pulse

Q2/vol 4/issue 2 hp in healthcare

• brave new world page 2

• streamlining the system page 4

• the war on bioterrorism page 5

• mission-critical data in a heartbeat page 6

• spanning the continuum from PACS to disaster recovery page 8

• helping give the greatest gift page 9

• virtual radiology page 10

• winning the numbers game page 11

• just what the doctor ordered page 12 brave new world

the consolidated hp tackles today’s healthcare issues head-on

Consolidating two global corporations is not unlike assembling an for industry challenged intricate jigsaw puzzle—except the stakes are higher and the potential impact is infinitely greater. As the pieces fall into place within the newly Currently in the United States alone some 44,000 people die each year combined and HP organization, a new picture emerges—one from preventable medical errors (To Err is Human, 1999 Institute of important facet of which focuses squarely on the healthcare industry. Medicine report). The Leapfrog Group’s CPOE (computer physician order Each of the companies brings to the table unique strengths in product line entry) patient-safety standard calls for physicians to enter hospital and market share, as well as powerful core competencies, with the intent medication orders through a computer system that is linked to of creating a synergy that will improve the quality and decrease the cost prescribing-error-prevention software. Even as the medical industry of healthcare. focuses on clinical systems for decision-making support, powerful new PACSs (picture archiving and communications systems) are re-inventing “Our aim is high,” declared HP chairman and CEO . “We the way the clinical community creates, views, shares, and archives want to build a company that is greater than HP or Compaq alone—a medical images. Other solutions integrate core clinical processes—like strong, market-leading company with a passion for customers. There is medical orders, test results, patient records, and pharmacy no better time to start than right now. Our industry is going through a documentation—to increase efficiency through enhanced workflow. dramatic transformation—from a world focused on products to a world where solutions matter most. It’s a world where everything works with The burning issue of HIPAA compliance is on everyone’s mind, everything else, everywhere, all the time; and where success depends highlighting the importance of patient privacy and secure information upon our ability to bring together all the resources necessary—from HP exchange. The emergence of e-health (online, interactive healthcare and our partners—to meet our customers’ every technology need.” communications) and a growing emphasis on consumer access to information point to the need for infrastructure consolidation, giving By design, the ultimate winners will be patients, clinicians, and medical impetus to the shift to industry-standard solutions. Meanwhile, institutions. And the timing couldn’t be more appropriate, as spiraling physicians are making fundamental changes in the way they conduct healthcare costs and the urgent need to improve patient outcomes challenge day-to-day business, increasingly using handheld computers to help healthcare solutions providers to reach new heights of innovation. them be more productive and efficient, as well as to comply with new requirements and regulations.

2 pulse As demands on healthcare systems continue to increase, the new solutions will focus on enabling physicians to be more productive and efficient by facilitating the rapid and secure flow of information across all sectors of healthcare. Rapid deployment is key to supporting customer efforts to achieve quick, measurable, and positive ROI. “Our aim is high. We want to build a company that is greater than HP or Compaq alone—a strong, market-leading company with a “Everything revolves around secure, reliable access to information— passion for customers. There is no better time to start than right now. Our industry is going through a dramatic transformation— anytime, anywhere,” Jarvis explained. “To that end, we’re focusing our from a world focused on products to a world where solutions matter efforts on four major areas: wireless solutions in healthcare, electronic most. It’s a world where everything works with everything else, medical-imaging management, next-generation digital healthcare everywhere, all the time; and where success depends upon our infrastructure, and HIPAA compliance. Because of the diversity and ability to bring together all the resources necessary—from HP and our partners—to meet our customers’ every technology need.” complexity of today’s healthcare environment, our objective is to provide true end-to-end solutions.” — Carly Fiorina, HP chairman and CEO partner with leaders

