When Martin Luther King, Jr. Community Hospital (MLKCH) opened in South Los Angeles in July 2015, it marked the opening of a hospital built from the ground up while incorporating the latest technology into its design. It also marked the closing of a one chapter of South Los Angeles’ health history and the beginning of a new one, as MLKCH shares the same site in the Willowbrook neighborhood as the area’s previous hospital, Martin Luther King Jr./Drew Medical Center, which closed in 2007.
South Los Angeles continues to be a community facing significant socioeconomic and health challenges. According to MLKCH officials, the area is federally designated as Medically Underserved and a Healthcare Professional Shortage Area. Residents rank lowest in life expectancy and worse than L.A. County in nearly every healthcare indicator, and the poverty rate is two times that of the rest of California. The average U.S. community has 10 times the number of doctors as found in South Los Angeles, hospital officials say.
“It’s a community that is reflective of the challenges of delivering healthcare in an urban, low-income, medically underserved community. We have very significant health disparities among our population. We have inadequate outpatient healthcare. We have a 1,200-physician deficit in this community. We have fewer hospital beds than in other communities. We have a lot of social conditions that contribute to poor health, and all of those add up to the challenges that we’re addressing here,” Elaine Batchlor, M.D., CEO of MLKCH, says.
According to a 2015 article in the Los Angeles Times, when King/Drew hospital opened in South Los Angeles in 1972 it was viewed as a victory of the civil rights era and a source of pride for black Los Angeles, as the hospital served one of the neediest parts of Los Angeles. However, the county-run hospital was plagued in later years by poor medical care, staff errors and a series of controversial patient deaths, according to the Los Angeles Times, and the facility shuttered in 2007.
The new private, nonprofit MLKCH is smaller than the previous hospital, with 131 beds, has a new management structure and was built as a state-of-the-art, “all-digital” hospital that serves as a safety net for the local community, according to MLKCH officials. While MLKCH shares the same ground as its predecessor, the new hospital is operating in a different healthcare landscape, one in which hospital leadership can leverage technology and digital tools to provide high-quality care to an urban, underserved community of about 1.3 million people. The hospital operates in partnership with Los Angeles County and the University of California.
“One of the benefits and opportunities of creating a brand-new hospital and a brand-new healthcare organization is that we were able to look for best practices from every area and incorporate those best practices. And, we could build an infrastructure that could support future healthcare delivery,” Batchlor says.
“We were fully unencumbered by technology and the systems that you would have in a hospital that had been opened for many years,” says Tracy Donegan, MLKCH chief information and innovation officer. “We were able to implement a fully integrated electronic health record (EHR) from the get-go.”
Donegan is slated to be the keynote speaker at Healthcare Informatics’ Beverly Hills Health IT Summit at the Sofitel Los Angeles at Beverly Hills November 8-9, where she will share her organization’s journey to developing a world class IT infrastructure.
Built from the ground up, MLKCH incorporates technology into every aspect of its design—from the facility itself to service delivery to post-discharge care, according to Batchlor. “We deliberately sought the technology and used the technology as we designed our policies, procedures and approaches to care delivery from the beginning,” she says.
Elaine Batchlor, M.D.
The hospital was recognized by HIMSS Analytics, the analytics arm of the Healthcare Information and Management Systems Society (HIMSS), as Stage 6 on the EMR (electronic medical record) Adoption Model in its first year of operation. This year, the hospital was recognized as HIMSS Stage 7 for EHR best practices—a status achieved by only 6.4 percent of hospitals nationwide by the end of 2017.
The inpatient facility was constructed to integrate technology into care delivery. All inpatient beds are “smart beds” that weigh each patient automatically each day and record the findings in the patient's EHR. The “smart beds” also detect when a patient is getting out of bed and can alert the attending nurse if the patient is deemed a fall risk, Donegan says. Inpatient rooms also are wired with MyStation technology for patient interaction. “By using the TV in the patient’s room, we can engage the patient in health education when he or she first arrives at the hospital. They take a fall risk assessment on their TVs, and that’s integrated with the EHR so that clinicians are notified of patients with a fall risk,” she says.
The hospital’s clinical staff carry secure smartphones that interface with the EHR system and inpatient biomedical devices. Donegan also notes, “We also have over three dozen unique medical devices integrated with the EHR, and that was unique and progressive at the time we opened the hospital.” The hospital opened with clinical protocols programmed into the EHR system, she says. “That helps clinicians practice in a manner that’s consistent with best practices and evidence.”
“Technology is really about supporting high-quality patient care and patient safety,” Donegan says. “One area that we are really proud of is our ability to leverage technology to support medication safety. We use smart bar coding and scanning for dispensing medications in the hospital and for use of blood products. That is a huge patient safety boost.”
