Maimonides Medical Center Makes a Quantum Leap with Advanced Computerized Patient Record Technology

Health Information Management Systems Society San Diego Convention Center February 12, 2003 Maimonides Medical Center Makes a Quantum Leap with Advanced Computerized Patient Record Technology

„ Fredrick Cassera, RPh, MBA Director Pharmacy

„ Steven J. Davidson, MD, MBA Chairman Emergency Medicine

„ Shoshana Haberman, MD, PhD Director Perinatal Unit

„ Allan Strongwater, MD Chairman Orthopaedic Surgery & Musculoskeletal Services

„ Ann C. Sullivan, MBA Sr. VP/Chief Information Officer

2 CPR System Planning The Medical Center

Staten Island

Manhattan

Mt. Sinai School of Medicine

Ambulatory sites

Voluntary physician practices with office MACS Top 100 Cardiovascular Hospitals (Solucient) Hospitals: Coney Island Medical Center Brooklyn Top 100 Most Wired Hospitals (H&HN) 2000, 2001, 2002 Lutheran Medical Center Note: Community physician offices too 1998 Computerworld Smithsonian Award - Medicine numerous to indicate on map

„ 36,861 Inpatients „ $564.5 Million Revenue „ 5.05 Length of Stay „ 4,612 Employees „ 1.87 CMI „ 277 Employed Physicians „ 253,316 Outpatients „ 401 Residents „ 77,118 Emergency Visits „ 978 Community Physicians

3 CPR System Planning

„ Vision…

To improve the quality and effectiveness of patient care by providing real time access to comprehensive clinical information wherever and whenever needed.

4 CPR System Planning Strategic Priorities

„ Clinical excellence & patient safety „ Humane, patient focused, patient centered care „ Strengthen physician collaboration & effective communication „ Supportive environment for physicians „ Fiscal viability „ . . .

5 CPR System Planning Leadership and Governance

„ CEO firmly committed to project & necessary organizational change

„ Leadership, financial, medical staff

„ Communicate process & project status

„ Financial commitment includes all ongoing support

6 CPR System Planning Needs Assessment

„ “Stuck in key punch era”

„ New York State’s deregulation

„ Strategic priorities necessitate state-of-the-art IT

„ Departmental-specific CPRs

7 CPR System Planning System Acquisition

„ Inpatient CPR was purchased in 1992 deployed in 1996

„ Patient safety and outcome initiatives required CPRs with knowledge-based decision support

„ Targeted an integrated single vendor CPR solution

8 CPR System Planning System Acquisition (continued)

„ No supplier could deliver

„ Clinical Department’s diverse requirements were best addressed by CPRs from different vendors

„ Modified “Best of Breed” approach with vendors who conformed with our technology standards

9 CPR System Planning Business Case for CPR

„ Complexity and expense of implementation

„ User, workflow committees, task forces, HIS executive committee identify capital initiatives that meet hospital-wide, departmental and individual needs

„ Gained buy-in throughout organization

10 CPR System Planning Business Case for CPR (continued)

„ Strategic priorities yielded investment of $43.909 million

„ Continuing annual request for $30 million

„ Metrics tie to business return

„ Required technology supports strategic priorities

11 Capital Allocation and Prioritization

„ Systems (example)

„ Ambulatory, Eclipsys enhancements, ED, document imaging, medication administration, etc. „ User wants „ Clinical success factors „ System priorities „ Economic priorities

12 Project Risk Management Timeliness, Budget, Completion

„ Risk reduction strategies

„ Implementation credibility

„ Resistance to workflow changes

„ Managing vendor relationships

„ Lack of technology infrastructure

„ Uncertainty of success with CPOE with community physicians

13 Implementation Planning and Process

„ Infrastructure

„ ATM enterprise network

„ Leonia, NJ, data center OS 390/2.5 mainframe

„ OC48 Sonet ring

„ 2300+ desktops and wireless devices

„ 113 servers

„ New MIS site

14 Implementation Planning and Process (continued)

Simultaneous applications and upgrades 1996–1998

„ Radiology Information „ Transcription

System „ Blood Bank Laboratory

„ PACS „ Anatomical Pathology

„ Voice Recognition „ Patient Registration

„ Document Imaging „ Master Person Index

„ Patient Accounting

„ Financial/HR/Payroll

„ Decision Support

15 Implementation Planning and Process (continued)

„ Physicians sought knowledge-based decision support (1999)