Ensuring customer success through value partnerships, Jarvis pointed out, is at the heart of the new HP healthcare strategy. Key healthcare partners for physician-practice solutions include Allscripts, Epic, and IDX. For hospital information system solutions, HP has aligned with Cerner, Eclipsys, McKesson, Meditech, and Siemens. TriZetto and QCSI are on tap to help deliver managed care solutions. “Major changes are sweeping across the healthcare landscape,” emphasized Ken Jarvis, HP North American Healthcare team leader, Highlighting the need for a next-generation healthcare infrastructure, “and it’s more critical than ever that we know our customers in their HP has aligned itself with heavy hitters like Microsoft, Intel, Oracle, and industry. HP understands its customers’ day-to-day business problems, Cisco Systems. To develop software that meets customer requirements, HP and we’re working to solve them. In healthcare, these concerns center will work with enterprise applications partners BEA, Commerce One, and around patient safety, care, and business efficiency.” Siebel. And emerging healthcare partnerships with groups such as the Patient Safety Institute, HL7, and Leapfrog will ensure that HP solutions The host of business challenges facing today’s healthcare providers, he comply with the latest standards in hot-button issues like patient safety or noted, is daunting but not insoluble. Reducing errors in billing and interoperability between information systems. prescription writing is high on the list. Reducing the high costs of administrative resources dedicated to supporting existing paper systems With a prominent presence in healthcare-access and infrastructure will help providers stay competitive and better serve their growing platforms, deep industry expertise and commitment, and the volumes of patients. Increasing efficiency and effectiveness in the clinical comprehensive HP Services organization, HP is well positioned to workflow will make burgeoning workloads more manageable. Facilitating capitalize on its strengths and partnerships to deliver a total solution to its the communication of medical and pharmacological information among healthcare customers. If HP’s “passion for customers” translates to clinicians is essential to maintaining quality of care. And, of course, improved quality and decreased cost of healthcare, then the Compaq reducing healthcare costs and enhancing clinician and patient satisfaction and HP merger could turn out to be one of the most significant new are in everyone’s best interest. developments in the unfolding world of 21st century healthcare. hp responds

The new HP, Jarvis added, is uniquely positioned to deliver cost-effective solutions—involving minimal customization—that address these challenges. “Many healthcare customers are seeking outside help to deal with these issues. A major aspect of HP’s strategy is to accelerate the adoption of new technology that will enhance clinical workflow, resulting in reduction of medical errors and improving the care delivery process.” “Everything revolves around secure, reliable access to information—anytime, anywhere. To that end, we’re focusing our To address the industry’s unique 24 x 7 technology needs, the HP efforts on four major areas: wireless solutions in healthcare, healthcare team is forming deep alliances with select software partners electronic medical-imaging management, next-generation digital and systems integrators to develop, implement, sell, and support best-in- healthcare infrastructure, and HIPAA compliance. Because of the class solutions that will enable faster, more cost-effective, higher quality diversity and complexity of today’s healthcare environment, our objective is to provide true end-to-end solutions.” clinical service at the point of care. Because limited healthcare budgets shouldn’t limit quality of care, an important aspect of the team’s strategy — Ken Jarvis, HP North American Healthcare team leader involves streamlining the charge-capture and billing process, thus reducing errors while accelerating the payment process.

pulse 3 streamlining the system

Siemens OPENLink interface engine running on hp platforms delivers maximum uptime with major time and cost savings at Lenox Hill Hospital

Growth happens. But when your expansion involves bridging elements in The Siemens OPENLink solution on the HP redundant platform is in daily heterogeneous systems, things can get tricky. use with more than 300 hospital personnel relying on the data it provides. Siemens OPENLink interfaces systems around the hospital, allowing the Two years ago Lenox Hill Hospital in New York City acquired Manhattan manipulation of data among them. It can “speak” different languages and Eye, Ear, and Throat Hospital of Manhattan and faced the task of use different codes, ultimately leading to enhanced usability throughout integrating the two facilities’ disparate systems. Interfaces needed to be the hospital. The system bridges Lenox Hill’s lab, radiology, ER, and ICU— implemented quickly; the situation called for a seamless solution that could any department that requires online data. It spans every facet of a deliver the minimal downtime so critical to a 24 x 7 hospital environment. patient’s stay, from admission through discharge (even notifying housekeeping when beds become available so they can clean), circulating To bring the different platforms together, Lenox Hill chose Siemens data so clinicians have constant access. OPENLink™, a robust integration engine that lets IT professionals easily manage complex information exchange using a comprehensive graphical “Patients can get total access to the services they want—cable TV and user interface (GUI) and tools. telephone—and all the systems pass data through billing, which is critical. That’s where the cost savings are the biggest,” McPherson said, adding “We had more systems coming online and needed to integrate different that it’s made a tremendous change in helping data-entry people populate platforms,” explained Chris McPherson, clinical systems and interface their databases. “It’s a 100 percent time-saver,” he noted. “Because we analyst at Lenox Hill. “Siemens recommended an HP ProLiant solution to have those interfaces working within the system, we’ve eliminated some meet our hardware requirements for full-time redundancy.” positions here, reassigning the people to other jobs because there’s no longer a need for their previous functions.” To serve as the platform for the Siemens OPENLink system, the hospital decided on two power-packed ProLiant 6000 servers. “We’re very happy The new system has minimized Lenox Hill’s growing pains and made life with how the servers work,” enthused McPherson. “We went from roughly easier for McPherson, who’s a one-man IT department and the only 30 percent to 5 percent downtime—some of which is planned. The reason interface analyst at the hospital. “When something goes wrong, it’s ‘Call is the redundancy.” Chris,’” he smiled. “But I hear it a lot less these days.”

