Methodist Hospital of Indiana (Part 2)

Dear Bloggers,
Saya lanjutkan studi kasus integrasi IT ke bisnis pada rumah sakit Methodist Hospital of Indiana, pada bagian akhir akan diberikan resume dan sedikit analisisnya :

The Pilot Applications
The major application provided through the pilot system was the Patient Care Application that provided physicians with information on their patients. The pilot system also provided a purchased electronic mail system and WordPerfect word processing software. Another application emulated the dedicated terminals of the laboratory computer system, the radiology computer system, and the physician office system on the IXP’s PC workstations. This emulation allowed a person to access these three systems from an IXP workstation, but did not change the look or feel of these systems, and the person still had to have an authorized password to access these systems. Because of its size and complexity, the team decided not to include the Master Patient Index application in the initial pilot. The data for the Patient Care Application were created as a result of procedures performed for a patient and were originally stored in ancillary or departmental systems, such as the laboratory
or radiology. This application extracted these data from the various computers and made the data available to physicians on intelligent workstations in several formats, such as reports and/or graphs.

As shown in Exhibit 6, the Patient Care Application employed a graphical user interface. By double-clicking on the In-Patients icon, a physician obtained a list of all his or her patients in the hospital, as shown in Exhibit 7. Information on patient ROBERTSON is contained in four folders that are available by doubleclicking
on Robertson’s name to obtain the Patient Care Results window shown in Exhibit 8. Clicking on the Laboratory icon displays a list of all the available lab procedures for patient Robertson in notebook format as shown in Exhibit 9, with tabs shown for each department that has performed tests on her. By clicking on the Hematology tab, we obtain the spreadsheet display of hematology tests shown in Exhibit 10. By pointing to the MCHC line, the physician could obtain detailed data from that test or cause the data to be displayed in graphical form as shown in Exhibit 11. The above example is representative of many options from which the physician could choose.
Installation of the Pilot System As mentioned previously, the pilot was scheduled to be delivered to users on April 1, 1992. But problems arose with project staffing and management, and there were delays in installing a new laboratory computer and in moving the multiplexer room, both of which caused delays in this project. In August 1992, the pilot system was installed and user training began.

When the pilot system was installed and used by a diverse group of about 30 people, it became clear that the software and hardware would not support a full deployment of the system. According to Zerrenner, The PICSTalk system for interfacing all our various computers with the system could not handle the load. Furthermore, OS/2 would not allow us to make a software change on our workstations from a central location—we had to physically change each workstation, which was not acceptable when we were planning to deploy a thousand workstations. The failure of the pilot was a major setback in the development of the IXP in both time and dollars, but it was not
fatal.

Methodist Hospital lost about a year, but according to Zerrenner:
We had invested about $2 million at that point, but we were able to salvage all the hardware and the system design work, so we only lost the $700,000 we spent on writing code. But this was a tremendous educational experience for my staff and made us a much better software purchaser. At that point Methodist management had to decide
whether or not to continue the IXP effort. Zerrenner went to CEO William J. Loveday and explained:
This was unfortunate, but it proves the value of the incremental prototype-pilot-deploy approach. Instead of risking a $20 million failure with a contract for a complete system, we are only out $700,000, have learned a lot from the experience, and have not been seriously embarrassed. Continuation of the Project Loveday might have shut down the IXP project and waited until the technology was more mature, but he agreed with Zerrenner’s analysis and authorized the continuation of the project.
In late 1992 Methodist Hospital sought another systems integrator to assist with the project. In April of 1993 Ameritech Health Connections (AHC), a subsidiary of Ameritech, was chosen to continue the project. According to Zerrenner, Ameritech Health Connections (AHC) had two efforts underway at that time—development of community health information networks, and building the repository for electronic patient records. These fit in with what we were trying to do in the IXP, and my staff felt that the AHC approach best fit our needs. It was also very “open,” with a standard interface engine and a standard database; nothing was proprietary.

Using AHC’s network technology, Methodist was able to rapidly upgrade the IXP network by replacing the pilot IXP’s hardware and software. The PS/2 communications server
running PICSTalk in Exhibit 5 was replaced with a Sun SparCenter 1000 computer running Datagate software under Unix (called the data integration hub in Exhibit 12), and the RS/6000 database server was replaced with the SUN SparCenter 2000 replication server as shown in Exhibit 12. In mid-1993 Methodist began to put applications on this upgraded IXP network and to add workstations and locations to the network.
In mid-1993 Methodist also negotiated a fixed-cost $600,000 contract with AHC to provide the repository for Methodist patient records. The repository was to be delivered in March of 1994, but that date proved to be unrealistic.

Zerrenner explained:
Unfortunately the AHC software was not as far along as we had thought. We started out Beta testing, soon went back to Alpha testing, and finally got back to quality assurance testing of the system. Then we went back through Alpha testing and Beta
testing with AHC before AHC finally had a product we could use and AHC could sell. That took an extra year, so we did not begin to install the production system until May 1995. Although it has been frustrating, the process has also been rewarding both for us and for AHC. AHC has been totally committed to the project and has poured resources into it far beyond what we paid for. Four or five major health centers around the country have already bought the system,so AHC will get its money back selling the system to other hospitals.