„ Eclipsys SCM to replace E7000

„ Purchased A4HealthSystems HMED CPR; NextGen CPR – Ambulatory and Faculty Practices; E&C Intelligent Patient Record for Obstetrics

16 Implementation Planning and Process (continued)

„ Data collection, workflow modifications, application screen design

„ Integrated testing of applications and interfaces

„ Downtime procedures, workflow and user access policies

„ Roll forward approaches

„ “Just-in-Time” Training

„ System “Go Live” support

17 Implementation—Project Governance “Right” Planning Environment

„ HIS Executive Committee

„ Physician Task Force

„ Nursing Council

„ Project sponsors break down barriers

„ Project Teams -> user committees

„ Technology Infrastructure—command center, training, etc.

18 Implementation Project Staffing

„ Maimonides physicians, nurses, pharmacists, lab and radiology technicians

„ Knowledge of hospital culture, formal and informal organization, institutional memory and medical staff relationships

„ IT skill mix broadened by adding clinicians

„ IT technologists broadened skill mix

19 Impact on Operations Successful System Implementation

„ Minimize adverse impact on hospital operations

„ Three to six weeks of go-live support

„ Closely managed phased approach based on user tolerance

„ “Big Bang” not possible

„ Patients come first!

20 Evaluation of Management of CPR Effort Lessons Learned—the Don’ts

„ Two or more CPRs at the same time

„ “Go Lives” in peak census periods

„ “Go Live” without full volume load integrated testing

21 Evaluation of Management of CPR Effort Lessons Learned (continued)

„ Backload data from paper charts

„ Customized order sets require physician consensus

„ Train around the clock with clinicians who understand the specialty and workflow

22 Evaluation of Management of CPR Effort Lessons Learned (continued)

„ Standardize alert levels among CPRs

„ Monitor interfaces 24x7

„ Evaluate and adjust downtime procedures post implementation—Do they really work?

„ Double testing time

„ Quadruple support for full CPR’s

23 Functionality Managing Paper—Ongoing for Years

„ Scanning forms & documents; signature pads

„ Balance computerized and paper-based data

„ Chart Content Committee:

„ CPR content

„ Printing for internal chart review

„ Standardized paper chart for external review

24 Functionality Knowledge-Based Prompting

„ Drug-Drug Interaction Checking

„ Perinatal- FDB Version “S”

„ Ambulatory- FDB Version “T”

„ ED – FDB Version “U”

„ Inpatient – FDB Version “V”

„ Eclipsys SCM - Multum

25 Functionality Knowledge-Based Prompting (continued)

„ Treatment/Monitoring Recommendations

„ Perinatal – Yes

„ Ambulatory – Yes

„ ED – No

„ Inpatient – No

„ Eclipsys SCM – Yes

26 Functionality Order / Clinical Practice Standardization

„ MACS guides caregivers, speeding order entry and clinical documentation

„ MACS Perinatal includes:

„ Order sets and note templates

„ Clinical pathways

„ Care plans based on risk or population group

„ Clinicians common choices and preferences (individual and departmental)

27 Patient Decision Support Recognizing when patient education is needed

Refusal Date

28 Workflow and Communication

In this example the tracking board is Placing the pointer sorted by acuity. over an icon produces Color coding denotes a pop up window acuity level. giving the user more information at a Those whose acuity is glance. The 2 nd column unassigned are at the displays patient top in Teal. name , total time Black is the most in the ED, and The users acute, followed by chief complaintselect. from red, blue, olive and ra dio green. buttons at Patie nt location is the bottom displayed in the to update 1st column. the s tatus in the forth To access column. the patie nt This als o re c o rd, the re s e ts the user selects time r. the desired Age, sex, and patient – The users select vis it type are in highlighting from radio the 3rd column. the row. buttons at the bottom to The user update status selects from and re s e t the the tabs at time r in the 4 th the top. column.

29 Communication Tools

30 Decision Support J. C. - Case Study

„ Pregnant patient arrives at triage and is registered.

„ H&P reveals a 32y patient, GA 41w+6d, G5 P2022, whose chief complaint included contractions and lower abdominal pain.

„ Streamed-in data from previous visits included OB US with BPP data suggesting Polyhydramnios.