4 pulse the war on bioterrorism

Cerner’s HealthSentry biosurveillance network can detect early signs of attack and provide immediate access to critical information

Bioterrorism. A year ago the word seemed remote, a term vaguely “HealthSentry is accessed primarily through the Web,” noted Mark remembered from some news item about a faraway place. Today it’s Hoffman, Ph.D., research and development architect at Cerner, “and it a different world, and Americans have first-hand experience with the is used on a daily basis. The site is secure, not publicly accessible. The horror of microbial attacks. But what are we doing about it? automated system catches cases that might not have been reported using the old manual method and delivers the information to the health The recent anthrax scares in the United States revealed just how department in a far more complete form. The whole power of the product is unprepared the public health system is to handle a wide-scale attack or in the automation—it saves time on both sides [reporting and receiving] of disease outbreak. Instead, they highlighted the failures of the current the system and improves the quality of data by reducing the chance of error. biosurveillance and detection infrastructure and did little to promote Bad or incomplete data, or illegible writing, slows down the process and confidence in the nation’s ability to effectively protect its citizens. corrupts the information. HealthSentry eliminates these problems.” That’s why Cerner Corporation of Kansas City, Missouri, created HealthSentry™, a biosurveillance network that automatically collects Eric Renner, senior network manager for Cerner, described the system critical biological information about potential disease outbreaks and behind the surveillance: “HP is a longstanding partner, and we team with immediately analyzes the data for specific patterns or trends. This timely, them to get the hardware for our environment and operating system. The precise data can speed surveillance notifications and responses— AlphaServer system running the OpenVMS operating system has been a any time of day or night. staple of ours, and many of our hospital clients also run on OpenVMS. We use it to the nth degree in our data center, as well as at our client “Under the law, medical providers have certain diseases they have to sites. Our disk systems are primarily HP storage networks as well.” report to the local health department,” explained Dr. Gerald Hoff, epidemiologist manager in the Office of Epidemiology and Surveillance The importance of the system’s 24 x 7 availability cannot be overstated, for the Kansas City Department of Health. “This has traditionally been since terrorists and predatory microbes have no respect for the clock. done by paper, telephone, or fax, usually with a single person designated If, for instance, an unusually high number of tests are ordered at one as the reporter. But when that person wasn’t there, the information fell hospital, caregivers at another hospital could quickly be notified— through the cracks—it was never a complete system because there were anytime, day or night—to look for similar symptoms in incoming patients, always data elements missing.” then react accordingly. HealthSentry can also geographically illustrate where outbreaks are centered or spreading, and help officials locate HealthSentry’s online reporting is designed to make sure no more the source of the contamination. This immediate access can help stop critical microbiology data gets lost or goes astray. Cerner’s information outbreaks from becoming epidemics. management solutions for healthcare—currently running at more than 1,500 sites—collect vast amounts of data, including approximately “Our relationship with HP is win-win, and that simplifies everything,” 25 percent of all U.S. microbiology data, as well as data on tests, concluded Renner. prescriptions, procedures, and associated clinical states. The detailed clinical data is analyzed at a research center built by Cerner and its If HealthSentry goes into widespread implementation, the people at clients; using this information, HealthSentry can provide automatic, Cerner are hoping any future attempted bioterrorism attack would turn rapid alerts of outbreak events or adverse trends. out to be a win-win situation for the American public as well.

