Pete Velez moved to East Harlem in New York from Puerto Rico when he was 7 years old. Though he's moved up the ladder of American-style success since then, he hasn't left New York's struggling newcomers behind.
Since reaching adulthood, he's worked tirelessly to open up access to healthcare services, primarily through a variety of positions at New York City Health and Hospitals Corp., where he has worked since 1976.
In his current position as executive director of Elmhurst (N.Y.) Hospital Center and senior vice president of Queens Health Network, he's focused on the growing and largely poor 2 million residents of west Queens. He's been at the helm of Elmhurst since 1989 and Queens Health since it was created in 1994. Queens Health-including 525-bed Elmhurst, 250-bed Queens Hospital Center and 21 outpatient clinics-is a part of New York City Health and Hospitals and a teaching affiliate of Mount Sinai School of Medicine.
"Our purpose is very clear," Velez says. "We are here because we are supposed to provide care to people who have trouble getting care. But the challenge for us is: How do we deal with the intensity of activity with the limited resources that we have? How can we be more responsive to the needs of our patients? How can we be more responsive to the needs of our community?"
The way to do it, Velez decided, is to invest in information technology. "I used to get a lot of paper reports, and I couldn't put my finger on what was happening in the organization. But the more I started to get reports electronically, the more I realized how simple the process was. The data is there, but how to construct useful information became very important to how I manage," Velez says.
The network's metamorphosis from an IT laggard into an early adopter of cutting-edge technology started in 1997 when the organization began using a computerized patient record, including a physician order-entry module.
Queens Health also has invested in a picture archiving and communication system and voice-recognition technology in radiology, as well as robotics in pharmacy and the laboratory. Now it is planning to adopt a "smart card" program.
"What stood out here was the comprehensiveness and the intensity of the applications that they have installed in both the inpatient and outpatient areas of their operation," says Dennis Barry, president and chief executive officer of Moses Cone Health System in Greensboro, N.C., and one of the judges for the CEO IT Achievement Award.
All of this has happened in just a few years because Velez, 62, has driven his organization to match his boundless energy and enthusiasm. Indeed, as he strides down the halls of Elmhurst talking to everyone he sees, the air around him seems to crackle.
Velez "is a maverick," says Benjamin Chu, president of New York City Health and Hospitals. "He is always pushing us to do things differently."
Queens Health was among the first in the health and hospitals corporation to adopt a picture archiving and communication system, computerized physician order entry and robotics. "He even has a mechanized vacuum on one unit that sweeps and mops floors, freeing up housekeeping to do a zillion other things," Chu says. The vacuum is an example of Velez's "kind of wacky openness to new ideas. He is willing to try something new, and if it doesn't quite work, he is willing to come back and try something else," Chu says.
A case in point: smart card technology. Despite concerns in the hospital industry about the robustness of applications for the technology, Velez says, "It is going to happen. We are determined."
Why? "On this particular issue, we are not focusing on cost savings but on the benefits for the individual. Can you imagine how it would feel to be a patient going into an emergency room and not being able to communicate in a language that you are comfortable with? This card would help."
Queens Health currently is working with Data Industries, New York, to develop applets for a smart card application. Negley, Ott & Associates, an IT consultancy based in Savannah, Ga., is developing an interface to Queens Health's clinical system.
Queens Health plans to launch a pilot in July with demographic data as well as some clinical information, including the patient problem list, allergies, active medications and selected lab results.
During the two- to three-month pilot, the cards will be given to about 10,000 patients at the primary-care clinic at Elmhurst. "If the rollout is well-received by patients and we do not run into any technical issues, we will probably move quickly to expand the patient base receiving the cards," says Alfred Marino, chief information officer at Queens Health.
While the ultimate results of the smart card venture aren't yet known, Velez's willingness to take risks on other information technology projects has reaped significant cost savings and improvements in patient care.
As a result of the efficiencies created in the care process from the electronic medical record, for example, Queens Health has been able to absorb a 23% increase in outpatient visits during the last five years without adding new caregivers.
Because of the ability to access electronic information from anywhere, Queens Health also centralized some ancillary depart- ments, such as the laboratory, saving $3 million annually.
