If anything, 2011 may be remembered as the year of industry focus when it comes to health I.T. At hospitals across the country, CIOs will be leading the charge on upgrading infrastructure and systems, revising documentation and workflow requirements, cajoling vendor cooperation, keeping tabs on system certification, and expanding their efforts to loop in physicians via integrated-or at least highly interfaced-ambulatory EHR ventures. The allure of billions in federal incentive dollars (plus the long-term Medicare payment cuts for providers not in compliance) has clarified these near-term goals for many a hospital. Med schools too are hopping aboard the I.T. bandwagon (see sidebar, page 53).
But 2011 will not be entirely about setting the stage for incentive payments. CIOs and their C-suite brethren will also be immersed in preparation for ICD-10 (the massive overhaul of the standard code set for clinical documentation and billing takes effect in 2013). And a handful will start analyzing another sea change just beginning to emerge, namely the government's push for so-called "accountable care organizations." The as-yet undefined delivery model-called for in the federal health care legislation reform passed last year-could dramatically affect reimbursement.
One organization eying a major infrastructure upgrade is Cherry Hill, N.J.-based Kennedy Health System, which runs three hospitals in the southern part of the state. "We are a little late to the game, but we are in the same shape as many mid-size health care systems," says Mike Archer, assistant vice president of network services. "We are in a hard drive to support meaningful use and we're all feeling the pressure and timelines."
In 2010, Kennedy began the migration to a new version of its legacy Siemens hospital information system. Implementing the new Soarian package-which entails a dozen or so modules-is, Archer reckons, "like reading War and Peace. There are a lot of chapters and pages, including a PACS upgrade, a data warehouse upgrade, and new systems for pharmacy and radiology."
First things first
During the first half of 2011, Kennedy Health System will focus on upgrading its infrastructure to support the new applications, Archer says. On the docket is a new 10Gb fiber-optic network ring connecting Kennedy's three sites. The set-up also includes virtual servers and switches, a way of configuring supporting network architecture using software to practically eliminate system downtime. It's a deeply technical project that exceeded the capacity of Kennedy's own 55 I.T. staffers. That led the hospital to hire a consulting group, Dimension Data, to assist. "The volume of information will increase dramatically as these new systems come online," Archer adds. "We will need to move information quickly and efficiently."
The Siemens upgrade timeline calls for deployment of clinical documentation and CPOE modules by spring. But other software will likely wait until 2012, Archer says. Most notably, that will be asset tracking technology. In 2011, Archer's crew will install additional access points for wireless connections to support the triangulation needed to electronically pinpoint the location of physical objects-or people-sporting RFID tags. "We are looking at software vendors now, but we need a lot more access points," he says. "We want to make sure we have the infrastructure in place first."
Kennedy is not alone in focusing on infrastructure. Even hospitals further along the EHR continuum are analyzing network needs and envisioning what care delivery of the future will need. Take Parkview Health, a cluster of eight hospitals centered in Fort Wayne, Ind. (see story July 2009), where bar code medication administration and CPOE have been part of a unified patient record system for several years. Parkview will open a new regional medical center in 2012, and will spend this year preparing for a new communications system, from Voalte, says Ron Double, CIO.
New technology will include a unified, IP-based communications platform, which will support a nurse call system and the hospital's EHR. Asset tracking technology will be woven into the mix, enabling Parkview to track both caregivers and patients. "It is amazing when you build a new facility, all the technology there is to improve the patient experience," he says, citing interactive patient kiosks that will provide automated way-finding as one example.
Parkview plans on going full-bore at the new facility, to the point of adopting "smart beds," which can interact with the hospital's EHR and nurse call system. CIO Double will spend the year mapping out the precise game plan, but he already has a keen vision of how the technology mix should operate. "We will focus first on feeding the nurse call system from the EHR," he says.
For example, a patient's risk for a fall is already documented in the EHR. The applicable test result can be downloaded directly into the bed, which automatically would set the bed for the lowest position for high-risk patients. If the patient moves around in the bed, its sensors will detect that, and could trigger an alert, which is dispatched directly to the nurse, either as a text message or a phone call.
Even though Parkview has long since deployed CPOE, one of the cornerstones of meaningful use, it must still use a certified system in order to qualify for the incentive money. In Parkview's case, that means a system upgrade, leaping up two notches to the latest iteration of GE's Enterprise, its inpatient EHR, which Double says will be certified.
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