Menninger Clinic, The

Hospital Frees Up 10 to 25 Percent More Time for Patient-Care Priorities

The behavioral health services of The Menninger Clinic of Houston, Texas, are in great demand worldwide—but with 135 beds and a waiting list, Menninger is challenged to meet the demand. Busy mental health professionals wanted to exchange time spent filling out forms and tracking down charts for more time on patient-care priorities. The IT staff strengthened the clinical information system with a searchable document repository and built-in workflow process based on Microsoft® Office SharePoint® Server 2007 and the Microsoft Office InfoPath® 2007 information-gathering program. The solution is expected to give staff 10 to 25 percent more time on patient-care priorities and reduce IT maintenance and development costs by U.S.$80,000 annually. The solution also provides improved information auditing for HIPAA compliance and will offer better integration with future applications.

 

Situation

Founded in 1925, The Menninger Clinic is an international psychiatric hospital located in Houston, Texas, with treatment for adolescents and adults, training programs for mental health professionals, and research. Menninger’s specialty treatment programs provide comprehensive diagnosis, individualized interventions, and relapse prevention planning for persons with difficult-to-treat mental illnesses, including depression and bipolar disorders, obsessive-compulsive disorder, eating disorders, personality disorders, and addictive behavior. The Menninger Clinic is affiliated with Baylor College of Medicine and The Methodist Hospital. Menninger operates a 135-bed hospital on 14 acres and has a staff of 400.

We expect that MCIS will increase the efficiency of unit coordinators, nurses, and other clinical staff by 10 to 25 percent…. Providing more efficiency is good for our patients and the quality of care. Terry Janis Director of Information Technology, The Menninger Clinic

Treatment stays at Menninger range from six to eight weeks for adults and two to four months for adolescents. Every program, mental health specialty, and phase of diagnosis and treatment is typically accompanied by the completion of one or more forms. Because packaged health and mental healthcare software and forms didn’t meet Menninger’s interdisciplinary treatment and record-keeping needs, Menninger developed a series of Microsoft® Word 97 templates to accommodate the growing collection of forms. Though this step, taken in the late 1990s, computerized patient data forms, staff still had to perform frequent data re-entry. At that time, there was no digital forms repository, so the forms were printed and attached to the patient’s chart. Clinicians often had to spend time searching for the chart if it did not accompany the patient to the next specialist.

In 2003, Terry Janis joined The Menninger Clinic as Director of Information Technology and immediately observed the time drain caused by paper-bound treatment documentation, admissions processes, and information tracking. He led the creation of a Web-based forms solution called the Menninger Clinical Information System (MCIS). MCIS featured automated forms connected to a back end based on Microsoft SQL Server™ 2000 database software. Demand for new forms and enhancements grew over time. However, every new form and feature caused the database to become less efficient, less stable, and slower—some forms took a full 30 seconds to load.

User productivity ebbed once again, and frustration rose among both users and the IT staff, which found itself consumed with the upkeep of the MCIS system. As Menninger added new features and forms to MCIS, other problems cropped up. For example, MCIS lacked a strong security model and detailed audit trails, which Menninger needed to comply with HIPAA (the U.S. Health Insurance Portability and Accountability Act of 1996).

Plus, MCIS existed alongside several other in-house and third-party applications that still required redundant data entry, potentially causing errors and additional rework. “The application was becoming a nightmare to maintain,” says Janis, who had one full-time employee and two full-time consultants dedicated to its maintenance.

Solution

While considering how to fix MCIS, Janis knew that, at some point, Menninger would need to move to an integrated information system. Such a system could provide patient tracking from preadmission to postdischarge, and it would include pharmacy and medication administration functionality as well. However, an integrated information system would cost as much as U.S.$4 million, which Menninger was not prepared to spend at that time.

About this time (mid-2006), Janis journeyed to Redmond, Washington, to attend a Microsoft CIO Summit, where he learned about the 2007 Microsoft Office system. Intrigued about its implications for MCIS, he located a Houston-based Microsoft Gold Certified Partner, Insource Technology Corporation, and began to envision a solution.

That vision called for collapsing MCIS and six additional patient applications into a single, integrated, easy-to-use forms-based application powered by Microsoft Office SharePoint® Server 2007 and the Microsoft Office InfoPath® 2007 information-gathering program. Janis and Insource began to work on the system using beta versions of the products in the 2007 release. In just three months, they had a functional proof of concept.

Office InfoPath 2007 and Microsoft Office Forms Server 2007 give us browser deployment of forms, which allows much broader and more cost-effective use. David Dean Senior Member Technical Staff, Insource Technology

“With Office InfoPath 2003, we could produce forms-based applications, but we had to install a rich client on all user desktops,” explains David Dean, Senior Member Technical Staff at Insource Technology. “Office InfoPath 2007 and Microsoft Office Forms Server 2007 give us browser deployment of forms, which allows much broader and more cost-effective use. Creating complex, multipage forms is also much easier with Office InfoPath 2007 than the custom programming we have typically used in the past to build forms.”

