SYSTEMS INTEGRATION

Walk into the vast, glassed-in lobby at Alegent Health Lakeside Hospital on the western outskirts of Omaha (population about 400,000), U.S.A., and you may wonder if you’re in an overgrown hunting lodge instead of a health center.  The smell of freshly baked bread lingers in the air, and you might hear the sound of piano music as you sink into one of the leather sofas or easy chairs huddled convivially around a big stone fireplace.  Feel relaxed?  That’s exactly the idea.

But if Lakeside Hospital’s patients are more relaxed than those at other hospitals, the reasons run far deeper than the upholstery or the chords of the baby grand emanating from a music therapy room.  Here, patients and their families can rest assured that when information is needed -- be it an expert opinion during an operation or a comparison of before and after X-rays when a patient’s mother asks how her daughter is doing -- it will be there, exactly when and where it is needed.

Wayne A. Sensor, Alegent Health’s Chief Executive Officer, describes the hospital’s commitment to Information Technology (IT) this way, “It’s not the number of widgets you have.  There are plenty of centers that have those.  The point is that here we have a single solution environment.  It is integrated, and the systems talk to one another for the value of the patient.”

STANDARDIZING DIGITAL SYSTEMS

That adds up to a focus on health care that is not only cutting edge, but, according to Tom McCausland, President of Siemens Medical Solutions USA, unique.  “Lakeside,” he says, “is one of the most technologically integrated hospitals in the world today.”  Indeed, Lakeside is the forerunner in a ten-year alliance with Siemens to standardize digital systems throughout Alegent Health’s nine hospitals and 100 sites of service.  Included in the agreement are diagnostic and surgical systems, lighting, building controls, fire safety, security, and IT -- an unmatchable synergistic combination.

Lakeside Hospital’s commitment to a single solution is particularly evident when it comes to medical care.  From registration to discharge, all the information associated with a patient -- from diagnostic and therapeutic to diet, pharmacy, labs, billing and insurance -- enters an electronic patient record.  “The centralized database is what makes everything come together for our medical staff,” explains Cindy Alloway, Vice President and Chief Operating Officer for Lakeside.  “T hat information is accessible to authorized care givers wherever they may be.”

At the heart of this comprehensive information package is Siemens’s Soarian Clinical Access and Health Information Management (HIM) software as well as its SIENET Picture Archiving and Communications System (PACS).  For Alegent Health Lakeside Hospital, which opened in 2004, these systems have amounted to an efficiency revolution in the way nurses and physicians work.  “Soarian’s advanced IT allows our nurses to spend more time with patients,” says Alloway.  “Rather than having to take down vital signs on paper and then input them at a PC, our nurses can do this at the bedside in real time using wireless computers on wheels or tablets.”

Adds Karen Sweeney, Chief Nurse Executive, “I think we are still in the teething stage as far as what our IT systems will ultimately be able to do for patients.  But already our nurses feel that IT has helped to put them back at the bedside.”  Physicians now bring tablet PCs with them on rounds and can pull up X-rays and lab results and review them with patients and their families -- one of the many reasons why patient satisfaction at Lakeside has reached stratospheric levels.  Furthermore, a growing number of Lakeside’s physicians now review their patients’charts and, if necessary, their real-time vital signs, as soon as they get up, so that before they leave home they know which patients have the most critical values.  “Everything is available when and where we need it.  We can view the images, report immediately, and click off to indicate that a study has been reviewed,” says Dr. Patty Helke, a Lakeside radiologist.  “I’m probably twice as efficient as I was six months ago.”  Efficiency could receive yet another boost before long.  The hospital is testing the use of PDAs that would support physicians while making rounds.  And Lakeside Health’s patient wristbands, which now carry bar code IDs, may eventually carry a tiny Radio Frequency Identification Device (RFID) that would help to track patients, reduce the risk of incorrect identification, and help physicians to get easy access to the patient file with an RFID-enabled PDA.  Patients and their families benefit directly from Lakeside’s wireless environment because they can bring their laptops in and log on anywhere -- especially since all rooms, including ER and post-op, are singles and are outfitted with sofa beds.  Advanced IT also plays a role in many other aspects of patient life.  For instance, if a patient is scheduled for an early morning X-ray, Soarian automatically notifies dining services not to deliver a meal.  Later, when the patient returns, he or she can order breakfast from a menu.  “There are studies that show that environment has an effect on the healing process,” says Amy Protexter, Alegent Health’s Operations Director for Corporate Communications.  “With that in mind, Lakeside emphasizes a high level of privacy and personalization.”

For those who are concerned that electronic information may come at the expense of patient privacy, there is plenty of evidence to the contrary.  Access to Lakeside’s physical plant, as well as to medical records, is managed by electronic ID badges, passwords, and/or biometric key pads.  The hospital’s Soarian software assures that access to information complies with the U.S. government’s extraordinarily tough Health Insurance Portability and Accountability Act (HIPAA) regulations.  Says Ken Lawonn, Alegent Health’s Senior Vice President and Chief Information Officer, “Soarian tracks who sees what, so that everything is documented.  Chances for abuse are extremely limited.  It’s true that IT systems allow information to be more broadly available.  But on the other hand, they also make it possible to discretely control access to that information.” Naturally, given the precision with which access to electronic medical records can be controlled, plans are evolving to give patients and -- with their authorization -- outside doctors, access.  “Why shouldn’t I, as a patient, have access to my own lab results?” asks Sensor.  “Here at Lakeside, with Siemens’s help, we are creating a platform to do just that.  This will lead to very advanced portals for consumers, and will add up to true health information portability.  It will also be the beginning of a new trend in which patients become part of the care team, rather than just care recipients.”  In addition to the privacy issue, documentation itself is becoming a red hot issue for U.S. hospitals.  “With a view to maximizing accuracy, government agencies and insurance companies are heading in the direction of evaluating medical centers according to how well -- among other things -- they maintain their medical records,” points out Alloway.  “As a result, they are increasingly demanding that facilities make use of electronic records.”

ELECTRONIC PRESCRIPTIONS FOR PATIENT SAFETY

With this in mind, Alegent Health Lakeside Hospital and Siemens are moving rapidly to the next phase of what Alloway calls “Soarianization” which will involve implementation of Computer-assisted Physician Order Entry (CPOE).  “Once CPOE goes online,” she predicts, “all of our physicians will enter their orders electronically.  This will mean a tremendous improvement in patient safety because there will be no room for misinterpreting physicians’ orders, the patient’s name or the name of a medication.  Furthermore, the software, which is now being tested, will flag inaccuracies, such as misplaced decimals or contraindications for patients with allergies.

As with most things at Lakeside, the software that makes new, advanced services such as electronic order entry possible is tailored to the user’s needs.  Weekly Web casts and regular on-site visits bring Siemens software experts together with Lakeside’s physicians, nurses and IT specialists to shape and optimize Soarian modules.  Try as they will, however, to make things as easy to use as possible, there is still an element of future shock.  “New technologies are not always easy to get used to,” says Sensor.  “To say to your doctors and nurses that because of electronic medical records they will no longer be able to get a physical chart is a tremendous cultural journey.  But frankly, we wouldn’t have it any other way.”