IT Strategy at Nationwide Children's Hospital Sticks to Basics

Even though healthcare is under tremendous pressure to improve outcomes, reduce costs and increase efficiencies, the famous healthcare mantra "do no harm" guided the technology decision-making that went into the newly completed hospital to Nationwide Children's Hospital in Columbus, Ohio.

"It is possible that the technology will bring savings by insuring that we better utilize nurse and physician time," says NCH CIO Denise Zabawski. "If the family and patient are happy with their stay at Children's and the care they receive, they are more likely to return to Children's. However, we did not set any financial goals or plan to measure for improved growth or savings."

NCH's new facility is the largest pediatric construction project in the nation, and it makes NCH one of the largest pediatric hospitals in the country. Each of its 12 floors is bigger than a football field; the whole project took seven years to plan and $430 million to build. With the addition of the new hospital, NCH will treat more than one million patients in 2013.

It's not often that a CIO or her IT department gets a greenfield opportunity of this caliber to work with. You might think she pulled out all the stops and installed as much cutting-edge tech as she could. But that's not what happened.

Better Staff, Clinical Workflow Target of IT Investments

When it comes to technology, healthcare is catching up to other industries. The reasons are many, said NCH's CIO Denise Zabawski, but the bottom line is that a pediatric hospital that admits only the sickest kids-some of whom stay for months, even years-is not the place to learn that a vendor was reaching a bit when it promised something would work.

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"A lot of what we put in the hospital was the [clinical staff's] desire to improve workflow processes," Zabawski says, as well as "safety and quality, to make it easy to do the right thing and hard to do the wrong thing for patient care."

With these marching orders in hand, Zabawski's team got to work. Fortunately, it came on board early to work closely with the clinical staff to find out what worked and what didn't. Taking a page from NASA's playbook, the team built full-scale mock ups of patient rooms, the ER and other key hospital departments so staff could study their layout and suggest where to put things. Cardboard cut-outs had to stand in for some to the new tech, but as much of the room as possible was functional.

"We were heavily involved," Zabawski says, "because we needed to understand where phones went, where network jacks went, what kind of density we needed for network based on technology and where the head end equipment was going in."

NCH also pushed vendors to customize the Intego Software nurse call system (the familiar bedside buttons) and Vocera paging system (which alert staff when a patient needs help) to work together more effectively. When a child's life is on the line, you don't want a code going out to the wrong team, explains Louis Nyktas, manager of NCH's converged networks services team.

The wireless call system at Nationwide Children's Hospital makes sure the closest staff member responds when a patient alert goes off.

"When an alarm goes off in a room-this person's oxygen level is dropping, this person's heart rate is going too fast-it can send out an alert directly to the person who needs to be involved," he says. "And if somebody doesn't respond within a certain period of time, it gets escalated to multiple areas." (Fortunately, the system works just as effectively when the patient wants more ice cream.)

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The paging system uses a hands-free 802.11 badge with voice recognition capabilities that tell nurses and doctors where they are needed and what's going on. The idea is to keep staff closer to patients and farther from the nurses' station. Five hundred wireless access points (APs) support this system-and give families and patients a lot of bandwidth. In fact, Nyktas says, because people download so many videos, movies and other data, NCH carved out and dedicated a piece of the data center for just this purpose.

Many staffers, depending on their role, have a second badge showing where they are so they can be found quickly. But this serves a secondary function of telling the control center who is in a patient's room. "We've really improved the patient care from having the users get this information wherever they are," Nyktas says.

On top of this system, many docs still rely on pagers-after all, they are reliable-but Nyktas and his team are testing Vocera for the iPhone and Android so docs can have private conversations on the go.

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IT is also responsible for a number of other tracking and safety systems now that used to fall under the purview of other departments. To cut down on mistakes, all meds and blood draws are barcoded, as is all the breast milk the hospital uses.

In addition, since NCH also manages the neo-natal intensive care units at central Ohio's two other main hospital networks, OhioHealth and Mt. Carmel, with nine facilities between them, NCH's IT department is ultimately responsible for safely feeding thousands of babies every day.

