Five physician informaticists and four healthcare organizations are winners of the 2008 Association of Medical Directors of Information Systems' Awards for excellence and achievement in applied medical informatics.
Health IT Strategist broke the news regarding this year's recipients on May 9. The awards were presented last week at the 17th Annual AMDIS Physician-Computer Connection Symposium in Ojai, Calif. For more information on the symposium, visit
amdis.org.
The winners reflect "an explosion of applied medical informatics in the world," says AMDIS President William Bria, chief medical information officer of Shriners Hospitals for Children system, based in Tampa, Fla. For the second straight year, AMDIS has presented an award to an institution outside the U.S.
As healthcare IT advances, the award winners increasingly reflect achievement beyond the installation of a single application, Bria says.
"These are guys who have actually moved an organization," Bria says. "The good news is that our lifelong vision of trying to get healthcare using systems is starting to happen, but the interoperability issue hasn't gone away," he said. "You've got all this stuff out there, but it's not talking to one another." The Certification Commission for Healthcare Information Technology "needs to be more insistent and go beyond a
Good Housekeeping seal of approval and say, 'It must exchange, it must connect,' " referring to IT systems.
Universal CPOE adoption came months ahead of schedule
Michael Zia, M.D., chief medical officer and vice president of quality management at 204-bed Decatur (Ill.) Memorial Hospital, has led the implementation and adoption of a computerized physician order-entry system at the community hospital.
Aware that the value of the system depended on widespread acceptance, he pushed usage through the hospital with the goal of universal physician adoption within one year.
Under Zia's leadership, the hospital achieved universal adoption about three months ahead of schedule, with physicians placing 100% of routine rounding orders electronically and paper order sheets removed entirely from patient-care units.
Among the performance gains linked to his efforts was a decrease in transcription errors to zero in October 2007. Between December 2006 and December 2007, the hospital experienced a 79% decrease in errors that had a direct impact on patients. Illegible orders declined 96% between March and December 2007.
"The CPOE system has allowed nurses to spend more time with their patients," says Jenny Brandenburg, director of pediatrics at Decatur Memorial and a nurse who helped spearhead the CPOE effort. "Before, if orders were incomplete or unclear, the nurses spent their time trying to contact the physician to clarify the order. The computer system has also given nurses the ability to pull up physicians' orders documentation or test results at the bedside."
Hospital uses team approach to prove value, capabilities of IT
Concord (N.H.) Hospital's clinical informatics team, established five years ago, has used clinical informatics to make it easier for providers to translate what they know into what they do at the point of care. The team's members are Joel Berman, M.D., a family physician and chief medical information officer; Wendy Angelo, M.D., a family physician; Paul Clark, M.D., an internist; and David Picard, M.D., a pulmonologist, intensivist and sleep specialist.
Since 2003, the team has been customizing the 220-bed hospital's outpatient electronic health record, which is used by nine physician offices owned by the hospital and another hospital-affiliated multispecialty clinic. Last year, the team implemented New Hampshire's first inpatient computerized physician order-entry and clinical decision-support system, gaining support among physicians by emphasizing CPOE's ability to enhance quality.
On the outpatient side, the team has implemented a chronic-care model that embeds evidence-based disease management into its EHR and helps engage patients in their own care while financially rewarding providers for attaining benchmarks for 25 outpatient quality metrics. On the inpatient side, it has used CPOE to improve compliance rates for preventing venous thromboembolism in hospitalized patients and to improve the documentation of reasons for radiology exams.
"Our electronic medical record gets us much closer to achieving several of the objectives of the Institute of Medicine, such as providing care that is safe, effective, timely, efficient and patient-centric," Berman says.
Physician leadership helps drive performance improvement
Although five-hospital Riverside Health System, Newport News, Va., began investing in an EHR for its physician group in 1996, its medication reconciliation application called RxConcile, which builds upon the EHR, demonstrates how physician involvement can lead to performance improvement.
Led by Chief Medical Officer Barry Gross, M.D., and Charles Frazier, M.D., a family physician and Riverside's director of medical informatics, the Web-based project enables caregivers to search for patients in the EHR, retrieve their medication lists and print out medication reconciliation order forms. At the time of discharge, caregivers can retrieve home medication lists, which pharmacists have already entered into the database at admission, and display them along with the hospital medications on the same discharge order sheet. The application has also cut the time nurses spend discharging patients because now they only have to access one application instead of several, those involved say.
"It used to take a half-hour to 45 minutes to discharge patients," Frazier says. "We got that down to five minutes. It's just been a win-win-win all around. The patients like it because they get their medication lists and it's clear what they need to be on. Nurses love it because it saves them a ton of time, and receiving physicians at other facilities like it because it gives them a legible list that's up-to-date."
IT helps Thailand hospital cope with double-digit growth
Bumrungrad International Hospital, a 554-bed private tertiary facility in Bangkok, Thailand, treated more than a million patients last year, about 40% of whom were international patients.
The largest private hospital in Southeast Asia, Bumrungrad scrapped its pieced-together clinical IT system eight years ago and contracted with Global Care Solutions, purchased by Microsoft Corp. last year, to install its enterprise system. The system covers a wide array of areas: registration, clinical, patient- and bed-management, laboratory, radiology, image archiving, pathology, pharmacy, financial accounting, materials management and human resources.