31 Data streamed from previous visits

32 The following ESSENTIAL items were presented (indicating the essential documentation items missing in this specific case

33 ‘Exists’ button was pressed to the two Suggested Problems

34 Prompted after Done Sequence in completed

35 J. C. - Case Study

„ EFM was entered = Reactive, Reassuring

„ Blood Type and Screen was ordered

„ Pelvic Exam was entered = Dilatation: 4 cm; SROM; Light Meconeum The following was then presented:

36 37 Technology

„ Philosophy: ‹ Flexibility (Modified “Best of Breed”) ƒ Applications chosen by users, with MIS guidance ƒ Integration, Communication, and Security are back-end standard deliverables ‹ Accountability ƒ Technical Personnel assigned to applications, not technologies ƒ Technical Managers responsible for insuring application support coverage 38 Technology

„ Philosophy: ‹ Scalability ƒ Rolling 3 year capacity planning for all systems ƒ Experience shows almost impossible to over spec storage, memory, or CPU ‹ Transferability

„ “No Fault” Post implementation analysis

„ No single success, all projects part of evolutionary process improvement

„ Involvement from all disciplines at all phases 39 Technology

„ De-Mystifying: The driver is healthcare solutions, not technology

„ Interface Engine „ Clustering „ SAN (Storage Area „ Inter-System Network) Communication

„ Enterprise Network „ Large storage „ LAN „ Communications „ WAN „ „ Wireless Security „ Intrusion Detection „ Redundancy Systems 40 Technology

„ How to deliver orders, „ Interface Engine

results, & clinical „ Enterprise Network

information to all „ LAN

departments quickly „ WAN

and securely „ Wireless

„ How to provide „ SAN (Storage Area 99.999% information Network) availability „ Intrusion Detection „ Data Security Systems

„ System Integrity „ Clustering

41 Technology

„ Standardization: a means to an end

„ Constantly evaluating flexibility vs. supportability

„ It cannot be achieved 100%

„ The process of asking the question does yield improvement in efficiency of technology support

„ It’s touch can be seen in all MMC systems

„ Standardization creates an inverse relationship between complexity and Total Cost of Ownership

42 Technology

Admin. MRC Bronchoscopy MEDE Membership NEIC Medrite HolterMonitor America Software Envoy Peds Echo Typical Floor Closets Pulmonary Lab Faxed Trace Master Downtime Results Vascular Lab CSC Claim 5000 5000 5000 5000 Submissio PC ADT Clicks Ultrasound n OP Administration Building Maimonides Medical Center COMM SPARKS Daily IP DOH Admits COMM 123 4 Faxed CDM IP MDCD DMZ Daily DRG Synersource Results Chrges OP DRG OC-3 OC-3 OC-3 OC-3 MDCD Pt Info System Cisco 7200 ADT 100BT Enterprise Network CheckPoint 10BT WEB Email Firewall Server Server Softmed T1 ADT MPI ADMIN A ADMIN B ABBDF 1 Internet Visits 18 Remote Sites (Typical) Daily OC3 OC-3 CDM Discharges ADT Chrgs Catalyst 2820 Surgi Charges IP BLCR CDM 5500 5500 5500 Server IP MDCR 10BT Chrgs OC-12 OC-12 Fuji 5 E7000 SMS Cisco 2610 PSN OP BLCR Omnipro