IT Staff Must Support Patient, Physician Needs

As mundane and ho-hum as barcodes and Wi-Fi sound, this tech is incredible important to patients given the medial errors it prevents, says James Ranjitsingh, clinical information systems manager. That's because as much of a patient's hospital visit as possible is tied to his or her electronic medical record from Epic Systems. Nationwide Children's Hospital has been a leader in adopting EMR technology, Zabawski says, noting that doctors haven't entered handwritten orders at NCH since the early 1990s.

RFID devices and QR codes help ensure that patients at Nationwide Children's Hospital receive the right medication.

"I agree that the technology in of itself is not bleeding edge but the work that we put into the tight integration with the technology is really where the magic happened," she says. "That was the big leap for us."

When it comes to user-facing technology, the IT department has two distinct implementations to manage. For patients, there's the in-room "edutainment" system that provides information, games, movies, live broadcasts from the stage at the Galaxy Lounge play area, and the ability to order meals any time. For staff, there's a combination of thin clients (Hewlett-Packard), virtual desktop infrastructure (Citrix Systems) and single sign-on (CA).

Rooms at Nationwide Children's Hospital give patients access to video games, movies, meals and information about their treatment.

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Eventually, Zabawski says, the plan is to roll out VDI to the whole facility. The convenience, time saving and productivity gains are undeniable. The biggest win, she says, is the "roaming profile" feature. "If you're a clinician and you're in your office and you sign on to Epic, if you go up to the floor and you sign on, you are in the same place you were when you were in your office. That's been a big satisfier for the physicians."

This type of functionality also extends to ultrasounds. These are broadcast over the Wi-Fi network so doctors can see them in real time from any device connected to the VPN. This includes a few doctors based in Hawaii. In the past, docs had to use a dedicated viewing room or take a 10-minute walk to the radiology department located in the older hospital wing.

Long-term Healthcare IT Strategy Addresses Device Integration, Big Data

With all this back-end integration, you might think a new data center would be in order for Nationwide Children's Hospital. Instead, though, the new facility needed a main equipment room and 29 telecom closets. NCH is planning for future needs by looking at converged infrastructure (CI) solutions to turn its disaster recovery facility into a high availability hot-site and use VMotion for load balancing for Tier 1 apps.

Nationwide Children's Hospital added telecom closets to accommodate its technology upgrade, but thanks to virtualization it didn't need a new data center.

So far, so good-but this is just the beginning, Zabawski says. "We went through an exercise of must-have, nice-to-have and then a wish list. We managed the budget with the must-haves. There's some still nice-to-haves that are still on our list."

One example is the capability for an individual patient's EMR to be able to automatically reset the dosage of a medication pump. Currently, NCH is testing real-time location service technology to manage the pumps' location, and IT can remotely push OS updates to all the pumps, but that's where it stops.

Nor does it stop with pumps. There are many more medical devices that Zabawski would like to integrate with clinical software systems, making them part of what she calls "the converged network," and to manage automatically.

Finally, Zabawski wants to integrate Epic and the in-room Get Well patient engagement system with a pain management system that lets kids to check in every hour and indicate how they feel based on the faces pain scale.

Along with bringing the rest of the 57-acre campus to the same standards of the new hospital, Zabawski, like most of IT these days, focuses on data. "We have the data from the EMRs, the data from the nurse call system, the data from Vocera," she says. "How do we use that data to improve? How do we improve care? How do we improve outcomes? That's a big part of the next two to three years."

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For Nyktas, Ranjitsingh and rest of the IT crew, this means more back-end work to keep all these integrated and interdependent systems functioning properly. This adds complexity from a support standpoint-but that's OK, Nyktas says.

"On the front end, we want to make it as simple as possible for the users. That's the purpose and that's the goal, to make it less complicated for them," he says. "It proves, from a safety standpoint, that we're responding to the kids' needs at a much faster time, and the right people are responding to it."

Allen Bernard is a Columbus, Ohio-based writer who covers IT management and the integration of technology into the enterprise. You can reach him via email or follow him on Twitter @allen_bernard1. Follow everything from CIO.com on Twitter @CIOonline, on Facebook, and on Google +.

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