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.