As Penn Medicine expands digital health across its health system with the continued implementation of electronic medical records for inpatients and improves patient-monitoring for patients at risk for readmission, it is striking a balance between the need for change and the need for carrying it out at a manageable pace.
Bill Hanson was appointed chief medical information officer in 2010, when the hospital was laying down the infrastructure for many of its healthcare IT programs. Among the projects he is overseeing are the rollout of the electronic medical records system. Last year saw the implementation of EMR for outpatients and the first stage of its EMR for inpatients that included nurses’ observations along with occupational therapists’ and physical therapists’.
Now, as the project advances, data from medical devices monitoring vital signs are in the process of being added. Physicians’ observations will come later this year.
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Hanson explained the complexities between digitizing outpatient records with those for inpatients. “In the outpatient environment, response times are usually not so critical; you can see a patient and then update the records on a patient’s next visit, which might not be for months or a year. “For inpatient records, where you have doctors from a variety of disciplines involved, everything needs to be communicated in real time from a minute-to-minute basis. There are a lot of moving parts and they have to mesh very well.”
A separate project, home telehealth, is aimed at high-risk patients with heart failure. It’s a suite of electronic monitoring tools with which patients weigh themselves, take blood pressure and communicate that to a central command center, so if the data indicates they are out of the safety bounds, the health system might send a home-care nurse. Although it currently has 75 of these electronic monitoring devices, it is buying more.
Hanson said although there are about four to five major projects under way, he estimates that there are probably 30 to 40 smaller projects he is involved with. Some he likens to “nudges” to improve patient experiences, such as data analysis and display that can show the health system how it is doing on issues like readmissions, patient satisfaction with noise level and quality of food, and complications like hospital-acquired infections. “We’re trying to make as much of this data available in real time as possible,” Hanson said.
Hanson explained that although it is important for institutions like Penn to implement these changes to prepare for the future, it must tread a fine line.
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“One thing we worry about from a management point of view is putting too much change out at one time. There is only so much change that a multi-workforce, multi-hospital institution can absorb before it breaks,” Hanson said. “We are always trying to find the right balance between change targeted with preparing for the future and overloading the system.”
