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Identify Yourself

March 30, 2009
by Daphne Lawrence
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Using palm vein scnning to ID patients fits right in with the innovative culture at BayCare

Lindsey jarrell

Lindsey Jarrell

‘We treat one patient at a time,’ is a philosophy so ingrained at BayCare Health System that staff ranging from registrars to the CEO cite it again and again. BayCare, a nine-hospital system based in Tampa, Fla., is the first hospital in that state, and the second in the nation, to implement the biometric identity technology called palm vein scanning that can instantly identify patients anywhere in the system - including outpatient.

This cutting edge technology, dubbed “Patient Secure Identity (PSI),” at BayCare, is illustrative of BayCare's culture which encourages and rewards innovation on a daily basis. “There are a few things we know to be true,” says Lindsey Jarrell, CIO of BayCare. “To move into the future and be ready, we recognize two things will get us there - high quality care and an innovative thought process.”

At BayCare, enhancing the patent experience as part of that high quality care is taken very seriously. Bruce Flareau, M.D., BayCare's CMIO, says when it comes to accessing and moving through the system, BayCare looks at the process from the patient's perspective. “We make that experience as good as it can be at the one-to-one level,” he says. “And one of the ways we do this is how we identify them.”

Palm vein scanning for ID is still a relatively innovative technology in healthcare (though its use is widespread in Japan for other industries). But for BayCare, this approach to identification was a no-brainer.

The Patient Secure Identity project evolved almost naturally as part of BayCare's Beacon project, a seven-year clinical transformation initiative to convert from analog to digital. “As you go from an analog world to a digital world, we find problems inherent in the system,” says Flareau. “Registering people manually led to many errors.”

But with many other patient identity solutions on the market, why did BayCare go for such a futuristic technology? Project champion James Schwamb, BayCare's vice president of Patient Financial Services, says it came down to two factors - the EMR and the patients.

According to Schwamb, hospitals may spend a lot of money on EMRs, but if they can't identify the patient, they can't access the patient information. “We knew that to get the biggest bang for the buck for our EMR, we were going to have to come up with some way to quickly identify our patients when they enter the system.”

As to Schwamb's other factor, patients said they were unhappy repeating the same information at each visit, and many had concerns about identity theft. “They kept asking us, ‘Isn't there something you can do so we don't have to give all this information to be identified?’” he says.

The solution was already out there, in use at 23-hospital Carolinas Healthcare (based in Charlotte, N.C.) - the Fujitsu (Sunnyvale, Calif.) PalmSecure palm vein scanning identity solution.

“We'd heard of it at Carolinas,” says Edward Hutcherson, one of the project leaders. “We're aware that we don't have all the answers, so we do reach out to other areas via the Internet, and networking, to stay aware of what's going on.”

Hutcherson says the organization looked at retinal scanning and fingerprinting as identity solutions and found the former too invasive, and the latter less accurate (in addition to carrying a stigma). With palm vein scanning, enrolled patients place a hand on the cradle to bring their record up on the screen.

To facilitate the project, BayCare first enhanced its existing Siemens (Malvern, Pa.) Invision green-screen technology by upgrading to Siemens OAS Gold. The team then wrote code to integrate the process with the existing registration pathways. “We didn't want it to be cumbersome for the registrars or the patients,” Hutcherson says, “so we looked very closely at the actual experience.”

He says the first two pilots went live in two months, with full implementation in three (including 90 points of entry into the system, such as ED and outpatient). “It's a relatively easy system to use, so there's not much training. But we wanted to communicate what this thing was.” And the organization did this in a novel way: by packing up a few PCs and going on the road to BayCare's biggest meeting of the year.

The team got on the agenda for BayCare's quarterly system meeting, which is attended by all staff at or above the director level. Schwamb made a presentation about the project, after which senior executives were promptly enrolled, including CEO Steve Mason (see photo). “They were all going around saying, ‘This is great.’ And when they went back to their hospitals, they were already sold.”

And once it was implemented, patients were quickly sold, too, with a 99 percent acceptance rate. “Patients come up and say, ‘I want my palm scanned,’” says Daisha Runman, a registrar and front-line user. “When someone comes in, especially when they're ill, the last thing they want to do is fill out paperwork.”

For front-end staff, Runman says the authentication saves at least seven keystrokes by eliminating the need to type in five demographics, in addition to time wasted waiting for screens to flip. “Your illness has already taken up hours of your day, so the last thing you want to do is wait for paperwork,” she says, adding that registrars inform patients that Patient Security Identity can be used anywhere in the BayCare system.

