Located in Richmond, Va., Virginia Commonwealth University Health System (VCUHS) is a $1.4 billion organization that includes the VCU Medical Center, a top-ranked hospital by U.S. News & World Report. MCV Hospitals is the teaching hospital component of the VCU Medical Center, which also includes outpatient clinics and a 600-physician faculty group practice. The 779-bed VCU Medical Center is a regional referral center for the state, and is the area’s only Level I Trauma Center. Recently, HCI Associate Editor Kate Huvane Gamble spoke with VCUHS CIO Rich Pollack about a number of issues, including the health system’s major wireless transformation, the challenges involved in balancing different clinician preferences, and the decision to offer EMR access via smartphones.
KG: I’d say so. Now you’re getting set to offer clinicians the capability to access the hospital information system from smartphones, which I think is very cool. Where are you in the process, and how difficult has it been to roll something like this out?
RP: Well, we’ve had a lot of hard lessons along the way. The application initially looked great; we got it in and deployed it in on, I believe, Palm-based devices. That was a disaster — it was a pilot group, so luckily there were only about 20 physicians involved.
We dumped those devices and we went to Treos. The Treo devices worked fairly well, except that the cellular coverage in the buildings was not great. We had too many dead zones, and so the physicians got really fed up. A lot of them started handing the devices back to us. So we kind of suspended that activity for a little while, worked with the carriers, primarily Verizon, to get some additional cell tower penetration, and then with the critical care hospital, they actually injected their signal in.
So now, we’ve sort of reenergized that whole thing. During that same period of time, Blackberry became certified as a PatientKeeper platform as well, and we are a major Blackberry site. So rather than continue with the Treos, we decided to migrate everybody over to Verizon Blackberries. The signal is solid now, the Blackberry platform is well-supported here, and so we’re now in the process of moving about 400 physicians onto the PatientKeeper Blackberries. And it’s been good so far.
But we’ve had some hard lessons learned in that process of smartphone use with the physicians. I’ve had to educate a lot of my technical people in that an individual person can be driving down a highway with their cell phone and lose a connection, and it’s not a big deal. It happens to everybody. We don’t freak out about it, we just accept it. But physicians, in their use of wireless for patient care — their expectation is very different. If they’re trying to look up lab results on a patient they’re taking care of, and they lose connectivity, they have no tolerance for that. It’s really got to be a much higher level of delivered connectivity and reliability than your typical cell phone has.
I think that was something that was underappreciated here initially. But that attitude of, ‘Hey, sometimes wireless isn’t going to work’ — don’t even go there with the physicians. If you’re telling them you’re going to deliver clinical information as soon as it’s available, just in time, they’re going to start to rely on the device. Don’t even give them the device if wireless isn’t reliable; in that case they’ll just go to the next PC or terminal and look it up wired online, and they’ll be less frustrated. So that was one of our hard lessons learned, and it took us a while working with the telecom companies to overcome that.
And it’s funny because the signal outside of the buildings is fine; the problem comes when you’ve got this eclectic collection of older buildings like we have with multi-general types of construction that you get this poor penetration of wireless signal.
KG: What is the status now with the smartphones?
RP: That’s just started. They’re in the process of transitioning to them. (This month), we’ll flip over the application to the Blackberries. In the meantime, we’re taking in their Treos and giving them Blackberries, and the PatientKeeper application will actually be going live on the Blackberries in late August.
KG: What EMR system do you have in place?
RP: Cerner. We’re a major Cerner shop.
KG: And the physicians will be able to access the Cerner system from the Blackberries?
RP: Yes. The nice thing about PatientKeeper is they’ve worked with Cerner for a long time and they extract the clinical result data out of Cerner and re-present that in a format that’s suitable for the small screen of the PDA. They take the labs and put them in a fishbone diagram, things like that, which is what you need to do if you use a PDA. You can’t just simply try to replicate what you had on a 17-inch screen before.
If you sit down with clinicians, they’ll tell you what information they need at their hip. They’ll say, ‘I don’t need the whole interactive flow sheet to look at, and I don’t need pages and pages of narrative discharge summary. I just need a patient list, current lab results and the summary results of the radiology report; a few basic things.’
They’re not expecting the full experience of Cerner Millennium on a 19-inch display with bringing up the PACS images or anything like that — although we can bring those images up on the PDA. They’re really looking for a much smaller subset of critical clinical data that basically alerts them to do something; pick up the phone, put an order in, go to a terminal to do some deep inquiry, or whatever. And they pretty much understand that it’s not the same thing as the 19-inch display.
PatientKeeper has done a great job over the years of understanding that need for clinicians for a subset of critical information that could be quickly and easily presented on a PDA, and not trying to become a complete EMR in your hip pocket.
KG: Very interesting. So the big question is, by presenting with clinicians with patient data that they can access from any location, can this lead to increased EMR adoption?
RP: I absolutely think it can, because it keeps the physicians more plugged in, and so it helps in terms of their workflow. They become used to interacting with the EMR, getting that information. So they might be out to dinner and they’ll get a message about a patient on the PDA, and if it’s urgent, they’ll make a phone call from the same PDA and give instructions to take an action. On the other hand, they might look at it and say, ‘Okay, and now when I get home, I can log in from my PC and some more in-depth research.’
It kind of keeps the momentum going; you have less of a break. Otherwise, in the absence of that, it’s a situation where I can use the EMR at work and I can use it at home, but I have all this time where I have no access to it at all. You’re sort of breaking it up. This way, we keep them connected almost continuously. They’re always connected to the EMR in one shape or another.
KG: It makes complete sense. Everyone is so connected these days, so why shouldn’t doctors be able to access patient records outside the office?
RP: For physicians, residents or attending, the way life is these days, they’re never signed off completely from their patients. Their patients are still their responsibility 24/7. In the old days, you’d try to handle it by paging and phone calls if you can get them and try to describe the condition. This way, we just kind of keep the stream of clinical information flowing to the physician nonstop.