Technology, lean principles changing healthcare

Networking helps providers give better care to patients


Connie Rockstad, director of the nursing program at Whatcom Community College, stands in the nursing lab where students practice with high-tech mannequins.


As the merger of Madrona Medical Group and Peace-Health nears final approval by Madrona stockholders this month, the move raises questions about the way the medical industry is changing. What will the future of health care look like?

According to several local experts, the local medical landscape is evolving in more ways than just the merger. Some of these changes include increased patient care because of efficient networking technology, more awareness of the need for “lean” practices on the hospital floor, and more integrated education of nursing students coming fresh out of school.

When it comes to network connectivity, Whatcom County is already one of the most wired medical communities in the United States, said Lori Nichols, director of HInet, the private intranet that connects almost all of the health care providers in the county.

“Technology is finally starting to support people so they don’t have to do the data entry, but they still have the information available to them in a usable format and available to anyone else who is involved in their care,” Nichols said.

HInet started the electronic network in 1995 by distributing 105 computers to various medical practices. The network now has almost 2,900 computers in 115 locations around the county. On this network, health care providers have access to reference materials and lab results, and they can easily send and receive information to other offices.

“The hospital has a lot of medical reference materials online,” Nichols said. “They’ve got more things online than on the shelf.”

More importantly, approximately 30 percent of practices in Whatcom County have done away with paper records and are now using electronic medical records over the network. That’s higher than the national average.

The HInet system is not just for health care providers, though. Patients in Whatcom County can now create a personal health record called a Shared Care Plan, which allows them to track everything from medical history to prescriptions to doctor’s appointments. This program rose out of a demand from patients for more participation in their own healthcare.

“Patients didn’t want just a view into the clinic system to see how things were going — they wanted their own record to be able to keep track of health information,” Nichols said.

HInet is looking into several different applications for this personal health record, one of which is standardized clipboard forms. Rather than sitting in the waiting room and filling out a stack of forms each time you visit a clinic, HInet would be able to take information from your record — insurance provider, allergies, emergency contacts — and put that onto a clipboard form that would be standard across multiple practices.

“This will print out just like the other forms that they use in their office,” Nichols said. “Then there’s less waiting time and it’s easy to update before you go to the practice.”

The hardest part about integrating new technologies is creating something that is easy to use and fits seamlessly into the current processes.

“Technology can have wonderful applications, but if it doesn’t fit with the work flow then it doesn’t get used,” Nichols said.


Applying lean principles

Finding new ways to apply technology to the medical system will certainly change things, but what if it’s the system that needs to change?

Local author Naida Grunden offers a few glimpses into one direction the industry is moving. In her recently released book “The Pittsburgh Way to Efficient Healthcare: Applying Toyota-based Improvements to Healthcare,” Grunden looks at the way that lean manufacturing principles from the Toyota Production System, such as reducing waste and error, can be applied to the medical field and achieve positive results.

But what does building cars have to do with health care?

“People picture a car company as robotic and regimented, but when you look at the Toyota system, it’s very different than that,” Grunden said. “It’s very dynamic.”

Grunden’s book examines the Pittsburgh Regional Healthcare Initiative (PRHI), which was started 10 years ago as a way to seek increased quality and decreased costs in the medical field through applying lean principles. It follows several hospitals in the Pittsburgh area that each took on a different task.

At one of the Intensive Care Units (ICU) at Allegheny General Hospital, the goal was to reduce the number of central line infections — which are infections located at the site of a tube that is inserted into one of the larger veins in the neck, chest or groin — down to zero. Though that may have seemed impossible, setting that goal was important because it kept everybody focused on that result, Grunden said.

“Maybe the human being is imperfect and zero is impossible,” she said. “But how close can we get to zero?”

By changing several simple practices, such as using hand sanitizer before entering or leaving a patient’s room and standardizing the way the procedure is done, the ICU reached zero central line infections in 90 days. After that, the infection rate remained low and by 2004, they had zero deaths from central line infections.

With the success of PRHI over the past 10 years, Grunden said she is optimistic about other lean-inspired quality improvements catching on.

“I think lean in health care is becoming more accepted,” she said. “The problem occurs when people think of it as the flavor of the week without understanding that this is a fundamental shift in the way work is done. The neat thing about the Toyota Way is that it’s woven into the work culture.”


Teaching the next generation of nurses

Often, the people at the front line of improving patient care are those who work with patients the most: nurses.

At Whatcom Community College, Connie Rockstad is busy training the next generation of nurses for work in a changing medical environment. As the program director, Rockstad makes sure that the skills students learn are the skills that the industry is looking for.

“It behooves us to teach them how it’s done in the industry and for them know the fundamentals of why they’re doing what they’re doing,” she said.

To keep the curriculum current, the program has an advisory board with representatives from several local clinics. Also, faculty members are encouraged to stay connected to the medical community by working part time in the field. This keeps the staff up to date on the needs of the industry.

“If you don’t have qualified nursing faculty, you don’t have qualified nursing graduates,” Rockstad said.

Back in the nursing lab, Rockstad shows off the high-tech mannequins on which nursing students practice. Each “patient” is hooked up to a central computer that controls all the indicators of each mannequin’s health, from heartbeat to breathing rate. They can even talk.

Sometimes, Rockstad said, she will set up errors, such as an incorrect dosage, to see if students catch them. That way, students learn critical thinking and they are “not just blindly administering medicine,” she said.

After all, even with the most advanced technology, improving the quality of health care comes down to knowledgeable and proactive people leading that change.


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