When Dr. Steven Altschuler became CEO of the Children's Hospital of Philadelphia in 2000, he knew the world of pediatric medicine was in the midst of big changes.
Just as was the case in adult medicine, medical care for children 12 years ago was moving from inpatient settings and specialists to outpatient settings and primary-care physicians. And pediatric research was becoming more varied and complex.
The challenge, as Altschuler saw it, was to nurture the hospital's expertise in medical research and tertiary patient care and also expand the organization's presence, particularly in primary care, throughout southeastern Pennsylvania and south and central New Jersey.
He has done just that, using digital health data as the thread to connect the various clinical and research operations at the Children's Hospital of Philadelphia.
“Ultimately, for a place like (Children's Hospital), information technology is a critical part of what we want to be and what we want to be known for, which is a leader and innovator in pediatric healthcare,” says Altschuler, 58, who has overseen a $250 million investment in information technology projects over the past five years.
“He set a clear vision. He has been very supportive intellectually, emotionally and from a hard-resource perspective, making sure this is what we are doing and where we are going with our funds,” says Dr. Philip Johnson, the hospital's executive vice president and chief scientific officer.
For his efforts, Altschuler is one of three recipients of this year's CEO IT Achievement Awards
, which are presented by Modern Healthcare and co-sponsored by the Healthcare Information and Management Systems Society.
Altschuler, a pediatric gastroenterologist, also was named to Modern Healthcare/Modern Physician's 2011 list of the 50 Most Influential Physician Executives
, where he was ranked No. 36.
The centerpiece of the hospital's investment in information systems is an electronic health-record system, which Altschuler says was “part and parcel” of an overall strategy to expand the number of outpatient locations.
The number of primary-care clinics went from three in 2000 to 30 today. Some 200 hospital-employed, primary-care pediatricians staff the clinics. “The strategy that Steve Altschuler had was to buy practices. Most of the old community practices that existed have become part of (the hospital's) Care Network,” says Dr. Bryan Wolf, senior vice president and chief information officer.
The off-campus outpatient sites also include 14 specialty-care locations, including three with outpatient surgery and one that also offers primary care. Other services include specialist's offices, imaging, laboratory, oncology, physical and speech therapy.
Children's Hospital physicians also staff inpatient pediatric and neonatal intensive-care units at 12 community hospitals throughout the region.
“It was in the context of this integrated approach to care that I felt an electronic medical record was going to be critical to that strategy,” Altschuler says.
So Children's Hospital bought an EHR system from Epic Systems Corp. based in Verona, Wis., on the outpatient side and installed it between 2001 and 2006.
The hospital already had an electronic record for inpatient services, which it purchased in 1987 from what was then known as TDS Healthcare Systems. Children's Hospital later transitioned to a system by Eclipsys Corp. (now part of Chicago-based Allscripts).
The IT structure on the inpatient side also included many smaller applications as a result of the hospital's longstanding commitment to a best-of-breed strategy, but the mishmash of systems was cumbersome.
“We had lots of interfaces and they were always not quite good enough. We had snafus,” Wolf recalls. “Each time we changed a system, we had to change the interfaces.”
That is why Altschuler pushed the information systems organization to select a single vendor for inpatient and outpatient applications. “We looked at all the vendors that were out there and eventually, after a lengthy selection process, chose Epic,” Wolf says.
In 2007, the hospital replaced its existing business applications for processes such as registration, scheduling, discharge and billing. It then switched to Epic's inpatient clinical modules in January 2011 after a period of planning, testing and end-user training. “We are a very deliberate organization,” Wolf says. “Whenever we introduce technology, it has to be as close to perfect as possible.” Why? “We are always very mindful when we do these things that the safety of our patients comes first,” he says.
Children's Hospital's IT department also worked with Epic to customize the computerized physician order entry application for the field of pediatrics. One example: the ability to order the appropriate dose of a medication based on a child's weight.
Wolf says he plans to roll out clinical documentation for nurses and physicians this fall—at which point he predicts that Children's Hospital will be 95% paperless.
The hospital still has some very specialized non-Epic software applications—such as in the cardiac center, surgery and anesthesia—which require employees to duplicate data entry, Wolf says.
The IT department also developed analytic tools, allowing managers to “take all of this data that we are sitting on and analyze it for research, for outcome studies, for better patient care,” Wolf says. “We think that is key—to make the data accessible to people so they can manage based on data.”
The next step is the rollout of cost-accounting software by year-end.
“What we have struggled with is understanding the cost of a service line. For example: a transplant. How much does that actually cost the institution?” Wolf says. “You take into account not only the professional fees of the surgeons and physicians, but also the cost of the ICU, the OR time. All of those different pieces.”
Managers will combine information on costs and quality to demonstrate the value of the organization's services to payers, Altschuler says.
Electronic health data is not only useful in clinical operations but also in research. Information gleaned from electronic patient records helps fuel new discoveries in research and build evidence for best practices in patient care.
“We really integrate the research and the clinical,” Altschuler says.
For example, in 2006 the hospital launched the Center for Applied Genomics with a $40 million investment. Researchers analyze information from de-identified medical histories in combination with genetic information, which is derived from biological samples stored in a biobank, to identify links between genes and disease. They already have identified genes associated with type 1 diabetes, autism, and attention deficit hyperactivity disorder, or ADHD, among others.
“There are at least 50 different disease areas where we have begun to discover genes,” Johnson says.
The goal, Altschuler says, is personalized medicine. “You can imagine that if you find a specific gene that is responsible for ADHD, that allows you to find or build more specific drugs with higher efficacy and fewer side effects,” he says.
Children's Hospital's biobank now has 150,000 samples.
In addition to genomics, Children's Hospital also has developed expertise in clinical informatics—using information technology to improve patient care—and biomedical informatics—using information technology to manage very large amounts of data for medical research, such as in genomics.
One example of clinical informatics is Care Assistant—a Web-based tool that displays alerts about evidence-based protocols through the EHR system. Care Assistant also alerts pediatricians when one of their patients meets the criteria for a clinical trial.
Hospital researchers are in the midst of creating an application that will track the proper care of premature infants and issue electronic reminders about blood-pressure screenings, immunizations, and eye and hearing examinations.
Care Assistant already has been linked to improved outcomes. For example, in a one-year analysis, the up-to-date immunization rates at four urban clinics among 24-month-old children increased from 81.7% in 2004 to 90.1% in 2005, according to a 2007 article in the journal Pediatrics.
“Everything we are doing is to take care of the health of children and to have better outcomes,” Wolf says. “You have the sense that you are making a change—a difference—in someone's life early on.” Linda Wilson, a former Modern Healthcare reporter, is a freelance writer based in McHenry, Ill. Reach her at firstname.lastname@example.org.