Right on schedule: Kentucky-based regional network eliminates scheduling conflicts and reduces wait times by implementing integrated enterprise scheduling systems - Scheduling: case history

Health Management Technology, Feb, 2004 by Phil Reynolds

Any large healthcare provider that wants to prosper must make its patients, physicians and staff happy, or it won't be in business very long. Key to fostering this behavior is utilizing a system that quickly and efficiently schedules procedures at multiple facilities, so staff can provide the best service, patients can comfortably plan their healthcare treatment, and physicians can rest assured that their patients are getting the services they need in a timely manner.

Jewish Hospital HealthCare Services (JHHS) is the parent company of a regional network that includes 50 healthcare facilities in Kentucky and southern Indiana and more than 1,400 beds. JHHS offers a complete array of services ranging from hospitals and emergency air ambulance to assisted living and home healthcare. Its flagship facility is the 101-year-old Jewish Hospital, a 442-bed referral center in Louisville, Ky., that offers outpatient care, hand care, and heart and lung centers. Jewish Hospital Medical Center East (JHMCE) opened in January 2003 as an ambulatory diagnostic center designed to be a near-paperless hospital providing advanced procedures and treatment via state-of-the-art technology.

Prior to 2001, physician practices initiated the scheduling of procedures by contacting the network's facilities directly, either by phone, fax, e-mail or an online form. Patients also called the facilities to schedule appointments. JHHS staff confirmed appointments by phone, fax or e-mail, but often practices or patients had to wait 20 minutes or more for a response, because the organization used a decentralized scheduling process with paper-based records. As the network grew to more than 50 locations and offered additional services, these delays became unacceptable. "We had to do a better job of resource management and cutting wait times," says Dave Pecoraro, JHHS vice president and CIO. "We didn't want to lose business because people couldn't get through."

To fix these problems, Pecoraro considered scheduling systems from a couple of vendors, with a careful eye to what benefits the systems would provide to JHHS. In the exploration process, he set up a meeting with Chesterfield, Mo.-based Unibased Systems Architecture Inc. (USA), due to a contact he knew there from a previous job.

Hearing about the healthcare organization's needs, USA proposed that JHHS purchase its Resource Management System (RMS) and periOperative Resource Management System (ORMS). RMS is an integrated enterprise scheduling system that automatically resolves scheduling conflicts between patient preferences and healthcare resources via an artificial intelligence rule set and user-defined profiles and tables. It lets users check availability throughout a multifacility network with a single sign-on, providing a graphical display of physician and department schedules. ORMS is a perioperative information system that features surgeon preference cards, nursing documentation, charge collection and more than 30 standard management reports in addition to conflict-free scheduling.

USA agreed to work with JHHS implementation staff to customize the systems as needed. "We said that whatever we created here needed to be the kind of system that, in 2002, you would see in 2005," Pecoraro says. "We threw everything at them that we could."

After visiting a Florida hospital system and seeing its improved workflow using RMS and ORMS, Pecoraro recommended that JHHS purchase the scheduling systems. The network's executives approved his recommendation.

Customizing the Systems

JHHS staff begun implementing RMS and ORMS in February 2000 with a phased-in approach for bringing various diagnostic areas onboard, one at a time. First was Jewish Hospital, and then the newly created central diagnostic and surgery call center, followed by the operating room (OR). "Part of the issue was, who would handle which calls. We chose those people who already had experience or were trained in those areas," Pecoraro says. "We gave serious consideration to which rule sets we would use--for insurance verification, for example." The implementation staff also integrated the systems with the organization's registration, billing and master patient index systems.

The entire process took about a year to complete. By early 2003, Pecoraro thought the systems had been fully debugged, so he was comfortable installing them at JHMCE.

RMS and ORMS were not turnkey systems for JHHS. Pecoraro explained at length to USA representatives how the organization operated, so the vendor could provide customized adaptations of the software that best suited JHHS. "We didn't find ourselves compromising because the systems would not allow it. When we asked for changes, USA responded quickly with how much they would cost and how much time it would take to make them," he says. "I like to think we made some changes that improved the company's products."

The implementation staff experienced several challenges. They had to rework the network's credentialing system, because it prohibited scheduling procedures for physicians whose qualifications it could not verify. Staff also needed to create interfaces between the scheduling systems and the materials management systems, since Pecoraro wanted the scheduling systems to automatically post supply changes to the materials management systems and generate a purchase order for any supplies needed. "It was a fairly rigorous process of building and designing the interfaces," he says.