KG: When you started at Lowell, what type of system was in place - was it mostly paper-based?
JG: No, we had a homegrown Web portal that we fed information into from disparate systems. So primarily, results of labs and things like that, and a handful of other things about the patient record that we were capturing electronically.
KG: And this is where you came in?
JG: Right. They brought me in to address a handful of things; address the departments, address the infrastructure, put in a new data center, put in a new wireless network, as well as a housewide system evaluation.
It was everything from refreshing the entire desktop environment, doing some standardization on what goes on the desktop, as well as putting in a brand new data center and doing a full evaluation for a complete HIS.
KG: What did you decide for the HIS?
JG: We went with Cerner. Our device strategy was multifaceted. We started with, obviously, the desktops. We also went with Motion Computing slate tablets on Ergotron (St. Paul, Minn.) as well as in carts and wall-mounted cabinets with full-sized keyboards and mice. This way, the nurses or physicians could use it outside of the room like a regular computer, or they could take the slate out of the docking station and bring it right into the room where they were going. In addition to that, we do have mobile carts, computers on wheels, and we also have roughly 200 Motorola MC70 handhelds, which we use for some nursing documentation, IMOs (inpatient medication orders), as well as closed loop medication, barcode scanning, medication checking.
So an array of different devices - those devices that are appropriate for each location.
KG: Was it a big bang implementation?
JG: It was, yes.
KG: How was IT able to pull something like that off, not having a huge pool of resources?
JG: It wasn't an IT project. It was an organizational project - that's what makes these projects successful. You do something like this, and it's driven from the top-down. The entire administration and C-suite drove the project. So it wasn't, ‘We're putting in a computer system.’ It was, ‘We're changing the way we're delivering healthcare to this community,’ and as such, we're looking at every one of our processes and workflows, and how we can leverage the technology to help streamline processes and provide enhancements to the care process as opposed to looking at it purely as a tool that we need to work around.
KG: How long was the process?
JG: From start to finish, the implementation itself was a little bit under 15 months. And that 15 months was from execution to conversion. So what we had prior to that was a system evaluation phase, and after that we executed an agreement, we put a lot of upfront time on planning the scope of what we were actually going to do.
KG: Once you went live, was it a smooth transition? Were there any serious issues?
JG: It was extremely smooth. We brought everything up, and 14 days after we went live, we closed down our command centers and it was business as usual.
KG: That's a pretty short time period. Was that less time than you expected it would take?
JG: I figured it would probably go for about a month.
KG: It's always nice when that happens. So to support all of these devices, what was required as far as infrastructure?
JG: We put in a whole, completely new wireless infrastructure. And the slate computers, the mobile carts and the MC70s are all running over that wireless infrastructure. The tablets are from Motion, and the wireless infrastructure is Extreme Networks (Santa Clara, Calif.). Motion did help us with a wireless evaluation, because we were investing so highly in their devices that we wanted to make sure that everything played well together.
KG: What did the evaluation entail? Were there concerns about connectivity?
JG: It really was just a matter of doing site surveys and making sure that we had access points placed appropriately and that we didn't have conflicting signals. So now we're using the three different radio bands - A, B, and G - for different devices, making sure there isn't too much bleed from one to the other. The basic things you do when you put in a wireless environment.
KG: Do you have CPOE?
JG: We do. We went live with CPOE in the initial implementation as well as physician documentation in the emergency department.
We have not finished rolling out CPOE housewide; we are in that project right now. We're in the planning phase; we anticipate starting the project phase this summer.
KG: Will you need to make any adjustments to ensure wireless coverage?
JG: I don't anticipate that we're going to have to look to add anything; our buildings remain intact as they are today. We are in the process of a capital building campaign, so down the road, we anticipate taking some buildings down and putting up some new buildings.
We have submitted our request to the state as well as started a campaign. We're waiting to go to bond, but our timing obviously isn't the greatest.
KG: We're hearing a lot of that. So you're in a bit of a holding pattern as far as that goes?
JG: Yeah, but we're still moving forward. We're still making changes; we're still making moves. We've acquired some other facilities off site where we're relocating different departments. The IT department has been relocated to a nearby city, where we have a redundant data center and the IT staff there. We're clearing out those buildings that are coming down. So we're actively still working toward the project.
KG: Where is your data center set up right now?
JG: We have one here at our main hospital in Lowell, and our secondary data center is in Tyngsboro.
KG: Are there any other projects you're looking at in the near future?
JG: We're in the process of implementing a wireless phone system with integration with our nurse call system, and integration with our telecommunications system for seamless communication from phone calls coming in to pages going out, all from a central location, as well as integration with those physicians or other individuals or clinicians who would be carrying those wireless phones, and pushing results to them. As far as the initial implementation, with Cerner, we've also been doing bidirectional medical device interfaces to our monitors. So, looking at enhancing and adding on more connectively to medical devices.
KG: I read that Lowell was installing monitors in the rooms where patients could access the Internet and watch TV. Is this live, and does it speak to any other systems?
JG: That was done in conjunction with the other major project, or shortly thereafter. It's the Skylight (San Diego) system, so it is a patient entertainment informational system that allows them to have on-demand movies and television as well as Internet access and play computer games. We also have the ability to order meals and fill out surveys. In addition, we're working toward pushing patient education to those devices to be ordered within the Cerner system, which will trigger the Skylight system to play a patient education movie. After the patient watches and accepts the movie, it automatically gets documented in the electronic medical record.
KG: Very interesting. How is that tie-in going to work?
JG: So you have a patient going in for a cardiac procedure. When a nurse orders the cardiac patient education, that information gets entered into the EMR, and that triggers the viewing of the video and the resulting acceptance from the patient, which then would document it in the EMR. That isn't in place right now; it's something we're working toward.
KG: What wireless network does the Skylight system ride off?
JG: That is actually a wired network and it's a separate network provided by Skylight.
KG: So in a matter of a few years, Lowell advanced very quickly in terms of IT systems. I would imagine something that like can't happen at a smaller, community hospital unless you have a very forward-thinking administration.
JG: Absolutely. The CEO, the COO and the chief nursing officer are all extremely engaged with all of these projects.
KG: That seems to be a recurring theme at hospitals and health systems in Massachusetts. Is collaboration part of the culture up there?
JG: I think, speaking on behalf of our organization, we certainly aren't the typical larger or mid-sized community hospital in Massachusetts. The community hospitals here in Massachusetts have primarily been Meditech shops. It's a good system - it works. But it doesn't necessarily provide the depth of feature function that you're getting out of some of these more contemporary systems. Certainly we do see the progression across the teaching hospitals or the Brigham and Women's, Mass General, Partners, Boston Children's, and Baystate out in Western Massachusetts. We have a lot of academics, we have a lot of focus from Harvard, etc., and I think because of such a collegiate environment we have here in Massachusetts, that causes people to push to want to have the very best.
KG: When it comes to pushing through health IT initiatives, do you think it's more difficult for the hospitals that aren't part of the large systems?
JG: I think it's very challenging. We're a mid-sized, non-profit hospital. We're the fastest growing hospital in the state, going on six quarters in a row, and we have the lowest length of stay. Prior to those six quarters, we were the second fastest growing hospital in the state in terms of volume.
So I think it is a challenge, but I think the great things we're doing here - the introduction of technologies, being the only hospital in the Merrimack Valley that has a DaVinci robot and is making significant investments across the board in technology - all of that is making a big difference.