The Web helps one group keep up with policy changes by Deborah Gesensway
Published in the February 2011 issue of Today's Hospitalist
AS THE HOSPITALIST GROUP at Boston's Beth Israel Deaconess Medical Center expanded from just a handful of doctors to almost 40, the group's administrative and clinical life also grew exponentially. There's the avalanche of all-group daily e-mails, for instance, and an unwieldy, always out-of-date program manual.
To address the latter issue, the group last year charged a newly hired hospitalist Roger Yu, MD, with finding a better way for colleagues to access key clinical and administrative information. Dr. Yu quickly realized that the group needed a tool that could handle constantly evolving
"We could start doing our sign-outs from doctor to doctor behind the firewall."
–Roger Yu, MD Beth Israel Deaconess Medical Center
"A hospitalist program's policies and protocols change frequently," he explains. "Who do you e-mail if you need something done? What do you do if you are on the night shift? What are the minimum things you should do when you admit a patient? How should you communicate with each group of primary care physicians? Who is on back-up today?"
A further challenge was how to bundle all this information without having to store hundreds of e-mails. "And how do you make it so the program director himself doesn't have to do all the work to keep it up to date?" he asks. Dr. Yu's solution was to help the group create its own Wiki. Put simply, Wikis are internal Web sites that users build and access from any computer or smartphone equipped with an Internet connection.
Dr. Yu was steered toward a Wiki in part to build upon work done a few years before by the center's internal medicine residents. The hospitalists occasionally consulted that Wiki to learn about departmental procedures.
As someone with no background, training or particular interest in computer programming, the first thing Dr. Yu did was talk to the Wiki administrators at both the residency program and at a local primary care group. Each of those groups had its own Wiki and helped him decide what software to use and how to organize the site.
In terms of software, Dr. Yu says there are dozens of easy-to-use programs available from MediaWiki, which was originally written for Wikipedia, as well as PBWorks and GoogleSites.
In the end, he went with Microsoft SharePoint, largely because it was already available at the center as part of its Microsoft Office package. Also, the doctors can access the program with the same log-in they use for the hospital's electronic medical record. In addition, Dr. Yu says, "if we wanted to, we could put patient information on the Wiki and it would be considered protected."
The group hasn't made use of that capability yet, he says, but it remains an option. "One day, we could start doing our sign-outs from doctor to doctor behind the firewall," says Dr. Yu. "We could just post our sign-out, and someone could pick it up from the Wiki."
The key, he adds, is to pick a program that you like and won't outgrow. "You don't want to start in one platform and have to migrate information to another," he says. "There is no way to do that easily."
In terms of organization, Dr. Yu decided that his academic hospitalist group's Wiki would be divided into four major components: clinical, educational, administrative and professional development. Think of these as four buttons listed down the left side of a typical Web site that users can click on to delve deeper into that topic.
"I started by taking our 120-page orientation manual and making each section a separate Wiki page," Dr. Yu says. Under "clinical," he put all sorts of information from provider schedules and the protocol for communicating with primary care physicians to when and how to call in back-up.
Under the professional development button, hospitalists can learn how to craft a curriculum vitae and a tenure dossier, and they can access templates for making posters to present at professional meetings.
There are also links to Up To Date, along with journals and reference resources available through Harvard University. "We list only those links that are relevant to our group," Dr. Yu says. "Links to hospital policies are filtered down to only what we need." That means that the Wiki doesn't include any policies related to operating-room procedures or to labor and delivery.
In addition, he says, the hospitalists keep their contact information behind a password-protected firewall that only group members can access. That allows them to update their own cell phone and pager numbers.
Group members use the Wiki to look up outpatient provider information, such as who to contact at Northeastern University's student health clinic to send discharge or follow- up information.
Another popular section is the continuing education area. Because hospitalists attend educational lectures every one to two weeks, Dr. Yu explains, "our administrator posts all the articles that we need to read, and we can download them from the Wiki."
Then there's the section with the schedule, which can change frequently. Some medical groups send out schedule updates, which arrive as e-mail attachments every time the schedule is updated.
"With so many e-mail versions of the schedule, it's hard to which is the most current," Dr. Yu says. The group posts its schedule on the site, knowing that the Wiki contains the latest version.
Only two people in the group who have a great deal of scheduling experience are allowed to make changes to that online schedule. "That's how we avoid major mistakes in editing the schedule that could result in a missed shift," Dr. Yu says.
Those "major mistakes" can be one potential downside to Wikis. The fact that anyone can update most sections of the Wiki by adding or changing site information, similar to what happens on social media sites or blogs, can endanger the information's integrity. But that fear hasn't materialized.
In part that's because "only a handful of changes are made each week," Dr. Yu says. Those changes are easy to monitor because the program uses a "track pages" function that shows what's been edited. In addition, the program saves all Wiki versions so anything accidentally deleted or changed can be easily recovered or fixed.
In the future, Dr. Yu adds, the idea is to get the hospitalists to use a discussion board portion of the Wiki instead of sending out group e-mails.
Already, he says, hospitalists who have started since the program manual was moved to the Wiki are using the software more than senior group members. "We actually run our orientation through the Wiki now."
"It has made me more efficient," Dr. Yu says. "Going through my day, I know where to look for information."
Deborah Gesensway is a freelance writer based in Toronto who reports on U.S. health care.