Pinnacle Health's technology transfusion

Source: Technology Digital

Date :7/30/2007 11:36:30 AM

Pennsylvania’s PinnacleHealth System is using IT to completely transform how care givers access and share information, and to improve every step of patient care

By David Weldon

With a population of approximately 50,000, the state capital of Pennsylvania — Harrisburg — is not one of the nations’ largest. Still, what it lacks in downtown demographics it makes it for in broader community. Greater Harrisburg is the fourth largest population center in the state.

Harrisburg proper is a highly diverse industrial-based city, nestled along the broad Susquehanna River, the longest river on the East Coast. Despite the timeless beauty of the gently sprawling river, the city itself has undergone a major transformation in recent years, making major investments in neighborhood revitalization, public services and recreational facilities.

It is also home to PinnacleHealth System, the city’s largest private employer, which is undergoing a major transformation itself. And what is happening at Pinnacle is a prime example of an organization undergoing change with the goal of total quality management.

PinnacleHealth is a non-profit healthcare system comprised of four area hospitals — Harrisburg Campus, Community Campus, Polyclinic Campus and Seidle Campus — plus several remote ambulatory and primary care settings. It serves the entire South Central Pennsylvania region, which has a population of approximately one million.

Pinnacle has approximately 600 beds, annual revenues of approximately $550 million, and has approximately 4,000 employees. Of that number, more than 1,300 are nurses, and hundreds more are technical or clinical specialists.

According to Steven Roth, vice president and CIO, Pinnacle “provides the full range of inpatient and outpatient services offered by Integrated Delivery Networks, with the exception of retail pharmacy.” And it has been a charitable organization for all of its 135 year history.

“Our mission is to maintain and improve the health and quality of life for people in Central Pennsylvania,” Roth says. “We are a mission-driven, charitable organization.”

What that simply means is that all profits generated by the hospital are put right back into its operating and capital budgets, enabling Pinnacle to maintain and improve its quality of care and service delivery capability. Pinnacle was recently named to the US News and Work Report Top 100 Hospitals in several specialties.

But behind the scenes, there are much larger forces at work that are impacting the bottom line — some driven by government regulations, and others by insurance providers.

Pinnacle, Roth says, is turning to technology to better schedule and monitor patient services and medications, to enable care providers to make better diagnosis and care decisions, and to improve communication between all levels of clinician — again with the focus being on improved quality of care and outcomes.

Nearly every healthcare provider in the country is dealing with the same issues. One health care provider recently called it “the decade of IT” in the healthcare industry.

This spells good news for patient, who should benefit from better kept patient records, more-informed care decisions, proper scheduling of needed therapies and medications, and improved access to all of those records by every care provider that needs them, Roth explains.

But the news is mixed for hospitals. Insurance companies are cutting the amounts they reimburse for individual services, and increasing the documentation they require to verify that services have been provided. Roth says this forces Pinnacle and other healthcare provider organizations to retain more detailed records, to make sure no needed services are missed, and to validate the clinical necessity for services that are provided.

“Some of the due diligence also focuses on future health,” according to Cindy Brown, director of clinical informatics at Pinnacle.

“While a patient may not need some of the services now, you’re suppose to prove — and document — advice you give them, and how you can create a more healthy lifestyle,” Brown says.

While all of these efforts would seem to be just what the doctor ordered, it is getting all the various systems operable and integrated that are causing pain.

Complicating things for not just Pinnacle — but most healthcare providers — is the need to have several technology initiatives underway at once, at various stages, all working toward that perfect electronic patient record system that public has heard so much about.

That ultimate system is still a few years off, however.

Immediate challenges for Pinnacle, Roth says, are: funding all of the technology investments needed; the lack of technology standards and interoperability among the various systems and vendors deployed throughout the organization; and finding the right skill sets in the job market to handle all the work. Technology standards and interoperability among healthcare provider systems is improving, but remains behind other industries such as banking and financial services.

“The bulk of our IS staff are outsourced,” Roth notes. Siemens Health Services provides approximately 65 designated technologists to the hospital with its services contract. In addition, Pinnacle employs seven IT staff including Roth and Brown, “primarily focused on process improvement and gaining increased value from the deployed suite of applications every technology dollar,” he explains.

“The incremental technology adoption is fueling a need for added staff,” according to Roth. “We’re adding new technologies, and we need more staff to get full value out of these technologies.”

Beyond Roth’s group, “We are a somewhat-decentralized IT department,” he says. “Many departments have their own IT expert.”

The total budget for IT is approximately $16 million, which is increasing at a rate of approximately 3 percent annually. With all of the new initiatives underway, that doesn’t go far.

Added to the funding and staffing challenges for the department, Brown says there are three primary technology issues facing Pinnacle overall: creating and managing electronic medical records, providing digital access to the broader regional health community, and the use of technology to improve patient safety.

For patient safety, Pinnacle is integrating technology into work flow records, Brown says, as well as a bar coding medication delivery system that provides alerts to hospital staff if a patient is being administered an incorrect medication or dose. Pinnacle is actually ahead of most hospitals with the bar coding system, since that is still in the planning — or even conceptual — stage for most.

Examples of the alerts the system might send out, Brown says, include any allergies that the patient has that would affect prescribed medications, any lab results that might affect medications, or any other physical symptom the patient has that should be considered when selecting proper medication. All of this information starts with the patient’s initial admissions profile, and is updated as they go through the hospital care system.

The broader technology strategy this year, according to Roth, “is to expand clinical information access to clinicians throughout in support of our regional health and wellness mission.”

Pinnacle is associated with several outside physician offices and medical groups, and as part of its information access goal is in discussions with several organizations with regard to increased information sharing and access.

“There are many in the system that are not employed by Pinnacle, including individual physician practices,” Roth says. “We provide them tech support in terms of access our systems. We don’t provide them global technology support.”

In terms of hardware and software investments, Brown says the hospital made “a huge hardware investment” for the bar coding medication delivery system.

Other large investments in just the last two years have included an Electronic Medical Record system for Pinnacle’s Ambulatory Services area, the Siemens’ SORIAN Clinical Information and Workflow system, the Picture Archival and Communication System (PACS), a fully automated robotic laboratory and advanced automation in the pharmacy.

Similar to other healthcare providers, digital storage is another major cost center. The hospital is currently hosting more than 80 different applications in its local data center.

Pinnacle uses Siemens’ Signature system for registration and billing by its employed physicians; and a disaster recovery process that was created in partnership between the Pinnacle IT staff and Siemens.

In partnership with Siemens, Pinnacle is in the midst of migrating core hospital applications from its INVISION system to the SORIAN system, both of which are hosted at the Siemens data center. That migration project is currently tapping approximately 70 percent of Pinnacle’s IT capital outlay budget. A high percentage of the Siemens staff are also dedicated to that effort.

Pinnacle is an early adopter of the SORIAN system, and is a beta site for testing a new Clinical Plans of Care module.

The migration to the SORIAN system are intended to provide improved and automated better work flow and work listing capabilities, Roth says. These features are critical to the hospital, with the new highly detailed layers of data now required.

“That’s where we hope to see a lot of return on investment,” Roth says. “The whole value and benefit of the SORIAN system is all about the work flow — the ability to provide the alerts, to push out information, and reminders, to help physicians and other clinicians make better decisions in patient care.”