“It also gives the patient a sense of belonging,” says Flareau. “As we have an increase in clarity around patient identity, there begins to be an element of continuity in our interaction with people.”

In addition to improving patient satisfaction, the ID system increases patient safety by eliminating mistaken identity.

According to Schwamb, increasing patient safety through innovation is part of the culture at BayCare. “There's a sense of constantly asking the question, ‘How can we do it better?’ and not backsliding into a comfort zone,” he says. “That becomes the personality of the organization.” But it has to come from the top, he says - and at BayCare, according to most, it does.

CIO Jarrell agrees. “It's easy to be a CIO when you have the kind of support that (CEO) Steve Mason provides for technology and innovation,” he says. According to Jarrell, BayCare's previous CEO had set that culture and Mason sustained it.

Every year, Mason conducts Town Halls at all BayCare's locations (90 access points) to interact with team members and share the message about technology and innovation with a servant-leadership approach. “When I or a COO walk through the hospital, it's not about, ‘Oh, here are the executives,’ says Jarrell. “It's about, ‘Oh, there's the guy I need to talk to about this idea, let me go engage him in conversation.’”

Jarrell says those ideas are often generated by a loose innovation council that involves the top three or four executives. “We talked about formalizing that council more this year so we can put a small set of incubator dollars toward different ideas,” he says.

In fact, so deeply committed is Jarrell to innovation that this year, for the first time, BayCare sponsored a full-day forum on leadership (see sidebar) that focused on healthcare technology in the future, and encouraged participants to think about technology in innovative ways.

Currently, new ideas go through the Quality department. BayCare has a significant Six Sigma program and, according to Jarrell, many ideas spin out of its work. The Six Sigma projects take place in the clinical space as well, with many initiatives around new and emerging clinical interventions. “We bring docs together around a content area and ask, ‘How might we do this differently; what can we study in a new and creative way to solve problems,’” says Flareau. “The culture lends itself to Six Sigma methodology and original research.”

Originality and creativity go hand in hand with risk, something BayCare accepts. “If you're allowed to take risks and do things differently, then you feel free to be creative,” says Schwamb. “We have lots of examples,” he says, citing the Siemens patient accounting system that was hard coded and difficult to use. Schwamb, working with IS, found that OAS Gold could sit on top of Invision for a much more user-friendly experience. “Most people would have said, ‘Gosh, you already have a system, why do you need another system on top of it? But that's the kind of thing we're allowed to accomplish here.”

At BayCare, when something is accomplished, people are recognized for it. “Success and recognition go hand in hand,” says Schwamb. That recognition - including rewards - is another key to BayCare's culture of innovation. “How you reward behaviors is one of the ways you establish culture,” says Flareau. “If you reward one idea, you may get five other great ones.”

At BayCare, every meeting in every department begins with the question: Who can we recognize and what do we have to celebrate? “You pull an agenda from any meeting at any level and I will assure you that's at the top of the agenda,” says Flareau.

Adds Jarrell, “It's our way to stop, pause and remember the good things that are happening.”

BayCare also has a “Kudos” program. This Intranet-based rewards program uses a third-party online shopping site where anyone in the organization can reward anyone else with gift cards and certificates. “It's built into our budgets on the top level,” says Jarrell. “No department manager could ever cut their quality Kudos budget.”

And when projects are completed, rewards also come in the form of celebration. “We spend a lot of time after each of these projects telling folks how much we appreciate what they did,” says Schwamb. For the Patient Secure Identity project, that meant a luncheon for the project team and users.

And Jarrell says that though it may seem simple, another factor encouraging innovation is allowing people to go to conferences, to publish and be recognized. “We encourage people to present at user conferences,” he says. “Those small things keep people motivated, engaged in their jobs, and lead to innovation and good ideas.”

Schwamb says team members are excited by creativity, a sentiment echoed by Hutcherson and others on the project team. And pride in innovation pervades BayCare at every level. For the doctors, having the latest robotics, molecular-imaging technology - and palm vein technology - means not only having better tools, but association with a cutting-edge healthcare system, says Flareau.

Jarrell adds, “We're allowed to innovate, we're allowed to have ideas that turn out to not make sense, and we're allowed to talk about them and to gain support or to have critical feedback. That's just okay to do here.”

Healthcare Informatics 2009 April;26(4):42-47

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