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Pennsylvania Board Of Pharmacy

"Our goal is to eliminate as much paper and as many manual systems as we can and to make our IT systems flow," says Margaret Twidale of Kane Community Hospital (KCH).

Licensed for 38 beds and located in rural northwest Pennsylvania, Kane does not have a typical chief information officer. Instead, Twidale has the distinction of being the manager of information systems, telecommunications, patient accounting, billing and registration. She also is the HIPAA security officer.

In the 12 years she has been with KCH, Twidale has been a driving force in advancing the hospital's IT strategy, although she humbly credits her CEO, J. Gary Rhodes. Rhodes' basic philosophy is that while Kane Community Hospital may be small and rural, to stay competitive, it must stay on the leading edge of technology. If it doesn't, the hospital won't stay in business.

Growth in Services

Competition definitely has influenced some of the decisions made at Kane Community Hospital. With three larger hospitals within 28 miles, KCH has focused on customer service, fiscal accountability, operational efficiency, physician recruitment and acquiring state-of-the-art equipment and services to be able to compete.

For example, when Kane's management saw that patients were going to other hospitals for MRI scans, KCH was able to secure state and federal grants to purchase the only stationary, open MRI unit in the region, Twidale says. But she admits that the biggest challenge in staying on the leading edge of technology is "thinking of creative ways to come up with the funding."

Even so, with an annual budget of around $13 million, between 10 percent and 12 percent is earmarked for information technology.

Kane Community Hospital's technology achievements have been recognized by Hospital and Health Networks magazine, which, in 2003, ranked the hospital among the top 25 "most wired" small or rural hospitals in the U.S.

The hospital's strategic planning, which began in earnest in 1994, also led administrators to choose a single vendor--Glenwood, Minn.-based Dairyland Healthcare Solutions (DHS)--to ensure a seamless integration of all administrative and clinical systems. "We have been computerized with Dairyland since 1994, and in those 10 years, we have totally updated everything in the hospital," Twidale says.

The hospital has grown into a healthcare network that offers home health services, community wellness programs and an occupational medicine program. It also owns five physician practices located within a 28-mile radius, she adds.

Single-Source Solution

Twidale recalls that when she was hired in 1992, KCH had only a few leased computers that were mainly used as word processors for patient registration, billing, medical records and inventory. "None of those microcomputers were networked," she says.

In 1993, hospital management made the decision to search for a hospital information system (HIS). A 13-member committee was assembled, and it investigated and considered at least 10 software vendors before narrowing them down to three.

The pharmacy already had its own system, and the hospital agreed to purchase a new laboratory system from a different vendor, so any new HIS would need to be interfaced with those two departments. "The only reason we had those 'foreign' systems is because at that time, DHS did not have sophisticated lab and pharmacy systems," she explains.

"We went live with all the DHS modules in 1994, but we didn't have their nursing home package or their home health module because we didn't offer those services," she says. But even that changed. "We went with home health in 1996."

In 1998, the hospital decided to take another look at the array of vendor offerings to see if it was feasible to go with a one-vendor solution rather than best-of-breed. By this time, though, DHS had ramped up its lab and pharmacy systems. Kane Community Hospital management decided to stay with DHS, which targets small and mid-sized hospitals, and to install all of DHS's clinical modules including those for lab and pharmacy.

By November 2000, KCH had installed all of DHS's financial and clinical modules except its long-term care module. The hospital began a major upgrade of the network it built in 1994 by replacing coaxial cabling with fiber and by installing new hubs. The hospital also invested in new thermal bar coding technology, bought 60 new computers and transitioned from inkjet to laser printers.

"In 2000, our goal was to have a full-blown electronic medical record," Twidale says. "We could be paperless now, but we still do some printing." In fact, when pressed, she admits that it may be this small amount of printed paper which prevents KCH from meeting her stringent definition of "electronic" medical record.

Epitome of Efficiency

In a matter of only 10 years, KCH has been able to achieve what many of the country's largest hospitals have not: improved efficiency through automation.

