G. Richard Hastings, president and chief executive officer of St. Luke's Health System, has long considered information technology to be a potent weapon in the battle to improve quality and efficiency.
While in the U.S. Air Force some three decades ago, Hastings saw how IT helped the military meet its goals, and he carried his enthusiasm for the potential of IT to his career in healthcare administration, which he began in 1977 as an administrative resident at St. Luke's Hospital, flagship of the system based in Kansas City, Mo.
"I think, in large part, our ability to provide care to a growing, aging population with fewer professionals to take care of (the patients) will be entirely based on our ability to use information technology," says Hastings, who was named CEO in 1995 of what is now a nine-hospital health system, adding the title of president in 1996.
St. Luke's plans to open its 10th hospital in suburban Missouri's rapidly growing Lee's Summit in 2006. "We plan for it to be all-digital," Hastings says.
For his steadfast commitment to information technology, Hastings has been chosen one of this year's winners of the Modern Healthcare/HIMSS CEO IT Achievement Award.
"He doesn't view technology as a cost but as an asset that can be applied to change the way an organization functions," says Pete Velez, executive director of Elmhurst (N.Y.) Hospital Center and senior vice president of Queens Health Network. Velez, who was a member of this year's judging panel, was one of two recipients of last year's award.
Hastings believes that IT is a crucial component of any continuous-improvement process, which he has championed at St. Luke's for a decade. Indeed, St. Luke's Hospital was one of seven recipients, including two hospitals, of the 2003 Malcolm Baldrige National Quality Award. The U.S. Commerce Department's National Institute of Standards and Technology administers the award annually. "I believe the reason why we won the Baldrige is that we are really dedicated to process improvement, reduction in variation, and those things can't be done very well without information technology," Hastings says.
IT long on his radar screen
Hastings' belief in the power of IT to improve the quality of processes began with his career in the military. When Hastings was a second lieutenant in the Air Force from 1967 to 1975, "One of the things I did in the Air Force was to use electronics and information technology to screw up the radar of the enemy," recalls Hastings. "I was able to see that you were able to do more with information technology than you were able to do without it."
After leaving the military and earning a master's degree in healthcare administration from the University of Minnesota in Minneapolis, Hastings joined St. Luke's, where he has championed IT for decades. "He has always encouraged us to leverage technology to be more efficient," says Sherry Marshall, vice president of quality at St. Luke's Health System.
In his current role, Hastings has advocated the use of technology to improve both administrative and clinical processes. During the past seven years, IT spending has averaged 26.2% of the capital budget and between 3.7% and 4.1% of the operating budget. The annual IT budget in 2003 was $30.8 million, including expenditures for operations and capital projects.
Hastings has never wavered in his commitment to technology or employees in the IT department -- even when surpluses were minuscule. In 1999, for example, the total margin at St. Luke's Hospital was about break-even on total revenue of approximately $550 million, according to the hospital's application for the Baldrige award. "Even in the lean years, they got 10 days of training," says John Wade, chief information officer of the healthcare system. In 2003, IT employees received an average of 13.4 days of training.
Hastings "has a clarity of vision about where the organization needs to go," Wade says. When Wade interviewed for the CIO position in 1993, he came away from his meeting with Hastings, thinking, " ?This person is going to move this organization forward. I will be fortunate if they pick me to be the CIO.' Here it is 11 years later, and I still feel the same way."
In recent years, Hastings' vision has focused on using IT to improve clinical care, although that's easier said than done. Hastings says, "The clinical part is the part that most organizations have difficulty with because you are dealing with lots of different physicians in lots of different locations."
Despite the hurdles, St. Luke's Health System has been successful. Examples include: electronic monitoring of cardiac patients' heart rhythms from a central location, electronic anesthesia administration and reporting, and building and maintaining an outcomes database with records spanning 20 years.
St. Luke's Mid America Heart Institute used a combination of wired and wireless technology to set up a central monitoring system for cardiac patients located throughout the system. Technicians at the central station at the Heart Institute keep tabs on patients who wear wireless transceivers to record their heart rhythms. If something seems amiss, the technicians alert nurses on the floor immediately.
The system -- PatientNet from GE Medical Systems -- allowed St. Luke's to reduce eight full-time positions for cardiology technicians while also increasing the quality of patient care. With the staff cuts, the $1.8 million cost of the system was recouped in eight months.
The quality improved because PatientNet allows the hospital system to "standardize the quality of monitoring" across all hospitals and floors to match the level of expertise at the Heart Institute, Wade says.
The Heart Institute also has seen an 11% increase in revenue as a result of the system. How? Because more heart patients now are cared for at their local hospital or on the pulmonary floor at St. Luke's Hospital, freeing beds at the Heart Institute for very sick patients. "There is a much more efficient use of beds," Wade says. Transfers from pulmonary units to the Heart Institute declined 11%, while transfers from rural facilities declined 17%.
Attending cardiologists are happy because unnecessary calls to them have dropped 18% since the PatientNet system was installed, according to Wade.
Administrators at Wright Memorial Hospital, Trenton, Mo., a rural facility, were prepared to shut down their cardiology service because they couldn't find enough cardiology technicians to staff the program around the clock. But with central monitoring of patients' heart rhythms, the program survived.
"What would that have meant for that community? Disaster," Wade says. "When someone has a heart attack, they (would have been) put in an air ambulance or a ground ambulance, and with ice on the road in the middle of February, that is not a pretty ride."
IT also has had a big effect on anesthesia administration.