pulse 5 Technology is a key component to making it all happen. The size of the IT infrastructure required to operate NBHD is staggering, and one of the most significant challenges facing NBHD’s strong IT team is the move toward a totally electronic medical record (EMR). Joe Wagner, vice mission-critical data president and CIO at the North Broward Hospital District, acknowledged that this will be a key project for the NBHD, and there is much work to in a heartbeat do in the hospital’s evolution to a paperless system. “The healthcare market here is pretty competitive,” Wagner explained, “and organizations such as ours are looking at ways to be more hp delivers the maximum uptime, competitive. Having our facilities as the number one choice for healthcare cost efficiencies, and rock-solid in Broward County is our strategic goal, and we’re counting on the shift to a totally electronic medical record [EMR] to keep us there.” reliability North Broward Hospital District’s medical staff needs Implementing an EMR system is one part technology and one part culture, Wagner pointed out. Not only does NBHD need reliable hardware and software, it must “change operational procedures and the culture of the clinician who is used to using paper.”

For cost efficiencies and rock-solid reliability, NBHD opted to rely on HP for everything from PCs, monitors, and printers to high-performance systems, industry-standard servers, and storage. The support of a large corporation was a big factor in NBHD’s decision to go with HP technology.

“When we’re buying more than 1,500 PCs, we can’t afford problems with equipment,” noted Wagner. “We need a vendor or partner who can assure us that the technology we’re buying from them is industry standard and supportable. If there are issues or problems, in a heartbeat “We can’t afford problems with equipment. … If there are issues or we need to get the appropriate technical resources from that vendor to problems, in a heartbeat we need to get the appropriate technical help us work through them.” resources from that vendor to help us work through them.” — Joe Wagner, CIO, North Broward Hospital District Glen Fell, director of systems development at the North Broward Hospital District, pointed out that there is a very serious nursing shortage in the industry. “Nurses can’t be waiting around for screens to flip,” he said. “They get very frustrated in that situation. PCs not only have to be reliable, they have to be quick.”

Size matters too. That’s why NBHD evaluated only small form-factor PCs. “Space saving is very valuable to us,” stressed Dennis Cheek, manager, Microsoft and Novell information technology. “A lot of our spaces have no room left for additional equipment.”

Fell said there are two sides to the IT scenario at the North Broward Imagine you’re in Broward County in southeast Florida. You’ve lost your Hospital District. “One is the desktop and servers that support the end wallet and are temporarily without resources, but you need immediate user—which is standardized on Compaq Evo D500 desktop PCs and medical attention. Where can you go for first-rate professional care? Compaq Evo notebooks from the new HP. The other is the whole system that supports the larger system, like our HNA Cerner Millenium Chances are you’ll end up at one of the North Broward Hospital healthcare application. In the case of the latter, we do make independent District’s (NBHD) four medical centers, the children’s hospital, or more evaluations and decisions.” than 40 other health facilities. These facilities serve a population of about 1.5 million, averaging 55,000 admissions and more than a million visits After one such independent analysis, the hospital recently upgraded a year. Accordingly, NBHD employs roughly 6,500 employees who need its enterprise server system, standardizing on the HP OpenVMS to access information quickly, easily, and reliably—not only to keep the operating system on the AlphaServer GS160 system to run the Cerner hospital operating efficiently and effectively, but also to facilitate and Millennium platform. safeguard patients’ healthcare, even save lives. This is as mission-critical as it gets. The Cerner system first went live using a database called OCF, or Open Clinical Foundation. Once all modules are installed, the Cerner application will retrieve and disseminate patient-specific clinical data across NBHD’s healthcare platform.

6 pulse “It’s all extremely mission-critical patient data,” noted Tony Ruiz, manager of clinical systems support, “which we need to access from many different levels. Uptime is very, very critical. My entire technical team here at the district is extremely sensitive to patient care needs, and we work at making sure that the medical staff has as much uptime as possible, working either through Cerner or HP to make sure we address issues proactively as soon as we encounter them.” “Uptime is very, very critical. My entire technical team here at the district is extremely sensitive to patient care needs, and we work at making sure that the medical staff has as much uptime as possible, Availability is doubly important for an around-the-clock enterprise. working either through Cerner or HP to make sure we address issues proactively as soon as we encounter them.” “One of the big things that differentiates us is the 24-hour, 7-day-a-week — Tony Ruiz, manager, clinical systems support, North Broward need for reliability,” emphasized Cheek. “It’s just as important for us to Hospital District have the system up Saturday night at 2 a.m. as it is on Monday morning at 9 a.m.”

