In response to the increased economic pressures and quality concerns facing hospitals today, many facilities are automating their perioperative systems in an effort to boost revenue and improve clinical outcomes.

March 8, 2010

No one, no matter how smart they are, can remember everything,” says Susan Almquist-Baldwin, Vice President of Perioperative Systems at North Shore Long Island Jewish (NSLIJ). “Healthcare is very complex with a lot of moving parts and it is getting more complex with each passing year. Human errors cost lives. Electronic information management is a tool, with its own inherent set of limitations, which can help eliminate some of those errors.”

No one, no matter how smart they are, can remember everything,” says Susan Almquist-Baldwin, Vice President of Perioperative Systems at North Shore Long Island Jewish (NSLIJ). “Healthcare is very complex with a lot of moving parts and it is getting more complex with each passing year. Human errors cost lives. Electronic information management is a tool, with its own inherent set of limitations, which can help eliminate some of those errors.”

NSLIJ, a hospital system serving 5.5 million New York residents in Long Island, Queens and Staten Island with approximately 5,000 beds, installed a perioperative IT solution from Surgical Information Systems (SIS) in eight of the 12 hospital sites to automate its information management in the OR.

“There was a manual system in place and it was difficult to complete the data searches that were needed,” Almquist-Baldwin says. “The perioperative directors wanted a system that would allow for the collection of clinical data in the operating room in real time, the ability to integrate data across the health system, the ability to capture OR charges, and the ability to obtain data for analysis to improve efficiency and effectiveness in the OR.”

The importance of a perioperative information management system is becoming more apparent in today’s surgical environment, particularly with the increased cost-cutting pressure hospitals are facing, says Kermit Randa, Senior Vice President of Surgical Information Systems.

According to Randa, the OR is the largest generator of both revenue and cost in the hospital. Up to 70 percent of the revenue for a hospital is created in the OR, while 40 to 60 percent of the costs occur there.

“It’s an unbelievably impactful area in the hospital,” Randa says. “[It makes up] most of the revenue, most of the costs and most of the margin. In terms of quality or safety, even if the OR isn’t the place where most of the errors happen, it is surely where most of the serious errors happen. It’s the driver of the hospital, the financial engine of the hospital.”

While many surgical departments today are still not automated, Randa says, the move away from paper or an older, less feature-rich system to an integrated perioperative record is important in maintaining safe and efficient processes.
“It's helpful to think of the OR sort of like a power plant,” Randa says. “When things are going well, it's really good and it drives everything else. But when something bad happens in the OR, everything else gets jammed up as a result—costs increase, satisfaction goes down and margin is reduced.”

Implementation At NSLIJ
In the past at NSLIJ, each of the hospitals acted independently. Reports were created on an as-needed basis, resulting in over 2,000 individual reports—many of which were only used once and were similar, but created separately for specific hospitals.

“Improvement in standardization was needed so that when reports are completed across the health system, there are similar processes in place to collect information and report in like manner,” Almquist-Baldwin says.

To do this, NSLIJ began installing a standardized IT system throughout its hospitals. “Utilization of one system and one database across all sites provides an increased ability to standardize, compare data and give us the ability to benchmark,” Almquist-Baldwin says. “The system allows improved charge processing and the ability to capture and feed data to other systems for analysis, including financial systems and clinical systems.”

Implementation, however, did not come without a significant time investment. According to Almquist-Baldwin, the time it took to implement the system involved:

  • Approximately six months to initiate the scheduling system and post operative case data entry, with another four months to implement charges and clinical data entry.
  • Two months to complete the pre-work, which consists of building the dictionary and definitions within the system.  
  • One month to train OR staff. 

Additionally, Almquist-Baldwin says the health system faced important obstacles in adapting a new information management solution, including getting the staff and physicians to "buy in" to the system, coming to a consensus on issues that were going to affect all the facilities, and obtaining the necessary human and financial resources.

“A major barrier in implementing electronic medical records (EMRs) is cost,” Almquist-Baldwin says, “which can be millions, even billions, of dollars in hardware, software and human resources."

Today, NSLIJ is working to modify processes and data definitions across the health system in an effort to standardize reporting. The hospitals are in varying stages of implementation, with some sites performing intraoperative documentation while others post case data entry.
The full implementation of clinical data entry at all NSLIJ sites has not been completed, but is planned for completion in each OR this year. The plan includes establishing a standard format for the intraoperative record, which will become a part of the health system's EMR moving forward, as well as installing SIS Analytics - a tool which provides real time business intelligence and graphic views of data.

Considerations For Your Facility
According to Randa, there are certain features and capabilities to consider when purchasing a perioperative information management solution:

A single database. “A big concern with any hospital is how do I get information from A to B?” Randa says. “You need a single database so you can track it. If you have multiple databases, it means multiple interfaces that always have to be in sync.”

Inclusion of anesthesia. Anesthesia has generally relied on paper for data management. Now, it’s a market “you absolutely need to consider” for automated perioperative information management, Randa says.

An understanding of how everything fits together. The expertise of a vendor who understands the workflow of the OR is necessary to help to see around the corners and plan. “Surgery is a different area—it’s different from the rest of the hospital. In many ways, it’s a hospital within a hospital,” Randa says.

Once the system is chosen, Almquist-Baldwin advises to spend all the time necessary in the preparation work and getting front line staff involved in the decision-making process. Come to consensus on naming conventions for procedures and supplies, and assure that procedures and supplies have the proper codes mapped to them on the back end. 

“The system has to be easy for the staff to use and it has to be easy for them to find information,” Almquist-Baldwin says. “Spend time on designing and building the preference or procedure cards. We found that this can drive savings if done properly. Set up a system of checks and balances to validate that charges are being captured appropriately and designate one or more individuals to help keep preference cards updated.” 

After initial implementation and looking to the future, Almquist-Baldwin says a perioperative information management system helps to realize benefits in the OR, including:

Improved communication. “Many of the errors made in hospitals are a result of illegible handwriting and human error when prescribing,” Almquist-Baldwin says.

“A paper medical record can lead to fragmentation of information and a lack of timely communication."

As Almquist-Baldwin explains, computerized physician order entry (CPOE) allows for the e-prescribing of orders and drugs based on best practice decision models for standardized orders sets, which reduces variability that can lead to poor outcomes.

An EMR uses alerts to prompt providers about potential drug interactions, critical values, high risk drugs, etc. It gives providers the ability to network and access a patient’s healthcare information from any computer or PDA, and enables physicians to look at lab test results, ECG strips and X-rays anywhere at anytime and simultaneously consult with a colleague about a case.

Cost reduction. Electronic management of records also has the potential to help reduce health care costs caused by people not getting effective care, enhancing revenue capture, improving efficiency and helping eliminate waste in the OR that stems from opening items that are never used and must then be discarded, Almquist-Baldwin explains.

Improved quality of care. Finally, according to Almquist-Baldwin, health information technology has the potential to improve efficiency and increase the overall quality of the health care delivery system.

“It has been shown that reduction in variability drives better outcomes,” she says, “and better outcomes save lives and money.”