St Luke's Hospital in Chesterfield, Missouri, USA, is a 493-bed operation, which handles an average of 170 000 out-patient visits and 20 000 inpatient visits annually. St Luke's also operates a 120-bed skilled nursing and residential care facility, three urgent care centres, as well as offering home health services and an affiliated hospitals’ dialysis centre.

Sensing changes in its environment, St Luke's set up a task force, which included physicians, administrators and key users, to evaluate existing systems and define a future direction. The task force came out with a strategy emphasizing empowering caregivers (one of its most valuable resources) to provide the high level service required for success in this sector. St Luke's strategy to deliver this was one that required it to be at the leading edge of available technologies. This led the hospital to implement information systems that empowered caregivers with the patient data they need. In January 1993, St Luke's went live with a self-developed Patient Information Network System (PINS) to provide caregivers information in a graphical format using client/server computing. St Luke's then began to look toward the next step, not only putting data in front of caregivers, but also transforming the data into information they can use. This led to its decision to develop and implement a computer-based patient record (CPR) system.

The role of IT in patient care service quality

Comments by George Tucker, chief of the Department of Surgery and chairman of the hospital's Medical Executive Committee, highlight the logic behind the decision to implement a CPR system:

‘I see the hospital functioning as an information exchange – we gather, compile and interpret data. Paper-oriented information-exchange processes are antiquated. Physicians spend most of their time gathering information [by] reviewing voluminous paper charts and tracking down patient information on the phone or in various parts of the hospital.

The computer-based patient record provides instant access to patient information. Patient information is presented in perspectives not available in a paper environment. I can sit at a terminal and look at a broad perspective of a patient's medical condition or I can look at detailed information including lab or pathology results. Looking at the patient's history this way, I can pull in histories and physicals, discharge summaries or operative notes for a specific patient.

The computer-based patient record helps us formulate long-term care plans and objectives, and then lets us evaluate outcomes and our treatment of the patient. We can compare outcomes for a single patient or group of patients.’

St Luke's has followed a six-step methodology (called CREATE) to implement its CPR system.

Step 1. Create an internal marketing and education strategy

Involving stakeholders (physicians like Tucker) was the first step in planning CPR implementation. It was important to remember that toolsets must be designed with user involvement, in this case caregivers who understood the benefits of this new technology.

After enlisting involvement from key stakeholders, an internal marketing and education strategy was developed to convey what the future delivery system was, what it could do, how it could be used and what were its benefits across the hospital departments. The internal marketing efforts were strengthened by continuous communication and education throughout the organization. The internal communications were used to present the benefits of the CPR system to administrators, caregivers and support personnel.

Step 2. Research, plan and build the communications infrastructure

Once there is initial support for the new system, the next step is to build an enterprise-wide network to support the CPR.

Step 3. Evaluate the data you now have available electronically, as well as the data you want to make available electronically

With the infrastructure in place, it was necessary to consider which data were relevant and important to provide over the network. Without a complete understanding of the data, data will remain data – not information. This process was helped by creating a life cycle for the data, and considering the following aspects:

   source of the data;

   quality of the data; and

   purpose(s) of the data.

The next step was to define the improvement paths available for the data. For example, to make it possible to electronically extract quantifiable results from dictated reports.

Step 4. Assemble a battle plan for your institution

Next, it was necessary to form integration teams and formulate departmental strategic plans based on compiled administrative and informed caregiver objectives. When assembling teams, it was important to ensure that there was informed involvement, because what is at stake is the basis of the organization's long-term future. The future must fulfil all stakeholder requirements – from the clinical to the financial end of the continuum.

Step 5. Team with your vendor

It is usual, unless one has an unlimited budget, to team up and create a partnership with a vendor. There are many systems out in the market-place, so the decision requires careful scrutiny and selection. St Luke's decided on First Data's First Empower solution because the system most closely matched the hospital's needs.

Step 6. Expand upon the model

The task then was to integrate existing data into the hospital's new information model. Following this there was a move to enhance the model contents with newly computerized information from best-of-class departmental or institutional systems.

With its successful internal marketing and education strategy, it was possible to unleash the true power of CPR in the hospital. This sharing of knowledge raised the quality of service and also helped the hospital to become more learning orientated.

Technology enables but internal marketing makes customer focus happen

Healthcare providers like St Luke's are faced with tremendous challenges for delivering excellence in patient care. The use of information technologies such as the computer-based patient record is increasingly playing a role in setting higher standards of service delivery. The success of new technologies is, however, based on effectively embedding them into the organization. This means getting employees to overcome their fear of new technology, getting them to understand how they could benefit from it and showing them how to use it efficiently.

Source: Steiniger, V. (1994). Checklist helps C-R-E-A-T-E a successful CPR. Health Management Technology, 15 (11), 37–41.