But as a state entity that’s publicly funded, the nonprofit North Broward Hospital District must ensure that it has the appropriate financial mix and revenue stream to remain competitive while still delivering a full spectrum of industry-leading healthcare services. No small challenge.

As a competitive enterprise, the North Broward Hospital District is using technology to help differentiate it from others in the healthcare marketplace. An entirely new Web presence (scheduled for delivery in January 2003) provides robust consumer, employee, and physician portals. Convenience services like online scheduling are part of a strategy to make it easier for customers to use the hospital’s facilities.

But the bottom line is quality of care. The North Broward Hospital District is counting on help from HP to address the ongoing technological challenges—data redundancy, compatible interfaces, scalability, and uptime to name just a few—that are potential stumbling blocks to offering the very best medical attention to the largest number of people, all the time.

pulse 7 spanning the continuum from PACS to disaster recovery

InSiteOne’s digital image archiving solution helps hospitals be more efficient and cost-effective

Yesterday’s breakthrough technology is today’s white elephant, and it’s no doctors and clinicians. As the server receives an image, it encrypts it secret that film-based medical imaging systems are obsolete. Film is bulky, and transmits it over a VPN (virtual private network) to InSiteOne’s data time-consuming, expensive, and available to only one location at a time. warehouse for permanent storage there as well as at another redundant The shift to electronic delivery of reports and images direct to physicians’ warehouse in Phoenix, Arizona. So at all times the hospital has three desktops is no longer just possible—it’s inevitable. But because of the size levels of backup; the server on-site in RAID storage delivers excellent of these images (25 megabytes is average; cardiology images can be performance, while the two backup copies ensure disaster recovery and 500 megabytes or larger) and the complex DICOM (digital imaging and business continuum. communications in medicine) standard, the conversion to a wholly digital system can be cumbersome and expensive. This explains why medical Cook said the system is being run at 100 different locations around the imaging systems are the final frontier in the digital evolution. country, with contracts in place for more than 120 sites. InSiteOne developed the software on the Linux operating system, designing it to To budget-strapped hospital department administrators, the situation be scalable for handling small imaging centers, as well as large IDNs represents a daunting challenge. InSiteOne saw it as an opportunity. (integrated delivery networks) or health networks that might have several hundred different locations. “Hospitals typically have no capital to purchase hardware or staff an IT department to install a solution,” observed David Cook, CEO of Making the images available in real time resolves multiple issues. The InSiteOne. “Also, there are significant problems with storing huge medical combination of onsite and off-site storage, plus centralized and distributed images, and there are legal regulations on how long the images have to software, means users can access the images anywhere in the enterprise. be stored. State regulations average five years, but national regulations Since InSiteOne purchases all the HP equipment, placing it on-site at demand that certain images—mammography images, for example—be hospitals under a long-term, pay-as-you-go agreement, CFOs can allocate stored for the lifetime of the patient.” their precious capital for something that’s more profitable for the hospital.

To create a win-win situation for all parties, InSiteOne developed, from “Users are happy because of the performance,” Cook noted, “and IS the ground up, a unique architecture for the management and storage of [information services] people are happy because of the security built into large digital diagnostic images. The company places HP ProLiant servers the system, as well as the HIPAA compliance. We’re using military-grade on-site at hospitals and links them by secure Internet connection to its own encryption at all phases of the system, so the information is always protected. warehouse, where it uses a large HP ProLiant server to store the images. This design kills two birds with one stone: Hospitals enjoy excellent “Because we put the systems on-site all over the U.S.—and eventually all performance since they can instantly access the images on their networks; over the world—we’re relying on HP Services for installation and service,” and they have automatic permanent archiving offsite—a HIPAA he added. “As a young company (InSiteOne is three years old), we don’t requirement, as well as sound business practice. have the ability to respond quickly to a hardware problem. Having HP behind us was a key factor in establishing quality control.” In a typical scenario, InSiteOne installs its InDex software—a database management system designed specifically to manage and store medical As creative solutions like InSiteOne’s find widespread adoption in images—on an HP server on the PACS network within a hospital or hospitals and digital imaging centers across America, HP technology imaging center. The HP server connects with all the imaging modalities and services are also likely to play a key role in taming the final frontier in the hospital and keeps roughly one year’s worth of images on RAID on the digital evolution. (redundant array of independent disks) storage for immediate access by

