"Rather than building a traditional hospital and then trying to retrofit it, we thought wed just bite the bullet and do it from the beginning," said Dr. Robert Kipperman, one of the Oklahoma City hospitals founders.
With the help of a consultant, the founders chose an electronic medical records system that best fit the hospitals needs. They realized they were breaking new ground when they discovered that they had to hire consultants to write the interfaces to all the electronics equipment in the hospital. Officials said the hospital spent about $5 million more than if it had not taken the all-digital route.
"I think we spent more on IS than any hospital had, and we had to write a lot of the content. It just wasnt available," said Kipperman. "We had a vision of what we wanted to do, and we learned as we went along."
Another lesson was that downtime of applications and systems is not an option. But maintaining high availability for a small IT staff of seven was not easy, and it came at a high cost for IT managers. Many alarms from the BMC Software Inc. Patrol application monitoring system in the middle of the night as well as during the day left managers more focused on maintaining existing systems rather than improving services to patients, doctors and medical staff.
As with most enterprise management systems that monitor events, Patrol generates a large number of alarms and alerts that dont necessarily indicate trouble but that cant be completely ignored or suppressed because some do indicate outages.
"With Patrol and those types of monitoring tools, you get a lot of alarms. Im on call, too. And my beeper goes off all the time. But I cant turn it off, even if its considered normal—like an alarm that keeps happening at 3 a.m. every Wednesday," said Dave Stinson, IT manager at the 3-year-old facility.
The hospital, designed from the ground up to be all digital and completely paperless when it opened its doors in August 2002, runs on Cerner Corp.s Millennium Health Information System. Components of the Millennium suite implemented at the specialty hospital include the PowerOrders computerized physician order entry system; the PowerChart electronic health record system; the PowerNote physician documentation system; the PharmNet pharmacy system; and the CareNet nursing system, which provides access to clinical information.
Every room in the hospital has a bedside computer, and caregivers have access to information in the Millennium system from multiple locations, including computers located at each nurses station, in the emergency rooms, day-patient areas, operating rooms and catheterization labs. Caregivers can pull up any clinical information on patients in digital form, including medical images, medication and allergy reaction records, past procedures, and consultations with other doctors.
"We have hundreds of computers. You want to access the [patients] chart when you need to. You live and breathe by your chart. You have to have it. It has all the information you have to have to take care of your patient," said Peggy Tipton, the hospitals chief operating officer.
But without an understanding of the full power at their fingertips, doctors could inadvertently bring the system to its knees. By scanning heart rhythms into the system using uncompressed file formats, for example, doctors could fill up all available storage and lock up the system, making it unusable.
Stinson, in fact, prevented such a scenario before any downtime occurred using a new tool that BMC brought to his attention. The BMC Patrol Analytics tool, OEMed early this year from Netuitive Inc., works in conjunction with Patrol to watch and learn the behavior of systems and then automatically generate dynamic, real-time thresholds. It cuts down on the number of false alarms and generates Netuitives Trusted Alarms, which provide more accurate and detailed trouble reporting.
Because it can also spot and highlight trends that forecast potential outages, Patrol Analytics allows users to head off issues such as the storage incident. "Weve caught two problems that were prevented because of the forecasting in [Patrol] Analytics," said Stinson.