Unlocking Medical Information

When Baptist Health of Northeast Florida started planning its move to a paperless healthcare environment, management from the CEO on down were clear on one thing: Unhindered access to digital information would be critical. Today, Intel® technology-based mobile point of care (MPOC) solutions are enabling new ways to work and deliver care at two of Baptist Health’s community hospitals, and the remaining three are on track for conversion by early 2008.

The results are pervasive. “There is no aspect of clinical practice and no corner of the clinical care environment that hasn’t been impacted and improved by having mobile, simultaneous access to digital health information,” says Keith Stein, MD, chief medical officer at Baptist Health.

Challenge

• Improve care. Influenced by the Institute of Medicine’s findings, Baptist Health’s leadership team wanted to use Healthcare Information Technology (HIT) investments to drive improvements in the quality and efficiency of care.
• Make the most of digital data and tools. Having made a commitment to embrace digital health records, computerized provider order entry (CPOE) and other healthcare applications, Baptist Health wanted to ensure that clinicians could access the new information and applications easily and securely, wherever their workflows required.

Solution

• Design the care model of the future. Baptist Health took the opening of a new hospital as an opportunity to design optimal, HIT-enabled clinical practices for all its hospitals. Wireless networks and mobile PCs were crucial enablers.
• Support clinician workstyles and preferences. Baptist offers a range of Intel technology-based mobile PCs, and has developed a patent-pending mobile cart that makes it easy for physicians to check out a laptop, tablet or sub-notebook as they come into the hospital. An integrated portal with single sign-on capability enhances convenience and productivity.

Assessing the Situation

Some of the biggest names in healthcare are lining up to visit a 120-bed community hospital in Jacksonville, Florida. They’re coming to see the all-digital information environment and mobile point of care solutions at Baptist Medical Center South, which opened as an all-digital facility in February 2005, and 54-bed Baptist Medical Center Nassau, which moved to a paperless environment a year later. In fact, Baptist gets so many requests from other healthcare leaders that it now limits tours to what can be accommodated on a scheduled, biweekly basis.

“There’s a whole set of new issues that come up as you automate clinical workflows,” says Roland Garcia, chief information officer for Baptist Health. “How do you provide seamless roaming? How do you handle distributed printing? How do you promote adoption? We’re a small network of community hospitals, but we’re ahead of the curve in adopting digital information. It’s exciting to have dealt with these issues successfully and be able to move on to bigger challenges – like building more evidence-based recommendations and decision-support capabilities into our solutions.”

Information at Your Fingertips

Unhindered information access was one of three core principles when Baptist Health began preparing its move into a digital environment. “In the paper world, information is something you compete for – there’s one chart, and it’s a valuable commodity,” Dr. Stein explains. “As we moved into the digital world, we wanted to make the chart available to every authorized user – rounding physicians, specialists, nurses and other clinicians – and we wanted them to be able to work with the data everywhere they wanted to use it.”

Baptist Health says mobile access reinforces the benefits of digital information and tools, adding efficiencies and increasing quality of care as well as physician productivity and satisfaction. “Think of all the times in the written world when you have to call a nurse to get information, or you’re doing a consult over the phone but only one of you can see the chart,” says James Altomare, MD, chief medical information officer at Baptist Health. “In the digital world, everyone can see the information when and where they need it. Care is pushed back to the bedside, where you want it to be. Physicians and nurses are free to chart where they want to. When there’s an extreme situation, everyone has access to the data.”

New Ways to Work and Care

Mobile flexibility affects care in a variety of ways. “If I get a call that my patient needs attention, I can pull up the data and see at a glance what’s going on,” says Dr. Altomare. “If I’m covering for a colleague and I get a call at 4:00 a.m., I can pull up the history and have it right there in front of me. If I’m handing off a patient to a hospitalist or consulting with a colleague, we can look at the electronic chart together even if he’s in his office and I’m in mine. It improves decision-making and the continuity of care we deliver.”

Mobile information access also helps busy clinicians make better decisions about how to use their time. “It used to be you did rounding linearly unless a nurse alerted you that a patient needed special attention,” Dr. Stein recalls. “Now, physicians do pre-rounding – they go through the patient list and review each patient’s condition to help plan their rounds. They see sicker patients first, and they can do the pre-rounding on the unit, from home, in their office, in the cafeteria – wherever it’s convenient.”