We now have a clinical repository that contains the information to satisfy about 80 percent of the requests for patient record information within a few seconds. The data in this repository is obtained through the IXP from other systems serving the
laboratory, radiology, and patient registration. Even dictated reports such as Post-Operative Reports and Discharge Summaries are captured from the medical transcription system that is on the IXP.
During the period from 1993 to 1995—while the repository was under development—Methodist installed over 30 applications on the IXP network. For example, the materials management system allowed users to order all supplies and medicines from any location in the Methodist Health Care System. Methodist also installed the Pyxis automatic drug dispensing system at the nursing units. This system was linked through the network to the materials management system so that inventories are updated and replenishment of medicines at the various stations is automatically scheduled.

The nurses’ staffing and scheduling system was interfaced to the patient registration system as well as a time and attendance system. This combination allowed Methodist to better utilize its nursing staff by immediately shifting nurses from an overstaffed unit to a unit that was understaffed based on current patient demand at each unit. The nurses’ staffing and scheduling system was also interfaced to the payroll system
that calculates each nurse’s pay based upon the rates of the various units within which the nurse has worked. Previously the unit managers had to do these complex payroll calculations manually, so this interface eliminated some 1,200 hours a month of effort by the 30 unit managers.

Status in September 1995
By September 1995, some 300 workstations at the main Methodist Hospital campus and some 18 remote locations were being served through the IXP, and the patient record
system was operational. When a patient showed up at the Emergency Room, the staff could immediately bring up his record on the computer instead of waiting 45 minutes for a paper record to be manually retrieved from medical records storage. Dr. Moeller’s vision that patients’ medical records be available through the system from every physician’s office and every Methodist Health Care location was becoming a
reality.

When Zerrenner took over in 1991, there were 98 people with six layers of management in the Methodist IS department. The main function of these people was to support the TDS system on the mainframe. In September 1995 there were only 58 people in the central IS department. Seven of these people were directors reporting to Zerrenner, and everyone else was a knowledge worker. The main function of the IS department had become supporting the IXP network and writing the interface code between purchased systems and Datagate rather than developing new systems. Most of the IS staff have become telecommunications people, database people, or systems integrators. As was true before the development of the IXP, other computer specialists continued to work for the various laboratories supporting minicomputers and systems that make data available via the IXP.

Zerrenner emphasized that the system was still quite basic:
Now that the physicians have access to all this information, they also want two-way communication so that they can order lab tests and X-rays through the system. Then they will want to place medication orders, so we will need to get the hospital
pharmacy system hooked in, and perhaps even include 448 Part III Acquiring Information Systems major drugstore pharmacy systems. Each time we add capability
to the system we will prototype it and pilot it before rolling it out.
According to Moeller, The current system only retains information on a patient for a
few months. With our modular system, it should not be too difficult to add a mass storage component for medical records so that we can make all the history of a patient available, although it may take a minute or so rather than a few milliseconds to retrieve it.

We have not even touched the research potential of having medical records in electronic form. We need to be able to analyze the effectiveness of patient care for a diagnosis-related group. For example, recently we had to do a very expensive
chart-by-chart review of coronary bypass patients in order to bid on a Medicare project. The cardiologists were shocked at some of the sources of error that they discovered when they systematically analyzed the data on a large number of patients. We have radically improved our success rate by modifying our coronary bypass process, and I am sure that we will greatly improve many of the other things we do when we can obtain the necessary data.

Dr. Moeller’s Role and Perspective
Dr. Moeller was on the original planning committee and has chaired the IS steering committee since its inception. Although there have been a number of physicians on the hospital staff who have been strong supporters of the IXP project, Dr. Moeller has provided extraordinary leadership in a number of roles. According to Zerrenner:
As much as Doug enjoyed playing with the IXP and computers, he was still a physician first. He truly understood the value of information at the point of care. And he was empathetic with the other physicians’ problems, whether they were specialists,
primary-care physicians, or whatever. Doug has been an effective voice for the IXP vision to the power structure of the hospital. He was on the executive committee
of the Medical Staff Council, one of the most powerful policy bodies in the hospital, and he constantly talked about the value of the information exchange platform to the council.

Doug was also on the Methodist Hospital delivery system board that was formed to enhance relations between the hospital and physicians. This board is very key in building our referral business and our managed care business, and in networking
between physicians, HMOs, and hospitals all across the state. Doug has been an enthusiastic and effective salesman. Not only did he design the prototype system, but he gave about 50 demonstrations to over 150 people. And every time he did a presentation he was just as enthusiastic as the first time! If a physician was looking at the screen he would talk in physician language, and when he was demonstrating to nurses he would talk in nursing terms. Because he understood their
problems and could talk their language, they could all visualize how they could solve some of their information problems with this platform.

Finally, as an influential physician, he was able to keep some of the players honest. Everyone understands that the physicians are the true customers of the hospital. Doug was able to defuse turf battles by being very vocal in keeping people focused on the hospital’s true business rather than on how the system affected their individual departments.

