Can we talk? Communications made possible through computer technology - Cover Story

Nursing Homes, Jan, 2002 by Richard L. Peck

We're a long way from the day when a "computer" was a machine that enabled you to perform mathematical wonders at prodigious rates of speed. Today's computers are parts of systems that enable people, of diverse descriptions, and at great distances, to communicate with one another as if they were in the same room. All hardware "pieces and parts" other than the computer--the connections, the wiring, the wireless devices--are available now to make this miracle come true. In the long-term carefield, this concept is meeting its acid test with new installations in two major organizations: the 1,630-bed Jewish Home and Hospital in New York City, and the 240-facility, 28,000-resident Evangelical Lutheran Good Samaritan Society (the largest not-for-profit long-term care organization in the United States), based in Sioux Falls, South Dakota. Obviously, these organizations are working with technologies (and budgets) scaled to their size. So what possible relevance would their experiences have for the smaller facility? Only this: If organizations this size can improve internal communication using information technology, smaller ones might find their own answers in the same technologies sized to their needs. You be the judge.

The Jewish Home and Hospital--Everyone Gets Into the Caregiving Act

The Jewish Home and Hospital (JHH) is big--in fact, it is three large facilities: the 816-bed Bronx division, the 514-bed Manhattan division and the 300-bed Sarah Neuman Center for Healthcare and Rehabilitation in Mamaroneck, New York. It employs more than 4,000 staff, including physicians, nurses, dietitians, social workers, rehabilitation therapists, housekeeping and security. And, as does any healthcare organization, it generates paper--lots of it. Until recently, it was estimated that nurses were spending three or four hours a day--half their shifts-- completing paperwork. Although JHH has been better than average in retaining staff (see "Keys to Retaining Staff: The Jewish Home & Hospital Experience," May 2000, p. 24), staff is still a precious commodity there, and President and CEO Sheldon Goldberg thought there had to be a better way for caregiving professionals to spend their time than writing on paper.

The $7 million answer was the clinical information system (CIS), which JHH began activating this past November after three years of planning. Using special "workflow-based" software developed by Per-Se Technologies, a Georgia-based vendor, the CIS makes sure that a complete and updated clinical picture of every patient is available at all times to every caregiver involved, at the appropriate "need to know" level, no matter where in the organization he or she might be. As soon as a patient is admitted, the CIS alerts a staff physician that a history and physical must be performed within 48 hours. The resulting data, plus medication orders, care plans and referrals to other departments, are entered into the system, and these entries themselves generate updated information and prompts of specific interest to specific caregivers.

For example, the pharmacist will see the physician's medication order, to which the CIS might have added specific needs or risks of that medication for the patient, leaving it up to the pharmacist to either approve the order or get back to the physician with further suggestions. Nurses, meanwhile, will have the patient's medication administration record (MAR) updated continually on their own particular computers. Social work's computer terminal might list family issues pertaining to the patient, while the beautician learns that a biweekly hairdressing appointment will be important to her, and will see a specific reminder about that appointment a week later.

As the CIS updates, it actually follows the caregivers about. Handheld notebook computers using wireless technology are mounted on medication and treatment carts throughout the facility, giving nearby staff immediate access to the patient data they need to know and, if necessary, prompts about tasks that have to be done at that point. The staff can also enter their own updates, which will go to the central database and be accessible to relevant terminals.

Needless to say, a communications network of this magnitude will take some time developing. JHH went online with two nursing units last November, anticipates adding four more by the end of this month and then plans to have all three facilities on board by the end of this year. "We want to make sure we take our time and get it right," says Chief Information Officer Kristine Cerchiara. Staff training alone, she notes, has been a major project, with staff from nurses through CNAs through housekeeping spending hours using the 18 basic modules, with written examinations, and follow-up specialized training offered by Per-Se.

Getting even to the basic level of training was a leap, says Cerchiara, because fully 350 of the Bronx division's 800 staff had never even touched a computer before the move to CIS was announced. "We had a lot of shaking and crying that first day," she says, "but it got better the second day." The situation was no doubt helped by JHH's unusual approach to the situation--setting up seven computer stations in the staff dining area, loading them with computer games and mandating the inexperienced staffers to play the games for a total of two hours during regular shifts.