Strategies to Improve Patient Intake Efficiency in a Medical Office - PDF

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					                                              Microsoft Customer Solution
                                              Healthcare Industry Case Study

                                              Surgery Intake and Tracking System Boosts
                                              Efficiency, Patient Safety, Bottom Line

Overview                                      “We now have the data to determine best practices
Country or Region: United States
Industry: Healthcare—Provider
                                              for both patient care and operating room efficiency.
                                              The information management system has made a
Customer Profile
Vanderbilt University, which includes the
                                              revolutionary difference in the way the OR operates.”
Vanderbilt University Medical Center          Dr. Michael Higgins, Chairman, Department of Anesthesiology, Vanderbilt University Medical Center
(VUMC), employs more than 22,000
people, making it the largest private
employer in middle Tennessee. VUMC            Vanderbilt University Medical Center (VUMC) is Tennessee’s largest
includes several hospitals and clinics, a
                                              and most prestigious medical facility. A decade ago, its
medical school, and research facilities.
                                              anesthesiologists initiated the development of an easy-to-use,
Business Situation
                                              electronic anesthesia documentation solution that has evolved into
Paper-based processes for surgical patient
documentation and tracking impaired the       a comprehensive patient information system specialized for acuity
hospital staff’s ability to deliver optimum
                                              care. Called VPIMS, the solution was developed using Microsoft®
patient care, operating room efficiency,
and hospital profitability.                   software and runs on the Windows Server® 2003 operating system
                                              and Microsoft SQL Server® 2005 database software. Using VPIMS,
VUMC used Microsoft® software to create a     VUMC staff members have been able to improve patient care by
multimodule application, used by
                                              having quick access to accurate patient data. The hospital has also
physicians, nurses, and administrators,
that supports the entire continuum of         improved its bottom line by making staff more efficient, reducing
surgical care, from scheduling to billing.
                                              surgery delays, reducing administrative work, and improving billing
Benefits                                      accuracy. By analyzing data generated by VPIMS, VUMC continues
  Improved patient care
                                              to improve on all metrics.
  Improved profitability
  Data for meeting healthcare initiatives
  and continued improvement
"We wanted to improve                           Situation                                          At VUMC, operating-suite inefficiencies began
                                                Throughout its 132-year history, Vanderbilt        with paper-based documentation methods for
care, especially during                         University Medical Center (VUMC) has been a        preparing patients for surgery, which
surgery, but we knew                            leader in medical education, research, and         sometimes led to delays and cancellations.
                                                patient care across the southeastern United        Usually, a patient was sent to a preoperative
that we had to start                            States and the nation. At the heart of the         center, where a nurse took the patient’s past
collecting data if we                           medical center is Vanderbilt University            medical and anesthesiology history on a
                                                Hospital, a 700-bed, tertiary-care not-for-        paper-based form. Using this report, the
were to compare the                             profit center with 58 operating rooms in eight     anesthesiologist developed an anesthetic
effects of different                            locations. VUMC also includes medical and          plan, made sure that needed medications
                                                nursing schools, a children’s hospital,            were on hand during surgery, and developed
medications and                                 extensive biomedical research facilities, and      a postoperative pain management plan.
anesthetics on different                        a number of specialty clinics. Combined,           However, often the paper report wasn’t
                                                Vanderbilt University and VUMC employ more         available on the day of surgery or was
patients.”                                      than 22,000 people, and they are the largest       incomplete.
Dr. Michael Higgins, Chairman, Department of    private employer in middle Tennessee.
Anesthesiology, Vanderbilt University Medical                                                      “Our anesthesiologist spent 30 minutes re-
Center                                          About ten years ago, a group of                    creating the report—not a good use of a highly
                                                anesthesiologists at VUMC began to address         paid and busy professional’s time,” explains
                                                the issue of patient-care consistency; quality     Dr. Paul St. Jacques, Associate Professor of
                                                of care had just begun to surface as an            Anesthesiology at Vanderbilt University
                                                important issue across the United States.          Medical Center. “Even if the report did show
                                                “We were treating thousands of patients in a       up, the patient data was sometimes
                                                large, thriving academic practice, but there       incomplete or illegible, which could result in
                                                was a lot of variability in care,” says Dr.        the surgery being cancelled, resulting in
                                                Michael Higgins, Chairman of the Department        waste of expensive resources.”
                                                of Anesthesiology at Vanderbilt University
                                                Medical Center. “Each physician did things         At the time of surgery, the anesthesiologists
                                                differently, but we had no real data to know       might find that they needed additional testing
                                                which way was best. We wanted to improve           or equipment that hadn’t been scheduled,
                                                care, especially during surgery, but we knew       which could also delay or cancel the surgery.
                                                that we had to start collecting data if we were    The worst case was that the surgery would
                                                to compare the effects of different                proceed with insufficient patient data, with
                                                medications and anesthetics on different           the possibility of an adverse outcome for the
                                                patients.”                                         patient.

