Published in the June 2007 issue of Today’s Hospitalist.
With just a flick of his wrist, Matthew Szvetecz, MD, head of the hospitalist program at Kadlec Medical Center in Richland, Wash., can click on a computer-screen icon anywhere in the hospital and access any patient’s lab results, EKGs, medications and orders.
In fact, thanks to a Web-based physician portal, Dr. Szvetecz, who is also director of internal medicine for Kadlec Medical Associates, can pull up a patient’s digital images, test results and previous discharge summaries on any computer anywhere that has a broadband connection. If necessary, he can go back as far as four years and review earlier records.
For the group’s hospitalists, the read-only portal means that the physicians don’t have to chase paper or film while they’re on-site. They can also sign off on patient charts at home, on vacation or while attending a conference. Even more importantly for patient continuity, Dr. Szvetecz adds, community physicians can use the portal to access their patients’ records and check patient data post-discharge for follow-up.
That capability has helped extend the boundaries of Kadlec’s referral network throughout Washington and Oregon, part of a successful expansion strategy that has increased hospital revenue more than three-fold over the past five years.
And the portal has proven to be a major plus for physician recruitment. (The hospitalist group recently hired its eighth full-time physician and is recruiting two more.) In his quest to bring new physicians to the 188-bed center, says Dr. Szvetecz, the portal has been "one of our biggest assets."
One-stop technological shopping
According to Dr. Szvetecz, the present portal is, in part, the result of a very forward-thinking hospital board. Richland is located on the Columbia River in southeastern Washington; the medical center serves a far-flung rural area. But the strong scientific and engineering culture of local corporations, including Bechtel andCH2MHill, has infiltrated the hospital.
"That technology orientation has passed down culture-wise through the ranks," Dr. Szvetecz says, adding that the hospital administration and board members have been "very willing" to spend money upfront and invest in information technology.
The portal, a $100,000 investment, is part of a multi-faceted information technology implementation strategy. When Dr. Szvetecz joined the staff five years ago, Kadlec had five different information modules that physicians could access (with separate passwords) to view data such as vital signs.
Four years ago, the information technology department introduced the portal with its single point of access.
"We quickly realized the value of one-stop shopping," says Terre Estes, RN, one of Kadlec’s two physician support specialists. "It’s a browser-based, point-and-click system that is fed data and information from many other systems, and displays it in a physician-friendly format."
While the core portal component is a McKesson product, the hospital’s informatics department was able to make the portal work with a host of other applications from other companies. As a result, physicians have remote access to medical imaging; dictated medical orders; EEGs, EKGs and fetal-heart tracings: and graphing capability.
"We’ve leveraged the portal’s integration and functionality," Ms. Estes says, "because we’ve brought so many disparate systems into one place."
The portal was also a key component of Kadlec’s business plan to become a regional referral center.
"Referring physicians have a lot of choices here in the Northwest," says Dave Roach, Kadlec’s chief information officer, who mentions academic centers in Seattle, Spokane and Portland, Ore. "It was a strategic decision to develop the portal to entice them here with ready information." As proof, several dozen physicians within a 100-mile radius are now sending patients to the hospital who were not doing so four years ago.
While the center’s growth strategy had several components, including the introduction of open-heart surgery, a neonatal ICU and the hospitalist program, "a lot of that is attributable to the portal," Mr. Roach says. During the past five years, the number of log-ins from physicians and staff to the Kadlec portal has shot up from 25 per month to more than 20,000.
One big push for widespread use came from making electronic sign-off the sole option. "There would still be many doctors who would say, ‘Send me a piece of paper,’ but we’re trying not to send paper or do films anymore," Ms. Estes says. Instead of using a film, which can cost the center between $5 and $6, Ms. Estes says the staff now rely on CDs, "which are $1 each. We’re able to deliver quality images and reduce costs."
While Kadlec has been expanding, the hospitalist service itself has undergone a rapid evolution. The center’s initial program, begun in 2004, had been staffed and managed through a national hospitalist management company. When the program went in-house and Dr. Szvetecz took over in spring 2006, it was fully staffed with locums physicians.
(The portal proved to be a boon when staffing relied so heavily on temporary physicians; locums physicians could leave at the end of their assignment and still sign off on patient charts.)
As Dr. Szvetecz began to look for full-time physicians, a number of recruits were some of the locums doctors already working in the center.
"One of the chief things they liked was the IT, just to have those data available in one place," says Dr. Szvetecz. "They didn’t have to run to the other side of the hospital to find an EKG or an X-ray."
For outside recruits, the Kadlec portal attracts physicians who might not be drawn to such a rural area. "That’s enabled us to get physicians to give us a second look," says Dr. Szvetecz. "Once doctors visit or see a demo of the portal, we have something that piques their interest."
Having patient information available via an Internet portal has also improved patient transitions back to the outpatient side, says Dr. Szvetecz. Generally, physicians will have complete access to what has happened in the hospital, although it won’t be entirely instantaneous.
"But it will be pretty close," he says. "As soon as the information is transcribed, they have access to it."
Any paper with new data is scanned into digital form within 24 hours and then destroyed. The digital copy becomes the legal copy, and all the data become available to the hospital medical staff or referring physicians.
While the paper chart that physicians print out before they see a patient might be four to six hours behind in terms of getting patient lab information, "the portal has improved our efficiency considerably," says Dr. Szvetecz. Not only are physicians spending a lot less time chasing paper, but when they get a referral from the ED, they can open the portal and preview the patient’s prior documentation and admission records.
"That’s dramatically improved the quality of the transition between services," he points out.
The hospital did try to implement a system where physicians would be able to download data into handheld computers, Dr. Szvetecz adds. "But I never saw anyone using them because there’s a computer every 10 feet."
And the portal’s broad use should help with implementing the center’s next technological wave: computerized physician-order entry (CPOE) within the next year, with electronic charting three to four years away.
"CPOE will just be another tab in the portal list," says Ms. Estes. "Physicians are so used to the look and feel of the portal that CPOE will be just another option."
Janice C. Simmons is a freelance health care writer based in Alexandria, Va.