Knowledge-enabling the noble art of medicine

In the Hippocratic oath, physicians pledge, among other things, to "impart a knowledge of the art ... " But the importance of conveying and sharing knowledge extends beyond doctors to everyone in the healthcare profession.

To ensure that they have all the information they need to make decisions and best serve their patients, healthcare organizations are embracing such information technology solutions as business intelligence, content management and Web-enabled knowledgebases, to name a few.

Proactive business intelligence

Dean Medical Center Dean Medical Center, for instance, in Madison, WI, has implemented a Web-based business intelligence solution for 22 regional clinics in four counties. The application has been so effective in freeing IT resources that Dean Medical officials expect it to expand from its 25-person user base of clinic directors to 125 more users in financial and analysis functions within the regional offices.

A component of Dean Health Systems, Dean Medical Center provides care to more than 200,000 patients through 315 providers in the 22 locations. As it has grown over the years, so has its need to track patient services and overall performance. In recent years, disparate, often homegrown, reporting and analysis systems were created to help doctors and operational directors run the clinics more efficiently.

Ron Thomas, financial reporting specialist, and Brett Hoffmann, who is responsible for IT support of such systems at Dean Medical, wanted to find a better solution.

Before choosing Comshare Decision and Microsoft SQL Server OLAP Services, the medical center had been looking at various reporting tools and multidimensional databases.

"Because Microsoft SQL Server is already being used at Dean Medical," says Hoffmann, "we were able to realize one-time cost savings of an estimated $75,000 over using a competitor product, while providing multidimensional capabilities that a pure relational database would not provide."

Administrators wanted a BI system that would pull information from different financial and non-financial data sources--such as payroll, accounting and budgeting, capital assets and human resource information--into a single, centralized database that could be accessed by geographically dispersed users. Ideally those users would find the information they needed to make decisions without burdening Dean Medical's already stretched IT department.

The new system, Hoffmann says, "allows us to tap information contained in our accounting, payroll and human resource systems, as well as our data warehouse, to help our users run the business more efficiently at the clinic level. Even non-technical people can use the system and easily build and access multidimensional views of data."

Thomas reports that the new BI system enables users to understand and analyze data in a more proactive way.

"Today we are more proactively monitoring information and identifying trends that help us take action before events create problems," Thomas says. "By putting information management in the hands of regionals users, we have created an environment where decision-making is more timely than ever before. Users can access information and create reports easily, plus power users can create calculations and what-if scenarios on the fly."

Says Hoffmann, "We are already looking at add-on budgeting capabilities ... to incorporate strategic planning, budgeting, forecasting, management reporting and analysis. Creating such an all-encompassing system is something that Dean Medical would like to do soon as well. We are only limited by our own imaginations."

Providence Health System has implemented a new content management system as part of its expanding Web initiative. The $1.8 billion healthcare delivery network, headquartered in Oregon, offers an array of services in that state, as well as in Washington, Alaska and California.

Because of the importance it placed on a new customer service Web site and corporate intranet for its regional offices, Providence wanted them running as quickly as possible, and, after evaluating several Web content products, chose Participant Server software from Eprise

Self-service site: key differentiator

Providence's Health Plan members, who number a million, and its other customers can use the site to search provider directories, change their primary care physician or provider online, review their specific medical benefits, preregister for Providence hospital stays and research general health information. The corporate intranet will be used to support and streamline administrative processes.

In choosing a solution, Providence wanted to not only educate the public on health issues, but also meet the needs of major subscribers.

"Two of our biggest corporate customers told us that online customer support was an absolute necessity for continuing to use Providence," explains Erik Sargent, lead Web developer for Providence Health System. "Oregon is an Internet-intensive region so we knew that a sophisticated self-service site would be a key deliverable to our customer base and a strong differentiator in the marketplace."

Ease of use was a critical factor in Providence's choice of software, he adds. Site maintenance and content contribution responsibilities are spread throughout the health system to keep information timely and informative, and to ensure an effective communication vehicle. Of the more than 200 content contributors to Providence's intranet, 90% are non-technical people, ranging from nurses to administrative assistants.

"Our criteria were pretty straight-forward," says Rick Skinner, chief information officer at Providence Health System. "The content management system must have a simple user interface, it had to integrate well with our databases, it had to support both Internet and intranet functionality in terms of security controls and interoperability with our back-office systems, and it had to be up and running in less than 60 days."

Users across the healthcare organization will be able to use the system to submit, edit, approve and post content on the fly and then have it presented to the appropriate audience at the time.

The birth of DM

When it formed in 1998,Louisiana Women's Healthcare Associates had the daunting task of merging 10 separate medical practices into one comprehensive, 17-doctor obstetric and gynecological facility.

That meant consolidating the individual infrastructures, procedures and paperwork of each practice into one comprehensive system. Included in that task was incorporating the records of 55,000 patients from 10 different charting systems. Each doctor had 4,000 to 6,000 individual patient charts.

