To address the problems caused by multiple systems and software platforms, Froedtert & The Medical College of Wisconsin forged a comprehensive enterprise solution
By Phyllis Hanlon
Walk into almost any hospital in the country, and you’ll likely witness healthcare professionals at bedside armed with a tablet and stylus or intently studying lab values on a computer screen. Gone are the days of recording vital signs on paper or waiting hours for radiology to interpret a film and deliver the results to the nurse’s station.
Technology is sweeping through the healthcare system, increasing efficiency and accuracy, but also, in some cases, creating redundancy. When multiple departments work on different platforms, communication becomes disjointed. The result can be a nosedive in patient, provider, and staff satisfaction. Until 3 years ago, this situation prevailed at Froedtert & The Medical College of Wisconsin. That was when a team of forward-thinking individuals developed an enterprise system, integrating superfluous and fragmented services, and earning staff approval and increasing productivity as a result.
In the Beginning
Froedtert & The Medical College of Wisconsin health system today comprises the Froedtert Hospital in Milwaukee, Community Memorial Hospital in Menomonee Falls, and St Joseph’s Hospital in West Bend, along with more than 30 clinics.
In 1996, former Marine and technology management graduate from Southern Illinois University Jeff Rehm joined Froedtert Hospital as clinical engineer. At that time, the clinical imaging department, typically referred to as clinical engineering in other institutions, operated within radiology with a part-time secretary and one other staffer who processed film, made slides, and did minor repairs.
Rehm’s military training and years of field service for surgical, ultrasound, and diagnostic companies positioned him well for a leadership role. During the next 3 years, he began to build the department, mentoring interns and hiring more engineers. In 1998, Froedtert installed a picture archiving and communication system (PACS) for ultrasound, and Rehm was appointed PACS system administrator. The following year, he became supervisor of the department, now officially known as Clinical Imaging. During these transitional years, the Clinical Imaging department still existed as a separate group, providing services to radiology and the laboratory. When the lab portion spun off into a different company, the radiology department, which included Clinical Imaging, became part of the Froedtert system.
Building a Relationship with IT
In time, Clinical Imaging’s responsibilities became entangled with information technology (IT), and the importance of developing a strong relationship between the two entities became apparent. “Many of the staff in IT came from banking, general business, and other industries outside of healthcare, and they were not familiar with the patient care environment,” says Jeremy Kingsbury, BS, who arrived at Froedtert in December 2000.
While working toward his biomedical engineering degree at Milwaukee School of Engineering, Kingsbury had also worked in IT at the school. “That was one of the best things I could have done,” he says. “Everything I do now involves computers.”
Kingsbury became unofficial liaison between Clinical Imaging and IT, fostering better relationships between both groups. “The IT department is removed from the clinical environment. In a lot of instances, they don’t understand the significance of issues and how resolutions could affect patient care and employees dealing with decisions,” he says. “I’m here to help everyone do their job the best they can. I consider that one of the biggest tasks.”
A major stumbling block for hospital staff involved the overwhelming amount of paperwork required for IT requests; as many as 35 forms had to be submitted. Managers across the system called for faster and more efficient access to IT processes and resources. In response, staff in IT consolidated the forms into one electronic computer access request that can be filled out online by managers and supervisors. “The few forms that are still used are downloadable and can be filled out in Word or Excel, but then must be printed and faxed in. IT is starting to accept the forms by email, if they come from a manager. So we are actually making progress.”
Kingsbury enhanced his standing with IT when he became a Microsoft-certified system engineer. “This has helped to bridge the gap between Clinical Imaging and IT. I could speak their language,” he notes. “IT began accepting Clinical Imaging as an equal.” In fact, the IT department asked Kingsbury to sit on its vulnerability assessment team. In this role, he was able to contribute to the decision-making process about Microsoft patches for the 100 PACS workstations throughout the system.
In December 2002, Froedtert installed PACS and Kingsbury became its first administrator, also serving as intermediary with PACS vendors. “Clinical Imaging began archiving from most modalities then, and radiologists began reading from PACS in June 2003. We wanted to have 6 months of data online before we switched from film to PACS,” he reports.