AC FA NOUTPUT AC FANOU TP U T AC FA N OU TP U T AC FAN OUTPUT OK OKFAIL OK OK FA IL OK OK FAIL OK OK FA IL

AC FA NOUTPUT AC FA N OU TP U T AC FAN OUTPUT AC FA NOUTPUT OK OKFA I L OK OK FAIL OK OK FA IL OK OKFAIL ISDN 5500 Dial Backup Electronic Medical ADT & Billing OP MDCR Record MDCR Fuji 4 BC OC-12 LECS Remit Backup#3 100BT HemoCare T1's ADT Eagle Access Blue Cross 7 BDF's Quest Daily ED Eligibility ADT Visits Aron Bldg Labs Monthly ADT & Batch Query Server RAD Daily ED EMEVS CMHC Bldg Data Center Fuji 3 Orders Orders Resultss Batches Gellman Bldg OC-12 Server Farm Orders Visit Medicaid Results & Results Updt Kronish Bldg Lab Batch Medicare Orders OPD Bldg ADT/ Orders GL Monthly Professional Bldg Lab Daily RAD Flexilab ED Non-Patient Research Bldg Kentrox Fuji 2 Orders CSU/DSU Orders Chrgs Cash; Daily Command Center Orders Sunquest Rack Daily OP Status HMED Visit Proc Fuji 1 Results Updt To Alicomp - RAD EDIS Proc IP BDF 7 DS-3 Orders ADT Disch OP People A B Eclipsys E7000 ADT EWEB-AIE OP Results Dx DS-3 64th Street Orders ChrgsOP 90 Soft IP OC3 Status Orders Visits IP DS-3 OC-3 Orders IP 90 To Alicomp ADT, Rad Ords, Sched, Status Bed FS Status Daily OP Adm Adm (Backup) Cancle Daily Census Cancel Results Chrgs Visits 5500 5500 Order Visits 64th Street T1 All E7 Med/IV (Backup) 7513 Initiated Orders IP

AC FA NOUTPUT AC FA N OU TP U T AC FAN OUTPUT AC FANOUTPUT OK OK FA I L OK OK FAIL OK OK FAIL OK OK FA IL IP Rad Orders Chartin Orders Paymnts g Chrgs Diag Payroll LES/BUS-VLAN2 Orders Status OP IP Disch GL DataCenter A DataCenter B Results Results Stor Paymnts 7513 OC-12 E*Gate Orders Status ADT OC-12 OC-3 LECS-Backup#2 Comm Interface LES/BUS-VLAN1 (backup) Cancle E&C PACS Engine Order 5500 5500 PMIS People Cisco AS5300B 100BT RAD AP CompOps A 56K Modem MACS CompOps B Orders Soft Reconcil ADT Daily Daily

AC FA NOUTPUT AC FANOU TP U T AC FAN OUTP UT AC FA N OU TP U T RAD OK OKFAIL OK OK FA IL OK OK FAIL OK OK FAIL ADT Results Visits OC-3 OC-3 Orders Chrgs HR OC-3 OC-3 Orders OC-12 PSN Results Resultrs Daily OrdersStatus Agilent ADT 5000 Orders Visit 5000 5500 Cisco AS5300A 56K Modem Status 5500 100BT Fetal Updt Results OC-12 Monitoring OC-3 Monthl Direct Clicks Physician 5000 OC12 OC12 Deposit AC FAN OUTPUT AC FAN OUTPUT OC12 OK OK FA IL OK OK FA IL RAD y AC FA NOUTPUT AC FANOU TP U T OK OKFA I L OK OK FA IL Cancle US Billing Daily DataCenter_MIS 56K Modem Orders Visits TSI Payroll Order (batch) 5 7 8 ADT 6 5000 Results NextGen Physician Payroll ADT Reconcil Typical Floor Closets LECS-Primary LECS-Backup#1 5500 Ambulatory Billing LES/BUS-VLAN1 LES/BUS VLAN2 OC-3 (Backup) Record

AC FANOUTPUT AC FANOUTPUT OK OK FAIL OK OK FAIL LS1010 Talk Station Rosetta-AIE ADT Visit Fleet Bank Monthl Displ OC-12 y Batch Update GL OC-3 DataCenter_5500C Resultss 100BT 100BT 100BT OC3 100BT (batch) CDM IDX Batch IDX BAR Switched 10/100 Unisys NCC HME Results ADT/Orders EPS Chrgs Network D 5500 RAD Mgmt Quest Physician Maimonides Medical Center Station Billing

AC FANOUTPUT AC FANOUTPUT OK OK FAIL OK OK FAIL Labs 1stDiagram=Displ2002 NextGe Server IPRob Physician n Network Dwg by : Server Farm Server Farm E&C Billing Maimonides Medical Center Interface Diagram October 25 2002 MACS CPR Availabilty vs. Internal SLA

In p a tie n t C P R 99% SLA A m99% b uSLA la to ry C a re C P R

100.00% 100.00% 95.00% U ptim e % 20 00 95.00% U ptim e % 20 0 1 90.00% U ptim e % 20 01 90.00% U ptim e % 20 0 2 85.00% U ptim e % 20 02 85.00% 80.00% 80.00% v n ul l a J n J Mar Sep No Ju ov May Sep N Ja Mar