8 pulse One of the greatest gifts imaginable is the donation of a body organ to someone whose very life may depend on it. Now HP is an integral part of this deeply human process. To better serve organ donors and procurement physicians, The Living Bank, the nation’s oldest and largest nonprofit donor education organization, has named HP its vendor of choice to enhance its national donor registry operations. helping give the The Living Bank, which already uses 5000 desktop computers, recently purchased and deployed industry-standard HP ProLiant greatest gift ML370 and DL380 servers running Microsoft® Windows 2000. The servers offer HP Remote Insight Lights-Out Edition—part of the HP Insight Management Suite—as well as information backup and redundancy, hp powers first Internet-based forming the foundation for the first Internet-based organ-donor registry. organ donor registry Jim Milton, HP senior vice president and North America general manager, said The Living Bank’s new Internet-based registry demonstrates the growing awareness in the marketplace of HP’s ability to meet the rapidly evolving technology needs of small businesses in the healthcare field. “HP has the breadth and depth of product line and services that can help smaller organizations make incremental changes that have a huge impact in meeting their goals. Our ability to deliver scalable, easy-to-manage technology solutions is what distinguishes HP from other IT vendors in the market.” The database provides organ procurement organizations across the country an efficient way to download scanned registration forms signed by the Among the Insight Management Suite of tools, HP SmartStart is particularly donor that can be shown to next of kin. The new registry streamlines the useful for smaller organizations because it enables users to easily configure administrative process by providing authorized personnel around-the-clock their ProLiant servers and painlessly install the latest operating systems and access to donor records. To date, the new registry has about 1.2 million drivers. The Living Bank uses HP Insight Manager to proactively monitor overall donors loaded in the database and is expecting another 400,000 names system health, reducing management costs, improving overall efficiency, and from Nevada, which passed donor registration legislation last June to minimizing downtime. The systems are protected by HP Services. encourage more organ donations to help reduce the shortage nationwide.

According to Jim Eiche, president and CEO of The Living Bank, the new “So far we have assigned about 60 logon IDs and passwords to organ Internet-based registry is accessible from any computer with Internet procurement organizations, and we anticipate the number growing capability and proper security authorization. “Organ procurement rapidly as awareness of the new Internet-based registry increases,” said organizations and tissue and eye banks that conduct the recovery of Eiche. “Last year alone there was an estimated 20,000 potential donors, organs and tissues are being assigned a secure password for access to but less than 6,000 actual donations.” the database,” he explained. “Ease of navigation is the mainstay—with only a few keystrokes, a procurement coordinator can determine if his or Eiche hopes the new enhancements will increase the number of donors her patient is registered.” whose final act of giving is carried out according to their wishes.

pulse 9 virtual radiology

enterprisewide, Web-integrated PACS lets multifacility Via Christi Hospital share images online

It solved a lot of problems for the expanded healthcare system.

“We have a radiology group that had been two groups before the merger,” related Eric Bruckner, applications specialist at Via Christi, “and when it became one group they were still treating calls separately. The solution let us have one on-call environment work for both campuses—whoever is on call can see the images from either campus, and take calls from both campuses.” “We have a radiology group that had been two groups before the merger, and when it became one group they were still treating calls separately. The solution let us have one on-call environment work for The system enables sharing of radiological images across the two both campuses—whoever is on call can see the images from either campuses. Instead of processing and passing around films among the campus, and take calls from both campuses.” various radiologists, clinicians, and physicians who need to see them— — Eric Bruckner, applications specialist, Via Christi Health System an awkward, inefficient, and time-consuming way to work—Synapse supplies instantaneous access as soon as the images are taken and sent through the system. Radiologists can read an image and turn around a report in minutes instead of hours.

The Synapse platform also harmonized workflow patterns within the group, facilitating centralized reading and workload sharing to maintain radiologist efficiency as demands increase. The system began running in a full-production utilization in July 2001, phasing in the hospital’s different imaging modalities according to a three-year plan. The challenge was complex, the high-tech solution brilliantly simple: “We’re well ahead of being installed in three years,” Bruckner noted. A merger brought together two disparate medical facilities in Wichita, “We’re already in our ICUs, we’re in the EDs, we’re in Trauma. We have Kansas, under the Via Christi Health System umbrella. That meant two all CT, MR, CR, and ultrasound images going through the system. We’ve radiology groups with different workflow patterns, two outdated film- reduced filming in ultrasound, CT, and MR images as well.” based teleradiology solutions, and a compelling need to pull it all together into one streamlined digital system for storing, retrieving, and Bruckner said the system has two key advantages. sharing radiological images.