                                                By identifying and standardizing best              Once in the operating room (OR),
                                                practices for patient care, the                    anesthesiologists, nurses, and surgeons
                                                anesthesiologists hoped to improve not only        wanted better, more convenient access to
                                                patient care but also operating-suite              patient data, which was difficult to obtain
                                                efficiency. In most healthcare institutions, the   when the data was on paper. In addition,
                                                surgical suite represents the largest source of    anesthesiologists often manage multiple
                                                hospital revenue and costs. Inefficient use of     patients in simultaneous surgeries and had
                                                a hospital’s most-expensive staff and              to run from OR to OR to monitor them.
                                                facilities has a huge negative impact on the
                                                bottom line.                                       “Once we began to think about capturing
                                                                                                   patient data electronically, we saw
                                           opportunities for process and care                  by records being unavailable or incorrect on
                                           improvements everywhere,” Higgins says.             the day of surgery.
                                           “The challenge was how to best collect and
                                           share patient information in the surgical           “One of the big advantages of using Microsoft
                                           suite, to provide a real-time view of what was      software is the ability to deploy something
                                           going on with a patient throughout the              quickly and iteratively—use it, improve it, and
                                           process, before, during, and after surgery.”        keep the cycle going,” Patel says.
                                                                                               “Sometimes, in those early days, we’d have
                                                                                               daily releases of the solution.”
                                           Doctors Higgins and St. Jacques turned to a         The team has since upgraded the information
                                           group of engineers within the anesthesiology        management system to run on the Windows
                                           department for help. This team, headed by           Server® 2003 operating system and
                                           Nimesh Patel—who today is Director of               Microsoft SQL Server 2005 database
                                           Perioperative IT for Vanderbilt University          software, using Microsoft .NET Framework,
                                           Medical Center—had been working on a                Web services, and forms technologies as the
“Microsoft software has                    variety of data-collection projects for the         development environment. “Moving to SQL
been key to our ability to                 anesthesiologists.                                  Server 2005 gave us big performance
                                                                                               improvements, and moving to Windows
get new modules out                        Rapidly Developed Surgical Tracking                 Server 2003 gave us long-term support for
quickly, incorporate                       System                                              our solution, plus the ability to manage
                                           The doctors explained their vision of an            upgrades more easily,” Patel says. “Using the
changes quickly, and                       electronic patient information system that          .NET Framework, we are able to create many
improve the application                    would span the surgical process. Patel’s team       more reusable components to make ongoing
                                           started by evaluating commercial healthcare         development faster and easier.”
in an iterative fashion.”                  information applications, but found none that
Nimesh Patel, Director of IT, Vanderbilt   could be adapted for use in the OR                  VPIMS, a Multimodule Solution
University Medical Center                  environment. “We wanted a system that               Over a period of ten years, VUMC has
                                           collected data on the entire continuum of           expanded its original patient evaluation
                                           care, from patient history to post surgery          solution into a multimodule solution, called
                                           discharge,” Patel says. “There was nothing on       VPIMS, that supports the entire continuum of
                                           the market that had everything we needed,           surgical care and patient monitoring, from
                                           so we decided to create our own.”                   scheduling to billing. Using Microsoft software
                                                                                               in an iterative development environment,
                                           VUMC already had a large investment in              Patel and staff have been able to incorporate
                                           Microsoft® software, so Patel’s team decided        new ideas and capabilities, test them in a live
                                           to create its new patient-tracking system           OR environment, and continue to improve
                                           using the Windows® 2000 Server operating            VPIMS at a rapid rate.
                                           system, Microsoft SQL Server® 6.5, and the
                                           Microsoft Access™ 97 database—software in           “Because this was not an IT-driven but a
                                           use in the mid-1990s. The first module,             physician-driven solution, we’ve seen a high
                                           created in just a few months, allowed               degree of adoption among the clinical staff,”
                                           anesthesiologists to digitally record all patient   Patel says. “Microsoft software has been key
                                           information during the preoperative                 to our ability to get new modules out quickly,
                                           evaluation. This early system eliminated            incorporate changes rapidly, and improve the
                                           paper records at patient intake and the             application in an iterative fashion.”
                                           associated rework and delays often caused
                                     Today, there are eight VPIMS modules:            used to provide comprehensive
                                                                                      information to the physicians and nursing
                                       Preoperative Evaluation Module. This           staff regarding the patient and the surgical
                                       module is the initial point of entry for       process. It continually provides updated
                                       patients’ medical history data. Clinicians     information to the Patient Tracking module
                                       use an electronic form to gather data,         for planning and OR scheduling.
                                       which is stored in the central database for
                                       future reports and queries.                    Gas Chart. An application for complete
                                                                                      intraoperative anesthesiology charting
                                       Patient Tracker. This module (see              designed to mimic standard workflow
                                       screenshot below) is the backbone of           patterns taught to clinicians during their
                                       VPIMS in that it brings together information   training. Documentation compliance is
                                       from all the other modules. It is used to      supported through more than 30 checks
                                       monitor patient status and improve staff       for record completeness, with electronic
                                       management and efficiency by providing         reminders that address potential errors.
                                       real-time information on case progress.        Decision support for key protocols such as
                                       Data entry at multiple points in the care      prophylactic antibiotics and beta blockade
                                       path (admitting office, preoperative holding   administration are also included.
                                       area, OR, postoperative anesthesia care
                                       unit), provides a time-stamp and indication    eORBoard. eORBoard displays all pertinent
                                       of patient status.                             information relating to the surgery
Figure 1: The VPIMS patient                                                           schedule in an intuitive, graphical format
    tracker module shows patient       Nurse Charting. An application for             that replaces the need for white boards,
    status throughout the surgical     recording events, patient information, and     markers, and magnets. The application is
    process.                           notes throughout the surgery. The              integrated with the electronic case
                                       documentation captured by this module is       information and patient status data
                                                                                      entered from other VPIMS modules.
                                                                                      Patient-protected data can be masked
                                                                                      from unauthorized viewing when the data
                                                                                      is displayed in public areas such as family
                                                                                      waiting rooms. Estimated case lengths are
                                                                                      adjusted as each case progresses, so
                                                                                      rooms and personnel can be effectively
                                                                                      managed in high-demand situations.