Hospital leadership also deployed technology tools to compensate for a shortage of physicians in the community. The entire hospital is wired for telemedicine, and telemedicine services are provided by physicians at UCLA Medical Center. “One of the areas where we use [telemedicine] is in our labor and delivery area, where we use tele-neonatology. We also use tele-radiology, tele-neurology and tele-psychiatry. In an area that has a severe shortage of physicians, telemedicine is a huge benefit to link residents to premier healthcare centers and to give them access to high-quality care,” Batchlor says.
MLKCH leaders note that the hospital is filling a need in the community for quality patient care. The hospital is on track to see 90,000 patients in the ED this year, and MLKCH’s patient satisfaction scores are in the top 20 percent of all hospitals nationwide, hospital leaders say.
A Culture of Innovation
Opening a new hospital has certain advantages, such as the ability to deploy the latest technologies without having to address older legacy systems. However, MLKCH leadership faced the unique challenge of designing and planning the IT infrastructure without having a full clinical staff in place.
“One of the huge challenges we had was that we had very little staff when we made decisions about what to purchase, what to implement, how to set it up, or the design of systems, and we used a lot of expert consultants and a pretty small group of staff members to make those decisions,” Batchlor acknowledges, “One the challenges we had after we opened was that we had to make a lot of adjustments for the permanent staff, and for the actual patient population that we were serving.”
Donegan initially began working with MLKCH as a consultant and then moved into the permanent CIO position. “With regard to technology, we had a very clear vision from the start that we wanted to use the technology to promote high-quality patient care, but we also wanted to use it to differentiate the hospital and attract high-quality talent. That helped us guide our technology portfolio because we understood, at the end of the day, what was really needed to be done to achieve these goals.”
And she notes that the complexity of the project was one reason she wanted to be involved in the design and opening of MLKCH. “What also attracted me was the mission of the hospital. It was very exciting. I’ve been in healthcare 20 years, and I felt that this would be the opportunity of a lifetime to have a direct impact on a community.”
Batchlor credits the hospital’s culture of innovation for the successful implementation of an advanced IT infrastructure.
“Some of the decisions we made were not obvious decisions,” Batchlor admits. “I often hear our IT team say that we implemented more Cerner modules than any other hospital has ever implemented. Some of that was risky and did require a willingness to work through problems, as we’re using technology that’s fairly new,” she says, adding, “It’s not always a slam dunk.”
She points to the deployment of the clinical staff smartphones as one challenging project. “The clinicians had some concerns and we listened to them. And, because of their concerns, we made a change to a different platform. It’s that kind of responsiveness that helps to make an IT initiative successful,” she says. “You have to be willing to struggle through those challenges, persist and solve problems. And, I think that’s something that is different about us compared to other places; a culture of supporting that kind of innovation.”
While MLKCH leadership faced a unique situation as a brand-new hospital, there were important lessons learned about technology adoption, Donegan says. “You have to involve the clinicians and any other stakeholders every step of the way in the choices and in the design; that is critical. It’s also extremely important to be very responsive to their concerns and their needs.”
Approaching Care Delivery Beyond the Hospital Walls
Beyond hardwiring technology into the inpatient facility, MLKCH executive and IT leaders also integrated technology into patient care plans. Each patient in the hospital, even those in the ED, is assigned a care coordinator, with the goal of reducing readmissions and providing targeted care to each patient. The EHR is integrated with dashboards and population health management tools for disease management and patient tracking.
“One of the things that’s important to us is continuous quality improvement and because we have such a great health information system, we also have access to real-time information about what’s happening with our patients, what’s happening with care that we’re providing, and it fuels our ability to monitor performance and improve that performance over time,” Batchlor says.
What’s more, MLKCH leadership are focused upstream from hospital care to prevention, disease management and community health.
“We are able to collect information about our population and approach our care delivery from a population health management perspective. We’re not just focused on what we are doing when our patients are within the four walls of our organization, but we’re thinking about what they need before they get here, what they need after they leave and we’re able to invest in building out other parts of the delivery system and just managing that whole continuum of care,” Batchlor says.
To this end, in December 2016, MLKCH launched its first outpatient medical practice, Advanced Care Clinic, with a post-discharge clinic and specialty care, and launched a nonprofit medical group, with five providers.
“One of the things that we quickly recognized after we opened was that many patients were coming to the emergency department with medical conditions that were not adequately treated in the outpatient setting,” Batchlor says, adding, “We are growing that medical group, it’s a multispecialty medical group. We have plans to build out a medical office building on campus, and that started with the recognition of the needs of the patients that we were seeing.”
The organization plans to break ground on the medical office building, the Wellness Center, later this year, offering space to accommodate specialty care physicians, along with services such as outpatient surgery, a dialysis center, an infusion center, a wound clinic and a retail pharmacy.