While a patient lies in bed, a swirl of activity is unfolding behind the scenes. The diabetic patient's dietary needs are carefully considered for the day's lunch. An essential intravenous medication is mixed and readied. Meanwhile, the radiology department has scheduled X-rays of the fracture that brought him to the hospital.
An orderly from radiology follows orders to go up and get the patient. After he's rolled away, a nurse comes in with the IV order all ready to go, but there's no patient. The lunch delivery arrives to an empty bed. It will sit there for nearly three hours-the time it takes for a backed-up radiology department to get the patient in, shoot the X-ray and clear him to go back to the room.
There's got to be a better way-but there really isn't, says Frank Lavelle, president of Siemens Medical Solutions Health Services Corp.
The Malvern, Pa.-based information services business, formerly Shared Medical Systems, is one of many that have computerized the various order processes in hospitals but not the synchronization of those processes across the multitude of departments working simultaneously and independently.
"It is clear that there has been a glaring shortfall in our ability to manage care effectively," Lavelle says. The problem is that once orders are given, there is no reliable or consistent way to check on what happened, creating dozens if not hundreds of opportunities for orders to fall through the cracks or get delayed because of conflict with another order, he says.
The flip side is that there are hundreds of opportunities to "eliminate all these nonvalue-added waits" by linking and coordinating tasks and managing workflow using computerized rules, Lavelle says. Not only could this reduce length of stay but also help patients recuperate more quickly because they wait less for care, he says.
After a year of intensive collaboration with its new parent, Siemens Medical Engineering Group, the company last month unveiled an ambitious initiative to recast itself as a workflow improvement agent in healthcare.
The central objective is to enable hospital customers to design their best re-engineering practices and then execute them in an automated, reliable way, says Sam Brandt, M.D., director of strategic initiatives. The intent: to elevate the order process to an ordered procedure rather than "a bunch of paper airplanes thrown over transoms to departments," Brandt says.
In that environment, the nurse with an IV and a dietary manager with a special lunch would be informed ahead of time that the patient is scheduled to be somewhere else in the hospital, he says. Better yet, the radiology department would be coordinated so it calls down patients when it's ready for them, putting that diabetic patient in bed for the nurse and the lunch instead of elsewhere.
Covering the bases
The new approach to software design moves the Siemens information services unit into the clinical-care management arena with leading-edge features that were absent from the applications inherited from SMS, says Barry Hieb, a research director with Gartner, a Stamford, Conn.-based IT research and advisory firm.
The next generation of applications, under the nameplate Soarian, covers clinical-care areas and financial and administrative operations, knit together by technology and by change management and workflow improvement services.
"We're seeing for the very first time what it means in reality for SMS and Siemens to be joined," Hieb says. "It's a refreshing look at what's been going on (during the past year), and by and large it's pretty good."
Until the word about the new product line got out, though, "we really didn't think they were competitive in many respects," Hieb says.
If Siemens developers hadn't come up with a new set of care-delivery applications, "they would be at risk of being totally eclipsed by other companies," he says. "Part of the risk is that at least up until the Soarian announcement, customers had a lot of reason to look elsewhere for solutions and not a lot of reason to stay home.
"Now at least they have a good story to tell," Hieb says of Siemens' future prospects.
The story revolves around monitoring and reacting to the goings-on in a healthcare system the same way a medical device with strategically placed leads keeps track of a patient's vital signs and warns of problems automatically.
Most of the time, there's no way to know how an order is faring in the facility, Lavelle says. Did something happen that was supposed to happen? If it was delayed or overlooked, who should know about it and do something to rectify the problem?
At a McDonald's restaurant, he says, a light goes off if an order hasn't been filled by a preset time. "No such thing exists in healthcare," Lavelle says.
The new workflow design of the Soarian product line would trip an alert if, for example, a drug was not dispensed within 20 minutes of the target administration time, he says.
A more complex example would be the process of discharging a patient, Brandt says, adding that when a discharge order is written, a chain of events should be set in motion to ensure that all necessary departments are notified.
Foremost is to notify a discharge planner but also the head nurse to prepare for a new admission. A clerk should be prompted to call the family of the patient. Respiratory and dietary departments also should be clued in, and housekeeping should know so they can clean the room and expedite the turnaround. Admissions should know to the minute when a new room is available.
At the facility level, the Soarian model incorporates a parallel monitoring process that grabs data behind the scenes and sends measures of clinical, financial and operational performance to the right managers, Lavelle says. The possibilities cover everything from how fast an activity is proceeding to the extent of variance with clinical protocols. "It's giving you results back all the time," he says.
Integrated vision vs. current situation
To get the full impact of the system so it truly manages the healthcare operation, Lavelle says, provider organizations would have to install the whole system of integrated clinical and financial applications, eventually including data directly from diagnostic and monitoring devices. But like McKesson, Siemens has to contend with the way things are, not how they ideally could be.
The success of the project paradoxically depends on stitching Soarian components onto older SMS applications of existing customers and gradually moving them into the Internet-technology replacements, Hieb says. "They're predicating their continued existence on being able to take the lion's share of their installed base and move it over," he says.
That's fine with Perry Pepper, chief executive of Chester County Hospital in West Chester, Pa., just 15 minutes from the Malvern headquarters of the Siemens IT division.
A Siemens/SMS customer for 22 years, the facility has advanced to the point of making results available to doctors via the Internet but has yet to add order entry and clinical management pieces to its IT infrastructure, Pepper says.
"This catches us at a time when we're ready to take the next step and integrate some of the things we're interested in," he says. The facility is one of four test sites for Soarian, which puts it in closer interpersonal contact with Siemens technical professionals. "We're willing to be the white rat for them, but we also want to be valuable to them so this relationship has reciprocal value."
So far, the four test sites are in it for the duration, and five additional Siemens customers have contracted to implement the new IT line "upon general availability," according to Siemens statements.
But a big question, Hieb says, is how many other customers will be "patient enough and confident enough in Siemens to stick it out" until the slated availability date of first quarter 2003, given the rapidly developing momentum for clinical-care management and the ability of competitors to supply an alternative now.