P e r in a ta l C P R Emergency Dept CPR

100.00% 100.00% 95.00% 95.00% 90.00% U p tim e % 2 0 0 2 90.00% U p tim e % 2 0 0 2 85.00% 85.00% 80.00% 80.00% r Jan Ma Jan Mar 99% SLA 99% SLA 43 CPR Value

„ Prove return on investment:

„ Demonstrate value of the application

„ Provide qualitative and quantitative benefit statements

„ Promote awareness of process redesign, cultural and organizational issues

„ Integrate people, process and technology

„ Initiate a smarter implementation

„ Organizational objectives:

„ Patient safety – clinical excellence

„ Humane, patient-focused, patient-centered care

„ Strengthen physician collaboration through effective communication

„ Supportive environment for physicians

„ Strengthen teaching and research

„ Fiscal viability

44 CPR Return on Investment

(000’s) CPR’s Ancillary; Enterprise Network $43.909 Interface Engine Capital Reimbursement (7.250) Grants (4.962) Net Cost $31.697 Ongoing Expenses 58,086 Savings and Efficiencies 75,876 Payback (years) 3.84 ROI 9.4%

45 CPR Return on Investment

„ Patient Safety

„ Warns clinicians of safety checks required for High Alert medications „ Ensures safe selection of confusing look-a-like, sound-a-like drug names „ Verifies the selection of the correct patient „ Reduces the number of adverse drug reactions „ Improve medication turnaround time „ Reduces pharmacy’s drug expenditure; drug spending for 1999-2002 has remained below National Average

46 CPR Return on Investment

„ Patient Safety – High alert medication

„ The prescriber is required to check the patient’s serum creatinine and age

„ After review of the serum creatinine and age, the prescriber may safely proceed to order Metformin

47 CPR Return on Investment

„ Patient Safety – High alert medication, cont.

„ Pharmacists similarly review patient’s serum creatinine and age, intervening with prescriber if necessary

48 CPR Return on Investment

„ Patient Safety – Look-a-like – Sound-a-like Drugs

„ When viewing the medication index, „ After selecting the desired look-a-like, sound-a-like medications medication, its indication for use is are highlighted in different colors displayed to further alert clinicians of the intended use 49 CPR Return on Investment

„ Patient Safety – Verifying the Correct Patient

„ The prescriber selects a patient „ After selecting the patient, additional from the inpatient screen specific information appears. “Is This The Correct Patient?” must be answered 50 CPR2000 Return on Investment 1873 1800

„ Patient1600 Safety – Reduced1603 Adverse Drug Reactions # Adverse Drug Reactions (ADR's) 1400 # Pharmacy's Clinical Interventions 1450

1200

1000 1046

800

600 619

400 435 436 325

200

0 1998 1999 2000 2001 „ As the number of pharmacist’s clinical interventions increases, the number of adverse drug reactions decreases (optimizing medication use reduces the number of adverse drug reaction reports) 51 CPR Return on Investment

„ Efficiency / Patient Focused Care Medication Turnaround Time

6

5 5.1 4.6 4.5 4.3 4.3 4 3.3 3.4 3 33 2.8

2 1.47 1.45 1.43 1 11 0.8 0.7 0.7 0.64 0.6 0.6 0.7 0.6 0.6 0.6 0.53 0.47 0.5 0.3 0 0.36 0.35 1992 1993 1994 1995 1996 1997 1998 1999

Time from when order is initiated until Pharmacy acknowledges order Time for Pharmacist to process order

Time for prescription to be filled and delivered to patient area. TOTAL TIME REQUIRED

52 CPR Return on Investment

„ Fiscal Viability $15,000,000

$14,202,633* $14,000,000

$13,000,000

$12,296,652** $12,000,000 $11,562,929* $11,158,487 $11,000,000 $10,802,384 $10,516,953 MMC actual dollar expenditures $10,000,000 $9,692,496 Adjusted expenditures that reflect annual budget increase on drug purchases experienced by Non-Federal Hospital $9,000,000 * Projected expenditures for 2002 ** Projected expenditures based on data from first 6 months of 2001

$8,000,000 1999 2000 2001 2002 CPOE Cost Avoidance Initiatives „ Medication Ordering Pathways „ Dosage Modifications „ IV to PO „ IV Push „ Therapeutic Interchange

