Joseph Hagos may not be a doctor, but the population at Canada’s largest urban community hospital depends on him just the same.
Hagos is the IS manager (technical services) for The Scarborough Hospital (TSH), a Toronto-based, multi-site facility that includes the Scarborough General and Scarborough Grace hospitals. On the surface, TSH’s IT department faces the same budget challenges as the average IT department. But after factoring in 630 patient beds, 4,000 doctors, nurses and staff, and a population of close to one million people, handling IT for Canada’s largest community hospital does have its differences.
A typical week, says Hagos, involves traveling between the Grace and General sites. When TSH was formed in 1999 after a merger of Scarborough General and Salvation Army Scarborough Grace Hospitals, both IT departments came under a single structure. The technical and analyst staff handle approximately 60 calls on a typical day. The calls can be as simple as resolving printer problems, Hagos said, to a server down situation and application-related problems.
“The technical staff may be required to travel to one of the satellite sites to resolve a problem that cannot be resolved remotely.” The sites are connected by a dark fibre link, Hagos said. “It’s challenging in that the technical staff not only provide services to the General and Grace campuses but also to the five satellite sites that are connected via T1/ISDN circuits to TSH’s main Healthcare Information System (HCIS),” Hagos said. “The network infrastructure and the main HCIS need to be up 99.9 per cent of the time.”
On the server side, TSH recently implemented an EMC Corp. storage area network (SAN) for most of its data, along with a serverless backup system from Bridgehead Inc. In total, TSH has 12 servers: nine Dell servers and three ITS servers connected on a SAN. They are all fully redundant, Hagos said, adding the goal is to maintain a single storage medium for data. In the past, each server had its own local storage and backup. But now all data can be backed up from the SAN, so it is not only totally serverless, it’s a quick split at the database without degrading the CPU or with any effect on users, Hagos said.
According to Diane Cybulski, director of information and telecommunication services for TSH, about two per cent of TSH’s annual budget of $236 million is devoted to IT. “When you compare hospital IT departments to other sectors, we are traditionally underfunded,” Cybulski said. On top of that, there is an increased demand for IT’s expertise because each of the clinical departments and all of the departments in the hospital have their own technology that they want to implement. As a result IT has to be “jacks of all trades,” Cybulski says, and provide leadership on technology issues.
The core of TSH’s 1,300 desktops run Meditech HCIS software, a Health Care Information System (HCIS). Meditech is responsible for various electronic functions, including admissions, staff scheduling, and payroll applications. TSH runs the Meditech (HCIS) on a version of Windows as the main software on Dell 2650 servers. An EMC Symmetrix 8830 stores Meditech data and images from the Agfa PACS (picture archiving communications system). “And that’s an integral part of patient records. Images can be viewed along with data (X-rays, MRI).”
All of the departments use the same Meditech system. “We don’t support a best-of-breed environment,” Cybulski noted. “It’s an integrated shop, (and) integrated software but each area will have its technology to improve the processes in that environment.” TSH is standardized on Windows, running the integrated Meditech system and an intranet on various flavours of the OS. Software training is offered both in-house and by bringing in external instructors. Application patches and fixes are automated, Hagos said, adding they are scheduled during times when server traffic is light.
Currently underway is a PC refresh program with flat-panel Dell PCs. The small form factor PC will enable TSH to save space, particularly on the nursing units.
TSH also recently acquired a health care resource management (HRM) and business intelligence (BI) solution. TSH has set up a partnership with Montreal-based vendor MediSolution Ltd. and working a way to manage data in a format that’s useful for management to analyze what’s going on. “We’re looking at setting up dashboards for the various patient service groups,” Cybulski said. “We are data-rich for sure. And we need to make better use of the data.”
It has been a little over a year since the Severe Acute Respiratory Syndrome (SARS) epidemic. The Grace Division was the first Ontario hospital to receive a SARS patient in March 2003.
At no time were the IT systems down during the outbreak, Hagos said. In fact TSH was one of the few hospitals that developed a wireless infrastructure and a computerized screening program for staff and doctors. Simply put, the system had to be able to track patient and staff data. “The use of barcode technology was put in place to identify and track all staff movement and to speed up the SARS screening process significantly,” Hagos said. The fact the TSH was integrated and connected by fibre helped matters, Cybulski added.
Two weeks before SARS, the Grace Division had gone live with the Meditech HCIS, joining the General Division’s Meditech database. The old system had limited IT support, Cybulski said. Being on a single system made patient tracking easier through reporting; using Meditech, all necessary patient information (name, account number, home phone number, date admitted, room transfer history and reason for visit) were compiled. Information on hospital staff was also collected and downloaded from Staff Scheduling and Payroll. These reports could then be customized and downloaded into Excel.
Among the lessons learned, according to Cybulski, was the importance of improved and standardized data and information sharing between hospitals and the public health departments. This was lacking and that’s something to move forward with in the future, Cybulski says.
NEW IT INITIATIVES
TSH is also looking at boosting the wireless infrastructure to allow staff to use handheld devices to record data such as patient vital signs and other information. Indeed, TSH is moving forward with several IT initiatives.
One example is the recently completed picture archiving communications system (PACS). The film-less imaging technology allows radiologists and clinicians remote electronic access to patients’ images. Also completed is a robotic medication management system, which automates the verification of medications by bar code. This not only cuts down on the potential for medication errors, it also boosts the efficiency of overall hospital medication management. There are four technologies: Robot-Rx, MedCarousel, automated medication cabinets (AcuDose-Rx) and an electronic bar code application for bedside medication administration known as Admin-Rx. The new system will handle the 2.5 million prescriptions the hospital dispenses each year.
Cybulski noted that TSH is among the first hospitals in Canada to have this fully integrated bar code based system where electronic verification is used in all steps of medication dispensing.
Overall, TSH has done a good job of keeping up with technology given the resources. According to Cybulski, the TSH, as any other hospital, has a capital process and funding is requested for technology initiatives. “We try to balance the needs of the organization and keep up with technology,” Cybulski said. “It’s a juggling game. One year IT will get a large chunk of capital funding and another year another department will.
“I think we do the best we can with the resources we have.”