Customer Solution Case Study
/ / Automating Patient Records Management Extends High-Quality Care to More Patients at the SwedishHospital of Seattle
Overview
Country:United States
Industry:Healthcare and Healthcare Insurance
Customer Profile
In 1910, Seattle’s SwedishHospital opened in a renovated apartment building with just 24 beds. Since then, the hospital has added new buildings, enhanced facilities, and evolved its scope of services until it became a major medical center and the region's hallmark for excellence in health care.
Business Situation
At the Swedish Hospital emergency department, the staff spends an hour on paperwork for every hour of patient care, a ratio that is typical throughout the U.S. Chief of Emergency Services Dr. Ronald Dobson sought to improve staff productivity by replacing the department's paper-based patient records system with an automated patient data management and collaboration platform.
Solution
Capgemini, a Certified Microsoft Partner, developed a clinical forms and collaboration solution that used XML-based Web services to integrate tablet PCs connected to a wireless network, an interface built with Microsoft® Office InfoPath™ 2003, and a document library managed by Microsoft Office SharePoint™ Portal Server 2003 with the hospital’s clinical and financial database applications. In 1910, Seattle’s SwedishHospital opened
Benefits
Improved patient care
Faster access to patient records and test results
Fewer errors in patient data and medical treatment
Single, unified view of patient records and status
More secure access to patient data
More accurate resource planning and billing / “The ability of the Microsoft Office System to integrate innovative functionality with our existing applications has helped us create a single, unified view of not only patient records but also patient status—a moment-to-moment snapshot view of the well-being of the people in our care. The Capgemini solution makes this information easy to create, share, and reuse to the ultimate benefit of our patients.”
Dr. Ronald Dobson, Director of Emergency Services, Swedish Hospital First Hill Campus
SwedishHospital of Seattle engaged Capgemini to develop an automated data management platform that enabled the hospital's emergency room staff to use tablet PCs connected to a wireless network to gather patient data and collaborative workspaces to organize, share, and manage it on the hospital intranet. Converting their manual paper-based records keeping system into a streamlined computer documentation and care management solution will enable the hospital to:
- Realize a 74-percent internal rate of return (IRR) and a payback of 13 months on its investment.
- Provide high-quality care for 10 percent more patients.
- Increase annual per-patient revenue at the hospital's First Hill facility by 3 percent.
Situation
When patients experience unexpected medical problems, the knowledge and experience of the emergency department staff and medical technology are the hospital resources that the patient first encounters. However, efficient workflow and accurate records keeping are other, less obvious elements of high-quality patient care.
As in most U.S. hospitals, the emergency department staff at Seattle's Swedish Hospital First Hill, Ballard, and Providence facilities spends about half of their workday caring for patients and the remaining time filling out forms and performing administrative tasks.
The staff's efforts at working more productively were hampered by a complex manual paper-based data collection and distribution process. The staff collected patients' personal and medical data on paper forms, which were organized on clipboards color-coded to indicate treatment priority. The status and location of each patient was listed on a white board hung in a nurse's station of the hospital's emergency care facilities.
Getting patient information from the hospital laboratory, imaging units, and medical database to doctors and patients in the emergency department often created bottlenecks in the examining rooms, where patients waited until the staff received needed diagnostic information.
Developing ways to help the emergency department staff spend more time in patient care is one of the concerns of Dr. Ronald Dobson, Chief of Emergency Services at SwedishHospital. For 14 years, Dr. Dobson considered ways to use IT to help his staff spend more time caring for patients. However, the technology then available was not up to the task.
The development of tablet PCs, wireless connectivity, and an easy method of recreating electronic versions of his departments many paper forms changed the situation completely. Dobson sought a solution that could help caregivers reallocate part of their administrative time to patient care, reduce records keeping errors, and ensure that organizational and regulatory requirements are met.
Dr. Dobson engaged consultants at the Seattle office of Capgemini to develop a forms creation and data management solution for his department. Jennifer Lane, RN, QA/Ed also provided invaluable assistance by participating in solution development.
Solution
The Capgemini clinical forms and collaboration solution integrated mobile PCs, wireless connectivity, and XML-based Web services with the hospital's mainframe-based clinical and financial database applications. The solution consisted of three major components.
Effortless Data Access, Entry, and Validation
The solution's front end consisted of tablet PCs, electronic forms, and a customized user interface.
The emergency department staff collects patient data by using tablet PCs running Microsoft® Windows® XP Tablet PC Edition connected to an in-house wireless network. The unfettered mobility of using the tablet PCs provided doctors, triage nurses, and treatment nurses a discreet way to collect data from patients during exams and treatment.
Data input and validation. Microsoft Office InfoPath™ 2003 information gathering program enabled department caregivers to capture structured data in a flexible, user-friendly way. Capgemini developers employed drag-and-drop controls and other easy-to-use InfoPath 2003 development tools to create XML-based, electronic versions of the paper forms that the staff used to document patient care and personal information. InfoPath 2003 also helped the developers build a user interface that enabled doctors, nurses, and administrators to access form templates, update patient data, and manage patient documents.