                                                                                      Continuous Quality Improvement. This
                                                                                      module is used after surgery by specially
                                                                                      trained staff members who follow up on
                                                                                      anesthesia care with the patient. Using
                                                                                      customized questions, they collect data
                                                                                      that is aggregated for specific reports on
                                                                                      patient satisfaction and quality of care for
                                                                                      peer review.
                                                                                      Reporting. The VPIMS reporting module
                                                                                      offers a robust set of operational, clinical,
                                                                                      and financial reports to track performance
                                                                                      across the perioperative enterprise. The
                                  reports are designed to capture key billing      on any mobile device (see figure below).
                                  information as well as all clinical
                                  information and use standard clinical          VUMC runs VPIMS on the OQO model 02 ultra
                                  terminology and symbols.                       mobile PC, which offers complete Windows
                                                                                 functionality in a pocket-size form factor,
                                  Vigilance. Vigilance evolved out of the need   critical for physician adoption. A sliding
                                  to improve the situational awareness of        display with pen tablet capability and
                                  clinicians managing multiple patients          ergonomic thumb keyboard facilitate easy
                                  simultaneously. It is a clinical decision-     data entry. Additionally, the OQO computer
                                  support application that mobile clinicians     can access data networks with built-in WiFi
                                  use to concurrently monitor all stages of      and mobile broadband, so physicians are
                                  care for multiple patients in multiple ORs     always connected to patient information.
                                  and within intensive care units. The
                                  clinicians have immediate access to vital      VUMC has deployed VPIMS in three hospitals,
                                  signs, lab data, and streaming video from      where it’s running on more than 1,000
                                  the point of care for instant assessment of    workstations and used by more than 500
                                  patient progress. Clinicians can subscribe     people, including anesthesiologists, nurses,
                                  to a number of alerts in the form of on-       surgeons, and administrators. VUMC has also
                                  screen messages as well as text paging to      recently made VPIMS available to other
                                  increase patient safety and respond rapidly    hospitals as a commercial product through a
                                  in critical situations. A clinician does not   third-party reseller, Acuitec.
                                  need to rely on others to summarize the
                                  patient’s situation when time is of critical
                                  importance; instead, Vigilance presents        Benefits
                                  pertinent patient data along with clinician    Vanderbilt University Medical Center has
Figure 2: Mobile device showing   configurable alerts that can be displayed      improved the workflow for surgeons and
    Vigilance.                                                                   anesthesiologists using a multimodule
                                                                                 surgical-suite application developed with and
                                                                                 running on Microsoft software. VPIMS
                                                                                 provides instant access to digital patient
                                                                                 information and clinical systems, reduces
                                                                                 surgery delays, and improves patient care.