Meanwhile, some 20 miles northwest, a support team was executing identical functions at Community Memorial Hospital, where Becky J. Duehring, who earned her Bachelor of Science degree in biomedical engineering from Marquette University, began working in January 2009. Initially, she served as PACS coordinator for Community Memorial for 3 ½ years. She is currently imaging informatics supervisor for the whole health system. Five years ago, she and four other support staff worked “in our own bubble,” duplicating tasks performed at Froedtert. “There was huge inefficiency,” she says. “Both teams supported the same imaging equipment and had the same responsibilities, but we had a segregated infrastructure and separate support teams.”
Community Memorial had built its own EPIC system for electronic medical records separate from Froedtert and had its own “clinical imaging–like department,” albeit smaller than Froedtert’s group. Providers who practiced at both sites felt the impact of the two distinct systems. They would have to log in separately at each location to view patient images. In some cases, they were unable to access images in both systems.
The health system’s third facility, St Joseph’s Hospital, operated under yet another technological system. St Joseph’s used EPIC, but had no radiology module and worked on a different platform. Also, St Joseph’s used Merge PACS and had IT manage the system. Froedtert Hospital and Community Memorial each supported their own PACS.
Additionally, the Froedtert campus, the only Level I trauma center in southeast Wisconsin, had a file room, where four employees from Radiology Support Services imported external studies and worked with PACS and Radiology Information Systems to ensure the films were compatible with the Froedtert system.
As the health system continued to expand, Rehm, now executive director of imaging services for the health system, realized the need for a cohesive structure to improve patient care, provider efficiency, and cost-effectiveness. Now that his responsibilities had changed, he needed to find someone to replace himself and lead the integration.
According to Rehm, all clinical imaging staff in the health system spent 3 months discussing the qualities they wanted in a manager as well as the appropriate structure for the integrated team. After an extensive search, they found an external candidate who fit the bill.
Matthew Dummert proved to have the right credentials, as well as the experience, to spearhead the project. He had earned a Bachelor of Science in electrical engineering from Marquette University as well as a Master of Science in healthcare technologies management, which is a joint degree program from Marquette and The Medical College of Wisconsin. In addition to experience as an imaging service engineer, Dummert had held both health system and regional leadership roles in biomedical engineering operations.
Once Dummert assumed his role as Clinical Imaging manager, all those who would be affected by any changes were invited to offer input on the integration. Rehm says, “I am a firm believer in having staff participation in redesigning a system. If you don’t have that, there is no buy-in. These are values we talk about, but don’t always practice. We wanted things to be clear and concise before we presented them to staff. It’s too late to offer input once decisions have been made.”
Duehring adds, “I’ve seen change in other places that were top down. We did not want to do that. We found that the more involved staff was, the easier the transition would be. There was a lot of communication. We wanted to hear from the team which career path they wanted to pursue. Staff is more willing to share their frustrations and concerns when they have input.”
Revamping the department proceeded with preparatory meetings to define and clarify responsibilities associated with each position. “We wanted to do a better job of refining roles, which were not clearly defined before. The thinking was, ‘The job is what you think it is and whatever else we need you to do,’ ” Duehring says. “The job descriptions within the department were disconnected, with no clear organizational structures.”
Dummert worked for nearly 8 months with the team, evaluating the specifics of each role, ironing out the details, and organizing the group into logical subsets. Rehm notes that approximately 80% of the positions in the department were reorganized.
In the end, a three-tiered staffing system emerged—entry level, mid tier, and senior level—providing an opportunity for advancement and lateral movement. “We encourage staff to learn about other areas if they wish and will send them for training,” Duehring says.
Even with roles more clearly defined, there continues to be some necessary overlap. “PACS staff can’t do their job without some knowledge of how what they do affects other areas,” Duehring points out. “Interfaces impact other processes and departments. The team clearly understands the downstream effects of their job. Previously, when jobs were siloed, many problems were passed along, creating a disconnect between Clinical Imaging and its customers.”
