In 2015, Dallas-based Parkland Health and Hospital System opened a new 2.8 million square-foot facility, almost twice the size of the previous facility, which was built in 1954. The new state-of-the-art hospital, built on a 64-acre site and employing 11,000 people, features 862 private patient rooms with annual patient visits exceeding 1 million.
The emergency department at the new Parkland hospital is over 100,000 square feet, with 250,000 annual ED visits, the most high-volume, single site ED in the country. From a technology standpoint, the new facility required 7.5 million feet of ethernet cable—equivalent of the distance from Dallas to New Jersey—as well as 500 server equipment racks, according to Parkland Health and Hospital System’s CIO Matthew Kull.
“When moving into a facility this size, it was not without its own challenges,” Kull said during a webinar sponsored by Healthcare Informatics detailing the hospital’s digital strategy transformation. The webinar can be accessed here.
As Dallas County has changed, the county’s safety net hospital had to change as well. Parkland can trace its history back to 1894, when the first hospital opened, and the hospital moved to a larger, 1.5 million square-foot facility 63 years ago. “In 1954, when we moved into our second iteration of Parkland, Dallas County had 430,000 people. In 2016, when we moved into our latest hospital, Dallas County had 2.6 million people,” Kull said. “In 1954, we admitted 14,000 people; in 2016, over 75,000. In 1954, in Parkland 2.0, we delivered 4,000 babies; the year we moved into our third site, Parkland 3.0, we delivered over 12,000.”
At the same time, Parkland’s patient population provides some unique challenges, as only 8 percent of the patient base has commercial insurance, 44 percent have Medicare/Medicaid and 50 percent are self-pay or charitable or have no ability to pay, Kull said.
“Parkland is a safety net for the most in-need patients. But, with that, driving innovation and efficiency is not something that we do for anything other than a mandatory need to drive that efficiency due to volumes. As it turns out, as technology has progressed, we’re finding that it is truly one of the biggest levers for efficiency that we have,” he said.
Changing physical logistics and a workforce that increasingly wants to change the way they work also presented challenges, he said. With the transition to electronic health records (EHRs) physicians are spending more time in front of the computer. However, with the patient floors at the new Parkland hospital measuring three football fields long, centralized nursing stations or clinical works areas are not viable, Kull said.
Parkland’s leadership team faced a number of critical needs when thinking about the digital strategy for the new hospital—clinicians wanted access to information anytime, anywhere; patients had to remain the top priority; and the security of the enterprise and patient information was paramount.
And, another caveat, as a county hospital, Parkland’s senior executive leaders had to plan the new facility to be in operation for the next 50 to 75 years. “Given the pace of change of technology, we had to look at what digital strategy means and how we’re going to apply it in a way that continues to give us flexibility and the ability to continually evolve as time goes on in our current facility. In this current evolution, technology is playing the biggest role in the transformation in the way that we treat our patients.”
The move to a larger hospital created a need for a new digital strategy and required IT leaders to design an alert management and desktop management environment that would allow users to move freely about large work areas and access data when they needed it, where they needed it, Kull said.
However, planning early proved to be the biggest challenge, as the hospital opened two years ago, but planning for the new hospital started eight years prior. “If we had been planning and picked solutions at that time, we would have a hospital full of people running around with BlackBerry phones,” Kull said. “When you’re planning a facility of this size and this kind of technical maturity it was difficult to plan early on in an environment where technology was changing. As an example, our mobile solution and our interactive patient experience, these didn’t exist.”
To meet this challenge, Parkland’s IT leaders had to define and design the capabilities and functionalities needed for clinicians, physicians, administrators and the IT team. “We had to define and create a digital platform, a wireless infrastructure that was medical grade, with the ability to capture and transform large amounts of data to an agnostic or non-specific endpoint. This allowed us to come up with an infrastructure that we think we could grow on and pick devices that were just in time and close to our opening.”
Working with Palo Alto, California-based technology vendor VMWare, Parkland’s leadership team seized the opportunity to employ virtualization and identity management tools enabling the deployment of a single sign-on solution and a tap-to-access roaming desktop profile for each clinician in the facility.
The result, he said, has been that users are spending less time with technology and more time with patients, delivering better care. Clinicians only need to enter their credentials once, and faster logins and easier access to applications equates to more engagement with patients.
“With the ability to implement a roaming desktop profile and a tap-and-go, a physician or a nurse provider walks into a room and, without breaking eye contact with a patient, reaches from their shirt collar to the tap sensor to tap their badge. It takes mere seconds,” he said, adding, “Our time studies show that we’re gaining back about 15 minutes per shift, per physician, which is equivalent to providers being able to see one additional patient. When you look at an 800-bed hospital, seeing one more patient per physician, this becomes a big deal,” Kull said.
From an end-user perspective, the desktop virtualization deployment was a big technology “win” for Parkland’s IT team. “It was, in my history, one of the most widely adopted and accepted solutions that I’ve ever implemented,” Kull said.
Kull also noted that getting key clinical, IT and executives stakeholders involved and invested early on in this IT project was critical to the success of the initiative.
“Understanding how the smallest changes can affect the entire workspace is critical, because when you’re creating several thousand desktops that all operate exactly the same, it’s important to make sure that each users’ experience and their needs are represented,” he said.
To this end, Kull and the IT team developed mock-up spaces to practice and drill workflow scenarios and then practiced those scenarios in hospital rooms, in the ED and in administrative spaces prior to the technology deployment. This was necessary to ensure the hospital could safely move patients into the new facility and that the technology was in place to support patient care.
The hospital also has been able to leverage mobile technology to send real-time alerts to nurses and clinicians regarding patient monitoring and bed management for better patient flow. “We’re developing approximately 24,000 total alarms and alerts out of the EHR (electronic health record) and tertiary systems per day,” Kull said. The hospital has seen almost a 30-minute reduction in patient transport times due to the implementation of these mobile devices, he noted. Hospital IT leadership is currently developing the ability to send alerts regarding imaging test results, such as X-rays and CT scans. “We also are working to develop enhanced warnings via predictive analytics specifically around sepsis out of the ICU and potential medication adverse events,” he said.
Kull also noted that transitioning to a virtualized desktop environment added an additional layer of security to the enterprise. “Virtual desktops refresh back to the golden image at midnight every night, thus eliminating a persistent threat that may have come through an email,” he said.
Moving into the 2.8 million square-foot hospital, Parkland executive leaders realized they needed to modernize patient care through technology. “We achieved what we believe to be a heightened focus on the patient instead of the technology. We’re allowing speed and ease of use with low IT overhead for our users and for our management. The desktops are fast, apps are easy to use, and again, with the follow me functions happening with virtualization, for us, in a high touch, high transactional environment, we’re truly saving time per physician,” Kull said.