“One, it’s Web-based. And two, it provided us an opportunity to The solution? Synapse from FUJIFILM Medical Systems, USA—a highly purchase a software-only solution—which allowed us to expand at will to Web-integrated PACS (picture archiving and communications system) our different modalities without significant additional costs. Many of the running on HP ProLiant servers (DL360, DL580, and DL380) and using competitors have dedicated workstations that you purchase through the HP StorageWorks EMA12000 for image archiving. But the beauty of the vendors at tremendous markup. Since we didn’t have to purchase system lies in its widely familiar user interface: Synapse uses Microsoft® hardware for our units, we realized significant cost savings.” Internet Explorer, eliminating many implementation issues and minimizing end-user training; since all images are displayed as Web pages, users With legendary HP reliability exceeding Via Christi’s expectations and HP’s simply view the images through the browser. 24 x 7 four-hour response service available for assistance, the hospital is helping blaze a trail into a brave new world of virtual radiology.

10 pulse Setting the leading standard for PACS’ (picture archiving and communications system) success provides Dr. Michael Trambert and his colleagues at Santa Barbara’s Cottage Hospital with a rewarding and exhilarating experience.

“Oh it’s very fun. I can tell you I’m having a ball,” acknowledged Dr. Trambert, lead radiologist for radiology information technology winning the at Cottage Hospital in Santa Barbara, California. numbers game According to Trambert, Cottage Health System, to which Santa Barbara Cottage Hospital belongs, operates in the rarified 1 percentile range of technologically advanced reengineered radiology departments across the PACS by DR Systems and HP cuts country. This means the other 99 percent have some catching up to do as the technology trickles down enough to become widely implemented. hard costs while productivity skyrockets at Cottage Health System Cottage Health System, formed in 1996 as the parent organization for Santa Barbara Cottage Hospital, Goleta Valley Cottage Hospital, and Santa Ynez Valley Cottage Hospital, decided five years ago to migrate its film-based radiology practices to a digital-based scenario. The healthcare group defined three goals: to drastically cut its hospitals’ use of film and film costs, to make radiologists and referring doctors more efficient, and—most importantly—to realize expedited and improved patient care.

A careful evaluation process led Cottage to select the PACS by DR Systems of San Diego, and the system was installed in April 1998. DR Systems had already partnered with HP for its image management solutions because it needed a high-end, robust server.

“HP fulfilled that need,” related Richard Porritt, president and CEO of DR Systems. “Adopting the HP desktop PCs as part of the PACS solution was a natural progression, as DR Systems wanted a highly respected and recognizable supplier.” “Adopting the HP desktop PCs as part of the PACS solution was a natural progression, as DR Systems wanted a highly respected and Trambert said the system delivers 99.9 percent uptime. “It’s been recognizable supplier.” extremely ‘bulletproof.’ However, we will mirror the online server in — Richard Porritt, president and CEO of DR Systems the near- to mid-term future since it’s a three-hospital enterprise and a 24 x 7, mission-critical endeavor.”