                                                                                 “VPIMS provides real-time information related
                                                                                 to the performance of the ORs, and can
                                                                                 also track key performance, safety, and
                                                                                 efficiency metrics for individual surgeons,
                                                                                 procedural areas, and departments,” explains
                                                                                 Dr. Naji Abumrad, Chairman of the
                                                                                 Department of Surgery at VUMC. “This
                                                                                 information is extremely powerful in enabling
                                                                                 us to review historical performance while,
                                                                                 more importantly, improving our processes,
                                                                                 clinical outcomes, and overall patient care
                                                                                 and satisfaction. This is accomplished
                                                                                 without inconveniencing the surgeon or
                                                                                 placing any additional tasks into their
“When doctors have all                          already-full daily workload.” Because of its      “This also helps us alleviate staffing
                                                continued investment in Microsoft software,       shortages and overtime charges.”
the information they                            VUMC has been able to create innovative
need at the point of                            solutions faster and less expensively.            As a result of using VPIMS, the medical
                                                                                                  center has realized multiple critical
care, they don’t waste                          Improved Patient Care                             operational improvements. For starters, the
time walking around                             Using VPIMS, the medical center has been          annual caseload has grown 10 percent
                                                able to make preoperative evaluation forms        annually for several years without the need to
looking for patient files                       instantly available to attending physicians so    hire additional staff. The number of on-time
or other medical staff.”                        they can deliver the best possible care. “Less    first-case starts has increased by 100
                                                time doing paperwork translates into more         percent since 2002. VUMC hospitals have
Dr. Paul St. Jacques, Associate Professor of    time for patient care,” Higgins says.             seen a 65 percent decrease in day-of-surgery
Anesthesiology, Vanderbilt University Medical   “Clinicians can complete tasks faster and         delays. They have also seen a 67 percent
Center                                          more accurately electronically, while following   reduction in the average time to complete
                                                the same processes they already know.”            and submit an anesthesia chart to billing and
                                                                                                  a 69 percent decrease in the number of
                                                With digital data on patients and each            anesthesia charts that need correction or
                                                surgery’s progress, physicians are able to        resubmission.
                                                engage in more proactive, timely decision
                                                making. “When doctors have all the                Additionally, the anesthesiology department
                                                information they need at the point of care,       has realized a 75 percent decrease in the
                                                they don’t waste time walking around looking      amount of insurance write-offs and a 96
                                                for patient files or other medical staff,” St.    percent reduction in missed and/or under-
                                                Jacques adds. With the ability to monitor         billing. Due to improved documentation made
                                                patients remotely, using mobile computers,        possible by VPIMS, VUMC has reduced its
                                                physicians and clinicians can provide better      third-party write-offs to less than 0.1 percent
                                                care for more patients.                           and is driving billing and collection costs to
                                                                                                  less than 1 percent of operations. “These
                                                Including reminders in the software has also      changes have helped to dramatically improve
                                                increased patient safety. “When we                our bottom line,” Higgins notes.
                                                programmed the information management
