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Category Archives: EHr

Hospitals are losing billions in 2022, how can IT improve ROI with existing infrastructure?

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healthcare financials

Hospital margins have been challenged by increases in labor expenses and shortages coupled with declining admissions and procedures. As financial pressures increase so too does the pressure on all departments to provide more value, more savings, and a greater ROI. Costs are rising faster than hospitals can raise revenues and prices.

There are a lot of solutions out there that offer promise of greater efficiencies for clinicians, new cloud based software that can provide greater insights into care practices and increased billing. Beyond the internal benefits, there are additional advances in hospital at home programs, and remote monitoring for chronic conditions. There is a learning curve to these systems, and for most it can often take months or years to realize the promised return.

How do you provide greater cost savings and efficiencies in care through existing IT networks and infrastructure? What can IT departments do now that doesn’t require education and training campaigns, massive investments in infrastructure or new systems?

In healthcare we know that early identification of problems is key to the most effective treatment. This is no different when it comes to IT systems ensuring safe and effective patient care.

How about monitoring the reliability of their current networks? All of these interconnected solutions require connected networks to function optimally and provide the necessary advances in patient safety and clinician efficiency. Buying the latest cloud-based AI solution to improve diagnosis, treatments, safety, and insurance denials, is only useful when the network is functioning.

Back in 2018 network reliability was identified as one of the risks to patient safety, what have systems done since then to ensure reliability? The pandemic likely radically changed or accelerated certain IT investments, moving up some upgrades or canceling others.

Calculating a basic ROI for pro-active network monitoring can be accomplished, just looking back at previous blog posts we can often see the time used by staff on this activity. If end-users are monitoring the network and checking for transmission of data and reports, their time is easily measured and value assigned. Are the IT departments measuring this time? Unlikely, but the unit managers can tell you how many hours each person spends on this.

  • When we considered the Cath Lab in a previous post, an RT or RN spends 3-5 hours every week checking feeds. Multiply this by every imaging area in the hospital, the numbers add up very quickly, at the most basic there may be 4 different imaging areas connected.
  • Pharmacy systems were also previously reviewed, how much time is spent reporting issues? It can be up to 20 minutes of a nurses time on the phone troubleshooting, likely with at least one additional call back.
  • How about remote monitoring programs? How much time will a nurse or physician spend on the phone with a patient trying to troubleshoot transmissions only to find that a connection was interrupted within the hospital’s own system?

Taking a look at the overall IT infrastructure the numbers can quickly add up throughout a hospital or health system. How often are feeds interrupted? Likely not that often, but even a single interruption after a monthly update can have significant ramifications to productivity when spread across an organization.

Those are the simple calculations to measure ROI, more difficult to measure are the ramifications to patient safety, staff satisfaction, and perhaps even future IT investment. If “nothing ever works around here” then there will be difficulty getting clinician buy-in to adopt the newest and best technologies.

Pro-active monitoring can enable early detection and warning. A simple message from IT can alert staff that IT is already aware of a problem and working on a resolution. Is IT optimizing the existing infrastructure to provide the best ROI?

Tido provides automated end to end monitoring solutions that will automatically alert your teams there is a disruption.

Systems reliability and the impact on safe medication administration.

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Medications Tablets

 

Inter-operability among systems in healthcare offers great hope for the exchange of patient information, ensuring clinicians are acting on the most up to date information possible and offering a double check for safety. Technology has become so central to a functional clinical environment that it powers pharmacy systems, saving time by performing critical checks. This technology has become so entrenched in the hospital that there are alerts and checks at almost every point of the medication transaction, from the time of order right through to administration.

How much can technology help patient safety? According to the NIH computerized physician order entry has reduced serious medication errors by 55%. Patient wrist band scanning is associated with a 51% decrease in adverse drug events at the time of administration. All of these systems, from prescribing to administration require connections to function properly.

The systems are there as a double check for patient safety, in a busy patient care environment mistakes can happen due to quick glances at labels or errors in manual dose calculations. No clinician wants to harm their patient, and we’ve come rely on these systems to make sure we haven’t missed anything. What happens when these systems are bypassed? Most of the time nothing happens, most errors may result in administration at the wrong time, or a dose that is not therapeutic. However there are times when a medication error can cause harm, at the most extreme death from an adverse drug event.

Why would any clinician bypass these safety systems? Emergencies are one area where automated safety checks are bypassed and manual checks are the norm. The other is when connections are down. If allergies aren’t updated in a pharmacy system from the EHR, an interaction may be missed. If medications aren’t updated from the pharmacy to the EHR, doses may be missed or medications over-ridden in the dispensing system.

Who monitors these connections to ensure they are operating? Most often, nobody. They are assumed to be working until someone reports a problem, because most of the time they do work.

Picture a busy unit in a hospital and let’s consider a broken connection between pharmacy and the medication cabinet.

