The IT team at Hackensack University Medical Center is not one to rest on its laurels. Having transformed this 820-bed teaching hospital from a low-tech organization into one of the most wired hospitals in the US, CIO Lex Ferrauiola and his team are busy working on the next generation of clinical IT, complete with robots that see patients.

Ferrauiola’s first job was to convince the hospital board to invest in IT. He must have been persuasive because they agreed to a capital investment of $78 million. This was before the famous report from the Institute of Medicine on medical errors, but Ferrauiola said the board recognized the potential value of technology for both patients and physicians.

The investment paid off, resulting in increased physician and patient satisfaction, reduced errors, shorter lengths of stay, and eight years in a row on Hospitals & Health Networks list of the top 100 most-wired hospitals. Today, the hospital has a sophisticated PACS, mandatory CPOE, a physician portal, an electronic maintenance-request system, and even robots that allow physicians to attend to patients remotely.

Find me an evangelist
One problem with having gone digital so early is the hospital’s clinical IT software is now outdated. True to form, Ferrauiola and his team are helping develop the next generation of software, Soarian, in conjunction with Siemens.

The new system will go live at Hackensack in early 2008, but Ferrauiola decided not to wait until then to implement mandatory CPOE, despite the fact that the current system is not terribly physician friendly. “The screens can be somewhat cumbersome for the physicians,” he admitted, noting that the hospital has close to 1,600 attending community physicians.

Ferrauiola believes having that bridge to the medical staff was essential for success. “Not every physician is thrilled with having to use the system, but our usage since we started mandating in January has risen to 50,000 orders per month.” Ferrauiola noted that Burns was hired in a dual role: working with technology as director of medical informatics and working with patients as a hospitalist to ensure credibility with the medical staff.

Another key factor in the rollout was Hackensack’s clinical informatics department, a group of nurses who provide round-the-clock floor support for physicians. Ferrauiola said the group’s director, Theresa Moore, works closely with Burns and that the group helped reduce the amount of feather ruffling on the part of physicians.

Have you seen the score?
Physicians aren’t the only ones relying on technology at Hackensack, of course. Benjamin Bordonaro, director of IT, points to the organization’s intranet as an important tool for department managers and executives. It features a scorecard showing key performance indicators that’s updated monthly, allowing a quick glance at things like length of stay and patient satisfaction, along with the ability to drill down into the statistics.

“The patient satisfaction number is especially important,” said Bordonaro, “but a unit director would look at all three numbers to get a balanced view. If your length of stay has increased, that might affect your patient satisfaction—you have to look across all indicators to get a good idea of how your unit is doing.”

“Say you’re a patient who’s ready to go home, and your family is there to pick you up, but you’re waiting for Dr. Jones to finish her practice in the office so she can make rounds in the hospital and discharge you,” said Ferrauiola. “With our technology, Dr. Jones can sit at a workstation in her office and control the robot with a joystick. She can ask you questions, look at diagnostics, and be able to discharge you.”

The hospital’s soon-to-be-implemented clinical software is similarly advanced. “Soarian will be a full EMR across the entire continuum of care, inpatient and outpatient,” Ferrauiola said. “It will support all clinical functions such as CPOE, physician and nursing documentation, orders, and results, and it will be driven by a workflow engine that uses artificial intelligence.”

That means the system itself monitors the patient’s treatment as it progresses, suggesting possible next steps. “With current systems, clinicians have to initiate each action,” Ferrauiola explained. “With workflow engines, the system is smart enough to initiate action, always within the control of the clinician.”

Advanced technology is certainly sexy, but Ferrauiola’s team hasn’t forgotten that the simple things are also important. Employee satisfaction runs just behind patient satisfaction at Hackensack, and the IT department plays a key role.

“We use technology to foster collaboration,” Ferrauiola said. “For example, if you’re a nurse on a unit where an air conditioning unit breaks, you can get on your workstation, go to a section of the intranet, and key in the floor you’re on and the problem.” The system looks to see which environmental person who is working that day would be appropriate, where they are, and sends a message to a portable hand-held device they carry so the problem can be solved promptly.

Not surprisingly, all data from the transaction is tracked, completing the circuit. “We track it so we know the satisfaction level of the person who requested it,” said Ferrauiola.