By Alan Dash, Senior Consultant, The Sextant Group

Back in the gentler days of Marcus Welby and Dr. Kildare, one doctor or a handful of medical staff would serve as a patient’s primary contact for care, billing and follow-up. Today of course it’s far different – patient satisfaction and clinical outcomes have driven clinical and business processes while concurrently driving efficiencies attempting to do more with less.

Public policy, technology and non-profit organizations that report on operational efficiencies and environmental performance have influenced the hospital CIO’s job requirements, forcing them to expand in scope and complexity with shrinking budgets. Meanwhile, hospitals scramble to adapt to the new regulatory environment of Electronic Medical Records. The software alone to support EMR can cost hundreds of millions of dollars – a dangerous place for a CIO to make even a tiny mistake.

How does a hospital CIO get a dose of well being in the current environment?

Parallel Paths: Healthcare and Information Technology

While the healthcare industry was growing, Internet Protocol (IP) was booming. IP is the most important element that defines the Internet. IP delivers data packets from virtually any source to any virtual destination without regard to manufacturer or protocol – elegant communications between disparate systems. Today, a hospital cannot be built without it. Because of its stability, IP has affected almost all communications systems, including those commonly found within the hospital environment–from nurse call and intercom systems to phone, tracking/locating, interactive patient entertainment/education systems, audiovisual control, building automation, security systems and point-of-care systems. The planning, prioritization and budgeting of these IP-based systems are the primary responsibilities of the technology design team.

The technology design team oversees this thorough integration which enables and ensures that disparate systems communicate with each other and with other systems. For example, nurse-call must be able to “talk” to the telephone system. The RFID/RTLS system has to communicate with the ERM/CRM database for inventory control. Building security systems must “talk” to the fire control system. Individually, all of these are smart systems, yet without proper coordination, a building will have numerous “smart” systems that cannot intercommunicate. Without intercommunications, simple processes require multiple steps which consume valuable clinician time away from the primary point of care. With the proper intercommunications, we decrease the steps of the clinician, reduce errors, speed bed-ready systems, track patients through the in-and out-patient processes and prepare for and implement future systems additions without impacting current operations.

Prognosis: Danger?

While hospital technology designs will always indicate these points of convergence, a “paper” design alone is not enough to ensure that once the building opens, the systems will actually unite. There are numerous opportunities for this failure. Examples: the contractor’s low-bid excluded integration, or the vendor “assumed” that another systems contractor would be responsible for a point where all systems come together, or the assimilation is so unique it was simply missed in the specification, or the manufacturer cannot provide a specific point of integration and elected not to share that information until their system was fully installed. These real-life obstacles occur and occur often.

Healthcare Technology Consultants: Creating the Vision

The best means of delivering effective systems integration is to have a single consultant responsible for designing, specifying and coordinating all of these systems through project completion. Having one responsible company conduct the “technology orchestra” allows everyone to play from the same sheet of music. This Healthcare Technology Consultant is ideally a specialty sub-consultant reporting directly to the owner (or alternatively to the Architect), coordinating work with the Architect, Electrical Engineer, Mechanical Engineer, Medical Equipment Planner and other members of the design team.

While often referred to as “Healthcare Technologies,” the term Medical Communications, or “Med Comm,” appropriately implies connection to other low voltage communications systems. If the same consulting practice has audiovisual expertise, it will almost certainly offer acoustical design and consultation as well [see also “Healthcare Acoustics”]. Including this type of firm on the architectural team is a well-established practice and can ensure not only integration but also extra LEED points and deliver a design more in line with external reporting and non-reporting agencies such as HIPAA and the Center for Health Design’s The Pebble Project. This team will also assist the owner in creating an RFP for the Technology Contractor.

Technology Contractor: Building the Vision

The resulting bid process awards all Med Comm systems to a single contractor for product, installation, testing, training and warranty service. Terms associated with this practice include technology general contractor, integration contractor, or simply “technology contractor.” While selecting a single technology contractor can be contractually difficult in projects using state or federal funds, the end result is typically a superior quality installation delivered at a lower cost.

All technology contractors are not created equal of course, and CIOs must select one that has depth in healthcare, an understanding of clinical processes, and can augment in-house staff during the transition. Often, small specialty firms over-extend their capability when they assume they are doing a simple IP integration. Even many large firms do not have the extensive depth in healthcare systems required to facilitate a full system convergence. While some may excel at project and program management, provide excellent warranty service and have a large presence on the global construction stage, they may simply see money on the proverbial table and reach for it. It’s imperative to properly vet the various firms and options. A few companies offer these services and do it well. These companies know healthcare, have experts close at hand and will perform the work on time and on budget. The right contractor can use its immense buying power to pass discounts along to the project.

Owner’s Representative: Ensuring a Positive Outcome

Some complex projects benefit from a third entity related to the Med Comm systems: an Owner’s Representative. This position is often contracted directly by the hospital (in addition to the Med Comm Consultant who is hired by the architect and the technology contractor who is hired by general contractor). This professional represents the CIO’s perspective throughout the process, and must be well versed in the cultural and technical aspects of hospitals, understand inter-department relationships, know the common points of integration and be able to direct the design team and technology contractor in the role of owner representative reporting to the CIO.

The owner’s rep is not responsible for the myriad of details that will be drawn, redrawn, modeled, and specified during the design process – that is the role of the Med Comm Consultant. Nor is the owner’s rep responsible for the equipment installation, testing, optimization, user-training and documentation during the construction phase – that is the role of the technology contractor.

Why is this other party needed? Normal hospital operations must be able to continue unimpeded, alongside with facility planning, designing, building and renovation (analogous to changing the oil on a plane in mid-flight — and can be just as dangerous). Internal departments cannot forsake day-to-day management and operations in favor of ensuring their voice is heard on a project. Conversely, internal staff cannot let someone else put their project together while just focusing on operations. This is a balancing act of insourcing vs. outsourcing the project-related responsibilities in order to focus on operational responsibilities. The best Owners’ Reps are experts at walking that tightrope hand-in-hand with hospital administrators.

Healthy Survival Rate

Assembling the proper team with depth and breadth of experience in medical communications, clinical operations, and facilities management will help to ensure a successful relationship between the ubiquitous and disparate technology systems, helping the CIO focus attention on that ten-thousand pound EMR gorilla checking in.

And perhaps beat the odds to survive the most dangerous job in America.


About the Author
Alan Dash, Senior Consultant for The Sextant Group, is an international specialist in Medical Communications Systems and an expert in hospital technology design. He was born in a hospital.