    • Physician enters the order in the EHR, it is sent to and received by the pharmacy system.
    • Pharmacy reviews and approves the medication to be removed from the cabinet.
    • Nurse sees the order, 30 minutes later goes to the cabinet, does not see the medication on the patient’s list, and overrides it to give to the patient because they need it (safety concern).
    • The nurse double checks the patient, medication, dose, route, allergies to confirm the medication is appropriate, does not check interactions because they are in a rush and the patient is only on a few meds. (safety concern).
    • Nurse administers the medication, but has to override the bar code scan because the approval was not received from pharmacy (safety concern).
    • The nurse assumes pharmacy is just slow and goes on with their day.

In this instance, there is no error and no harm, everything went as expected despite the nurse missing the check for interactions. Will that be the same for the next nurse administering the next medication? It may not be several hours until the nurses realize that no new medications are being approved from pharmacy, at which point someone will call pharmacy, who will call the IT help desk. This will begin a chain of tickets to IT specialists and vendors to start checking pharmacy feeds. Several hours and countless medication administrations after the feed went down.

This isn’t a made up scenario, it occurs countless times in hospitals all over the country. Hospitals rely on physicians, pharmacists, nurses and others to manually check when systems go down. But if nobody realizes the system is down, some checks might get missed. This poses a safety concern for patients and removes critical check for busy staff who rely upon it. It could take an entire shift for a nurse, doctor, and pharmacist to manually check every medication for a single critical patient.

What if these systems could be automatically monitored and IT teams notified immediately if a feed was interrupted? Staff that rely on safety check in systems can rest assured that they are working, that the system is operating as intended. If there is a problem, they can be quickly notified and make sure they are following processes meant to ensure safety when systems cannot.

Tido provides automated end to end monitoring solutions, that will automatically alert your teams when there is a disruption.

Low visibility tech that has a high impact for clinical staff.

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Cath Lab Technology

How to avoid staff sentiment of “nothing works like it’s supposed to.”

Low visibility tech that fits so seamlessly into a workflow, we don’t know it’s there until it tells us it is.    Tech that actually saves clinical workers time and allows them to focus on patients, could it exist?

Absolutely.  There are so many systems healthcare is reliant upon, when they fail to connect, big problems arise that will have a big impact on clinical workers.  This can be such a problem that many clinical areas within hospitals will dedicate a person to check information is flowing where its supposed to.  They are not IT, they are patient care professionals taking time to check these systems because they know the problems that arise when patient information doesn’t flow.

Consider a Cardiac Catheterization Lab, the simplest lab might have 3 different systems, the most complex, maybe 10 or more.  A typical solution to checking systems within a lab:

  • Everyday, or every week, a Cath Technician or Nurse may spend 3 – 5 hours checking reports to make sure they went to the EHR, and images to make sure they went from the local system to the PACS/VNA/EHR/DICOM.  At best any interruption in transfer is caught before the patient leaves the procedure area, at worst, it is not caught until someone is looking for the results.
  • Once the interruption is caught a staff member will check operations on their end to make sure it wasn’t an issue with what they did.  Then they reach out to the IT help desk to report the problem.  IT will ask several questions and have the staff member perform checks manually to make sure everything was done correctly on the user end again.  
  • At this point the IT help desk will forward the ticket to another area or vendor if needed.  In a serial manner, the issue will get passed until the proper team or vendor is found that controls the part of the feed that was interrupted.

This is what happens during normal operating hours.  Most interruptions to connections occur when upgrades to one of the systems happen, most often during the night or weekends when staffing is lightest.  Cath labs have staff that are on call for emergencies, but not on site during those times.  If they are called in for an emergency they may discover the problem when they arrive and have a ‘network failure’ message on one of the systems, or it may not be discovered until after they have left the building and someone is looking for more information.  This will result in the physician or staff being called at home to provide the missing information.

Systems that don’t connect will inhibit the flow of patient information, and frustrate staff trying to provide patient care, this often leads to the sentiment “nothing works like it’s supposed to.” 

Low visibility tech that monitors these feeds can save staff time when things are operating normally, and can save frustration when its not by alerting the right people; often before the issue is even noticed by the user.

Imagine a Cath Lab solution with such a technology in place:

  • Cath Lab Technologist or Nurse is providing patient care, not checking different systems.
  • Feed from the imaging system is interrupted and a message alerts the appropriate IT team and/or Vendor as well as the Cath Lab.  In an ideal world this will be done on a hospital’s secure messaging platform so everyone can communicate a problem or resolution instantly.
  • All teams are checking for a problem on their end simultaneously.
  • Cath lab calls IT, confirms they have checked systems on their end, they are told that problem is known about and all teams are looking into it at the same time.
  • From experience we know that by the time the Cath Lab team finishes checking systems on their end, the other teams will have too.  The problem is often resolved by the time the Cath Lab is calling the help desk.

Since most interruptions occur during an upgrade, if the problem is found immediately, the IT team is notified immediately, likely before they are even finished with the upgrade and have left for the night.  

Implementing such a solution means you have freed up 3-5 hours per week of a highly trained patient care worker, and eliminated a major source of frustration for caregivers when systems don’t connect.  Low visibility tech that ensures smooth and hassle free operations for your staff, allowing them to focus on what really matters, the patient. 

Talk to Tido about their end to end monitoring packages to let your staff focus on their patient.