make a spot for those conversions to be noted. "It doesn't sound like a big deal, but you'd be surprised how much conversation it generated," Almquist-Baldwin says.
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