Collaboration, Communication, and Process Coordination
Microsoft Windows® SharePoint™ Services provides the Swedish emergency department staff with a dedicated intranet-based team collaboration site that serves as a hub for vital communications and document management functions. In the Windows SharePoint Services team site, SharePoint lists provide the caregivers with an electronic version of their whiteboard, which on-duty staff members review constantly for patient status information. The indexing and intranet-wide search capabilities of Microsoft Office SharePoint Portal Server 2003 enable the emergency services staff to organize all patient-related forms by the patient's name. The portal also serves as a document library, from which caregivers check out, modify, and check in patient forms at each step of the ED care process.
Comprehensive process coordination. Microsoft Office BizTalk® Server 2004 automates the processes needed to collect and report personal and clinical data for each patient, check documents in and out of the project's document library, and forward the data to the hospital's medical and financial databases. The solution accomplishes this by exchanging information contained in patient forms across the solution's data access, entry, and storage applications.
The BizTalk Server Adapter for HL7 add-on provides specialized functionality designed for healthcare environments.
The Microsoft .NET Framework that supports all of the solution's functionality enables Capgemini developers to set up communications and document management tasks as a series of Web services. By clicking on the Microsoft .NET-connected solution's custom user interface, staff members call Web services that move data and documents into and out of the SharePoint portal and team site and into the hospital's databases.
Powerful Data Storage and Analysis
The solution's back-end resources include databases that store completed emergency department patient forms, clinical data, and billing information. Microsoft SQL Server™ 2000 provides the hospital with a local repository of completed emergency department patient documents.
The SwedishHospital clinical forms and collaboration pilot program began in mid-October 2003. Rollout to the hospital's downtown location is scheduled to begin in February 2004.
Benefits
Deploying the Capgemini clinical forms and collaboration solution will enable the SwedishHospital emergency services staff to reallocate administrative time to more patient care, reduce errors in patient records keeping, and perform trends analysis on their emergency care processes. As a result, SwedishHospital expects to realize a 74-percent internal rate of return (IRR) and a 13-month payback on their investment.
Less Time Translates into More Time for Patient Care
At SwedishHospital, emergency patients progress through a four step process of triage and registration, assessment, treatment, and discharge or transfer to a bed in the inpatient portion of the hospital.
During triage and registration, the triage nurse checks for an existing patient record in the HIS database. If none exists, the nurse opens an empty Emergency Department Assessment form template stored in the SharePoint Document Library. A request for a new form calls a Web service that makes a blank InfoPath-based form available on the user's tablet PC. Finally, the nurse fills out the patient's personal information and assigns the patient a treatment priority.
If the information entered is incomplete or does not satisfy pre-established data entry rules, the solution alerts the nurse, who can make the correction immediately.
When the nurse closes the file, the solution timestamps the form, checks the form back into the SharePoint patient document library, and transfers the patient name onto the Active Patients list on the SharePoint collaboration site.
During the medical assessment, treatment, and discharge phases of the ED process, the basic workflow is the same:
Check for existing records
Check out the appropriate form
Fill in relevant information during each task
Correct errors identified during validation
Check the form back into the document library
At each stage of emergency care, the solution's communications, collaboration, or document management capabilities can reduce several common problems that beset SwedishHospital's legacy document management system. The following table describes both the problems and the capabilities of the solution that helps to solve them.
The ability to create, display, share, and manage information in a shared work environment will enable Swedish Hospital to provide high-quality care to 10 percent more patients per year, generate 3 percent additional revenue per patient each year at the hospital's First Hill facility, and spend 80 percent less time tracking information for audits.
How Benefits Were Measured
Navigant Consulting, Inc., an independent consulting organization, performed a cost and benefit analysis to determine business and financial metrics associated with the investment in the Microsoft Office System solution.
Using established cash flow analysis, standard financial data was measured, including: payback, the time it takes a company to recoup its investment in the solution; net present value (NPV), the total value to the customer from investing in the solution, expressed in today's dollars; NPV per user, the NPV divided by the number of users affected by the solution; and internal rate of return, the rate of return that the customer expects from investing in the solution.
While every organization has unique considerations for economic analysis, this case study highlights key areas where potential economic value from the Microsoft Office System can be realized. Navigant Consulting's Value Impact Analysis (VIA) practice strongly recommends that all significant IT investments undergo a rigorous economic justification to comprehensively identify the full business impact of those investments.
Microsoft Windows Server System
Microsoft Windows Server System integrated server infrastructure software is designed to support end-to-end solutions built on Windows Server 2003. It creates an infrastructure based on integrated innovation, Microsoft’s holistic approach to building products and solutions that are intrinsically designed to work together and interact seamlessly with other data and applications across your IT environment. This allows you to reduce the costs of ongoing operations; deliver a more secure and reliable IT infrastructure; and drive valuable new capabilities for the future growth of your business.
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