Moeller reminisced:
When I started out I knew very little about the technology, but Walt gave me some books to read and took me to some conferences, and I have worked hard to educate myself. The hardest part was learning the terminology, not only computerese but also understanding business terms. I have found that the discipline involved in the design and analysis process is quite similar to the analysis I do if you come to me as a patient. A human can be viewed to be a system of components—liver, heart, kidneys—with very complex relationships and communications between these components. My
definition of a complex system is one in which multiple measures exist for each component, and if you simply pick one and fail to measure others you can come to the wrong conclusions by reducing the system to something simpler than it actually is. That is why information is so important to medical care.

This exposure to the systems approach has radically changed the way I do almost everything that I do, including my medical practice. Physicians have always been trained to be independent decision-makers, and they tend to function as independent
units. The transition that health care needs to make is to go from a craft-based specialty organization to a team-based production facility, where there is interdependency and shared resources. If the internetworking that can occur in our IXP system is successful then we will have made a major advance in supporting health care requirements.

Dari studi kasus di atas, terdapat beberapa permasalahan yang dapat kita simpulkan :
1.Clarian Health merupakan hasil merger dari Methodist Hospital of Indiana dengan Indiana University Hospital, membutuhkan integrasi sistem IT.
2.Methodist Hospital of Indiana melakukan merger di saat kondisi rumah sakit dinyatakan sehat dari aspek manajerial, keuangan, dan lain-lain, dapat dilihat dari jumlah tempat tidur 1.200 buah, 80.000 kunjungan ke UGD, 250.000 pasien yang berobat jalan dan 43.000 pasien rawat inap, terdapat perubahan mekanisme kerja dan beban fungsi IT semakin meningkat dengan adanya merger.
3.Dengan sarana dan prasarana IT yang cukup baik, namun masih terdapat kendala pada ketidakmampuan untuk sharing data pada TDS (patient management system) yaitu hanya dapat menampilkan data pasien pada saat itu saja dan tidak dalam jangka waktu yang panjang, tidak terhubung ke sistem rontgent, farmasi, penelitian medis dan marketing, hanya dapat diakses dari terminal di rumah sakit/tidak dapat online di luar jangkauan rumah sakit.
4.Data pasien tidak dapat dengan segera didapatkan dari dokter dan perawat sehingga kesulitan mendapat hasil tes, diagnosis dan prosedur (dokter) dan kurang informasi tentang prosedur yang diberikan oleh dokter (perawat).
5.Nomor pasien yang tadinya 7 digit menjadi 8 digit mengakibatkan sistem arsip tidak dapat menemukan penomoran pasien sehingga dokter sulit mendapatkan sejarah data medis pasien dan pada akhirnya dilakukan cek ulang terhadap pasien yang berdampak pada tertundanya obat dan pemborosan.
6.Pada integrasi sistem pasien rawat jalan, pendaftaran dilakukan di setiap klinik sedangkan klinik tidak memiliki akses medis ke klinik lain, sehingga dokter sulit mendiagnosis suatu penyakit dan pasien harus membawa catatan medis sendiri.
7.Rumah sakit memiliki masalah komunikasi antar departemen (75.000 karyawan), sehingga setiap pegawai tidak seluruhnya mengetahui visi dan misi rumah sakit serta proses yang sedang berjalan.

Namun Zerrenner (CIO) mengubah IS Departement yang tadinya dissatified with service (poor reputation) dengan visi yang disesuaikan yakni SIM rumah sakit merencanakan setiap dokter diberikan PC, namun dalam menyusun rencana strategisnya yang telah dikembangkan tidak meminta masukan dari user.

Selanjutnya dikembangkan Proyek IXP yang memiliki dasar tujuan dan ruang lingkup, prototipe, sistem pilot dan status produksi. Karena IS Departement tidak memiliki teknologi terdepan dan keterampilan dalam pemanfaatan teknologinya, mengakibatkan masalah teknis komunikasi di lokasi terpencil.

Memang dalam pengembangan proyek tersebut terjadi kegagalan yaitu mundur selama 1 tahun dari yang telah dijadwalkan sehingga memakan biaya dan waktu. Permasalahannya yaitu tidak adanya kompabilitas/integrasi antara software dan hardware yang tidak didukung sistem secara penuh seperti OS/2 tidak dapat melakukan perubahan software pada workstation yang lokasinya tidak terjangkau. Walaupun sistem sudah terinstall dan dilakukan pelatihan user.

Jika kita melihat pada teori integrasi IT ke dalam bisnis, permasalahan human acceptance adalah prioritas yang paling penting diperhatikan. Sehingga methodologi pada IT Strategic Planning harus mengacu pada :
1.Key question
2.Vision
3.Assessment : IT Assessment is a snapshot of IT efficiency, IT SPOT (Strategy, Process, Organization, Technology)
4.Strategy formulation : Blueprint IT Infrastructure, applications, information, business. Knowledge Management, contoh Reimenting process yaitu Core activity clusters, technology platform, cross platform linkages.
5.Planning : project prioritization
6.Solution selection