Even if you work in a so-called “most wired” American healthcare facility, I guarantee if you look around you’ll still find lots of paper forms and processes. Paper is endemic in American hospitals and clinics, even in those with fairly robust enterprise information systems and electronic medical records. Paper is still used for staff scheduling, HR processes, reporting, transfers, discharges, and all kinds of other tasks.There are a couple of ways around this. You can ask your HIS vendor to automate a work-flow that’s still trapped on paper. But often the aggravation, delays, and high costs don’t justify the return; and that's if you can even get them to do small projects like this. You can also buy specialized software to solve these problems, but you just end up with a bunch more departmental applications in an already crowded and complex array of applications that don’t talk to one another.
That’s why I have been so pleased to learn what some of our most innovative customers are achieving with software that so many of them already own. This is particularly true of the way some hospitals and clinics are using Microsoft Office and SharePoint Server (MOSS) and InfoPath Forms.
One such example comes from Children’s Memorial Hospital of Chicago. Last week at our Healthcare Executive Forum event in Minneapolis/St. Paul, Eric Gasber, RN, followed me on the podium with a presentation that truly wowed attendees. Eric describes Children’s use of SharePoint as a solution that “begins where the enterprise applications end”. In example after example he showed paper based workflow, reporting, and collaborative processes that had been automated with MOSS. Most of these solutions were developed by Eric with little help from IT. He’s created solutions for time off requests, patient financial services, crash cart logs, meeting agendas and materials, service requests, and pre-procedural forms and scheduling for interventional radiology, cardiac catheterization, and anesthesia. Some of these solutions took just hours to put into production. Some took days or weeks. Eric soon identified “power users” in the organization who could develop their own solutions and forms. “If they have ever created a form in Word, they have most of the skills they need”, he says.
In some cases the return on investment from these solutions is measured simply by delighted clinical or business staff. But in many cases, Eric can claim real dollars coming from his work. His solution for Cardiac MR scheduling resulted in an 80 percent increase in scanned cases per month. Total increased throughput in Cardiology and MRIs have resulted in an additional $6.5 million to the bottom line. Eric attributes this success to the fact that the solutions he designs using SharePoint Server and InfoPath are fast to develop and implement, highly flexible, and very intuitive for end users.
This is another great example of how commodity software is being used to address critical business and clinical processes in hospitals and clinics, at a cost that is affordable. And that means more money for what really counts in healthcare; taking care of our patients.
Bill Crounse, MD Healthcare Industry Director Microsoft
Hi, Dr. Crounse,
I'm having trouble finding a way to contact you, Brad Hesse of NCI suggested your name for our May 8-10 working group on ehealth theory. I'm part of a National Cancer Institute Center of Excellence in Cancer Communication Research, and we are trying to figure out how explain how our interactive cancer communication system works to reduce suffering for cancer patients. You may have heard about us, we have been doing this work for 20 years! It's a system called "CHESS."
I'd really appreciate it if you would contact me at firstname.lastname@example.org. Thanks!
Thanks for writing and leaving your e-mail address. I have contacted you directly.
Bill Crounse, MD
I love using SharePoint in just the types of scenarios you've described above. The one burning question I must have answered before we REALLY get our mileage out of SharePoint is:
How do we remain HIPAA-compliant if we're storing PHI in SharePoint?
Presumably any solution you build will run into the "PHI wall", wherein you either work around the problem (i.e., lose functionality), or you hurdle the wall and build in access logging and auditing support so you're HIPAA-compliant. And that's a lot of work.
Instead of the HL7 accelerator we have been given, I'd rather have a HIPAA accelerator to jumpstart any custom solutions built in .NET and/or SharePoint.
Anyway, just a thought.
Hey Peter, thanks for contributing to the conversation.
Storing PHI in SharePoint in a HIPAA-compliant manner is very possible as SharePoint offers a series of capabilities that will make enforcement of privacy and security practices easier.
As an example, there are extensive access control capabilities that in the 2007 version we have extended down to the item level (such as a document in the library). SharePoint 2007 also includes extensive auditing and logging features as well as support for Information Rights Management (IRM).
Please have a look at this whitepaper that highlights these features in more detail:
Let us know if you have any more questions.
Its been a pleasure reading your blog. I am the director for business/technology development for a medical accounts receivable management company outside of Chicago (www.physibill.com).
