Children’s Hospital Boston is a 396-bed pediatric medical center that treats more than 527,500 patients annually and is the primary pediatric teaching hospital of Harvard Medical School. As one of the largest pediatric medical centers in the United States, Children's offers a complete range of health care services for children from birth through 21 years of age. It is a certified Magnet hospital for nursing excellence, and was ranked first in five specialties in the 2009 edition of America’s Best Children’s Hospitals as featured in U.S. News and World Report. Recently, HCI Associate Editor Kate Huvane Gamble spoke with Senior VP and CIO Daniel Nigrin, M.D., and CMO Eileen Sporing about the importance of involving nurses when selecting and implementing IT systems, the issues they’re looking to solve in rolling out technologies, and the fundamental differences in caring for pediatric patients.
KG: Do you have a real-time location system in place?
ES: Only in the ED.
DN: We have been scouting a few of those technologies for equipment tracking, but it has not been deploying widely. We’re still evaluating RFID, but not to track people.
KG: So it’s something you’re planning on further down the road?
DN: I think we’re going to keep looking. We’ve had some marginal success with the pilot, but the problem is that there are multiple competing technologies, and to us, it’s not entirely clear which is going to be the winner, so to speak. So with that industry in flux, we’re taking a more cautious approach.
KG: That sounds like a smart strategy. What about your EMR system? You have Cerner, right?
DN: We do. But just to be clear, we actually have a hybrid system. The majority of the pure clinical applications that our nurses and doctors are working in is a Cerner system, but we also have an important Epic footprint with respect to patient registration and ADT systems, as well as patient scheduling and hospital billing.
Some of the infrastructural systems related to clinical encounters are Epic-based, but the application that the doctors and nurse are using most often is the Cerner system.
KG: So you’re not best-of-breed, but you’re not a shop of one particular vendor.
DN: We do try to limit the amount of vendors, so we’re definitely not a best-of-breed shop. But we’re also not the other extreme where we’re only going to deploy applications from a single vendor. We try to limit most of our systems to being from either Cerner or Epic, but when necessary, we make exceptions to that rule.
KG: Do you have any plans for bar coded medication administration?
DN: We have a pilot running on three units using Cerner’s handheld technology, and hopefully over the course of the next year we’ll be ramping that up to extend beyond those initial three units.
KG: Now with that that particular technology, are you looking first and foremost to improve patient safety?
DN: Yes. In fact, even in this pilot already, we’ve seen some pretty impressive “good catches,” where the handheld device is firing off an alert that a medication was about to be given inappropriately to a patient for whatever reason. We’re tracking those as best we can, and it’s impressive already the numbers that we’re seeing, just based on these three individual units.
It underscores also the focus of CPOE being the only thing that’s going to reduce errors; that’s an important point that there are many other steps in the process in which errors can occur. And so the point of administration is one in which we know that errors occur, and frankly, that’s the last point where you’re going to be able to intervene before a medication is given inappropriately. So we think it’s very important.
KG: Another common driver I’ve heard in implementing technologies is for nurses to be able to spend more face time with patients. Is this something you’re striving for?
ES: Absolutely, but I think that in the real world, there’s a huge learning curve with getting accustomed to using this technology, so to expect that in the beginning is probably not realistic. For us, clearly, one of the benefits of having an electronic medical record is that we see a lot of repeat patients, and the time that both nurses and physicians used to spend pouring over old records, trying to find information in the paper record has almost been eliminated, because now that real-time review can occur with the family and the patient at the bedside. So that’s been a significant improvement.
KG: Earlier, you touched on some of the challenges that are unique to pediatric care. Can you elaborate a bit on that?