Dairyland's financial information system consists of 21 modules, including accounts payable, admission-discharge-transfer and real-time census, an appointment scheduler, report archiver, electronic billing services, electronic claims, home health, materials management, patient accounting, payroll/human resources and physician practice management. Kane Community Hospital uses them all.

These modules are fully integrated with Dairyland's clinical information system, which includes order communication, physician access, clinical documentation, an electronic patient record, pharmacy, laboratory, radiology, ancillary therapies and transcription modules. With a single source and fully integrated technology, Kane is poised to gain maximum benefits from its IT investment.

As an example of how automation works at KCH, Twidale says patients are billed for supplies through the use of bar code technology. "We have bar-coded charge labels on everything and use scanning throughout the hospital. We scan the patient label and the supply, and this goes to inventory reduction automatically, and also automatically matches the charged supply with the right patient for automated billing." The system also uses an archiver, so reports that need to be saved are electronically archived, thereby eliminating paper files.

Appointment scheduling throughout the hospital is done through the HIS, Twidale notes, adding that even the five off-site physician practices have access to the scheduler. Additionally, these physicians can access patient records from their offices or clinics and can enter orders that are automatically sent to the appropriate department and become part of the patient's electronic medical record.

Even patient registration has become more efficient. "We just purchased scanners for registration, and these will be tied into the hospital's electronic medical records. When a patient arrives, we will scan his driver's license and insurance card, and these will be electronically attached to his medical record."

Coding also is simpler and hilling more accurate now that KCH has interfaced its HIS with an encoder, a software program that checks diagnostic codes to ensure that the proper coding is being used. "We don't want to send bills out with the wrong codes," she says, citing a potential inefficiency that the hospital has overcome with IT.

Of course, the billing system is fully automated. "We don't print out any bills, and our hilling hold days are now down to three or four," she adds.

All in the Family

Since patients are billed electronically, there's no reason why the hospital's staff shouldn't be paid electronically. "We have the payroll module interfaced to the time clock, and we require everyone to have direct deposit," Twidale says.

Greater efficiency also has been realized by having the HIS seamlessly integrated with clinical information systems. Lab tests are ordered electronically. Then, when results come back, they automatically are made part of that patient's electronic medical record.

KCH also uses wireless pen-touch laptops mounted on carts that can be rolled into patients' rooms. This enables physicians and nurses to access a patient's record and do documentation and ordering right at the bedside.

A few of the 17 staff physicians at KCH regularly use handheld devices, and Twidale says Dairyland currently is developing PDA software that will integrate with the modules KCH already has in place.

Although KCH does not have a cardiologist on-site, EKGs and stress tests are read in-house by internists. But should there be the need for a second opinion, these tests are sent electronically to the Hamot Heart Institute in Erie, Pa., where they are read by cardiologists and the results electronically returned to KCH. Similarly, the hospital's staff radiologist can access a patient's X-rays or MRI scans from his office or, via a secure Internet connection, from his home. "For years, we have used teleradiography, " Twidale notes. "Anywhere we can use Internet connectivity, we do."

In fact, KCH recently installed computers in some of its waiting rooms so patients and their families can access the Internet to get additional health information. Patients still cannot access their medical records online, and Twidale says she's not sure whether that's going to be an option in the future. But they can access the hospital's Web site, where they can catch up oil hospital news, e-mail their doctor or register for hospital-sponsored events such as blood pressure screenings.

Taking a headlong leap into the future like KCH has done can present its own set of challenges. A big one is getting everybody on board and assuring that new processes and workflows are perceived by staff as better than earlier ones. But Twidale says there has been little resistance from the staff because the technology has been phased in and there are always numerous training sessions. "The fear factor is no longer there," she says.

For more information about HIS from Dairyland, www.rsleads.com/403ht-203

Richard R. Rogoski is a free-lance writer and contributing editor to HMT. Contact him at rogoski@aol.com.

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