With the release of .NET 3.0 as well as the new Office Suite, my mind has been racing with ideas and concepts. These tools can help us become more efficient relatively easily.
Sanjay V. Gidwani
Thanks for your comments. One minor correction; it's not Peter's Blog. HealthBlog is mine :)
I'm glad your mind is racing with great ideas and concepts for Office and other Microsoft technologies in healthcare.
Bill Crounse, MD Director, Worldwide Health Microsoft
Sorry Dr. Crounse. I was caught up in reading all the posts and comments on your blog. Hope to see you at HIMSS.
Bill, very insightful but I am wondering if there were other process redesigns that occurred in the Diagnostic Imaging and Cardiology Departments that also accounted for some of that $6.5 million and was that a projected or audited actual profit? And more MRI and Cardiology (Cath Lab?) procedures do cost money with staffing, equipment maintenance, etc., what is the true ROI that this example realized.
In my world we cannot count savings such as that because it is considered SOFT SAVINGS.
Plus, I am sure that many hospitals do have many forms that may be eliminated but many of these forms are under control by Group Purchasing Contracts and the hospital's forms vendors. We are an consulting firm that focuses on reducing costs and I think forms costs are the least of healthcare organization's issue right now.
On average, any given hospital can purchase between 5,000 and 25,000 line item products and forms (growing smaller every day) do take up a few hundred or so but hospitals have been working to reduce this costs dramatically. Even with the advent of Electronic Medical Records, I believe hospitals will still be scanning many forms (definitely from the past) and probably many going forward unless you have the patient sit right at the computer when they are admitted.
Bottom line, what was the total forms expense that was eliminated, maybe $20,000 to $30,000 annually for those two departments overall? How much did they spend on the software and servers to implement that solution? ROI?
I like where you are going with all this though!
Robert T. Yokl - 37 year veteran of the Healthcare Cost Management World
It is interesting that your first question is pretty much the same question we had when we started to try to figure out why we had a sudden and dramatic jump in completed cases and billable procedures. As we eliminated all of the identifiable variables, we arrived at the conclusion that the only variable that had actually changed was SharePoint facilitated use of information. Our staffing did not change, our scheduling templates did not change, our imaging protocols and study lengths did not change, and no new equipment or upgrades were added to the mix during this time period.
I think it’s fair to say that what we really did was to maximize our potential by using our tables and staff as efficiently as possible, and this improved productivity resulted in the noticeable change in revenues. Still, anytime you can improve utilization of equipment, staff, and improve patient outcomes and satisfaction all at the same time- it’s a good thing, even if it can be hard to quantify all of the benefits in dollars and cents.
It’s also important to note that we did not explicitly set out to achieve this goal. We were simply trying to improve better delivery of care, through improved information sharing which allows optimal decisions to be made on behalf of the patient. We were wildly successful with our primary goal, and eventually were pleased to discover the “accidental” effect that this had on other areas of operations that ultimately do affect the bottom line. In terms of investment, SharePoint Portal was already in our institution, as was SharePoint services and InfoPath. I was the first clinician to begin experimenting with these tools in our institution, and I worked on it as time permitted at work. I became familiar with the InfoPath product during a 60 day trial on my home computer, and became convinced that I could use it to develop a tool that would address a long standing problem with screening and set up of cases. It probably took me 6 weeks of my own time to figure out my first version of our prescreening tool, but I thought this was pretty good, since I am not a programmer, and have no formal training. I spent much of those 6 weeks learning how not to design a form.
Unknown to me at the time, our Anesthesia Department had a group of consultants in who (Very expensively) designed a process to improve their prescreening and setup for cases. They created a paper based process that introduced 11 new forms and subforms to achieve the same thing that I was doing with the medical imaging cases. When we compared the process and results, the SharePoint approach is producing superior results and consistency with a single form that adapts to Sedations, Anesthesia, and venue. All this and I cost less than 1 day’s worth of consulting fees!
I would agree that it is very hard sometimes to gauge the “Soft” number value of many of the changes, but this cuts both ways. It means that it is also very easy to have numerous hidden opportunities for improvement that cumulatively can have a significant net positive effect for any organization.
Back in January, I wrote a piece entitled Big Healthcare Savings from Surprisingly Simple Solutions .