While restructuring plans moved forward, Rehm realized that actively involving departments and facilities across the system would be key to its success. Staff within the hospitals and clinics feared they would lose customer support once all systems were integrated. He wanted to reassure them that this would not happen. “There was a lot of change management, but open communication had a big, positive effect. There were concerns at some locations that they would not get enough support, but now they have more support than they had in the past,” Rehm says.
Thus, before fully implementing the integration, Clinical Imaging—now called Imaging Technology Management—had to sell the plan to the actual tech resources. “We opened up discussion to all who are part of the restructure,” Dummert notes. “We considered the problem and all possible solutions. There was fragmented support and a different leadership structure at each facility.”
Historically, Froedtert was the larger facility and embraced a different mentality, according to Dummert. “Community Memorial was the most reluctant. The smaller technology group there was reluctant to be wrapped into the package,” he says. The Community hospital imaging department, he explains, hesitated to relinquish control of their support team. “We had to change their way of thinking. They had a hard time seeing the benefit of becoming part of an enterprise team. But as we explored the future road map of our enterprise, they, too, trusted it was the right direction to go.”
With Community Memorial as her home base, Duehring witnessed firsthand the skepticism at the hospital. “We received mixed reviews from customers,” she says. “At Community Memorial, for those used to having a dedicated team, it was a struggle. But our team has a global mind-set. We serve three hospitals and more than 30 clinics. It’s been a difficult transition for those who were used to certain faces and immediate support in-house. But for those who never had support, it’s been a huge win.”
Rehm applauds Froedtert’s top leaders for its hands-off policy when it comes to department business. “One of the greatest things is, we are given latitude to do what is best within our areas without a lot of micromanagement,” he notes. “If there’s overlap, we connect with the leader at that point. If it falls within our area of responsibility and has no effect outside, we can run with it. We started out under five different entity leadership structures across the health system and had to have support from each one.”
Throughout the process, Dummert and Rehm kept leadership in each entity apprised of the progress with quarterly or semiannual reports.
IT or CE?
In spite of having a clearer direction and focus, and a new name, the department still struggles with whether it should be under the aegis of IT or Clinical Imaging. Rehm says, “We maintain so much equipment, and every piece of technology is highly integrated to support our workflows.”
Imaging Technology Management is also responsible for maintaining all of the diagnostic imaging equipment in the hospital system, which includes diagnostic, computed tomography, magnetic resonance imaging, nuclear medicine, ultrasound, cardiovascular, mammography, and other related devices. The team works with more than 100 departments and services roughly 1,200 devices across the system.
After some initial resistance, for the most part the integration has increased job satisfaction and earned acceptance from its customers. Duehring points out that the staff knows they have other team members on which to rely, and even though Imaging Technology Management has a tremendous amount of ground to cover, they strive to keep their faces and names known to hospital staff.
Duehring credits teamwork for the success of the integration. “The way the last one-and-a-half years have been with new sites on the core platform, planning and organization would not have gone as smoothly if we had not been aligned as a team. Our team was speaking the same message rather than being disjointed. I am so excited for what our team has accomplished. There have been incredible changes and an increase in team morale. The biggest advantage is that there is a career path for many who didn’t have one before.”
Twelve years ago, Froedtert struggled with patient, physician, and staff satisfaction. Rehm says, “This project grew out of that dissatisfaction.” Today, the numbers have been turned around. Froedtert ranks in the 85th percentile nationally for patient satisfaction and in the 70th for staff satisfaction. “The last two times it was measured, we ranked in the 90th percentile for physicians in radiology services.”
Imaging evaluates its services on a quarterly basis, and so far those reports have been positive as well. “Imaging Technology Management’s last quarterly result was
100 percent, a top box score,” Rehm says.
After 3 years of hard work, Imaging Technology Management at Froedtert & The Medical College of Wisconsin operates on one platform within a unified system. This achievement, Rehm says, “completes the informatics revolution.” 24×7
Phyllis Hanlon is a contributor to 24×7. For more information, contact editorial director John Bethune at [email protected]