Attaining the ranking is an unusual achievement in health care information technology circles: Less than one percent of U.S. hospitals have earned the designation-and even fewer have reached the Stage 7 pinnacle. As a matter of fact, more than half of hospitals are still mired in the early stages of electronic records adoption, with 19.3 percent at Stage 0, 14 percent at Stage 1 and 37.2 percent at Stage 2.
To rise to the upper echelon of this scale, providers need to pass through a series of checkpoints proving that they have successfully implemented various systems.
To achieve the Stage 6 ranking, UCSD has implemented a slew of information technology systems including computerized physician order entry (CPOE), clinical data repository, closed loop medication ordering and enterprise picture archiving and communication systems (PACS). Most recently, the two-hospital system has forged further down the EHR road with the adoption of voice recognition software and an advanced oncology management system.
With that said, you'd expect Babakanian to get all fired up when talking about computers and the like. Not so much. While technology is peppered into his conversations, he tends to wax philosophical about other topics such as user adoption and leadership style-and, most especially, quality of care, medical error reduction and efficiency.
That attitude permeates the UCSD culture, as the CIO's peers and reports seem more preoccupied with clinical practice than they do Web 2.0.
"I have a background in information technology but I don't look at information technology as something I do. We do it here at University of California San Diego because it has an impact on the delivery of care," Babakanian says.
And, thus, while UCSD has developed an information technology strategic plan, it's this philosophical bent that seems to drive the academic medical center's successful migration toward the paperless environment. Following is a look at how Babakanian and other UCSD leaders follow some specific philosophies.
Philosophy #1: Use a kinder, simpler checklist
As health care providers aim to pass through the various stages of the HIMSS EHR Adoption Model, it would make sense to use a checklist of technologies as a guide. After all, the program requires that certain technologies be implemented before organizations are bumped up to the next level.
However, UCSD's journey toward a computerized environment started well before any of these initiatives-and their corresponding checklists-were even a glimmer. "We were on our journey long before there was any national discussion about the use of I.T. in health care," Babakanian says.
As a result, technology, itself, never drives the UCSD bus. Instead, clinical care sits at the center of all that UCSD does, making the journey toward a computerized environment much less bits-and-bytes focused. "Any information technology investment we make simply has to meet two goals. One is improving patient safety and quality of care-and the other one is making people more efficient," Babakanian says. "We never want the discussion to be about the gadgets."
With these goals in mind, it was simple for UCSD leaders to decide that the organization needed to begin moving toward a CPOE system and a closed loop medication system about eight years ago. The decision became even more of a no-brainer when the oft-cited Institute of Medicine Report, To Err is Human, pushed the problem of medical errors to the forefront in the early 2000s. With the issue garnering significant attention, all of UCSD's leaders-from the CEO to the CMIO to clinical department heads and others-wanted to address the potential safety problem with the utilization of technology such as CPOE.
"We were not specifically having any crisis or problems with medical errors but the report made us realize that we needed to address this issue. With the CPOE system, we wanted to get all physicians to enter their orders online, eliminating the possibility for handwritten errors to be misinterpreted," Babakanian says.
So, about eight years ago, UCSD became one of the first health systems in the country to institute a bi-directional CPOE system with the implementation of technology from Siemens Healthcare, Malvern, Pa. The system enables physicians to enter a prescription order online in a program that is linked directly to the pharmacy's computer system.
When the pharmacist has validated the order, the medication is distributed through an automated dispensing system used on all nursing units that is electronically connected to the patient's pharmacy profile. When a nurse accesses a patient profile and selects a medication, the appropriate drawer opens for retrieval of that medication. The nurse then brings the medication to the patient and scans it through a barcode reader, ensuring that the right medication reaches the right patient.
Philosophy #2: Make clinicians believe in the overall mission
Although it is important to select capable systems, getting users to believe in the technology is, perhaps, the most important precursor to success. After all, users are not going to change for change's sake. With this in mind, Babakanian has exerted considerable effort to get users-specifically clinicians-to understand the benefits emanating from the CPOE and medication administration systems.
To do so, Babakanian identifies the clinicians and staff members who are potentially interested in making a change-and he starts doing what he does best: building alliances. "We basically build a coalition with the people who will be touched by the technology," he says.
He always emphasizes that the goal of information technology initiatives is not to implement certain systems or to deploy gee-whiz gadgets but to do one thing: Empower physicians, nurses and pharmacists with information where they need it most-at the patient bedside.
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