Lower cost, higher value with in-house healthcare solutions
One of medicine's most exciting new frontiers isn't found in operating rooms or research labs, but in hospital IT departments where small bands of developers are coming up with innovative solutions to healthcare's information-processing needs. And often they're doing it inexpensively—even for just pennies on the dollars they once spent to acquire proprietary systems from third-party vendors.
The secret of their success doesn't rest with some new technological breakthrough but with off-the-shelf commodity software. Using generic development tools, many but not all produced by Microsoft, IT professionals are creating custom solutions that are highly intuitive, flexible, interoperable, and economical to use and create.
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Get a bigger bang if you build it yourself
It's not unheard of for a single good-sized medical center to spend upwards of $200 million to acquire a proprietary system from a third-party vendor. Unfortunately, many of these solutions are built on outdated legacy applications, rendering them highly inflexible and incapable of meeting customer expectations associated with solutions that have been designed with world-class Web services in mind.
By contrast, in-house IT departments that adopt a "build instead of buy" mentality are achieving truly impressive results for as little as a few hundred thousand dollars. Or in some cases, even less.
Consider what has been achieved at Hospital de São Sebastião near Porto, Portugal. Since its opening in 1999, chief information officer Rui Gomes and his 11-person IT staff have built a highly integrated electronic patient records (EPR) system that makes São Sebstião more "wired" than any number of much larger U.S. hospitals.
Doctors roam the halls of the 317-bed facility using Fujitsu Tablet PCs to access a full array of patient data, which also is available to nursing and pharmacy personnel. A special emergency room component of the system tracks patients as they enter treatment, automatically performing triage so the most serious cases are treated first.
To achieve the same functionality with a third-party system would have cost the hospital about $1.2 million, Gomes says. The price of the in-house effort? Only $108,000.
Two other examples highlight the diversity of what's being done as well as the impressive returns on investment being tallied.
Operating more efficiently and profitably
At Vanderbilt Medical Center (VMC) at Vanderbilt University, an effort to capture data more efficiently as it flowed through the hospital's operating suites had consequences far beyond the original goal of facilitating research. The Vanderbilt perioperative information management system (VPIMS), begun in the mid-'90s, has evolved into a kind of "master control" for all clinical and non-clinical aspects of surgery from scheduling to patient monitoring to materials management to billing.
Development of the system was begun, says Dr. Paul St. Jacques, director of anesthesiology informatics at VMC, because the desired functionality wasn't to be found in commercially available solutions. So development proceeded in-house, spearheaded by just a handful of developers and guided by input from the clinicians and administrators who would be using the system.
Because IT staff members already were familiar with Microsoft products, the VPIMS team used Microsoft Access 97 as its development tool and Microsoft SQL Server 2005 for backend database management. (The application currently is being rewritten using Microsoft Visual Basic .NET.)
The result, St. Jacques says, is a system that is "heavy on user compliance" and is capable of flagging user errors as soon as they're made. This is important because insurers are sticklers for correct billing charts, and uncorrected chart errors can lead to significant delays in payments to providers.
The resulting 67 percent reduction in chart errors means that where previously an average of 12 days was required to submit a billable chart, the process now routinely is completed in a matter of hours. Timelier billing has resulted in an annual gain of more than $1 million in physician and anesthesiology fees.
Other improvements resulting from VPIMS include: a 100 percent improvement in on-time case starts; an increase from 60 percent to 90 percent compliance with perioperative antibiotic protocols, which translates into a 50 percent reduction in surgical wound infections; and a 10 percent yearly increase in case volume without adding capacity. This last figure is particularly significant because adding just a single case per day generates additional annual revenue of more than $1 million.
Through 12 years of development and evolution, St. Jacques estimates VPIMS has cost "more than one or two million and less than 20." The relatively small size of the VPIMS IT department—12 developers and five technical support staff—would argue for the lower figure.
Whatever the precise cost, one thing is certain: The system will continue to expand. "I have a development list that's longer than my arm," St. Jacques says.
Connecting young patients to the world outside
At Arkansas Children's Hospital in Little Rock, where system-wide medical information processing is provided by a MEDITECH solution, the IT department functions as a kind of "skunk works," filling in the gaps not covered by the larger system, according to chief information and technology officer David Higginson. Such a gap was encountered when the hospital decided to expand its in-room media capabilities.
The goal was to replace a simple television system with one that provided a full spectrum of on-demand movies, television, Internet, video gaming, and patient education. A system that could be expanded was a priority, as was one that would allow parental control.
Third-party solutions were too generic and quite expensive, Higginson says, so development was done in-house by team of 10 developers and about the same number of support staff. The solution was built on a Microsoft Windows XP Media Center platform with Microsoft SQL Server 2005 providing database management at the backend. The system was further extended and customized using Microsoft Visual Studio and Microsoft ASP.NET.
The resulting system is controlled from a 15-inch bedside monitor, while media offerings are viewed on wall-mounted 32-inch plasma televisions. Because the solution is linked to the broader MEDITECH system, medical personnel can access a patient's information, including x-rays and other records, on the bedside unit.
The cost of all this functionality is surprisingly low. By the end of 2007, when it has been rolled out to all 280 beds at the hospital, the total cost of the solution will be around $1 million. That compares with the $2 to $3 million less robust third-party solutions would have cost.
As for the effectiveness of the solution, that can be seen on the faces of the young patient users. "Their quality of life at the hospital was not good," Higginson says. "But now they have all this connectivity."
These are just three examples of the many I've seen around the world where hospitals are using commodity software to build solutions to improve the quality and safety of patient care, as well as the satisfaction of those providing and receiving care. I believe we have finally arrived at the tipping point for ushering in a new era of compelling, highly intuitive, very powerful and yet economical information technology solutions for the healthcare industry.
Dr. Bill Crounse, M.D., is the worldwide health director for the Microsoft Corporation. Dr. Crounse is responsible for working with industry partners and healthcare organizations to help them benefit from using Microsoft technologies and solutions. Prior to joining Microsoft, Dr. Crounse was vice president and chief medical information officer for Overlake Hospital Medical Center and the Overlake Venture Center in Bellevue, Wash. |
