Hospital benchmarks its way to best networked’ health care system in U.S.
Main campus supports more than 70 remote sites
While most hospital systems are struggling to integrate their information systems at a single site, Geisinger Health Care Systems in Danville, PA, has pulled together a network that connects more than 550 physicians, 70 remote clinics, two acute care hospitals, and one detox facility across 31 counties and five geographic markets.
Sporting enough bells and whistles to make even the computer savviest sigh with envy, Geisinger’s network supports an intranet that accommodates the exchange of information and databases across its systems, some 2,500 e-mail users, and access to the Internet.
In fact, the network is so outstanding that Geisinger was chosen from a field of 80 hospitals as the "Best Networked Healthcare Organization in 1996," by Healthcare Informatics, a bible for health care information system geeks.
Geisinger wanted to operate as one effective system rather than a group of independent providers, says Joe Bisordi, Geisinger senior vice president and chairman of medical informatics. To do that, Bisordi observes, information must be communicated rapidly and efficiently throughout the enterprise. And that meant networking disparate systems and making access available to remote sites.
Today the main campus in Danville and a large regional hub in Wilkes-Barre each run on local area networks. Clinics and hospitals are linked together on a wide area network. (See a diagram of the wide area network structure, p. 3.) The network supports a variety of applications, including patient billing, laboratory, medical reference, Internet access and e-mail. By providing these applications over the network, the system enables Geisinger to consolidate functions such as accounting and lab work, and to take advantage of cutting-edge health care applications like teleradiology.
To get this system connected, it was necessary for Geisinger to move from a mainframe/terminal environment to a more flexible, client-server, workstation-oriented network. Benchmarking helped determine the best way to connect remote offices to hospital applications, and to create a universal workstation concept. These workstations allow inpatient nurses and other health care providers to access multiple applications from a single personal computer.
The legacy system on the main campus consisted of isolated Novell networks (operating systems) that didn’t talk to each other, and terminals dedicated to each kind of host computer, says Frank M. Richards, administrative director for information services at Geisinger. The various applications ran on different hardware, as well, such as IBM and Digital Equipment Corp. computers, and network servers. Medical personnel had to use a different terminal or PC to access each system. And the remote offices were linked to a single mainframe system using a connection that supported only one kind of communication.
The goal of the benchmarking effort was to find a simple way to link all the central computers and desktop systems using a common connection, and to hook the remote sites to this network. Geisinger chose to benchmark with the Medical Center of Delaware in New Castle, and Harris Methodist-Fort Worth (TX) because, "We were looking for organizations that started with the same hodgepodge of a system, and had moved to a single-wire-connected workstation," notes Richards. Like Geisinger, Harris Methodist had a large central campus with many host-based systems, and a number of clinics to support. The Medical Center of Delaware had fewer remote sites to link together, but it was more similar in size to Geisinger.
The benchmarking team consisted of information systems administrators, Geisinger’s chief information officer, the vice president of information systems, network managers, chief technicians, and mainframe support personnel. They met with their counterparts at the benchmark sites. The team looked at hardware, software, how the networks were configured, system protocols and engineering, and cost data. They talked extensively with Harris and Medical Center system managers about how their systems worked, their capabilities, and alternatives tried and discarded.
While the team was able to see how various network hardware would support different protocols, it also brought back other valuable ideas. "We were able to see a network that allowed you to check remote hubs," says Richards, "and to monitor the volume of traffic or use on the system." Both ideas found their way into Geisinger’s network setup.
But the five-year sojourn to "Best Networked" that began in 1991 for the 800-bed Geisinger system had several stumbling blocks to overcome, Richards admits. Whereas the project had 1.5 FTEs dedicated to it initially, that was woefully too few. A better estimate was eight people, he says. The original funding estimates for cabling the network proved too small, as well, he says. And the team found out after the fact that the communications personnel needed more training to implement some of the project, he says.
But five years and nearly $3 million later, the value of Geisinger’s network is becoming apparent. For instance, the network helps move information via e-mail among employees who are geographically spread over 31 counties. The first clinical use of the network was to provide enter- prisewide access to the central lab in Danville. This not only gave clinics quick, on-line returns of patient lab results, it also made it easy to pass the information across the system from provider to provider, thus avoiding duplicate testing.
The network also supports new capabilities such as TEL-A-NURSE, an application from National Health Enhancement Systems that allows patients to call in and discuss health issues directly with registered nurses. By providing access to several databases like the clinical lab, scheduling, and demographics, the network enables a nurse to quickly and efficiently answer patient questions while working at one PC.
Geisinger has an intranet for internal communications, as well. Nursing policy and procedure manuals are now on-line for the nursing staff to access, the lab is working on a similar project, and human resources will soon be posting jobs and other announcements over the network.
In addition, Geisinger is using its network to extend its reach from tertiary care centers to rural practitioners by supporting telemedicine initiatives. For example, Geisinger is supplying after-hours teleradiology services to community hospitals that can’t afford to have a radiologist on call. Geisinger’s vision for building a successful integrated delivery system continues to evolve. Next, the organization will implement an on-line clinical information system called EpicCare by Epic Systems Corp., in Madison, WI. The electronic medical record system will be tested initially on the 70 outpatient sites before it is rolled out to the entire enterprise. As Geisinger continues its quest to provide high-quality, cost-efficient service across the continuum of care, this ability to easily share patient information throughout the organization will "allow us to offer the best possible service for the patient, in a rational and cost-effective manner," says Bisordi.
[Editor’s note: For more information, contact Frank M. Richards, Administrative Director, Information Services, Geisinger Health Systems, (717) 271-6454.]
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