"We had to decide whether we wanted to do it with paper or with computers," says Tom Schmidt, CEO of Louisiana Women's. The healthcare organization eventually chose an automated solution that integrates Fortis document management software from Westbrook Technologies Westbrook Technologies with the Medical manager billing management application for doctors.

Louisiana Women's Healthcare took the solution a step further by incorporating Fortis PowerWeb to provide access to information via Internet browsers.

"Right now doctors go in the exam room with a small, hand-held computer with a writing surface," Schmidt explains. "As they speak to the patient they retrieve the record on the computer. New information is taken down on paper, then it is scanned into the system after the examination."

PowerWeb also allows doctors to connect to the information database via a secure Web link.

The ob/gyn facility plans to incorporate PowerWeb into its Web site to provide patients with access to certain information.

"We want patients to become more active in their health. That's the whole paradigm of healthcare," Schmidt says. Internet access also will ultimately provide patients with educational information about women's health issues, individual test results and even video AV files for sonograms.

The solution at Louisiana Women's Healthcare Associates recently won Kinetic Information's Kinetic Information Vision 2000 Award and its Healthcare Vertical Market Solution Award.

Vital info for Vitas

A large provider of hospice care has embarked on a multimillion-dollar, multiyear project that involves installation of a new Web-based patient management system. Vitas Healthcare will use technology from BlueFlame to track data across its 32 sites nationwide.

Blueflame developed Vitas' original enterprisewide patient management system from 1992 to 1996. The client-server system, which is still in use, was designed to run on a DOS-based PC infrastructure.

With the new system, healthcare professionals and decision makers can access the most current data about their patients online--data that is needed to make life-or-death decisions sometimes. Vitas officials also say the solution will help them monitor and control costs.

The system comprises patient care, clinical systems and interventions, triage, billing, accounts receivable, human resources, payroll, staff scheduling, marketing, paging, IVR, management reporting and fax capabilities. A security system controls access to each part of the system via user-specific profiles, and an electronic signature mechanism controls the approval of events. In addition, Blueflame will develop a wireless, Web-enabled application to give Vitas caregivers patient information at any time or location via handheld devices.

"The system helps us achieve our ultimate business goal of improving the quality of patient care while allowing caregivers to monitor and share knowledge and best practices," says Karen Rosenberg, VP of IT Services.

Resolving problems

Like all large enterprises, healthcare providers need good services to support their complex technology needs.

The University of Utah Hospital & Clinics The University of Utah Hospital & Clinics wanted an electronic resource to help solve IT problems--one that would involve a large repository of solutions to the most common desktop problems, as well as to issues specific to the medical environment and healthcare applications. While a desktop suite was a good foundation for the support team's problem solving needs, the hospital also needed a knowledgebase of customized solutions.

The Customer Services team supports all of the facilities contained within the University of Utah Hospitals & Clinics, plus the School of Medicine. More than 5,000 physicians, administrative staff and medical students rely on the team's 20 support analysts and Integrated Data Management team leader, Michele Mills. At any given time, about half of Mills' team is answering calls--1,300 to 1,600 per week on average. The other half is dispatched to handle onsite services.

A key challenge, Mills says, is dealing with increasingly diverse applications--some of which are "homegrown"--that run much of the patient care equipment. The university has standardized with the Microsoft Office Suite within the hospital itself, but standard operating systems and applications have been harder to implement in clinics and academic facilities.

The result is a myriad of custom programs, without a centralized resource of solutions. To solve that problem, the Customer Services team turned to Serviceware's eService Suite, a set of integrated solutions that allows the organization to quickly and accurately answer inquiries made via Web, phone, fax or in person.

"Everyone on the team had opinions on how to solve particular problems," says Mills, "but no one wanted to take the time to write them down or organize them for use by others. It was imperative that our solution enable us to build and organize a quality knowledgebase through a customizable and minimally intrusive process.

"The new software enables the team to capture its collective knowledge and put it to use in problem resolution. Now analysts have immediate access to the solutions in their custom knowledgebase, with an interface that connects them to packaged IT knowledge and custom knowledge created by ServiceWare. They can view the solutions in a question-and-answer format, or they can focus on the exact solution using search technology from Verity

How is the team measuring the success of the knowledge management initiative"First and foremost we'll gauge success by whether or not analysts are using the knowledge tools," Mills says. "We're taking a close look at usage and putting incentives in place."

The University of Utah Hospital & Clinics, she adds, is already reaping benefits in terms of decreased length of call time and improved quality of calls.

"We can look back and evaluate not only how long it takes our analysts to get to the right answer, but their overall effectiveness in responding to inquiries," Mills says. "In an age when high turnover in IT staff is commonplace, the ability for us to tap into the knowledgebase of our service team--and record that information for future use--is critical."