Perioperative Analytics Bolsters NY Hospital

Arnot Ogden Medical Center, in a path to become a HIMSS Analytics Stage 7 hospital, embarked on a project to update its perioperative IT and streamline its surgical services. Arnot Ogden Medical Center in Elmira, N.Y. is an independent, not-for-profit, 256-bed tertiary medical facility with more than 300 physicians from over 50 specialties. Arnot Ogden has received HIMSS Analytics Stage 6 recognition and is now working toward Stage 7, which would create a true paperless patient record environment. Since replacing its Mediware (Lenexa, Kan.) OR system with Surgical Information Systems (Alpharetta, Ga.), the hospital has seen increased efficiency through reduced turnover times between procedures from 40 minutes to 27 minutes, a 32.5 percent improvement. The hospital has also been able to optimize block scheduling in the OR by analyzing the precise utilization rates of surgical suites to better assign block schedule times. HCI Associate Editor Jennifer Prestigiacomo spoke with Hazel Boyd, Arnot Ogden’s business director of perioperative services about the Medical Center’s customized dashboard and lessons learned during implementation of the new system.

Healthcare Informatics: What led you to your particular vendor choice for your perioperative system?

Hazel Boyd: Surgical Information Systems (SIS) resonated with us [because of their] user-friendliness, forward thinking, key features (preference cards, wizards, interconnectivity), data reporting capabilities, and analytics. Their sales team created a familial sense and took pride in their product and demonstrated a willingness and desire to partner and grow.

HCI: Do physicians at Arnot Ogden do direct post-op reporting into the perioperative system?

Boyd: No. Our physicians dictate into a phone and then the transcriptionists type up the record and that is entered into a different program that is acceptable by QuadraMed’s Computerized Patient Record [QPCR, our EMR]. So that is a separate PDF, and it just goes into a separate section where all interfaced documents reside.

HCI: Do you have any metrics for data entry error reduction since switching from paper-based systems?

Boyd: We do not. We actually switched from one electronic documentation record to another electronic record. We were able to extract data out of the old system using Crystal Reports. This is now viewed in analytics through the use of SIS.

HCI: Tell me more about your customized dashboard. What KPIs does it contain? Is it real-time?

Boyd: We have several items that are outlined in our customized dashboard. Tabs within analytics to help us review data and develop action plans associated with them. Currently the KPIs that we pay the most attention to are utilization of our ORs (capacity vs. utilization), OR volume (cases vs. minutes), OR volumes by service, block utilization, and turnover time. These are metrics that we are always interested in exploring and developing action plans to improve the processes. This is not a real time system. Instead, we can review snapshots or all documentation from the previous day back to the past (day one of implementation). There are filters that allow us to drill down or narrow down to the pertinent information as necessary. We have the capability to go local or global with stats.

HCI: What other efficiencies have been realized besides reduced turnover times?

Boyd: We have been able to recognize cost variance between services and surgeon practices. We have a clearer picture on what the cost impact of change can create. We have provided ourselves with more predictable models for change using the system. We have begun to hold surgeons accountable for poor block utilization. We have used the system to create consistent documentation practices.

Historically, we have a surgical services committee that manages the block, and we as OR management provide the data that is used to deal with block [scheduling] and the efficient use of it. So analytics has a block utilization tab, and the tool that we use can tell us how much time was used in the block, and how much time was used out of the block and we’ve also keyed in our turnover time as well to be a part of that. Because surgeons will say, “well my block is at 52 percent utilization because of turnover time takes so long, and you’re not counting that 60 minutes between cases, and that’s time I really can’t use because I am filling up my block.” So with the analytics tool we were able to pull that turnover time in, and it’s actually specific to that surgeon. So that helps provide that data to the surgical services committee when they’re making decisions on block utilization and making sure they’re using it the best way they should.

HCI: What quality gains and cost savings did your organization reap?

Boyd: Cost savings is hard to contrast. We were able to switch to a better version of acuity-based charging using the rules based charging module. We are in the process of deploying the inventory control module. I am sure that we will be able to realize some gains from there.

The main [quality gain] we had was our rapid turnaround. We did a pod redesign where we allocated two new resources. Basically, there’s an air traffic controller, which is at the nurses’ station in the OR, and we have another air traffic controller in the inner core, and they’re the star person that manages a group of four rooms. We use the analytical tool to assess turnover time and to make sure we’re reducing turnover time, lag time in between, [make sure] patients are starting on time, and that bundlings are completed.

HCI: What has it been like getting clinicians onboard to use this new surgical information system?

Boyd: It was not difficult to get our clinicians using the system. They were familiar with electronic documentation; we just had to reintroduce them to this version of it. Some of our older nurses had difficulty with implementation, but that was more specifically around their desire not to change.

HCI: How does this fit in with the rest of the organization’s clinical information systems?

Boyd: We currently use [the Reston, Va.-based] QCPR for our electronic medical record. SIS interfaces have been developed for use between both Lawson (St. Paul, Minn.) and QCPR. Those interfaces are not currently live at the moment, but we are working toward that goal. We’re waiting for the MIS people to build the folders for these reports to go into in order for us to test it. Right now, we print the report and it goes with the patient, so we’re still able to provide the care. But obviously, if we ever want to have an electronic medical record we need it to talk to the big hub. Hopefully, by the end of February we should be live.

HCI: What were some lessons learned through this process?

Boyd: Always, always ask the question, ‘what else is available,’ and ‘is this the newest version?’ Ensure that you are getting the same picture between the implementation and sales sides of the spectrum. Ask what is required for optimal use not minimum specifications. Realistically, when you’re looking at a system you’re going to go, ‘what are the minimum specs required for this.’ And while they may be the minimum specs required, that doesn’t mean that it’s going to operate the way that they [the sales team] show it to you. Every company that shows you something is going to show you the slickest, nicest, coolest version of it. The question at the end of the day is, ‘is that what you’re paying for?’ Just asking the questions is important.

Review contractual language over and over and over again to make sure that there isn't anything that you missed. Let at least five sets of eyes go over it for understanding. Ask the question: ‘what do I get for this?’ Repeatedly. Communicate. Communicate. Communicate.

HCI: What were some challenges your organization faced through this process?

Boyd: We’ve been live with SIS since June 2009. It’s slick, and it’s able to do so much stuff. The system we had before was like a black hole; we put information in, but we could never really get it out. We did a lot of backend work on our old system. We ran into some problems recently with analytics. The tool that we use is so technologically savvy and forward thinking that they are constantly improving it to make it better, which is wonderful. But at the same time you’re phasing through version after version after version. To me as a business director, on the maintenance side, I have to maintain my system, but what am I maintaining exactly if I have to pay again if I want to be upgraded to the next [product] because the company is so forward thinking and fast? That’s been the unfortunate piece of this.

HCI: What’s in store for the future?

Boyd: Anesthesia and perfusion modules and upgrades to current software. Lots of QI [quality improvement] projects!