April 11, 2013
It's difficult to think of a technology solution with more immediate revenue implications than patient flow automation systems.

It's difficult to think of a technology solution with more immediate revenue implications than patient flow automation systems.

Neal Ganguly

A lack of coordination between hospital departments often leads to bottlenecks, with patients backed up in emergency departments waiting for beds to open up, which in turn can force emergency departments to go on “divert” status. Patient flow systems automate business processes and promote communication between admitting, cleaning and transportation staff. They also help logistics officials measure departmental response times while monitoring bed status on a computer screen.

“Bed turnaround applications get at the heart of what many hospitals are struggling with, and if they are implemented properly, can have tremendous economic benefit,” says Marc Holland, research director for Health Industry Insights in Framingham, Mass.

In fact, the pain points may be so obvious to hospital officials that they see no need to ask CIOs for ROI business cases up front.

That was certainly the case at 217-bed CentraState Medical Center in Freehold, N.J. In 2007, patients admitted through the emergency department averaged 539 minutes in bed wait time. Despite earlier efforts to reduce length of stay, hospital officials faced the possibility of having to fund new construction to add patient beds. “We were looking at a variety of options, including a new observation unit,” says Vice President and CIO Neal Ganguly. “But this technology solution was clearly one of the most important options. It had demonstrated value at other hospitals.”

Ganguly says CentraState officials liked what they saw at other hospitals using solutions from TeleTracking Technologies (Pittsburgh) and Premise (recently purchased by Atlanta-based Eclipsys Corp.) but had “sticker shock” at the five-year cost of $700,000 to $800,000.

Ganguly's IT group realized that by using a workflow engine embedded in the clinical information system, his organization could build its own bed management system. CentraState was able to cut several hundred thousand dollars off the purchase price by building a solution in-house. “We hired someone to design the front end and married it to the back end we created, and got the robust functionality for about $250,000,” he says.

The system has a patient throughput dashboard that the admitting department uses to measure key performance indicators, including length of stay in the emergency department, and time spent to clean a room or transfer a patient, as well as discharge delays. They report to a throughput committee and hospital management team every other month.

The bed management solution went live at the end of September 2008, and the results have been impressive. The time between an emergency department physician entering an admit order and a patient reaching a bed fell from 278 minutes to 128. Between January and November 2008, the time to transport a patient dropped from 30 minutes to 20, and the time to clean a bed fell from 50 minutes to 36.

The system has also helped to reduce divert status at the medical center. The hospital was on divert six times between January 2008 and August 2008, and has not been on divert since the bed management system went live.“These are significant decreases,” Ganguly stresses. Though he doesn't have an exact dollar figure regarding the savings, he says, “Those financial metrics do tell a good story.”

Building the business case

Pam Arlotto, a consultant who specializes in helping healthcare organizations develop ROI cases, says CIOs need to be proactive in measuring the value of technology projects such as patient flow automation, even if they are not getting pressure from a CFO or a board to do it.

“At some point, board members look back and say, ‘Look at all that money we spent on technology. We could have built a new building for that amount and really had something to show for it.’ You have to be able to show them what they are getting for their investment, so they are more likely to fund the next project,” she says.

Arlotto, president and CEO of Atlanta-based Maestro Strategies, tells CIOs that ROI studies should extend beyond the upfront business case to the entire implementation. Such a strategy, she says, shows that the project can actually deliver on what was promised and make adjustments if progress isn't keeping pace with plans.

Some CIOs may see ROI cases as only about hard dollar savings. But Arlotto notes that when Maestro helped an Illinois hospital measure the impact of patient flow automation, it created several metrics, many of which were more qualitative. “If you measure something like turnaround time,” she says, “you can identify how it impacts the growth in patient volume, which may be a strategic organizational goal.”

That study also identified $287,469 in annual hard dollar savings through reductions in emergency department diversions and $308,256 in cost reductions through cuts in logistics staffing.

St. Barnabus Medical Center in Livingston, N.J., has been using TeleTracking technology for several years, and last September began a pilot project to gain greater efficiency by integrating its notification system with the hospital's Vocera Communications (San Jose, Calif.) hands-free wireless devices, worn by transport staff.

“Sending the request directly to the Vocera badge, rather than paging the staff, streamlines the process even more,” says Mike McTigue, CIO of the 645-bed hospital. “The next piece is for those transport workers to send a message back with an estimate of when they will arrive to pick up the patient,” he says. McTigue has worked with the transportation department on benchmarks to highlight the process improvements.

The recent purchase of Premise by Eclipsys may elevate this niche market, because these systems are clearly cost-effective, and hold the potential to save hospitals money, says Health Industry Insights' Holland. Yet he notes that the track record of these applications sometimes falls short of expectations, not because of any problem with the software. “It's because there is such a big cultural change necessary among so many players in the hospital. The system can provide notifications, prompts and metrics, but it's up to the people to implement it.”

Healthcare Informatics 2009 March;26(3):36-38

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