                                                system with prompts such as, ‘Administer          “Comparable solutions are typically
                                                antibiotics before incision,’ we saw infections   associated with hardware purchases or
                                                decrease by 67 percent,” Higgins says. “The       enterprise solutions and are significantly
                                                magnitude of outcome improvements as a            more expensive,” St. Jacques adds.
                                                result of simple process improvements was a       “Additionally, configuration and support for
                                                surprise to us.”                                  off-the-shelf packages add significant
                                                                                                  expenses to the original purchase price.”
                                                Improved Bottom Line
                                                By using VPIMS, Vanderbilt University Medical     Data for Payer Initiatives and Continued
                                                Center has been able to maximize surgical-        Improvement
                                                suite throughput while maintaining quality,       VUMC is now able to gather deep, qualitative
                                                which is critical to maintaining financial        patient data that it can analyze for signs of
                                                viability. “VPIMS improves OR profitability by    continuous improvement. VPIMS produces a
                                                allowing us to improve surgical case volume       wealth of data that helps VUMC hospitals
                                                and resource utilization,” St. Jacques says.      support pay-for-quality (P4Q) and pay-for-
                                                                                                  performance (P4P) initiatives that many
For More Information                                            health plans have adopted. The depth and          Microsoft Solutions for the Healthcare
For more information about Microsoft                            richness of the reporting module not only         Industry
products and services, call the Microsoft                       supports P4Q and P4P initiatives, but also in-    Healthcare and life sciences organizations
Sales Information Center at (800) 426-                          depth research and analysis, operational          are under tremendous pressure to meet
9400. In Canada, call the Microsoft                             evaluation and improvement, clinical              regulatory requirements, improve patient
Canada Information Centre at (877) 568-                         outcomes and tracking, and financial              care, and reduce the time it takes to develop
2495. Customers who are deaf or hard-of-                        management.                                       drugs and take them to market. To meet this
hearing can reach Microsoft text telephone                                                                        challenge, Microsoft and its partners have
(TTY/TDD) services at (800) 892-5234 in                         “We now have the data to determine best           developed cost-effective solutions that
the United States or (905) 568-9641 in                          practices for both patient care and operating     enable healthcare organizations to
Canada. Outside the 50 United States and                        room efficiency,” Higgins says. “The              streamline and automate daily processes that
Canada, please contact your local                               information management system has made a          improve productivity and deliver information
Microsoft subsidiary. To access information                     revolutionary difference in the way the OR        whenever and wherever it is needed. The
using the World Wide Web, go to:                                operates.”                                        result is enhanced productivity, safety, and                                                                                                 quality.

The VPIMS and Vigilance technologies are                                                                          For more information about Microsoft
commercially available through Acuitec. For                                                                       solutions for the healthcare industry, go to:
more information, contact Acuitec at (205)                                                              
266-0848 or visit the Web site at

For more information about Vanderbilt
University Medical Center products and
services, call (615) 322-5000 or visit the
Web site at:

For more information about OQO products
and services, call (877) 676-6688
or visit the Web site at:

                                                                 Software and Services                            Technologies
                                                                    Windows Server 2003                           − Microsoft .NET Framework
                                                                    Microsoft Server Product Portfolio           Hardware
                                                                    − Microsoft SQL Server 2005                   OQO model 02 mobile computer

This case study is for informational purposes only. MICROSOFT

Document published February 2008

Description: Strategies to Improve Patient Intake Efficiency in a Medical Office document sample