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Transforming the Hospital with IT

At St. Michael's Hospital, our information management plan aligns with a strategic redesign of parallel systems and processes that support our commitment to knowledge-based care.

Toronto, July 11, 2008

As reported on Canadian Healthcare Manager

Anne TraffordHealthcare delivery today is as much an information business as it is a people business, said Anne Trafford, CIO at St. Michael's Hospital in Toronto. As practitioners in a knowledge-based science, physicians and other clinicians receive a constant barrage of information and updates from a diverse network of sources, including research, education, policy, protocols and daily practice.

In theory, translating that knowledge into evidence-based care can improve patient-care outcomes. But that doesn't always happen. The sheer volume of information and research generated daily is difficult to keep up with, and there may be cultural or structural barriers within the organization that prevent practice application.

And yet, in order for healthcare settings to improve patient care and safety, Trafford said, flexible, responsive, proactive action needs to fill the bench-to-bedside knowledge translation gap. Information technology is the key conduit to make that happen.

It's not a simple matter of shopping for the right clinical systems and integrating the technology — an entire rethinking of how processes happen is required. Organizational transformation on this scale requires major investment in organizational development and cultural change.

At St. Michael's, this approach is apparent in the alignment of the information management plan with a strategic redesign of parallel systems and processes that support the organization's commitment to knowledge-based care.

One of the major focuses is on implementing workflow-driven technology to inform and engage change processes for clinicians. Workflow technology sends the right information to the right people at the right time; intelligent software programming automatically triggers real-time notification alerts and pending work with next steps. It provides clinicians the benefit of immediate information with behaviour-change cues and instructions to take instant action, something that manual processes can't achieve.

Embedding workflow technology in advanced clinical systems enables the design of process improvements on countless application levels in multiple clinical settings: from co-ordination and allocation of tasks and synchronization of handoffs to expedited distribution of information and behind-the-scenes automation of process steps.

This time-sensitive and streamlined technology carries many benefits, including enhanced clinical decision-making, reduced costs through co-ordinated systems and processes, promotion of best practices, minimized evidence variability and the immediacy of risk identification.

Activating the technology system's workflow engines at St. Michael's has delivered positive outcomes in just a few months, Trafford said.

Replacing the semi-automated process with an automatic workflow notification to family physicians about patients admitted to the hospital or seen in Emergency has produced a 78% improvement in the awareness of family doctors that their patients were seen.

The Hospital's new MRSA screening workflow with desktop alert notifications underscores the potential of risk reduction benefits. Not only have occurrences of patients discharged without being screened dropped to 1% from 7.8%, but the screening time is shortening as well, with a greater proportion of patients screened within their first 11 hours of admittance rather than the previous norm of 12 to 24 hours.