53 CPR Return on Investment

„ Efficiency / Patient Focused Care Laboratory Tests 1996 - 2001

Microbiology Se r ol ogy Urinalysis

90000 300 00 27 000 80000 1 250 0 80000 119 00 t 1 200 0 250 00 70000 60000 1 164 0 115 15 20000 1 143 3 16288 15766 60000 49422 474 91 200 00 4889 9 48623 1 150 0 15551 16018 50000 10 884 1 100 0 150 00 40000 10 460 100 00 30000 1 050 0 Total Num berof T es Total Number of Test of Number Total

TotalNumber Tes of 20000 1 000 0 50 00 10000 950 0 0 0 19 96 19 97 19 98 19 99 20 00 200 1 19 96 19 97 19 98 19 99 20 00 20 01 199 6 19 97 19 98 1 999 200 0 200 1

Hem at ology/Coagulation Chem is try

30000 0 280000 262936 262999 246000 258466 120000 0 990000 231807 25000 0 100000 0 780000 80000 0 20000 0 505174 60000 0 443662 475458 490265

15000 0 Test 40000 0

10000 0 20000 0 Total Number of Tes Total Number of of Number Total 0 5000 0 1996 1997 1998 1999 2000 2001 0 1996 1997 1998 19 99 2000 2001 Year Ye ar

54 CPR Return on Investment

„ Patient Focused Care

Radiology Turnaround Time to Final Report

200 180 160 140 120 100

(hours) 80 60 40 20 0

Average Time Completed Exam to Report Final Exam Completed Average Time 9 9 9 9 9 9 9 9 9 9 9 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 2 2 2 9 9 9 9 9 9 9 9 9 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 - - - - -9 - l- - - -9 - -9 ------l- - - -0 - -0 ------l- - - -0 - -0 - - - n b r r y n u g p t v c n b r r y n u g p t v c n b r r y n u g p t v c n b r a e a p a u J u e c o e a e a p a u J u e c o e a e a p a u J u e c o e a e a J F M A M J A S O N D J F M A M J A S O N D J F M A M J A S O N D J F M

55 CPR Return on Investment

„ Fiscal Viability

Radiology Department Monthly Comparison of Procedures 1999; 2000; 2001; 2002

15249 1550 0 14489 14493 14 50 0 13 70 2

13 50 0

1999 12 50 0

1150 0 2000

10 50 0 2001

n r y y v c a a a un Jl ug J Feb M Apr M J A Sept Oct No De 2002

56 CPR Return on Investment

„ Patient Satisfaction 100% 90% 85% 84% 80% 84% 80% 70% 72% 73% 70% 69% 67% 63% 60% 50% 40% 30% 20% 10% Satisfaction with Admissions / Registration / Surgical Overall Medical Patient Satisfaction Likelihood to Recommend Information/Communication/ Education Transition and Continuity 0% 1997 2001 1997 2001 1997 2001 1997 2001 1997 2001

57 CPR Return on Investment

„ Patient Safety / Regulatory Compliance The Ambulatory CPR:

‹ Improved compliance with problem lists from 67% to 97%

‹ Improved allergy documentation from 88% to 100%

‹ Improved pain assessment documentation to 95%

‹ Improved medication list documentation from 67% to 100%

58 CPR Return on Investment

„ Patient Access

Incremental Length of Stay Discharges Year Discharges Discharges vs. Base Reduction Attributed to MACS Year 1995 28,356 0 0

1996 .56 30,200 1844 461

1997 .91 32,150 3794 949

1998 .05 33,148 4792 1198

1999 .26 35,493 7137 1784

2000 .23 35,687 7331 1833

2001 .17 35,626 7270 1818

Total 2.21 230,660 32,168 8043

59 CPR Return on Investment

„ Fiscal Viability

Cash 1996 – 2001 (in millions) 200

180 203

160 Med Admin Ambulatory EMR Emergency EMR 140 Obstetrical EMR 134 120 TSI, Reinstallation 100 of Patient PACS Accounting & 80 RAD 60 POE 71 40 43 36 20 26 0 Dec-96 Dec-97 Dec-98 Dec-99 Dec-00 Dec-01

60 Vision For Future

„ Expand patient safety initiatives „ Expand decision support and knowledge documentation CPRs „ Break Ground New Hospital – planning to become a Digital Hospital

„ OR/Anesthesia Records

„ Virtual Imaging Radiology

„ Clinical Equipment Integration CPR, physiological, images, audio

„ Physical plant computers

61