Patient care has improved too. In a 2002 survey, 73% of caregivers at Elmhurst and 85% at Queens Hospital said the electronic system improved their access to patients' records.
And there have been fewer medication errors-specifically, a 50% reduction in the number of pharmacist interventions in medication orders in ambulatory care.
The system's ease of use also brought the organization into 100% compliance with the requirements of the Joint Commission on Accreditation of Healthcare Organizations to document a patient's problem list, including diagnoses, history of significant procedures, allergies and current medications.
Queens Health began using a computerized patient record-the Patient1 clinical system from Atlanta-based Per-Se Technologies-in ambulatory care at Elmhurst in January 1997. Unlike many organizations, Queens Health opted to begin rollout on the outpatient side as a way to manage rapid growth in patient visits, particularly in the primary-care clinic.
The rollout was completed in 2002, and there are now more than 3,000 PCs throughout Queens Health-located in all inpatient and outpatient departments-allowing more than 1,625 caregivers to access the system daily.
The electronic clinical system interfaces in the laboratory with a robotics system that was introduced in 1998. Queens Health is rolling out interfaces to robotics in the pharmacy, where a system was introduced this year.
From the beginning, Velez told physicians and other caregivers-who were involved in planning-that they must use the computerized system. And they have, becoming more comfortable with it over time. In January 2002, clinicians logged on to the system for an average of 43 hours-double the 21 hours per month logged in January 1997.
The medical records at Queens Health are almost paperless. The only paper elements include patient signatures on forms for treatment consent and receipt of privacy practices. Pediatric growth charts and EKG strips also are on paper, though EKG images also are available online.
Velez now is striving to break staff members' paper habit. He started with Elmhurst's main primary-care clinic four months ago. "Medical records would pull hundreds of charts a day, and basically, nobody ever looked at them. They were just there as a security blanket," says Diane Carr, associate executive director of healthcare information systems at Queens Health.
Picking up the story, Velez says, "We decided to take a very bold approach. I told the people in medical records, `Do me a favor-don't send any more paper records.' Of course, our director of medical records panicked. I think she had two or three people on standby-just in case."
The first day, physicians requested 10 paper charts, but by the end of the first week, they requested only two out of 350 records.
Revolutionary change has been a standing order in radiology as well.
As a result of a picture archiving and communication system-Agfa IMPAX from Agfa Corp., Ridgefield Park, N.J.-and voice recognition-TalkStation Radiology from Agfa's Talk Technology unit in Bensalem, Pa.-Queens Health removed all film from Elmhurst in January 2000 and Queens in January 2001.
"We sent out an e-mail to physicians. I think we gave them one month, and then we said, `There will be no more film,' " Velez says.
The automation in radiology saves the institution nearly $1.5 million annually, made up primarily of savings in film, real estate and staff costs. "We had four or five people in our file room filing films and another couple of other people running through the hospital looking for lost films," Velez says.
Under Elmhurst's manual system, 24% of images went unread, primarily because of misplaced films, according to a study done in October 1997, compared with just 2% in January 2000 under the new system.
"The improvements in patient care are significant," Carr says. One example: Physicians' orders for X-rays are entered online and transmitted to the picture archiving and communication system, which automatically schedules patients' appointments. Patients no longer endure long waits in radiology simply to present a paper order for an X-ray and schedule an appointment.
Donald Ashkenase, executive vice president of Montefiore Medical Center in the Bronx, says the project has been so successful because Velez insisted on doing away with all film. "There is always the temptation to allow the radiologists to keep film, but as soon as you don't make it 100%, you don't get the cost savings."
Velez not only works to replace manual systems inside Queens Health, but outside as well. He was instrumental in the decision to hire a corporate CIO at New York City Health and Hospitals.
He continually pushes the organization to adopt technology standards so that patient information as well as highly specialized physicians, such as radiologists, can be shared.
On a national level, Velez belongs to the boards of directors of the Institute for Healthcare Improvement and the National Association of Public Hospitals & Health Systems.
Says Ashkenase, "You'd think somebody who has been in the job for more than 20 years would slow down but he hasn't."