Patients and family members benefit as well. “I had an ER patient who just didn’t believe she had pneumonia,” says Dr. Altomare. “I took the tablet to her bedside, pulled up the Picture Archiving and Communications System (PACS) image, and said, ‘Here, let me show you.’ She accepted the diagnosis and we proceeded with the treatment.”

Spotlight: Baptist Health

• Faith-based, not-for-profit healthcare system serving Northeast Florida and southern Georgia
• Five hospitals delivering the region’s most comprehensive care, including a state-of-the-art cardiology and cardiovascular surgery program, a comprehensive cancer center, orthopedic institute, women’s resource center, neurosurgery, outpatient services, home health care, a network of primary care physicians’ offices throughout Northeast Florida, and Jacksonville’s only children’s hospital
• 899 licensed beds, 226,000 inpatient days and more than 190,000 emergency center visits annually
• Recipient of numerous awards for quality of care and patient satisfaction, including Baptist Medical Center’s National Research Corporation’s Consumer Choice Award as the area’s most preferred hospital since 2000
• Official healthcare provider for the Jacksonville Jaguars National Football League team

Delivering the Solution

As Baptist Health prepared to transition to mobile point of care solutions, its leadership team focused on the long-term goal. Their philosophy was: We’re not deploying laptops, we’re enabling new ways to work. “When you move from paper to electronic charts, you have a great opportunity to facilitate optimized workflows for clinical practice and patient flows,” says Baptist Health’s chief technology officer David Dully. “Wherever clinicians are in their workflow, you want to provide access to the clinical data and tools.”

There was also recognition that the stakes were high. “You really only get one shot,” Garcia says. “You cannot introduce technology that’s not reliable, and you cannot have dead spots or security issues. People will get frustrated very quickly, and adoption will drop. Once you lose people, it’s hard to recover.”

Baptist Health chose Intel technologies for nurses’ workstations and mobile PCs. Clinicians can choose from three Intel-based mobile PCs: a Fujitsu LifeBook* sub-compact, Panasonic T Series notebook and HP TC Series tablet. PCs based on Intel® Pentium 4 processor or Intel® Core™ 2 Duo processor are available at nurses’ workstations and on Ergotron wireless computers on wheels (WOW) carts.

The Cerner Millennium* suite is used for electronic medical records, clinical documentation, CPOE, enterprise scheduling and other functions. Emergency centers, pharmacies and operating rooms use department-specific Cerner modules. Clinicians and informaticists worked together to design workflows, which were simulated before being put into action. Extensive training and 24-hour support facilitated the transition.

Choice and Change

Mobility involves a culture shift, according to Dr. Altomare. “People need to gain comfort with it, and not everyone is going to use it in the same way,” he says.

Baptist Health facilitates the shift and promotes adoption by providing a range of choices to meet the range of clinician workstyles. “We are clear that we are making this move – but we give clinicians a lot of choices in how they interact with the information and tools,” says Dr. Stein. “They can sit at a PC at the nurses’ workstation, wheel a WOW into the room, or bring a laptop to the bedside and share it with the patient. They can chart at the bedside or chart when they’re finished. Basically, they’re liberated to work in whatever way is best for them to take care of the patient and the record-keeping.”

Clinicians were involved in virtually every aspect of planning of the digital environment and workflow, including the choice of devices. “The IT team developed the basic technical requirements – durability, screen real estate, integrated keyboard, handwriting recognition, voice recognition and reputable vendors,” recalls Garcia. “Then we brought in a number of models and opened the process up to the medical staff.”

Intel technologies were selected for their high performance, variety of form factors, and architectural advances that enable smaller, lighter designs and longer battery life. “Anything that increases performance and enables clinicians to work longer without recharging is a benefit for healthcare mobility,” says Dully. “Intel’s advances with multi-core technologies are very significant.”

Dully sees Intel® Virtualization Technology (Intel® VT) adding flexibility to the clinical environment. “By virtualizing the application image, we can better support a variety of devices and enable physicians to bring in their own notebooks, but still ensure the integrity, security and manageability of the environment,” he says.

Baptist Health improved convenience by coming up with a creative way of making mobile PCs available to visiting physicians. Baptist Health worked with several vendors to design and optimize a mobile cabinet that houses multiple mobile PCs. Each unit has a PC depot, and physicians simply swipe their ID badge to check out a PC on their way into the hospital. Depots also incorporate battery chargers and extra batteries, to help clinicians work without interruption.

