Streamlining: How Hamilton Health Services took care of clutter

In 1996, four hospitals merged to form Hamilton Health Sciences. Today, it’s one of the largest teaching hospitals in Ontario. It operates across four sites and has 8,000 employees, 1,000 physicians and 1,160 beds. Through its affiliation with McMaster University’s Faculty of Health Sciences, it has a focus on academics and research.

The problem at the time of the merger was that each of those four facilities had its own systems with different technologies and cultures. Nothing was connected and it was impossible to get a global view of a patient. Hardware was outdated and support cost was high.

Since we kept compiling more patient data, we had to do something. So we talked to other hospitals but couldn’t find one that archived its data online. Our idea was to standardize everything across the four sites. In 2000, we replaced our business systems with one system – PeopleSoft – and then looked at our clinical system, which had about 250 applications with different vendors, computers and different platforms. In April 2002, we moved to one system on one platform.

Data from disparate systems had to be archived, including the Sunquest Lab System, Cerner PharmNet System, Cerner RadNet System, AMS Purchasing System and Clinics Scheduling System. In April 2002, these systems were replaced by the new medical information system – Meditech – and that’s where Loris Technologies Inc. came in.

Loris is an innovator in the programming, development and on-site application of digital storage technologies. Its product, FileNexus, is an electronic data repository of records – for any type of file, including electronic files, paper, forms, microfilm and even non-communicating computer systems, from any source, including host systems, PCs, scanned images, emails or faxes. Records stored to FileNexus can be retrieved instantly without the user leaving the desk.

Loris offered functional ability and a sound business case for price performance. They were cost-effective, flexible and Canadian, with ease of access and ease of use for caregivers.

However, with 8,000 employees, training on new systems could have been a nightmare. But no training was necessary – a big plus because so much had to be archived.

For example, our lab needs detailed patient information. For a blood transfusion it must know who donates the blood, how much is donated and where it goes. This means that every transaction processed by the system must be archived and searchable, and when you handle 40,000 daily transactions like we do, that’s an ambitious undertaking. Also, since we’re a teaching hospital, data must be retrievable for research purposes. In short, we had to move more than 5 billion records and millions of pages of data.

When the new medical information system Meditech went live with admissions, discharge, scheduling, radiology, labs, order entry and patient results, we found that some staff resisted because they feared losing their information; it was a cultural change. But Loris built a prototype for our diagnostic imaging department and did a demo which reassured staff. The same thing was done for purchasing, which found they could access information they never got out of the old system.

In our old system, using various screens and loading tapes and paper, it took up to six months to compile a complete historical record for a patient. Now information is archived immediately. The user – a physician, nurse or radiologist – merely keys in the patient name and gets all the archival material.

The system has meant that:

– Software support contracts for legacy systems, which held information and cost over $400,000 a year, are no longer needed and neither is full-time staff to maintain that equipment;

– The transaction processing from one system to another that had involved some 180 interfaces now involves only five;

– The need for risk inherent with legacy systems – which involved old, unreliable systems on old hardware – is no longer a factor with the move to a more secure system;

– The whole system, including hardware and software integration and internal resources, paid for itself in months.

Later this year we’ll extend FileNexus to patient billing and accounts receivable, payroll, HR, and Time & Labour. This will offer us the potential for even more savings, at nominal cost. We expect to increase the speed of the system due to the archiving of historical data from the production systems. We also expect reductions in paper and microfilm, as well as in related storage and staffing costs and in host user fees.

Finally, there is an audit trail of everyone who has viewed a patient record from the archive. An authorized person can also annotate a record, sort of like a Post-it-Note concept, with restricted access placed on the content. These two features, along with the fact that original records can never be altered, position the system strongly for privacy and health information acts.

Winston Sullivan is Manager, Information and Communication Technologies, Hamilton Health Sciences.

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