ZIFFPAGE TITLELinking Systems
The hospital decided to go with a third-party software package from Sentillion, an Andover, Mass., company that helps health-care organizations link different computer systems. James thought Sentillion would best meet the hospitals needs. The Sentillion product, Vergence, is designed to let doctors sign on once and access both the GE and ICIS systems. In this setup, Sentillion sits between the two systems. When a user logs in to ICIS, Sentillion will connect to Centricity and tap into it on request, allowing the GE program to appear as a selection on the ICIS screen. But the pilots have resulted in some "flippy" exchanges, says James. Sometimes when a nurse or doctor picks a patient from one system, they get an "Other Patient Not Found" notice when they look for a file in the other system. "It doesnt work half the time," James laments.The cultural challenges, however, proved to be just as tough as the technical travails, Johnson says. Cincinnati Childrens knew from the beginning that if it was to have any chance of success, it needed to get its medical department directors, doctors and nurses to use the system consistently and happily. But the hospital did have an edge. Unlike a community hospital, in which private practitioners treat patients in the facility, the doctors who work in Cincinnati Childrens are hired hands. Being the boss gave the hospitals managers the ability to mandate usage of the system. "I dont know how [one] puts these systems into a hospital where all the physicians are independent, private practitioners," Johnson says. Throughout the process, both Johnson and Jacobs said they wanted to be sure there were no revolts like the one that led to systems suspension at Cedars-Sinai in Los Angeles. The plan: provide extensive training tailored to doctors schedules. Also, offer one-on-one sessions and plenty of 24/7 support when the systems went live in the units. Nurses, though, took the brunt of the implementation headaches. Installation of the computer terminals disrupted the daily flow, as new machines were put on the floors and both the paper and electronic systems had to run in parallel during installation so no orders were missed. Plus, while doctors come in and out of the units, a large part of a nurses day is taking vitals and administering meds, which had to be done electronically. Yet some of the nurses had never touched a computer. For the "newbies," the hospital provided basic computer training. And the hospitals nursing managers held some hands and held others feet to the fire, to get the staff using the system. "Nursing leadership was big," Johnson says. The project team also rolled out the system in stages. Johnson and the ICIS leaders came up with a plan called Radiology Lite, a pilot system that allowed one group, intensive care, to perform one task, radiology orders, on the system. The pilot introduced doctors and nurses to the system, promoted its acceptance, and allowed the ICIS team to test the system in the real world. After its success, the full order entry and clinical documentation system was piloted in two medical surgical units in the spring of 2002, with rollouts to the hospitals other units through the end of that year. Today, ICIS is widely used throughout the hospital, although some pieces are still not up. In the hematology/ oncology unit, an order set for chemotherapy treatments has yet to be built. Chemotherapy is based on a number of factors, including how well a treatment works and how a patient responds to a dose. Because of the variables, the staff has had to spend additional time checking order sets. And Johnson is working on a PACS upgrade. Hes leading a team implementing an image and record-keeping system that will feature voice-recognition dictation. That way, radiologists could sit at a terminal, look over results and dictate the findings, all in one sitting. The goal is compiling radiology reports in as little as an hour, Johnson says. His department and GE are trying to work this through. But much of the code the vendor is writing is new. For GE, he says, "Its like starting over." Perhaps a more strategic initiative is getting single, complete records for every patient the hospital treats. The outpatient department is testing GEs Logician software, which is tailored for handling one-day visits. The outpatient staff is just beginning to make decisions on how the system should collect and send admissions, orders and test results to inpatient and other patient care systems. For now, inpatient and outpatient electronic medical records are not unified. But Johnson isnt sure the hospital should even call the end result an electronic medical records system. "I hate that term," he says. He doesnt feel it accurately describes what happens in the hospital, as the systems are more than just a electronic copy of a patients chart. What Cincinnati Childrens is using, he says, is a clinical information system: "The chart doesnt say, Doc, its the wrong dose." The Bush administrations electronic health records push is also looking at more than just electronic charting. The aim is to create an information infrastructure that can be used not just to record whats happening to current patients, but to improve care of all patients in the future. But Johnson wonders whether Washington understands the challenges. "Its good that the national political scene is paying attention. But Im personally concerned," he says. "Just as the expectation of the doctors hereeven a few years agowas that if we picked the right vendor, got the right technology and installed it, everything would work perfectly. That is no longer the myth it used to be in this institution." Johnson says hes worried that people outside health care dont realize the technical and cultural challenges involved. And they may not be ready for the unanticipated consequences. "Throwing money and technology alone at hospitals will not [give] them integrated, beautiful electronic medical records anytime soon," Johnson says. As Cincinnati Childrens has found out, "Its a long slog."
"Its a question of working out the bugs," she says. "Its part of being on the edge of trying to do things that are different."