31-county information link is not mission impossible
Intranet brings together 70 remote sites
Your assignment is to develop a health information network that pulls together more than 500 physicians, 70 remote clinics, two acute care hospitals, and a detox center, all spread across 31 counties and five distinct markets.
Your goal is to allow users in all of these locations to share information and databases and accommodate 2,500 people who use e-mail and the Internet. And do it all in a secure manner.
If your answer is "Maybe in the next century," you’re behind the times. The Geisinger Health Care Systems in Danville, PA, has done just that, using an intranet-based system.
Geisinger wanted to operate as one effective system rather than a group of independent practices, 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 800-bed 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, PA, each run on local area networks (LANs). Clinics and hospitals are linked together on a wide area network (WAN). The network supports applications that include patient billing, laboratory, medical reference, internet access, and electronic mail. By providing these applications over the network, the system enables Geisinger to consolidate functions, such as accounting and lab work, and take advantage of cutting-edge health care applications like teleradiology.
To get to this level of connectivity, Geisinger had to move from a mainframe/terminal environment to a more flexible client-server workstation-oriented network. 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 of 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 was to find a simple way to link all the central computers and desktop systems using a common connection and hook the remote sites to this network. Geisinger looked to two other health systems for guidance the Medical Center of Delaware in New Castle and Harris Methodist-Fort Worth (TX).
Like Geisinger, Harris Methodist had a large central location 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 was more similar in size to Geisinger.
A team from Geisinger looked at hardware, software, how the networks were configured, system protocols and engineering, and cost data. The team talked extensively with Harris and Medical Center systems 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.
The five-year sojourn that began in 1991 had many stumbling blocks to overcome, Richards admits. Lessons learned included the following:
• Appropriate staffing.
Initially the project had 11¼2 staff positions dedicated to it, but that was woefully too few. A better number was eight people, Richards says.
• Appropriate funding.
The original funding estimates for cabling the network proved too small as well, he says. And the team found out later 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 began proving itself.
The first clinical use of the network was to provide enterprisewide access to the central laboratory 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 different databases like the clinical lab, scheduling, and demographics, the network enables a nurse to quickly 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.
Even though Geisinger hasn’t finished all that it wants to do, it already has impressed others. It was named the Best Networked Healthcare Organization in 1996 by Healthcare Infomatics magazine.
Next, the organization will implement an on-line clinical information system called EpicCare by Epic Systems Corporation in Madison, WI. The electronic medical record system will be initially tested on the 70 outpatient sites before it is rolled out to the entire enterprise.
Frank M. Richards, administrative director of information services, Geisinger Health Care Systems, North Academy Ave., Danville, PA 17822-3301. Telephone: (717) 271-6454.
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