Creating the Wall of Knowledge at NewYorkPresbyterian Hospital: a Case Study

1
Creating the Wall of Knowledge at
NewYork-Presbyterian Hospital a Case Study
Abigail Suberman Director, Technology
Strategy New York-Presbyterian Hospital Phil
Brzezinski Vice President, Healthcare
Systems LiveData, Inc.
2
Agenda

• NewYork-Presbyterian Hospital
• Challenges in the OR
• The Wall of Knowledge
• Return on Investment
• Security and Privacy
• Questions

3
NewYork-Presbyterian Hospital
Morgan Stanley Childrens Hosp 16,050 Discharges
Columbia Univ. Med Ctr 33,500 Discharges
Weill Cornell Med Ctr 42,200 Discharges
Payne Whitney Westchester 4,100 Discharges
Allen Pavilion 13,600 Discharges
4
A Major Academic Medical Center

• Certified Beds 2,224
• Operating Rooms 85
• Discharges 110,100
• Ambulatory Encounters 1.68 Million
• Employees 15,000
• Faculty Physicians 5,500
• Residents 1,500
• 2006 Revenues 2.6 Billion
• Operating Margin 2.5

2006 Data Excludes House Staff FTEs
5
Trends in Surgery

• Facility design to improve safety, efficiency and
  communication
• Culture of safety and physician/staff
  satisfaction
• Convergence of medicine and surgery (e.g. hybrid
  procedures, targeted drug therapy, etc.)
• Explosion in device development to complement
  minimally invasive techniques

6
Current State of the Operating Room

• Retrospective (if any) data analysis
• Information in silos
• Isolated from key areas outside OR
• Few tools to improve communication, workflow and
  patient safety

7
How to Improve?

• Increase Situational Awareness Through
• Enabling Easier Access to Critical Clinical
  Information in the OR
• Images and Video
• Patient Data
• Equipment and Materials Status
• Enhancing Patient Safety OR Efficiency
• Improving Team Communication Collaboration

8
Innovative Diagnostics Therapeutics (IDT)
Committee Formed to Evaluate New and Emerging
Technologies

• Develop and manage long term strategy
• Prioritize capital expenditures
• Focus on clinical challenges and technology
  solutions

• Facilitate multi-disciplinary decision-making
• Implement through pilot projects before
  wide-spread implementation

9
Wall of Knowledge Pilot Project

• Pilot 4 ORs
• Investment 900,000
• Retrofit existing ORs
• Install new hardware and software
• Many hours of free manpower to develop
  prototype
• Dynamic display and control of relevant,
  real-time information, images, and video

10
Program DevelopmentThe Right People and
Manageable Projects

• Physician champions
• Periop staff involvement
• Multidisciplinary PM team
• Empowered vendor partners

Id like to remind you again, Winfield, that
daydreaming is only a part of the creative
process.
11
Desire to Capitalize on Existing IT Investments

• The Wall of Knowledge integrates information from
  disparate systems and accelerate payback from
  currently installed IT technology.
• Our Wall of Knowledge interfaces with the
  following systems
• Staff, Patient and RFID Asset Tracking
• Central Sterile Supply Tray Tracking
• Nursing Perioperative Record / EMR
  Information
• Lab/Pathology Reporting
• Anesthesia Record Keeping
• Medical Devices

12
Wall of Knowledge
13
Building a Visually Integrated Operating Room
LiveData OR-Dashboard
LiveData VIOR Control System
Surgical Video
NYP PACS Patient CDRoms
Wall of Knowledge
Pathology Results
Central Sterile Supply
14
IT is Just an Enabler
Live demo in the OR lunchroom

• Workflow analysis
• Cultural change
• Information management

it all take time!
15
OR Dashboard
16
Audio Visual Communications

• Easily controlled by the nurse, resident or
  surgeon, inside or outside of the field
• Allow PACS image display in the OR
• Allow OR to communicate more effectively with
  Pathology, Central Sterile, and others
• Display images and clinical information on
  large-format LCD screen on the wall and in the
  surgical field

17
Facilitate Information Flow Between Departments
Outside Data Sources
Pathology Lab
Operating Room
18
Measuring Success

• Hypothesis
• Improved Physician and Nurse Satisfaction
• Common Operating Picture Who, Why, What
• Preoperative Briefing
• Direct AV Link Between OR and Central Sterile /
  OR and Pathology
• Improved Efficiency and Productivity
• Tray and Cart Location Information
• OR Turnover Time
• Culture of Safety
• Administration of Antibiotics
• Performing Preoperative Briefing
• Measuring Instruments are being designed
• Pre/Post Questionnaire, OR observations,
  efficiency data analysis

19
New Security and Privacy Issues

• Goal Share Information Between Clinicians and
  Other Groups
• Result New Security and Privacy Issues
• Shared/Public Dashboards
• Easy Access from Anywhere
• New Sources of Digital Data
• More Mobile Data
• More Comprehensive/Complete Data

20
The Old Single User Information
21
The New Shared Information
22
Who Owns Security and Privacy?

• Hospital Policies are Key
• Collaborative and
• Iterative Process

23
Shared/Public Dashboards

• LiveData OR-Dashboard in Privacy Mode

24
Shared/Public Dashboards

• Dashboards in the OR, Nurses Station, PACU, Break
  Room Waiting Room?
• Who is really looking at the patient data?
• No user login/logout What to send to HIPAA log?
• Privacy/Blocked Modes for the Dashboard

25
Easy Access from Anywhere

• Web-enabled technology allows easier access to
  information
• Anesthesiologists can monitor any room from
  within the hospital network
• Dashboard can be displayed over internet to
  enhance telemedicine and tele-education
• Importance of secure networks VPN, LDAP
  Authentication, etc.

26
New Sources of Digital Data

• Audio, Video, and Medical Device Data is now
  available over the Network
• One-to-many streaming of real-time OR activity
• Patient identifiers now attached to video, images
  and physiological information
• More critical data is produced which increases
  probability of data breaches

27
More Mobile Data

• Data attached to beds and other devices
• More wireless data
• RFID Tracking of
• Patient, Staff and
• Equipment

28
More Comprehensive/Complete Data

• Patient Identifiers attached to Video, Audio and
  Physiological Data - All available in one place

29
Questions