In addition to the “three 9s” uptime, the system has racked up more impressive numbers—the results of measurements Trambert and staff have compiled for various scientific abstracts and presentations. Trambert’s own productivity in conventional radiography is up by 87 percent using PACS compared with film; another radiologist’s productivity improved by 45 percent. The cumulative radiologist survey perspective is that overall productivity in conventional radiography is increased by 75 percent department’s online server—a ProLiant ML530 with Intel Xeon processor— using computed radiography on PACS, compared with the previous which, in turn, communicates with a Web server. Every three minutes the optimized film-based scenario wherein technologists preloaded all Web server checks the online server for newly added exams and radiologist exams on film-based alternators. voice clip reports, harvests them, and makes them available through secure Web access for referring doctors to view on hundreds of PCs within the He added that with the digital modality paradigm, Cottage Health System Cottage Enterprise, as well as in hundreds of doctors’ offices throughout saves roughly US$600,000 per year on film and processing and another Santa Barbara. The setup is completely HIPAA-compliant. US$200,000 per year on conventional radiography. But these hard costs don’t take into account the significant increases in productivity of the “We interpret and archive 100 percent of the studies filmless, and the radiologists, referring physicians, technologists, and front offices in radiologists are 100 percent paperless on dictation, except for special radiology and referring physician offices. procedures wherein the requisition is used to log complex procedure codes,” Trambert noted. “We don’t print any film for primary interpretation, “Compared with 1997, we’ve doubled our MR and our CT volumes,” but rather typically for patients who need to take them to another hospital or Trambert pointed out. “Ultrasound is up 50 to 60 percent, and conventional clinic that’s still film-based.” radiography is up 25 percent. We haven’t hired any radiologists despite those increases in volume—in fact, we’ve downsized, and we could The dizzying numbers continue: This year the enterprise’s front office will probably absorb another 30 to 40 percent of volume without hiring anyone handle just 5,000 film jackets instead of 84,000. But the bottom line is because of the productivity gains we’ve gleaned from this technology.” still improved and expedited patient care—unquantified, but real—which can’t help but make a positive impact on people’s lives. The DR and HP partnership meant that the PACS installed at Cottage Health System relied on HP servers for its online distribution and HP PCs for its Talk about a rewarding and exhilarating experience. reading stations throughout the hospital system. Radiology’s LAN (local area network) feeds exams entered by all connected modalities to the pulse 11 healthcare providers to see complete inpatient, outpatient, and pharmacy records. The order-entry capabilities of the system make it possible for physicians to transmit electronic orders for medications, procedures, nursing care, and ancillary services. This approach eliminates redundant paperwork and the risks posed by illegible handwriting. Using the just what the system’s electronic physician order-entry capabilities, New York’s Montefiore Medical Center documented a 51 percent reduction in doctor ordered potential medication errors. To achieve fail-safe patient care in the enterprise clinical systems marketplace, the Carecast solution prescribes three ingredients: think- enterprise clinical solution speed computing, unsurpassed reliability, and comprehensive clinical promotes fail-safe healthcare software. As Carecast transitions onto a NonStop SQL software-based architecture, improving workflow and functionality, Krassner hopes that following this basic formula will further contribute to long-term, long- lasting reductions in medical errors while improving patient care.

Consider this disturbing statistic: Some 44,000 people in the United States die each year from preventable medical errors, including adverse hp.com drug reactions. Healthcare organizations are now realizing that hp pulse information technology is a vital tool for replacing paperwork-intensive processes with immediate and clear electronic communications. managing editor: Claudia McGurk +1 (410) 384-9443 The Carecast enterprise clinical solution from IDX Systems sharpens [email protected] communications across the healthcare continuum. Carecast is designed to website: www.compaq.com/healthcare improve the quality of medical care and help healthcare enterprises August 2002. Intel is a trademark or registered trademark of Intel Corporation in operate more efficiently and cost-effectively. the U.S. and other countries and is used under license. Microsoft and Windows are U.S. registered trademarks of Microsoft Corporation. All other product names mentioned herein may be trademarks or registered trademarks of their By integrating core clinical processes—such as medical orders, test respective companies. HP shall not be liable for technical or editorial errors or results, and pharmacy and clinical documentation—Carecast automates omissions contained herein. The information is subject to change without notice. The warranties for HP products are set forth in the express limited warranty workflow and creates a lifetime patient record that’s notable for its statements accompanying such products. Nothing herein should be construed as completeness, accuracy, and secure accessibility. Carecast helps prevent constituting an additional warranty. medication errors through computerized physician order entry (CPOE), Printed in the U.S.A. 02-0747 which replaces handwritten medication orders and alerts clinicians to ©2002 Hewlett-Packard Company potential ordering errors like incorrect dosage or patient allergy. The Leapfrog Group, a consortium of large employers concerned with the rising cost of healthcare, has identified CPOE as one of the top three practices that can measurably improve patient safety.

The Carecast system also integrates administrative and financial processes for scheduling, registration, admitting, charging, and billing. Carecast combines an intuitive, compatible, Web-based user interface with an expanded range of wireless devices, including PDAs.

Because it runs exclusively on the HP NonStop™ platform, Carecast is always there when the healthcare community needs it. “We operate in a mission-critical environment,” noted Larry A. Krassner, president of IDX’s Integrated Solutions Division. “The NonStop system is a major asset to IDX in helping advance fail-safe patient care.” For IDX, advancing fail- safe care means that healthcare providers can depend on fast, reliable information from their clinical information system—and use this information to improve both the quality and cost of care.

The Carecast system further contributes to quality care by integrating patient information from all points in the delivery network, allowing

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