The long reach of IT

"I tell people that the reason I have calluses on my hands is because I have to hold the reins back,” says Gary Gregory, board chairman at Miami Children's Hospital, referring to the hospital CEO's exuberance when it comes to health information technology.

Since Dr. Narendra Kini joined 272-bed Miami Children's as president and CEO in 2008, it has been full speed ahead with IT implementation, as Kini has driven a digitalization strategy that includes initiatives in telemedicine, mobile technology, “big data,” patient engagement and revenue-cycle management. They're the results of Kini's goal to create an environment for patients and their families similar to what they experience in other segments of the economy.

“People expect convenience, efficiency and most activity to be on the Web,” says Kini, 50. “So how do you translate healthcare functions? How do you get all of that activity in the same manner or format as (an airline) boarding pass or making a purchase on the Web?”

That has been the challenge and the philosophy that Kini, his board and the staff at Miami Children's have been facing for the past five years. And it's why Kini is one of two recipients of this year's CEO IT Achievement Awards, presented by Modern Healthcare and co-sponsored by the Healthcare Information and Management Systems Society.

The recognition comes more than a year after one of Kini's crowning achievements at Miami Children's—the implementation of a $67 million health-record system (partially offset with federal stimulus funds) that replaced a 42-year-old paper process. The system went live in April 2012. Though the hospital would be in jeopardy of losing a portion of its Medicare and Medicaid funding beginning in 2015 if it didn't have an EHR system in place meeting the “meaningful-use” criteria, the extensive list of other IT initiatives at Miami Children's provides evidence that governmental pressure was not the sole motivating factor behind the IT push.

Before then, other hospital stakeholders—starting with board members—had already begun to see evidence of a digital evolution of sorts.

“Three years ago, Kini came to me and said that we're going to get rid of all paper for the board. We're going to give them iPads,” Gregory says. Today, the board operates without paper, allowing them to access and share data anytime and anywhere.

“It pushes IT and its benefits,” Gregory says, pointing to the increased efficiencies that have trickled down from the hospital board and executives to the entire staff.

Tablets are now used throughout the hospital in both business and clinical settings—to collect insurance information and copayments, allow patients to read and sign electronic consent forms, and provide bedside access to medical histories and other clinical information.

The hospital has reported that in its emergency department, self-service tablets and kiosk-based patient management systems have decreased the average time from triage to registration from almost an hour in July 2012 to just two minutes by December 2012.

But it isn't just a matter of moving away from paper, Kini says. “We realized that a lot of the data that comes from medical equipment is part of decisionmaking and needs to interact with the electronic medical records, so we're bringing other devices into that environment.”

That has meant an effort to bring online content—educational information, clinical materials, forms and templates—into a portal format that patients and their families can access. There's a secure e-mail/contact method for physician and patient communication, as well as a technology infrastructure that monitors the security of patient data. And the hospital is also implementing an enterprise data warehouse that incorporates clinical, financial and operational data for improved and personalized clinical solutions; tracks operational metrics; and correlates financial measures with clinical and operational measures.

Thanks to those data-mining and business intelligence tools that handle voluminous data collected through the EHR system, the hospital's executives and clinicians are provided with actionable information that they can use to improve the effectiveness and efficiency of patient care. For example, between 2006 and 2010, asthma hospitalizations at Miami Children's dropped from 350 excess days to 50. It saved money for patients and third-party payers and also improved the quality of care.

Gregory says the transformation hasn't benefitted just kids in the community. “Now, because of our IT prowess, we're serving West Palm Beach, which is 90 miles away. Never would we have thought in our wildest dreams we'd be serving West Palm Beach.”

In 2010, Miami Children's Hospital formed an affiliation with 166-bed Palms West Hospital in Loxahatchee, Fla., to provide pediatric emergency care to Palm Beach County. And last fall, the Miami Children's Hospital Nicklaus Outpatient Center opened in Palm Beach Gardens, Fla., to offer pediatric rehabilitation services, imaging services and urgent care to the community. Technology is what has enabled the affiliations.

But expansion of services hasn't been limited to South Florida. Through its technological investments, the hospital is now able to treat children in South America, Russia and many other nations. Last year, Miami Children's signed telehealth partnership agreements with pediatric healthcare providers in Colombia, Peru and Ecuador. The global telemedicine effort is one component of Kini's three-pronged Pediatric Digital Outreach Project that integrates a telehealth center, mobile health applications, and interactive mobile equipment and devices.

The telemedicine command center is a 2,400-square-foot facility on the hospital's main campus that allows for global access to pediatric specialists and remote interpretation of high-resolution visual images, radiology reports, laboratory tests and other diagnostic information.

“We embarked on bringing our expertise to any patient, anytime, anywhere, through a telehealth capacity,” Kini says.

Another way Miami Children's is doing that is through proprietary mobile health apps, such as its own “ScripteRx,” which helps improve patient adherence to prescribed medications and doctors' orders. For example, it sends a weekly report on compliance, including information as to what times or doses were skipped most often.

Further from home, the hospital is beginning its deployment of telehealth peripherals that are part kiosk, part cart, part mobile application, part robot. Those kiosks, or “pods,” can be placed anywhere in the world to afford children and families 24/7 care from a Miami Children's physician. Though Gregory says “the robots are in their infancy,” Kini expects to have them placed in various locations worldwide and be up and running by year-end.

“These are devices we can place in any environment where people can come and seek care,” Kini says. “The interaction is much more than an audio/video consult. A doctor or nurse can take your vital signs, do some bloodwork, see your skin.”

Gregory notes that IT investments can be challenging for what he calls a relatively small and independent hospital that, as a pediatrics facility, doesn't have the base that adult hospitals do. Its annual IT budget is less than $50 million. But since the start of Kini's tenure, the once small IT department of 10 to 15 people has grown to 165 employees.

“We had to do it. We had to make the investment,” Gregory says.

“Kini convinced the board to give him $1 million to build the telemedicine center. It's kind of our showpiece,” he says. “Now we're negotiating licenses with other hospitals without them having to make capital investments because we made the investment already.”

And with the licensing of that showpiece and the addition of new global markets, Gregory expects to see some boost to the hospital's bottom line. Miami Children's anticipates its mobile technology initiatives alone will generate about $1 million in additional revenue by 2015.

Kini acknowledges that it's not the technologies alone that drive improvement. “There needs to be a lot of prework done in two specific areas—culture management and process improvement. You cannot take paper-based processes and digitize them. And you have to prepare organizations well in advance for change,” he says, referring to the Lean business improvement model that he introduced soon after joining the organization.

Some of that cultural acceptance is also certainly tied to the fact that Kini is a practicing pediatric emergency physician himself. “I've never seen the doctors buying into the administration's ideas like this,” Gregory says. “He manages through data and evidence-based medicine, and people are starting to see the benefits.”

And although it's been a busy and productive five years already, Kini's philosophy for the next five suggests that Gregory probably shouldn't expect the calluses to heal anytime soon.

“The era is changing because of the consumer,” Kini says. “We've gotten so used to the convenience of online and Web-based capabilities. Our opinion is that we have to catch up.”

Follow Rachel Landen on Twitter: @MHrlanden