I.T. Dependency Requires Responsibility
There are areas within every hospital system that are, for the most part, invisible to those who are bustling and managing patients’ clinical needs on the front end. It takes every team member to be successful. Hospitals provide critical care, surgical services, complex invasive procedures, and diagnostic testing every day. The public and staff see these services and the value and knowledge of those carrying out each task, but those behind the scenes are contributing just as much to the patient care overall outcome as those who provide direct patient care. The front-line direct care providers have welcomed an incredible amount of technology into these procedures in order to allow them to be safer, more efficient, and hold a greater power for report generation and statistical data collection, thus allowing quantifiable foundations for increasing safety and efficiency yet again.
These invisible areas are very self-contained in their management of services – as long as everything is going well and functioning as expected. Introduce one suspicion of the word “downtime” and suddenly your Information Technology teams are the most popular experts in the facility.
Moving a facility and rebuilding an entire network to run a technology-driven organization such as a high-end hospital certainly spotlighted the importance and level of impact that IT has on every single step of the patient experience and medical outcomes
UP Health System recently moved our system’s largest hospital to a newly-constructed facility. It required over two years of planning for multiple clinical and non-clinical teams and disciplines to prepare for a short 12-hour window to relocate our entire operation, including critically ill patients and all services. This consisted of reviewing current practices, finding opportunities for improvement, writing plans, testing and practicing for Nursing, Physicians and Clinical Care, Plant Operations and Facilities, Quality and Safety, Educators, Environmental Services, and Accounting/Finance, just to name a few. The list goes on and on from renewal and upgrade of dozens, if not hundreds, of levels of licensing, ordering supplies and medical equipment and coordinating interoperability, and of course, all of the necessary hardware, software, and networks required to make a large healthcare institution functional.
While some of the departments in our Level II Trauma Center were able to migrate into their new spaces on or near the actual move date, our Information Technology teams were in the new building over a year in advance. They were required to build, run, and maintain parallel systems in both facilities for months in order to install all computers and equipment, test networks, test resident and web-based programs for functionality and compatibility, and anticipate the needs of about two-thousand people who would converge on their new work space all on the same day and basically all at the same time.
While building and testing the systems and placing hardware throughout the new facility, they also had to maintain a mirrored image of the entire production at the original facility where continued care for hundreds of patients on a daily basis kept moving forward. IT manages our networks, maintains our patient electronic medical records systems, specialty area software, Emergency Department management system software, Lab testing evaluation and reporting systems, and also the control of our communication networks both for email and phones as well as all other systems that need IT support. They need to assure that all employees can access what they want, when they want it, how they want it, and preferably without any delays –ever. This can certainly be a colossal task on a normal day. Now with two functioning facilities, they needed to do this in two locations and with as little disruption as possible to all end users.
On the day of the hospital move, we relocated all patients using Paramedics and ambulances to the new location. This required dual nursing units in both locations and all of the tools needed to provide medical care. We had to maintain electronic charting ability and all systems needed to be live and functioning until the moment the patient was moved. In a six- to ten-minute window of transport time, each patient’s data needed to be discontinued and then re-appear live at the new facility, with a new bed assignment. Orders could not be duplicated to be sure we would avoid dangerous medication replication. Nursing needed access to receive the patients, know their needs and medication requirements, and view all physician orders to cause no interruption in safe patient care delivery. In order to do this, the IT system experts built a new “BedMaster” in the system, which allowed us to electronically assign patients a bed, and confirm patient location for all of the other departments/areas that need access to that patient both physically and electronically.
Each patient transfer was managed within the Patient Move Command Center by System Specialists as soon as the patient left the sending facility. In that six to ten minute time span, the patient needed to be relocated electronically to their new bed assignment and all other systems that feed off of that BedMaster needed time to receive that information and load successfully.
As a Healthcare Risk Manager, I spent many nights pondering the potential for error on patient move day and the possible consequences. Our back-up plans had back-up plans. Fortunately, things went well. On any normal day, however, back-up plans consist of paper and manual systems. Let me step back to that word that can really shake up an otherwise mundane and routine day, much less a day of complete changeover to a new location. Downtime can be expected, and unfortunately can also be unexpected.
In healthcare, we are very presumptive and confident in our IT systems to be available and functioning, providing what we want, when we want it, and how we want it, as noted previously. Practicing downtime procedures on a regular basis is critical to avoiding catastrophic patient outcomes Not having a backup plan and solid downtime procedures with access to critical information impact the ability of the healthcare teams to properly care for that patient. From an emergency management and risk management perspective, lack of functional and familiar downtime procedures is a fail. While some industries may find downtime a serious inconvenience, a lack of critical patient information in an emergency can lead to poorpatient outcomes. Development of procedures and staff awareness and testing of these procedures when not under duress is critical to safe patient care. When management proclaims “yes, we have downtime procedures”, but the nurse or lab technician working at 2 a.m. on a weekend is unaware of when or how to utilize them, they are being over-confident to a fault that can jeopardize lives.
Moving a facility and rebuilding an entire network to run a technology-driven organization such as a high-end hospital certainly spotlighted the importance and level of impact that IT has on every single step of the patient experience and medical outcomes. Dependency on these systems also comes with great responsibility by leadership to assure all vulnerabilities are known and have been assessed, and that a plan to function and continue care is in place and usable. Fortunately, for our large undertaking of the full-facility relocation, our IT teams did some incredible work that was very visible. I can only imagine what work was required and accomplished in the background of which we were not even aware. We continue to learn and grow as we are only in the infant stages of getting comfortable and running at full efficiency in our new building, but IT is at the table every step of the way as, in one way or another, they touch every aspect of healthcare delivery.