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One-on-One with Penn Medicine VP and CIO Michael Restuccia, Part I

February 10, 2009
by root
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Restuccia discusses his strategies for integrating inpatient and ambulatory systems.

Penn Medicine is a Philadelphia-based $3.5 billion enterprise consisting of the University of Pennsylvania School of Medicine and the University of Pennsylvania Health System, (UPHS) which includes three hospitals — the Hospital of the University of Pennsylvania, Pennsylvania Hospital and Penn Presbyterian Medical Center. HCI Editor Daphne Lawrence recently spoke with Vice President and CIO Michael Restuccia about his IT projects and new patient portal.

DL: What are you working on over there, Mike?

MR: From an inpatient perspective, UPHS has 100 percent CPOE across our enterprise, and that was pretty much in place when I got here two years ago. We used the Eclipsys Sunrise manager for that platform. Now we’re in the process of installing the Eclipsys knowledge based charting solution, and in addition we are installing the integrated Eclipsys pharmacy system.

DL: So you’re doing a complete enterprise solution?

MR: For inpatient clinicals we’re utilizing Sunrise for everything. We use Cerner Millennium for lab, and for radiology, we use IDX radiology system. So we have a lot of activity on the inpatient clinical. We are three hospitals with 1600+ beds. On the ambulatory side, we began to roll out the Epic EMR.

DL: You have a lot going on there. How’s everybody playing in the sandbox?

MR: The reality of it is you can’t store all your ambulatory information in your inpatient system, and vice versa, you can’t store all your inpatient information in your ambulatory system. So we focus on providing ease of access to systems and what we mean by that is the two systems, Epic and Eclipsys, don’t consistently talk to each other but we do have them share information. So a discharge summary comes out of the Eclipsys system and we store a copy if that in the patient’s ambulatory record.

DL: That’s through an interface.

MR: Yes, initially it was a manual interface where we scanned it and loaded it up as part of the ambulatory chart, but now it’s an electronic interface. We did that about six months ago.

DL: So you’re sharing discharge summary. Are you going to be sharing anything else?

DL: We’ve also begun to roll out the Sentillion single sign on context management solution, so that helps in reducing the number of sign-ons and passwords a physician has to remember. But it also provides the access to patient information into other systems they’re authorized to see.

DL: Was making life easier for the docs the driver for that?

MR: It’s twofold. It’s reducing the amount of sign-ons and passwords they have to remember. And it’s also context management. Let’s say I’m a clinician and I’m viewing Daphne’s record in Eclipsys and I say, this is interesting, I wonder if she’s been seen in any of our ambulatory clinics and I wonder if there’s any information there that may be helpful in my treatment of her as an inpatient. So I’m in the Eclipsys inpatient system, let me go to the top and click on that tab that says Epic. Your Epic record was already loaded at the time of sign on so all I do is click on that tab and up pops your ambulatory record. So I’m in context. I scan through and see something about allergies, meds, maybe a physician note, then I click back onto the patient chart.

DL: And that’s bi-directional?

MR: Yes. So that’s something we have begun to roll out, and as you can imagine, it’s a huge win for a few reasons. One, there’s nothing like having to remember fewer sign-ons and passwords. Second, it’s so easy to get access to additional information; all you do is click and you’re there. And the third things is the learning curve — I think the time for a physician to learn the system is between 10 and 15 minutes. So it’s really just a navigational issue. It’s changing the paradigm for the physician, instead of signing in to each system, remembering the sign-on and password to each system, remembering how to spell the patient’s last name, all that’s going to take place behind the scenes; ten minutes to learn the single sign on tool. And it’s not just docs; it’s rolled out to all our nurses.

DL: What about your nurses, what are they doing?

MR: Our knowledge-based charting for the nurses will be rolled out in September of 2009. So far, Our CPOE is orders and results — the documentation on the patient is still done on paper by everybody BUT physicians. So we’re presently working with the nursing staff of our three hospitals to develop a common system. Whatever we roll out at one of our hospitals is to be used at the other two. We want the systems to be the same, we want the education to be the same, we want the use to be the same, we want to protocols to be the same and we want the support to be the same. It’s a lot of hard work up front, but once you implement in that manner, the benefit to the health system from a continuity of care perspective is high. And mobilization of workforce is high. Our three hospitals are the Hospital of the University of Pennsylvania, Pennsylvania Hospital and Presbyterian Medical Center. So you could have staff from Penn Hospital moonlight up at Presbyterian Medical Center and not have any education issues surrounding the information systems. They’re the same. And in this day and age with nursing shortages and clinician shortages, that’s a big advantage.

DL: Any tips for tying all this information together?