You may have never heard of Henry Mayo Newhall Hospital (HMNH), but the 238-bed not-for-profit community facility is a model for how new innovations should be implemented in today’s evolving healthcare environment. This is due, in large part, to vice president and chief information officer Cindy Peterson, her information-solutions team, and their processes for launching new technologies.
When Peterson arrived in 2001, HMNH’s IT department had a staff of ten, no enterprise-wide architecture or Internet, five interfaces, IBM AS400, two servers for a handful of stand-alone systems, fewer than twenty software applications, and a budget of $1.9 million. Today its operations have grown into a staff of sixty-five (including biomedical, compliance, and a full group of analysts and informaticists), more than 275 interfaces, 286 servers, 1,249 workstations, fully standardized institutional software (including MEDITECH for fully integrated electronic medical records) and a budget of more than $9 million.
This growth—and how HMNH achieved it—earned Peterson a spot on Becker’s Hospital Review’s “100 Hospital and Health System CIOs to Know” in 2014. She modestly suggests that being under budget and on time in approximately 95 percent of its technology initiatives might have had something to do with being added to the list.
“We’ve been able to achieve that kind of success because of our planning and structured approach to project management and how we involve all stakeholders from the very beginning,” Peterson says. “That way we aren’t viewed as working on ‘IT projects’ but on operational improvements.”
She points out that early engagement means stakeholders are involved from the very beginning in prioritizing and approving projects, as well as allocating funds. Once decisions are made, her technical planning approach then involves executives, department directors, and staff in project implementation. This includes planning, training, go-live, and follow-up analytics that rely on a matrix of specific goals that are used to measure success at six-, eighteen- and thirty-six-month intervals.
For example, when the hospital launched its computerized physician order entry (CPOE) system, physicians had helped develop order sets, reviews, and coordination with all medical specialties. Their “ownership” in the project was also supported by technology “red shirts” who were available to provide immediate support, if needed, after the system was launched. As a result, CPOE use grew by 12 percent in the first month and now exceeds 80 percent.
Peterson uses a philosophy of “service-enabling clinicians” to identify appropriate new initiatives. “What can we do to save steps, improve work flows, make processes more efficient, and create more time for physicians to spend with patients?” she asks. “First we gain a full understanding of how they’re doing things today; then we look at alternative approaches so they can do them better tomorrow.”
This approach was applied to enhancing emergency-department work flows when a new emergency-department management solution was implemented in 2010. Having completed a full assessment of the current work flows—processing and identifying areas needing improvement (such as 4 percent of patients who left the emergency department before being seen)—Peterson and her team decided to implement the new solution and other adjustments (including the logistics of how and where patients are greeted and triaged) in a single phase rather than the vendor’s recommended two.
This resulted in improved efficiency and patient experience, including an 80 percent reduction in patient time to triage; a 60 percent reduction in patient time from triage to room; a 63 percent reduction from room to physical exam; and an 83 percent reduction in patients leaving the emergency department without being seen, which resulted in an accompanying $2 million increase in revenue. The single-phase implementation also saved $363,000 in project costs.
Peterson oversees a strategic plan that constantly evolves through ongoing interactions with hospital executives, board members, clinicians, vendors, and organizations such as HMMS and CHIME to identify existing challenges and current trends.
“It’s all part of our efforts to make sure that whatever is rolled out has a positive impact on overall quality of care,” she says. “After all, that is our mission: to positively impact the care of our patients.”
Projects under the current strategic plan include a system for monitoring blood transfusions, a telehealth project, deployment of a smart-device initiative, and a community portal to improve communications between physicians’ office staff, medical groups, and the hospital. Preparation is also under way for the February 2017 launch of MEDITECH 6.16, a totally redesigned platform for EMR management.
“The new system is completely rewritten with a new OS fully integrated and requires all new hardware and software, so we can’t maintain any of the old system,” Peterson says. “It’s a ‘big bang’ approach, where everything has to change simultaneously.”
She is quick to point out the contributions of HMNH’s IT team to all of the hospital’s past and future successes. “They continue to surpass my expectations every time and deserve all the credit for operationalizing the strategic plan we create,” she says. “I don’t make all this happen on my own.”