Over the past eight years, the IT system has helped Bumrungrad keep up with double-digit growth while keeping costs down and maintaining high-quality service. Among the resulting achievements are a decrease in the time it takes to retrieve a medical record from 25 minutes to almost immediately, a 39% decrease in patient waiting time, a 14.5% decrease in laboratory processing time, and a decrease in accounts receivable days to 10 from 15. With paper forms eliminated, the hospital was also able to convert 10,000 square feet of medical records storage space into a revenue-producing pediatric center.
"Half of the 3,200 patients we see each day arrive without appointments," says Mack Banner, Bumrungrad's chief executive officer. "The hospital information system allows us to manage schedule demands, multiple languages, medical records, billing and regulatory compliance so efficiently that the average waiting time to see a doctor is only 17 minutes."
Doc spearheads adoption of CPOE, early-warning system
Peter Lindenauer, M.D., medical director of clinical and quality informatics at three-hospital Baystate Health, Springfield, Mass., has spearheaded the system’s adoption of a computerized physician order-entry system and its ongoing move toward an EHR. Among the system’s successes are the development of 60 clinical guidelines and 700 care order sets as well as medication reconciliation tools, early-warning system indicator alerts and transfer communication tools.
Baystate Health is one of 10 Massachusetts healthcare organizations with CPOE, and as early as 1989 had 65% of its orders entered electronically by physicians at its tertiary academic medical center.
The system’s goals have included 100% physician order entry across all of its three hospitals by 2005 and an electronic health record by 2010.
“Dr. Lindenauer’s recognition lends credibility to Baystate Health’s accomplishments as a national leader in the field of computerized physician order entry and electronic medical records,” says Joan Sullivan, vice president of clinical informatics and re-engineering at Baystate Health. “He is the driving force behind the success of encouraging over 2,000 of our physicians to embrace technology, dramatically improving the coordination of care at Baystate Health and improving the patient experience.”
System uses technology to deliver higher quality, safety
At Lehigh Valley Hospital and Health Network, in Allentown, Pa., compliance with best-practice guidelines for prophylactic antibiotic choice and timing rose significantly after the hospital implemented a suite of intensive-care, anesthesia-management and decision-support systems across its ICU, operating room and emergency departments.
The intent was to use the information management systems to “provide a continuum-of-care system to caregivers wherever the critical-care or anesthesia patient presents in our organization,” according to materials Lehigh Valley provided to AMDIS.
Compliance with a core measure of antibiotic timing increased to 92% from 62% in the first six months after implementation and is now at 95%. Surgical-site infections also dropped nearly 11% to 101 from 113 over the same time period.
“Our approach here at Lehigh Valley Hospital is that healthcare technology has little or no value unless it has a positive impact on patient care and safety,” says Thomas McLoughlin Jr., M.D., chairman of the anesthesiology department. “This recognition is gratifying because it demonstrates how teamwork, including an effective use of communication technology and systems, means higher quality and a safer environment for patients.”
The two-hospital system plans to expand the technology to document the provision of pre- and post-anesthesia care and to use it at the labor and delivery bedside as well as in the endoscopy laboratory.
Doc puts his medical and technological skills to work
Kaweah Delta Medical Center, Visalia, Calif., is on the cutting edge of medical informatics technology in large part because of the expertise of Roger Haley, M.D., as a physician and programmer, says Mark Garfield, vice president and chief medical officer for Kaweah Delta Health Care District. Haley, medical director of dialysis and medical director for informatics for the hospital district, has a long history of promoting physician use of IT and of using medical informatics to improve quality.
Beginning with his creation of a dialysis facility information system that earned the 303-bed hospital a commendation from the Joint Commission for quality improvement, he then led the district’s medical staff through installation and implementation of a clinical information system, later adding a medical documentation system now used by two-thirds of the active medical staff.
Using the slogan, “No pen by 2010,” Haley has made it his goal to bring the medical community into the 21st century, “screaming and clawing all the way if need be,” as he has said to his colleagues.
Lack of essential data was one of the emergencies in ER
Craig Feied, M.D., and Mark Smith, M.D., were hired in the mid-1990s as director of medical informatics and chairman of the emergency department, respectively, at Washington (D.C.) Hospital Center. Their task was to turn around the emergency department and reduce patient wait times, which at the time were up to nine hours. The two realized that its overcrowding and long waits were the result not of a lack of space but of a lack of access to instantaneous patient data.
To address this, Feied and Smith created Azyxxi, a cross-application healthcare information access platform that integrated data from various areas of the hospital, including demographic, laboratory, financial, imaging and scanned document data. When the system went live in 1996, patient satisfaction climbed to the 95th percentile, consumer surveys rated the emergency department one of the best in the region and the medical staff voted it the best clinical service department in the hospital.
“I’m honored to congratulate both Drs. Mark Smith and Craig Feied on the receipt of such a prestigious award,” says Catherine Szenczy, chief information officer of parent system MedStar Health. “As co-creators of the Azyxxi technology, they have provided a tool that helps clinicians quickly assess a patient’s condition and make decisions about their care.”
Within three years, Azyxxi became the clinical information system used throughout the hospital, and under Feied and Smith’s leadership, it has been adopted at six other hospitals within the MedStar system. In July 2006, Microsoft Corp. acquired Azyxxi and renamed it Amalga, and Feied joined Microsoft to lead the development team.
Barbara Kirchheimer, a former Modern Healthcare
reporter and news editor, wrote all profiles. She can be reached at bkirchh@sbcglobal.net.
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