May 14, 2007

If at First You Don’t Succeed...
By Laura Gater
For The Record
Vol. 19 No. 10 P. 12

Southwestern Vermont Medical Center (SVMC), a 99-bed community hospital in Bennington, was unhappy with its mobile software system. Poor functionality and a lack of reliability made the system a hindrance and sent SVMC in search of a replacement.

Under the old system, it was impossible for physicians to add patient information to their mobile devices unless they knew the patient’s eight- to 12-digit medical record number and entered the number exactly as it appeared, including the right amount of leading zeros. In addition, synchronization times were relatively long, and the wireless connection was unreliable. The product also failed to provide access to some particular report types—such as nursing notes—that physicians needed and relied on. The interface was not user-friendly, and users were unable to plot or trend data.

This unreliability meant that SVMC could have lost support for its overarching IT plans, which included a computerized physician order entry system. Adoption was low and continued to decrease over several years as physicians and the vendor tried to work out the problems.

“We were voted one of the most wired hospitals in the nation,” says Simon Drew, MD, a physician at SVMC. “We wanted something more useful and wireless.”

While requests for enhancement by the vendor went unresolved, the hospital upgraded its wireless infrastructure in hopes of improving the reliability of wireless connection. The excitement that should have persisted for a new electronic environment and its capabilities had dwindled, and the outlook for future technological enhancements was not bright.

According to SVMC’s Tim Chapman, MD, the failed project turned out to be a waste of time for IT staff and physicians. “We did ask for some enhancements/changes in the software, but largely the project dwindled because of little or no continuing interest from the physicians and more urgent needs of the limited information systems staff,” he says. “While we did lose some money and work on the failed endeavor, another major loss was the decreased interest and support from the medical staff in other future IT projects. Doctors said that if this product looked good and failed, why should they invest their valuable time and effort in another system? Dollars are difficult to quantify; however, much IT and physician time was wasted with the failed project. Thankfully, the hardware was able to be repurposed for PatientKeeper.”

Physicians from SVMC met PatientKeeper representatives at a trade show and explained their predicament. When the PatientKeeper Mobile Clinical Results option became available, SVMC opted not to renew its contract with the previous vendor. In late 2006, the new software was installed at the hospital, and the first group of doctors was up and running within three to four weeks.

PatientKeeper enables physicians to access their patients’ electronic records, write prescriptions, enter charges, dictate notes, document encounters, place orders, and send secure messages to colleagues in one integrated environment. Furthermore, the system can be personalized to meet each physician’s specific needs.

The program’s physician information system has been successfully integrated to all of SVMC’s major information systems and electronic medical records, including Cerner, Eclipsys, Epic, GE Healthcare/IDX, McKesson, MEDITECH, QuadraMed, and Siemens. Access to patient information is possible anytime and anywhere through the use of PDAs, smartphones, and PCs running a Web browser.

PatientKeeper, which features bidirectional capability, has helped enhance SVMC’s patient safety, increase physician affinity, and create time savings for physicians and patient support personnel.

“This time, only four or five physicians used PatientKeeper and piloted it for a while. They [PatientKeeper] were able to change the program to suit us,” says Drew. “I can now do prerounds on patients by reading what the nurses have written about them overnight and reviewing patient vital signs and test results before I see the patient.”

Drew and his colleagues use an iPAQ, an HP Windows mobile device, to access patient records. He has been using PatientKeeper for two months, and soon all 150 physicians at SVMC will be able to utilize the technology. For Drew, using the system is as simple as logging in, pressing the “sync” button, and reading a list of his patients. He can then tap buttons to review lab test results, browse nurses’ notes, or read vital signs.

“SVMC wanted the option to add other PatientKeeper applications, such as our physician portal and electronic charge products, after PatientKeeper Mobile Clinical Results is fully deployed,” says Stephen S. Hau, the company’s founder and vice president of marketing.

Lessons learned from this experience are that system stability and a physician-friendly design are key to a successful software implementation. “If the physicians don’t adopt the software, then the project cannot be a success, and it can hurt enthusiasm for future IT projects,” says Chapman.

According to Hau, in some ways, the second implementation was easier because SVMC was an experienced, educated customer. Nevertheless, the second time around was a source of anxiety for many. Physicians clearly knew what they wanted from a physician information system, but some were skeptical because of the initial project’s failure.
“The physicians already had a very bad experience, so we knew they would have very little tolerance for mistakes of any kind,” says Hau. “Now, the physicians are very excited about having a physician IT system.”

— Laura Gater’s medical and business trade articles have been published in Healthcare Traveler, Radiology Today, Corrections Forum, Credit Union BUSINESS, and other national and online publications.