The hospital system spent $2.5 million to set up an electronic system, which monitors and documents the flow of anesthesia agents during surgery. The solution -- Care Suite, from Picis, Wakefield. Mass. -- has been in place at St. Luke's Hospital since 1998 and St. Luke's South, Overland Park, Kan., since 1999.
IT delivers ROI
The investment has paid big returns. St. Luke's Hospital has saved more than $3 million annually in anesthesia agents. The savings accrue as a result of physicians' analysis of electronic information. The analysis helps physicians spot universal trends in anesthesia administration as well as track individuals' reactions to specific agents and doses.
St. Luke's is probably best known for its heart-outcomes database, which was implemented in 1984 at its heart institute. The database contains information on more than 80,000 cardiac patients and has cost more than $1 million to build and maintain. But system executives believe the outcomes database has been a worthwhile investment because the information helps prove to payers and consumers that St. Luke's provides high-quality heart care, Wade says.
St. Luke's isn't resting on past achievements. The system this year is implementing an electronic solution in intensive care that will allow intensivists -- physicians with special training in critical-care medicine -- and registered nurses to monitor patients at multiple ICUs from a single location at St. Luke's data-processing hub in Lee's Summit.
The system -- eICU from Visicu, Baltimore -- will be rolled out to three hospitals with a total of 58 ICU beds by year-end.
The eICU system will allow critical-care physicians and nurses to monitor patient's vital signs, such as heart rate, blood pressure and breathing rate. Using digital imaging technology, these off-site specialists also will be able to zoom in on patients, as necessary, to check such things as a patient's wound, skin color or pupil size.
"Over the holidays in December, I went out and played with it to see how it works. It is incredible," says Hastings, who admits, "I like gizmos."
The clinical quality payback of the system promises to be incredible as well. In 2001, Sentara Norfolk (Va.) General Hospital reduced mortality rates in its ICU by 25% and shortened length of stay by 17%, according to a 2001 study by Capgemini.
Hastings says when he saw the eICU system in operation at Sentara, he was so impressed that he came back to his system and said, "We've just got to do this."
The technology will allow St. Luke's 13 intensivists to be deployed more effectively -- an important consideration, given a national shortage of physicians with this special training. The Washington-based Leapfrog Group, a business coalition that's promoting patient safety initiatives, encourages hospitals to staff ICUs with intensivists as a way to improve outcomes in critical care.
Wade also anticipates that the system will improve the longevity of registered nurses in critical care because they will get a break from the emotional stress of hands-on care while serving a stint at the central monitoring station.
The eICU is layered on top of a suite of core clinical applications from McKesson Corp., San Francisco, including: patient scheduling, admitting, patient accounting, radiology reports, patient results reporting, medical imaging, decision support, and progress and discharge reports. Physicians and nurses use browser technology to tap into patient information.
St. Luke's has not yet implemented McKesson's physician order-entry module. "We have the tool, but, by choice, are not implementing it, based upon the input of our physicians," Wade says. Members of the physician technology committee urged the hospital system to first automate the electronic health record. The committee's members want the medical staff to be comfortable accessing patient information electronically before adding order entry, Wade says. About 60% of admitting physicians are now using the McKesson system.
If all goes as planned, physicians should be able to place all orders electronically by 2006.
Nonetheless, St. Luke's Health System is working this year on automating part of the prescription-writing process. It's in the midst of rolling out personal digital assistants so physicians can order prescriptions electronically. So far, more than 95 of St. Luke's salaried physicians are writing the prescriptions electronically with software, TouchWorks Rx+ from Allscripts Healthcare Solutions, Libertyville, Ill. Because the Allscripts software isn't integrated with St. Luke's McKesson system, physicians still print out prescriptions.
The new prescription process should improve patient safety because it alerts physicians to possible adverse drug interactions or incorrect dosages. It also eliminates errors that result when a nurse or pharmacist misinterprets a physician's handwriting. Electronic prescribing is an example of how information technology "promotes safety as we continue to improve our processes," says Hastings.
Hastings not only champions IT within the St. Luke's system but in the larger healthcare community as well.
William Corley, president and CEO of Community Health Network in Indianapolis, says he has traded information on process-improvement initiatives and technology with Hastings since they met 15 years ago. "Not only is he improving healthcare in Kansas City, he is improving healthcare in Indianapolis, and I know Rich does this with other CEOs," Corley says.
Hastings has promoted the benefits of information technology to a large, national audience of hospital executives through his role as board member of both VHA, an Irving, Texas-based alliance, and Novation, the joint supply company of VHA and University HealthSystem Consortium.
In addition, he's a board member of the Missouri Hospital Association, the Missouri Patient Care Review Foundation and the American Hospital Association's Regulatory Reform and Relief Advisory Committee.
Hastings not only works with his peers, but with up-and-coming administrators as well. He has been a preceptor of graduate students in healthcare administration at the University of Minnesota since 1982. The students spend a year as administrative fellows, or interns, at St. Luke's after earning their graduate degrees.
He's also been an adjunct professor in healthcare administration at St. Louis-based Webster University's campus in Kansas City.
Says his CIO Wade: "I work hard, but he puts me to shame. I don't know where he gets the energy."
Linda Wilson is a freelance writer in McHenry, Ill. She can be reached at[email protected]
St. Luke's Health System
Headquarters: Kansas City, Mo.
Data as of 2003
Number of hospitals: Nine
Gross revenue: $1.42 billion
Operating income: $25.2 million, or 4.3% margin
Annual information technology budget: $30.8 million (includes both operating and capital combined)
Total employees in information technology department: 112
Annual discharges: 36,713
Staffed acute-care beds: 886