Ubiquitous, Convenient, Secure

To meet its clinicians’ needs, Baptist Health wanted a highly secure network that would deliver reliable access wherever clinicians needed it, along with flexible, intuitive and consistent procedures regardless of what applications or devices a clinician used. It built a robust wireless network based on Cisco routers, switches and access points and the 802.11g WiFi protocol.

The network is managed by Cisco Wireless LAN Solution Engine (WLSE) and uses Cisco Fast Secure Roaming. To protect network security and the confidentiality of patient data, Baptist Health uses WiFi Protected Access (WPA) and the Temporal Key Integrity Protocol (TKIP) for authentication, encryption and key management.

“There’s always room for improvement, but by and large, clinicians can move anywhere on the Baptist Medical Center South campus – the hospital, clinics, offices, elevators, between floors, around floors – and stay connected,” says Dully.

Most applications are unified under a portal with a single sign-on procedure enabled by Passlogix* software and Entrust* secure identity management. Clinicians can wirelessly print a report or other document on the nearest printer, or direct it to an alternate location.

“Once you’re connected and signed on, you stay connected and signed on as you move around the hospital,” Dr. Stein explains. “If you get a call that a patient needs attention, you can instantly check the chart. You don’t have to hunt for a machine and find it and sign in and wait for it to recognize you and find the application. The efficiency and timeliness of your response is definitely better.”

Innovating for Healthcare

Looking to the future, Baptist Health leaders say they’re happy to see Intel’s increased involvement in healthcare. “Hospital environments have different challenges from a typical office,” Garcia observes. “To have Intel developing a deeper understanding of our industry and applying its resources to drive innovation for healthcare – that’s a big win.”

Garcia points to Intel’s mobile clinical assistant (MCA) platform as a great example of the type of innovation healthcare needs – and Intel can deliver. “Intel has had a big impact in improving wireless computing, going back to when they introduced Centrino mobile technology,” he says. “We’re glad to see the MCA, and we’re looking forward to next-generation technologies that will be even better. Things like hands-free computing and improved speech-to-text will make a big difference in promoting technology adoption.”

Ultimately, the technologies are all about fulfilling Baptist Health’s faith-based mission of delivering compassionate, high-quality clinical care. “The real reason to do this is to make care more clinically effective and improve outcomes,” says Dr. Altomare. “We’re just at the beginning. There are myriad opportunities to bring additional support to the physician at the point of care – by making greater use of evidence-based medicine and artificial intelligence, and making it more expedient for busy, stressed clinicians to make the best decisions possible. There is a huge potential that is yet unrealized.”

Return on Investment

Baptist Health leaders say digital information, technology-enabled mobile workflows and powerful Intel platforms are improving numerous aspects of healthcare delivery – sometimes in surprising ways.

• With mobile PCs, clinicians say they tend to write more complete notes, providing a more thorough record for other members of the care team and making data available more quickly. Paper-based handwriting errors and inconsistent abbreviations are eliminated.
• Clinicians who chart at the bedside spend more time with the patient and family, which increases patient satisfaction and gives clinicians a deeper understanding of the “whole patient.” Patients and family members who review electronic data with a clinician tend to become more involved and compliant with treatment recommendations and to experience less anxiety.
• Collaboration and decision-making are faster and more effective when everyone can access comprehensive, up-to-date clinical information simultaneously.
• Care is more efficient. For example, new medication orders are filled in an average of 16 minutes, compared to the two hours or more that Baptist says is more typically found in health systems without an electronic medical record. As technology adoption has increased, throughput measures such as the emergency center’s “arrival to discharge requested” metric have improved.

Find a healthcare IT solution that is right for your hospital system. Contact your Intel representative, visit Intel’s Digital Health Business Web site at: intel.com/healthcare

For more about Baptist Health, visit www.e-baptisthealth.com

Copyright ©2007 Intel Corporation. All rights reserved. Intel, the Intel logo, Intel Leap ahead, Intel Leap ahead logo, Pentium, Pentium Inside, Centrino and the Centrino logo, Core and the Core 2 Duo logo and Intel Xeon and the Xeon logo are trademarks or registered trademarks of Intel Corporation and its subsidiaries in the United States and other countries.

This document is for informational purposes only. Intel makes no warranties, express or implied, in this document.