“We determined that if we had varied ways of implementing our IT system, we would not have that viability,” Fine says. “What someone was looking at on a screen in a small, critical-access hospital had to be the same as what they saw in a large academic medical center. We were rigid about our standards and expectations, and to some extent that rigidity made things easier for us.”
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That approach falls right in line with Fine's leadership style, says Michael Warden, Banner's senior vice president of information technology and chief information officer. From his first day at Banner, Fine made it known that the system, which was formed in 1999 after a merger between Lutheran Health Systems, Fargo, N.D., and Samaritan Health System, Phoenix, would work as an operating company and not a holding company, Warden says.
Fine's centrally directed tactics made it easier for two very different organizations to merge successfully, Warden says, and it leveraged their ability to think about health IT across an entire system.
“It's one thing to say you want to do something, but Peter worked to find ways to prioritize and finance our care transformation model,” Warden says. “He changed the way we allocate capital to a centralized model that guaranteed the resources needed to support our plan, and he also measured progress along the way.”
More than seven years and $180 million later, Banner, which admits more than 240,000 patients in seven states each year, has implemented an electronic health record from Cerner Corp. in all of its 22 hospitals and is well on its way to a fully paperless environment.
Fourteen of its facilities are expected to be using computerized physician order entry and positive patient identification systems by the end of this year, and the other eight are set to hit that target by the end of 2011. Also, Fine says, Banner aims to equip all of its physician clinics with EHR and CPOE systems by the end of 2012.
“We did it without any of the significant pain or difficulty you might expect, and that's because we did not waver one bit from the method of implementation, the resources needed for it and the expectations for how it would be used in clinical practice,” Fine says.
Banner may have kept a tight rein on hospitals' implementation, but it also learned from mistakes made along the way. One of the keys to its success was a reliance on a franchise model that rolled out IT systems one hospital at a time, watching carefully to see which methods worked and which ones faltered.
And the best place to start automating, Warden says, was at Banner Estrella Medical Center, a brand-new hospital with new employees that opened in 2005 in Phoenix. Hiring an entirely new staff gave Banner a significant advantage, Fine says, because the incoming employees knew ahead of time that they would be working in a highly automated environment.
After achieving success at getting Estrella, the basis for its franchise model, up and running, it took the lessons learned and applied them to Banner Gateway Medical Center, Gilbert, Ariz., a new hospital that opened in 2007 and replaced Banner Mesa (Ariz.) Medical Center, an older facility that opened its doors in 1963. That site proved to be more of a challenge because there was an existing staff and no automation agreement in place, says Fine, who credits the use of physician champions and gradual phase-in of CPOE.
Since then, they have rolled out their clinical systems at several more of their smaller hospitals and last October, they completed implementation at 391-bed Banner Thunderbird Medical Center, Glendale, Ariz.
“We had three opportunities to learn: first, at a new hospital with a new staff, second, at a new hospital with an existing staff, and third, at an existing hospital with an established staff,” Fine says. “Each stage brought progressively more difficult challenges and we learned something new about how to do implementations successfully.”
And they have seen some impressive results, Warden says. In January 2007, two years after implementing clinical systems at Banner Estrella, the health system collaborated with Cerner in a study to assess quality improvements and cost savings. When compared with a weighted average of eight other Banner hospitals, they found a 7.1% reduction in average length of stay, a 17.8% reduction in pharmacy costs, an 84.3% reduction in adverse drug events, a 15.8% reduction in nursing staff turnover and a 95.6% reduction in document storage costs.
Two years later, they conducted a second study examining performance on key quality indicators at Banner Gateway compared with five facilities that had not yet undergone a franchise model implementation. The results demonstrated similar gains in length of stay, prevention of adverse events, nursing turnover and other metrics.
“Those results told us that what we are doing is reproducible and works in multiple locations,” Warden says.
Fine also has insisted on a high level of involvement in larger data-sharing efforts. For instance, at Fine's direction, Warden serves on the board of directors of Arizona Health-e Connection, a not-for-profit organization made up of providers, payers, vendors and other groups, which promotes health information exchange across the state.
Warden also sits on the board of the Arizona Medical Information Exchange, a healthcare information exchange in use by more than 400 physicians and containing medical records for about 40% of the state's population. The exchange, known as AMIE, collaborates with the Southern Arizona Health Information Exchange, which includes more than 30 member hospitals, physician practices, health plans and other organizations, in a joint effort to merge the two organizations into a unified, statewide exchange, he says.
Fine expresses confidence that Banner's investments in time and money have put them right in line with the government's meaningful-use requirements, and he says he is hopeful that the system will receive a significant financial benefit to reward its efforts.
“He has had the vision to operate as a system, the fortitude to maintain that vision day after day, committing the necessary resources, and he is relentless in requiring progress,” Warden says. “Peter starts with the end in mind and he moves us in that direction no matter what. He truly believes in the clinical return on these investments and their impact on quality, and there is no way we could have come this far without his leadership.”