Version 2 of the MCIS application uses Office SharePoint Server 2007 as the document repository and application user interface, with SQL Server 2005 as the data store. Menninger develops forms with Office InfoPath 2007 and deploys them using Microsoft Office InfoPath Forms Services to present the forms to users over a browser. All the server-side software runs on the Windows Server® 2003 R2 operating system, and the desktop software runs on the Windows® XP Professional operating system.

“Office SharePoint Server 2007 gives us the ability to easily store, manage, and retrieve patient demographic information and clinical documentation,” Dean says. “A normalized relational database design for this application might require dozens of tables. The document-centric design of MCIS uses SharePoint Server 2007 to reduce this to a handful of lists and document libraries. We also get automated document versioning, auditing, and search at no additional development cost.”

Even before a new patient walks through the door, the Menninger Admissions Office staff can query MCIS for the individual’s name or birth date and instantly see whether the individual has ever been a Menninger patient. If so, the system displays a page summarizing the patient’s demographics, health history, and treatment and provides a list of 20 to 25 forms relevant to that patient, according to his or her history and condition.

When the patient checks in, staff and unit coordinators use the system to perform standard patient management activities—such as making room and bed assignments; assigning a treatment team; and performing transfers, discharges, and readmissions—quickly and easily, without redundant data entry. During the course of a patient’s stay, the staff completes multiple documents pertaining to assessment, treatment planning and documentation, and legal requirements, storing all documents in Office SharePoint Server 2007.

At any time, clinicians and other authorized staff members can easily find, display, and create treatment documentation for any patient, using integrated search tools and customizable forms. Users store patient documentation in and retrieve it from organized, searchable document libraries that use predefined rules to automatically control security, versioning, archiving, and records retention.

Administrators use the Active Directory® service to quickly and easily manage user access and security privileges without developer intervention. IT developers and support staff can easily enhance existing forms, design new forms, and create reports and documents without having to reenter patient information.

Benefits

The new centralized clinical information system at Menninger has reduced time-consuming paperwork by 10 to 25 percent, freeing valuable hours each week that staff members can spend on patient-focused activities and quality-of-care priorities. The IT staff has been able to reduce application development and maintenance costs by $80,000 annually and provide a solid foundation for smoothing the transition to an integrated information system. The solution is also helping to reduce the frustration staff experienced from duplicating information across multiple patient forms. Menninger estimates that the new system will pay for itself within nine months.

Up to 25 Percent More Time for Patient-Care Priorities
The rejuvenated MCIS system will streamline the completion, routing, and storage of forms at Menninger, returning from 30 minutes to eight hours a week to busy staff members, depending on their role and specialty. “We expect that MCIS will increase the efficiency of unit coordinators, nurses, and other clinical staff by 10 to 25 percent,” Janis says. “About 65 percent of our staff is involved in direct patient care, so providing more efficiency is good for our patients and the quality of care. Plus, the productivity gains are worth approximately $300,000 a year to us in valuable clinician time.”

$80,000 in Annual IT Savings
MCIS version 2 has enabled Menninger to eliminate several aged systems and their associated licensing and maintenance fees, as well as reduce the developer effort needed to create, maintain, support, and enhance medical forms. Specifically, Menninger has been able to eliminate the following IT expenditures:

• $30,000 annually in licensing and maintenance fees for the old records system
• $30,000 annually in support and maintenance of an old patient documentation system
• $20,000 one-time cost avoidance for data conversion when Menninger moves to an integrated information system

“Saving $80,000 a year is significant to an IT staff of our size,” Janis says. “We can devote those funds to other projects that contribute to higher-quality patient care.”

Also, the use of Active Directory eliminates the need to repeatedly create security authorizations for multiple applications. “I estimate that 20 to 25 percent of our help-desk calls involved password resets. Active Directory will reduce that number,” Janis says.

Improved HIPAA Compliance
The improved document management capabilities, integrated support for security, and auditing capabilities of Office SharePoint Server 2007 will give Menninger tighter internal controls and improved compliance with HIPAA privacy rules. “HIPAA guidelines are strict about protecting electronic patient health information and producing auditable logs,” Janis says. “Using Office SharePoint Server 2007 and Active Directory, we can easily produce these logs. We simply would not have been able to fulfill the requirement otherwise.”

Smooth Transition to Integrated Information System
The improved data design and system architecture will facilitate the integration of MCIS with other current and future systems at Menninger. Specifically, Janis expects MCIS to ease the transition to an integrated information system by eliminating expensive data conversion work, because both MCIS and Office SharePoint Server 2007 use industry-standard XML and Web services for data import/export and interoperability.

Microsoft Office System
The Microsoft Office system is the business world’s chosen environment for information work, providing the programs, servers, and services that help you succeed by transforming information into impact.

For more information about the Microsoft Office system, go to:
www.microsoft.com/office

 

For More Information

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For more information about Insource Technology Corporation products and services, call (281) 774-4000 or visit the Web site at:
www.insource.com

For more information about The Menninger Clinic products and services, call (713) 275-5000 or visit the Web site at:
www.menningerclinic.com