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.
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